Weekly Digest

Key Takeaway: PSI did not improve glenoid baseplate positioning versus free-hand technique (version error 5°±5° vs. 5°±5°), but significantly reduced clinically relevant peripheral screw angular errors, including anterior SI gap errors (11.3% vs. 43.4%).

Key Takeaway: In 213 knees randomized to patellar resurfacing (PR) versus non-resurfacing (PNR) with a patella-friendly PS-TKA, 5-year implant survival was equivalent (93.6% vs 91.8%, P=0.96) with no significant difference in any clinical outcome score.

Key Takeaway: BMAC augmentation improved CT-assessed host-graft junction integration at 3 months post-FOCA transplantation (p<0.05), but this advantage disappeared by 6 and 12 months with no difference in any patient-reported outcome at 2 years.

Key Takeaway: DASH, PRWE, and VAS scores after volar locking plate fixation of distal radius fractures show statistically significant heterogeneity across up to 9 cultural regions (p<0.01 for all three instruments), meaning outcomes from any single region cannot be globally generalized.

Key Takeaway: Cementless mobile-bearing UKA achieved non-inferior 5-year survivorship (91.7%) versus cemented UKA (95.6%, P=0.24) with equivalent Knee Society scores and radiographic outcomes.

Key Takeaway: A single T1-mounted IMU demonstrated excellent agreement with 10-camera motion capture for sagittal plane trunk kinematics in spine patients (ICC 0.89–0.96, RMSD <5°) across gait, lifting, and sit-to-stand tasks.

Key Takeaway: Hypothyroidism increases PJI risk by 69% (OR 1.69) and periprosthetic fracture risk by 26% (OR 1.26) following TJA across 18 studies and 4,622,479 procedures.

Key Takeaway: A 4-point preoperative risk score (symptom duration <6 months, ODI >41, pelvic tilt <20.9°, microdiscectomy procedure type) predicted MCID achievement ranging from 39% with 0 predictors to 100% with all 4 predictors in 199 lumbar decompression patients.

Key Takeaway: Two-stage exchange reimbursement exceeds one-stage by 28% ($4,342 vs $3,382, p<0.001), though a 43-minute operative time savings per case may equalize cumulative surgeon revenue across 10 cases.

Key Takeaway: Higher preoperative objective physical activity predicts better FJS-12 at 12 months post-THA (p=0.004), but these patients only recover to baseline activity levels, while lower-activity patients exceed their preoperative step counts by 12 months.

Key Takeaway: CT measured posterior tilt averaged 14° versus 9° on plain radiograph (p<0.001), reclassifying an additional 15% of Garden I/II femoral neck fractures as exceeding the 20° arthroplasty-consideration threshold.

Key Takeaway: Among T2DM patients undergoing first MTPJ arthrodesis, GLP-1 RA use reduced pseudarthrosis rate from 11.8% to 7.7% (RR 0.65, p=0.026) at 1 year.

Key Takeaway: Only 9 studies with 813 patients met inclusion criteria for wearable device use in lumbar fusion outcomes, with steps per day as the primary metric in 55% of studies, revealing a near-complete absence of standardized evidence in this space.

Key Takeaway: Across 2,380 rTSA cases over 17 years, overall acromion/scapular spine fracture incidence was 5.4%, but dropped significantly with successive technological advances, with year-to-year variability falling from 5.33% to 0.45% after routine preoperative virtual planning was adopted.

Key Takeaway: GLP-1 receptor agonist use was not associated with increased 90-day or 2-year complications after TSA (OR 0.86 and 1.24, respectively; both p>0.40), and GLP-1 users showed lower re-tear rates after RCR (12.5% vs. 18.3%) in this meta-analysis of 43,415 patients.

Key Takeaway: A novel FAIR score combining age, revised risk analysis index, and geriatric nutritional risk index predicts 30-day SSI or wound dehiscence after ankle fracture ORIF with an AUC of 0.814, versus AUC ≤0.517 for any individual index alone.

Key Takeaway: In patients ≥60 years with acetabular fractures, acute THA/CHP reduced reoperation risk 2.6-fold compared to ORIF (RR 2.60; 95% CI 1.42–4.75) and yielded Harris Hip Scores 6.11 points higher at 1–2 years.

Key Takeaway: Line-to-line cementation ('French Paradox') achieves >90% implant survival at 10 and 17 years across multiple cohorts, with rotational stability and subsidence comparable to or better than standard undersized cementing.

