Weekly Digest

Key Takeaway: Dexmedetomidine added to ESPB extended time to first rescue opioid by 9.6 hours versus ropivacaine alone (15.5 vs 6.2 hours), while dexamethasone produced greater attenuation of systemic inflammatory indices in lumbar fusion patients.

Key Takeaway: Providing postoperative ROM photographs to TKA patients improved knee extension by 3° at 6 weeks (0° vs 3°, P=0.01) but produced no clinically meaningful differences in flexion, PT metrics, or KOOS scores.

Key Takeaway: At 24 months, non-ACLR and ACLR groups achieved equivalent IKDC-SKF scores and comparable RTS rates (72% vs 77%), but patients aged 26–40 years undergoing ACLR had a 3.15-fold higher risk of not returning to sport versus nonsurgical management.

Key Takeaway: In medium-sized full-thickness supraspinatus tears, preoperative shoulder stiffness did not produce worse 24-month outcomes versus non-stiff shoulders, with 100% vs. 83% of stiff patients achieving CMS MCID at final follow-up (OR 32.1), despite distinct inflammatory tendon transcriptomic signatures (254 upregulated, 554 downregulated genes enriched in inflammatory tendinopathy subtype, NES 2.6).

Key Takeaway: In 849 DCM surgical patients, network analysis revealed that surgery reorganizes SF-36 domain interdependencies rather than uniformly strengthening them, with Role Physical emerging as the most central HRQoL domain both pre- and postoperatively.

Key Takeaway: After surgical repair of Rockwood Type 5 AC dislocations, trapezoid ligament thickness remains reduced compared to the contralateral side regardless of fixation technique, yet functional outcome scores are favorable and ligament thickness does not correlate with patient-reported outcomes.

Key Takeaway: Central sensitization raises the anchor-based BPI MCID threshold from 9.8 to 15.3 points after TKA, and CS patients are significantly less likely to achieve that threshold at one year.

Key Takeaway: Femoral nerve palsy occurred in 3.1% of children (2.0% of hips) treated with orthosis for DDH, with Pavlik harness use (84.0% vs 61.9%, p<0.001), lower femoral head percent cover, and lower α angle identified as independent risk factors.

Key Takeaway: Transverse (bikini) incisions reduce wound complication risk by 55% compared to longitudinal incisions in DAA THA (RR 0.45, 95% CI 0.23–0.89) across 35,300 cases.

Key Takeaway: Graft type, surgeon, and surgery center explain 84% of total cost variation in ACLR, with a 3.2-fold supply cost difference between the 10th and 90th percentiles across 8 hospitals.

Key Takeaway: Coronal-plane CT Hounsfield units independently predict mechanical complications after distal humerus ORIF (OR 0.973 per HU unit, p=0.048), with only 5 complications in 153 patients (3.3%).

Key Takeaway: Standalone anterior/oblique/lateral lumbar fusion without posterior instrumentation reduces radiographic ASD odds by 49% (OR 0.51) and ASD-related reoperation odds by 42% (OR 0.58) compared to posteriorly instrumented fusion, at the cost of a 2-fold increase in cage subsidence (OR 1.99).

Key Takeaway: Machine learning analysis of 105,336 primary THAs identifies 52.5–71.5 years as the optimal age window for lowest composite adverse outcome risk, with revision risk rising before age 46.5 and mortality risk rising after age 79.5.

Key Takeaway: An isolated elevated ESR with normal CRP carries a PPV of only 1.1% (TKA) and 1.2% (THA) for PJI, and when clinically suspicious cases are excluded, the rate of occult PJI drops to 0.5% and 0.4% respectively.

Key Takeaway: Government-sponsored insurance was the only independent risk factor for poor PT adherence after ACLR (P=0.006), with 35.9% of patients missing >15% of sessions despite 93% believing PT was necessary.

Key Takeaway: ARB use versus ACEI use in hypertensive TSA patients was associated with a 33% reduction in periprosthetic fracture risk at 2 years (OR 0.733, P=0.004) and a 33% reduction in dislocation risk at 2 years (OR 0.668, P=0.002).

Key Takeaway: ADHD patients not on stimulant medications had significantly higher rates of arthrofibrosis at 6 months and increased ED visits and hospital readmissions at both 3 and 6 months post-ACL reconstruction compared to stimulant users.

Key Takeaway: Staged bilateral rTSA performed within 12 months of the index procedure carries 1.8–2.4× greater odds of 90-day surgical complications versus unilateral rTSA, with a calculated risk-attenuation threshold of 390 days.

Key Takeaway: Diabetic patients undergoing adult spinal deformity fusion had 2.5x higher odds of proximal junctional failure (19% vs 9%) and lower 2-year revision-free survivorship (85% vs 93%) compared to propensity-matched non-diabetic controls.

Key Takeaway: At mean 8-year follow-up, pincer morphology patients (LCEA ≥40°) converted to THA at 7% versus 19% in nondysplastic controls (p=0.046), suggesting acetabular overcoverage may be chondroprotective.