Key Takeaway: GLP-1RA use was associated with reduced 90-day PJI risk after TKA (OR 0.75), reduced 90-day revision after THA (OR 0.76), and decreased readmissions, but carried an elevated myocardial infarction risk after TKA (OR 1.39) across 346,899 patients.

Key Takeaway: Bankart repair with remplissage for on-track Hill-Sachs lesions yields 0.41 additional QALYs at $1,647 incremental cost over 10 years, achieving cost-effectiveness in 99.89% of simulations at a $50,000/QALY willingness-to-pay threshold.

Key Takeaway: Single-level ACDF volume in hospital-owned ASCs more than doubled from 33,687 cases in 2016 to 73,024 in 2021, with Medicare's share of payer mix expanding from 8.6% to 29% over the same period.

Key Takeaway: BIO-RSA achieves 98% prosthesis survival at mean 12.7 years with 95% complete bone graft incorporation, and zero instability events, though severe scapular notching occurred in 32% of shoulders.

Key Takeaway: In 119 patients with symptomatic lumbar spinal stenosis, dynamic pelvic compensation during gait—not static standing alignment—correlated with ODI disability, with pelvic tilt dynamic compensation (ρ adj. = 0.19) and spinosacral angle dynamic compensation (ρ adj. = -0.20) reaching significance.

Key Takeaway: Subscapularis repair in rTSA for intact-cuff glenohumeral OA yields superior IR ROM (PASS rate 93.8% vs. 75.9%) and early PROMs at 3–6 months, but no PROM difference at minimum 1-year follow-up, with the unrepaired group achieving greater AER improvement (32.5° vs. 20.8°).

Key Takeaway: Early ACDF for asymptomatic cervical spinal cord compression yields an ICER of $83,015/QALY and is cost-effective in only 56.2% of simulations at a $100,000/QALY threshold, requiring annual progression rates >3.5% (asymptomatic-to-mild) or >11% (mild-to-moderate) to become economically justified.

Key Takeaway: In 825 anatomic TSA patients at mean 37.9 months, standard-length stems had a 11.9% humeral radiolucent line rate versus 1.7% for short-stem and 1.6% for stemless components, with no difference in PROMs, complication, or revision rates.

Key Takeaway: Pelvic fixation carries an OR of 5.04 for hip OA progression in the full cohort and OR of 8.48 in long-fusion patients, with new-onset OA developing in 21.7% of the long-fusion subgroup at 5 years.

Key Takeaway: HO occurs in 59% of primary rTSA cases at 2 years, with type 1c (incomplete ankylosis, 2.9%) producing the most clinically meaningful deficit—abduction reduced to 117° vs. 136° without HO.

Key Takeaway: Nail-plate combination (NPC) constructs reduced construct failure to 1.2% versus 19.7% for lateral locked plate alone (HR 17.43, 95% CI 2.23–136.10) in distal femur fractures, with 70% of NPC patients permitted immediate weightbearing at discharge.

Key Takeaway: The ADLER score demonstrates excellent interobserver reliability (ICC=0.98) and responsiveness (mean 23-point improvement post-L'Episcopo transfer) for quantifying ADL-specific external rotation deficits in massive irreparable rotator cuff tears.

Key Takeaway: Ceftriaxone and piperacillin-tazobactam monotherapy produced equivalent FRI rates (25.4% vs. 29.0%, P=0.501) and AKI rates (11.9% vs. 15.9%, P=0.636) in 136 open fracture patients, while diabetes independently predicted FRI (OR 6.62, P=0.003).

Key Takeaway: In patients ≥75 years undergoing rTSA for Neer 3- or 4-part proximal humerus fractures, ASA score was the only independent predictor of poor outcome (OR 0.36), with a decision algorithm achieving AUC 0.78.

Key Takeaway: Mini C-arm use during ED closed reduction of distal radius and ankle fractures eliminated repeat reductions (0 vs. 65) and reduced total radiation exposure (0.4 vs. 0.9 mGy) compared to traditional post-reduction radiographs.

Key Takeaway: Postoperative medial glenosphere-to-lateral scapular column distance (MGLS) >10 mm yields 73° vs. 57° external rotation at 90° abduction and superior internal rotation (L3 vs. L4) compared to MGLS 5–10 mm after lateralized 135° rTSA.

Key Takeaway: AVN developed in 38% of displaced talus fractures/dislocations, but 90% had <25% talar dome collapse and AVN did not independently drive secondary reconstructive surgery (25% overall SRS rate).

Key Takeaway: Anterior shoulder pain occurs in 12.4% of rTSA patients and is independently associated with inlay humeral design (15.8% vs. 11% onlay), greater glenoid lateralization (2.5 vs. 1.84 mm), rotator cuff deficiency, and lower patient weight.

Key Takeaway: Initial vertical patellar fracture displacement >26.6 mm predicts nonunion (AUROC 0.818) and >21.7 mm predicts hardware failure (AUROC 0.838), with each millimeter increase raising risk of either complication by ~15%.

Key Takeaway: Female sex (OR 20.29) and younger age (OR 0.94 per year) are independent predictors of outlier poor outcomes (OES <35) after radial head replacement for acute complex elbow instability.

Key Takeaway: Opioid prescriptions after pilon fracture ORIF fell 61.8% (434 to 166 per 1,000 surgeries) from 2010–2021, with MME per 1,000 surgeries dropping 91.3%, while nonopioid analgesic prescriptions declined only 29.4%.

Key Takeaway: Inflation-adjusted Medicare reimbursement for TSA (CPT 23472) fell 42% from $2,467.96 to $1,433.64 between 2000 and 2025.

Key Takeaway: Liposomal bupivacaine use in outpatient TKA was associated with 4.8 fewer opioid-treated days and $1,318 lower total healthcare costs over 360 days compared to matched controls.

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

Key Takeaway: Social media sentiment scores for rTKA and mTKA were statistically equivalent across all six thematic categories (P > 0.05) in 737 patient comments spanning 2011–2024.

Key Takeaway: Post-rotator cuff repair shoulder stiffness occurs in 12.9% of patients overall, with concomitant subacromial decompression conferring the highest risk (OR 3.26), followed by fatty infiltration (OR 1.58) and diabetes mellitus (OR 1.51).

Key Takeaway: High pelvic incidence (60° vs 52°, P=0.015) and excessive transverse version of the acetabular cup (38° vs 32°, P=0.042) were independent predictors of primary THA dislocation in a prospective matched cohort.

Key Takeaway: After revision ACLR, only 48.2% of patients return to their prior competition level, and adding a lateral extra-articular procedure raises the overall RTS rate from 74.9% to 90.6%.

Key Takeaway: Non-cross-linked vitamin E-enriched polyethylene achieved 93% 20-year Kaplan-Meier survival versus 85% for conventional polyethylene, though the difference did not reach statistical significance at mean 9-year follow-up.

Key Takeaway: ACLR+LET in pediatric and skeletally immature patients yields a graft rerupture rate of 0.8% versus 12.6% for isolated ACLR (OR=0.12; p=0.0036) with only 0.63% rate of physeal disturbance.

Key Takeaway: In THA for LCPD, 29% of patients had residual postoperative LLD ≥10 mm, and inadequate global offset restoration correlated negatively with residual LLD (rho = -0.44, p = 0.0001), a relationship absent in primary OA controls.

Key Takeaway: Autologous osteochondral transplantation achieved the highest RTS rate (96%) for capitellar OCD in youth baseball players, but only 52% of pitchers returned to pitching regardless of procedure.

Key Takeaway: RA patients undergoing UKA have a 2.5-fold higher PJI risk (4.0% vs. 1.6%, P=0.004) compared to non-RA patients, reinforcing RA as a meaningful contraindication to UKA.

Key Takeaway: Introduction of the internal joint stabilizer (IJS) into the terrible triad treatment algorithm reduced the medial approach rate to 3.9% versus a historical mean of 38.3% (RR 0.10, p<0.001).

Key Takeaway: Cementless TKA complication rates—including PPFx (OR 3.0, 95% CI 0.6–14.9) and aseptic loosening (OR 0.46, 95% CI 0.17–1.21)—showed no statistically significant differences across age groups from <60 to >80 years at 2-year follow-up.

Key Takeaway: Knotless double-anchor footprint fixation (DAFF) Bankart repair achieved 100% bony union in fragment-type cases and reduced mean glenoid bone loss from 17.5% to 4.8% at ~25 months, with erosion-type cases showing only modest improvement (12.0% to 10.2%).

Key Takeaway: Extended antibiotic prophylaxis (>24 hours) did not reduce PJI rates compared to standard prophylaxis (≤24 hours) in primary TKA across 17,223 cases (0.34% vs 0.40%, P=0.67).

Key Takeaway: Over 20 years, rTSA failures now equal hemiarthroplasty failures as a revision indication (358 each), with rTSA carrying the highest re-revision rate at 21% driven by instability, baseplate failure, and infection.