Key Takeaway: Scaffolding ETO closure achieves 50 mm of distal bicortical contact versus 28 mm with reconstitution, and >30 mm distal bicortical contact below the ETO reduces clinically significant subsidence (OR 0.12).

Key Takeaway: Robotic-assisted THA was associated with a 50% reduction in revision for dislocation at 2 years (HR 0.5, 95% CI 0.3–0.9) compared to conventional THA, but no difference in all-cause revision (HR 0.9, 95% CI 0.7–1.1).

Key Takeaway: Preoperative air travel was not associated with increased PJI risk after primary TKA, with identical 90-day PJI rates of 0.5% in both air and land travel cohorts across 23,732 propensity-matched patients.

Key Takeaway: 1-2 level lateral single position anteroposterior fusion (LSPS) achieves a cost per QALY of $46,736 USD at 2 years, meeting the WHO 'highly cost-effective' threshold (<1× GDP/capita) by 20 months postoperatively.

Key Takeaway: Taper junctions in revision TKA show significantly greater fretting corrosion than threaded designs (median mGS 3–4 vs. 1, p<0.001), but corrosion severity does not correlate with radiographic osteolysis or revision etiology.

Key Takeaway: After DFEO in children with CP, PDFA remodeled 64.4% toward neutral by 3 years, yet KFD recurred in only 17.6% of knees with no significant correlation between remodeling magnitude and recurrence.

Key Takeaway: Elevated BMI increases DVT risk after TSA (overweight vs. normal: RR 1.48; obese vs. overweight: RR 1.36) but does not increase infection, revision, or mechanical complication rates within 2 years.

Key Takeaway: Diaphyseal osteotomy with IM nail fixation achieves weight-bearing approximately 6 weeks earlier than proximal osteotomy with plate fixation (9.5 vs. 15.7 weeks; IRR=1.66) with comparable complication rates (13% vs. 10%).

Key Takeaway: Cementless TKA with porous titanium tibial components achieved 97% 5-year revision-free survivorship equivalent to cemented TKA, while beaded CoCr cementless tibias had a 3x higher revision hazard ratio driven by early loosening within 1 year.

Key Takeaway: MICA with first metatarsal head lowering and MICA with second DMMO resolve intractable plantar keratosis beneath the second metatarsal head at equivalent rates (87% vs 91%), but second DMMO produces new third metatarsal head keratosis in 10% of cases while first metatarsal head lowering causes plantar first metatarsal discomfort in 17%.

Key Takeaway: C. avidum caused true PJI in 83.3% of Cutibacterium-positive rTHA cases versus 56.4% for C. acnes, and was strongly associated with the direct anterior approach (58.3% vs. 17.7%, P<0.01) and higher BMI.

Key Takeaway: In 3,814 patients with metastatic bone disease, rapid-growth tumor histology doubled the risk of a subsequent SRE (subdistribution HR 2.00), while elevated alkaline phosphatase, brain metastasis, male sex, and older age were each independently associated with subsequent SRE risk after competing-risk analysis.

Key Takeaway: Mean TKA out-of-pocket costs reached $2,472 from 2015–2020, with a 3.8-fold geographic range (Hawaii $1,024 to Alaska $3,910) and ambulatory surgical centers consistently generating higher OOPCs than outpatient hospital settings.

Key Takeaway: Insertional reattachment for acute Achilles sleeve avulsion fractures yields durable outcomes at 5 years, with AOFAS improving from 50 to 96 and 78% of preinjury athletes maintaining sports participation.

Key Takeaway: A nomogram combining GNRI, fall risk score, comorbidity index, pain score, and admission type predicts extended LOS (≥10 days) after THA with AUC 0.750, sensitivity 71.4%, and specificity 72.1%.

Key Takeaway: Complete pre- and postoperative PROMs were available for only 40.3% of TKAs and 41.5% of THAs, yet patients with complete data showed no demographic differences from those with missing data, supporting generalizability.

Key Takeaway: Technology-assisted DAA THA produced statistically higher 2-year Oxford Hip Scores and SF-36 subscores than manually performed STAR THA, but MCID attainment, patient satisfaction, and complication rates were equivalent in 132 propensity-matched pairs.

Key Takeaway: Younger patients (<65 years) had an 11% cumulative 10-year revision rate after anatomical TSA versus 6% in older patients, but after multivariate adjustment age was not an independent predictor (HR 1.4, p=0.069); prior ipsilateral shoulder surgery was the dominant risk factor (HR 1.9, p=0.002).

Key Takeaway: Switching entirely to cemented femoral fixation for femoral neck fractures in Medicare patients could save $126.6 million annually and gain 1,356 QALYs over five years, with cost-effectiveness demonstrated in 92% of simulations.

Key Takeaway: Computer navigation for rTSA using a single-design platform prosthesis was associated with a 29% reduction in revision rate (HR 0.71, 95% CI 0.50–1.00) in time-matched analysis from 2017 onward, with no significant benefit demonstrated for aTSA.

Key Takeaway: In Indian TKA patients, pain relief expectations were fulfilled in 91% but culturally specific activities (squatting 36%, sitting cross-legged 29%) were met far less often, with 80% overall satisfaction at one year.