Key Takeaway: Cementless TKA achieves 5-year survivorship of 99.1% for aseptic loosening and 96.3% for all-cause revision, statistically equivalent to cemented TKA across all time points.

Key Takeaway: Strut allograft augmentation in revision TEA achieved 93% radiographic incorporation but carried a 24% cumulative re-revision incidence at 10 years, with periprosthetic fracture risk linked to strut-implant co-termination.

Key Takeaway: Preoperative cryoneurolysis before TKA reduced opioid utilization at 12 months (24% vs 41%, p<0.001) and improved pain scores (2.0 vs 2.4, p<0.001) compared to controls.

Key Takeaway: Combined rTSA with lower trapezius transfer eliminated Hornblower's sign in all 12 patients and improved active ER from -10.8° to 35.0° (p<0.0001) at mean 35.4 months.

Key Takeaway: DAIR failure occurred in 40.4% of cases with no significant difference in failure rate based on time to surgery from first contact (P=0.97) or formal diagnosis (P=0.84), suggesting emergent same-day intervention confers no advantage over urgent next-day surgery.

Key Takeaway: Knee hemarthrosis aspiration in tibial plateau fractures reduced mean leg compartment pressures from 36 to 29 mmHg (average 4–7 mmHg decrease, up to ~20%), but aspiration volume did not correlate with magnitude of pressure change.

Key Takeaway: Psychiatric comorbidity in TKA patients is associated with 3.06-fold higher odds of failing to achieve CMS-defined substantial clinical benefit, while THA patients show no significant SCB difference despite worse utilization metrics.

Key Takeaway: Robot-assisted percutaneous fixation with a novel circular distractor for Sanders II/III calcaneal fractures restored Böhler angle from 7.4° to 25.4° and achieved a mean articular step-off of 0.9 mm with zero wound complications in 52 fractures.

Key Takeaway: Using MSIS Outcome Reporting Tool criteria, two-stage revision THA PJI success was only 58.2% at a tertiary referral center, versus 86.6% when the less stringent Delphi criteria were applied to the same cohort.

Key Takeaway: Osteochondral autograft or allograft transplantation yields superior outcomes over débridement alone for capitellar OCD lesions >1 cm² or laterally based defects in young athletes.

Key Takeaway: Mechanically preconditioned BMSCS-encapsulated dTFBC scaffolds achieved a mean ultimate failure load of 203.9 N at 12 weeks, a 73% improvement over standard repair (118 N, P=.003) in a rabbit rotator cuff model.

Key Takeaway: Urogenital injuries complicate 6-16% of pelvic fractures, and modern evidence supports selected internal fixation over historical external fixation preference without increased infection risk.

Key Takeaway: Biweekly electrical stimulation after median nerve repair produced significantly lower grip strength (2.6 ± 0.9 N) than weekly stimulation (3.9 ± 1.0 N) and reduced axon counts (1930 vs 3618) at 11 weeks in a rat model, indicating that increasing stimulation frequency impairs rather than enhances nerve regeneration.

Key Takeaway: A bibliometric analysis of 413 articles on surgical OLT management (1980–2024) identifies an 8.12% annual publication growth rate, with current research clustering around bone marrow stimulation, cartilage repair, and platelet-rich plasma as the dominant emerging topics.

Key Takeaway: Suture bridge fixation demonstrated significantly higher pre- and postcyclic stiffness (0.0113 vs 0.0067 N·m/deg and 0.0215 vs 0.0089 N·m/deg) compared to chondral pin fixation, with 5 of 7 chondral pin constructs failing completely by end of testing.

Key Takeaway: Combined systemic and localized 3D-printed nanofiber vitamin D delivery achieved the highest load-to-failure at 12 weeks post-repair (139.6 ± 25.3 N vs. 99.5–102.3 N in all other groups) in a rabbit rotator cuff model.

Key Takeaway: Retrograde IMN after TKA femoral preparation increased flexion gap by only 1.5 mm and AP translation by 3.13 mm without a femoral component in place, but neither metric differed significantly once the femoral trial was seated.

Key Takeaway: A collagen-PLLA biocomposite scaffold augmenting ovine infraspinatus repair produced 180% greater tendon thickness versus nonoperative controls and significantly increased ultimate load between 6 and 12 weeks (P<.01).

Key Takeaway: In all three rTSA designs, middle deltoid contribution to terminal abduction torque drops to only 9–38% (vs. near 100% natively), with infraspinatus and subscapularis compensating up to 80% of total elevation torque beyond 120°.