Key Takeaway: Anterior L-shaped tear pattern is the strongest independent predictor of retear after arthroscopic repair of medium-to-large rotator cuff tears (OR 3.26), with an overall retear rate of 15.1% at six months.

Key Takeaway: Among 115 morbidly obese TKA patients, only 40.9% achieved ≥5% preoperative weight loss and 21.7% achieved ≥10%, yet neither threshold was associated with improved intraoperative or postoperative outcomes.

Key Takeaway: Stemmed pyrocarbon shoulder hemiarthroplasty in 277 patients achieved a revision rate of 0.75 per 100 component-years at mean 50-month follow-up, with Oxford Shoulder Scores improving from 36.4 at 6 months to 40.8 at 5 years.

Key Takeaway: In high-risk ACL reconstruction patients treated with LET, posterior tibial slope independently predicted graft failure with an adjusted OR of 1.63, and slopes exceeding 11–12° were associated with high failure probabilities despite LET augmentation.

Key Takeaway: In 17 patients under 20 with severe scoliosis and lumbosacral deformity, posterior-only multi-rod constructs corrected the major curve from 62.1° to 19.6° and the lumbosacral Cobb from 33.6° to 7.7°, with corrections maintained at minimum 2-year follow-up.

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

Key Takeaway: Female athletes have 24-28% lower odds of returning to sport at 12 months (OR 0.76) and up to 24 months (OR 0.72) after ACLR compared to males, despite no significant difference in return to competition or preinjury activity level.

Key Takeaway: An image-based quantitative osteotomy planning algorithm for congenital proximal radioulnar synostosis improved forearm rotation in 7 of 8 cases, but only 2 of 8 achieved concentric radial head alignment, with larger plan-execution discrepancies correlating with radial head subluxation or dislocation.

Key Takeaway: Conversion THA following failed hip fracture ORIF achieved 88.2% all-cause survivorship at 1, 3, and 5 years with a 21.3% complication rate and mean Harris Hip Score improvement from 47.5 to 83.3.

Key Takeaway: Open capsular shift with Achilles allograft augmentation achieved 0% recurrent instability rate at mean 10-year follow-up in 10 shoulders with MDI, including EDS patients, with mean ASES of 73 and SSV of 79.5%.

Key Takeaway: General EM physicians in hybrid EDs achieved successful or suboptimal-but-improved fracture alignment in 81% of 437 pediatric fractures, but failed to change alignment in 19%, with coronal/sagittal plane reductions carrying 13.1-fold higher odds of success than translational or bayonet corrections.

Key Takeaway: Arthroscopically assisted latissimus dorsi transfer for irreparable subscapularis tears improved mean Constant score from 37.4 to 70.5 (+31.5 points, p<.001) at mean 15.3 months follow-up.

Key Takeaway: Physeal-sparing ITB autograft ACL reconstruction achieved 91.7% knee stability at short-term follow-up in 24 knees with congenital ACL deficiency, with no growth disturbances observed.

Key Takeaway: The Arthrex VaultLock uncemented central-peg all-polyethylene glenoid achieves 99.2% clinical and 95.0% radiographic survival at 5 years, with central peg bone grafting reducing Lazarus score ≥2 rates from 23.2% to 9.5%.

Key Takeaway: Closed reduction with chemo-denervation for glenohumeral dysplasia in brachial plexus birth injury fails in 35.1% (13/37) within one year, with lower birth weight, instrumented delivery, and greater initial shoulder abduction predicting failure.

Key Takeaway: TEA following prior olecranon osteotomy achieves 76% 10-year survivorship free of revision with a 37% overall complication rate and mean MEPS of 78.

Key Takeaway: Revision THA in JIA patients yields only 36% reoperation-free survival at 10 years, with a 41.2% overall complication rate.

Key Takeaway: A scapular spike sign ≥0 cm (lateral border fragment at or lateral to the glenoid on AP radiograph) carries 100% PPV for meeting established surgical indications in extraarticular scapula fractures, though sensitivity is only 28%.

Key Takeaway: Cementless highly porous titanium tibial baseplate in primary TKA achieved 96.7% all-cause survivorship and 99.7% aseptic loosening-free survivorship at minimum 10-year follow-up.

Key Takeaway: Combined proximal tibial and distal femoral endoprosthetic reconstruction achieves 10-year revision-free implant survival of 61% and limb salvage of 69%, with infection as the leading cause of long-term limb loss.

Key Takeaway: LTB knotless double-row rotator cuff repair achieved 80.4% survivorship at mean 15.9 years, with 9 failures (19.6%) occurring predominantly after 10 years and 94.4% return to recreational activity.

Key Takeaway: Peroneus longus tendon harvest causes significant evertor and invertor peak torque deficits at 6 months (p<0.001 and p=0.010, respectively), but isokinetic strength normalizes by 12 months at both 60°/s and 120°/s testing speeds.

Key Takeaway: The ELTO preserves abductor attachment by incorporating the lesser trochanter and medial femoral cortex, potentially eliminating postoperative abduction bracing and protected weight-bearing compared to standard ETO.

Key Takeaway: Preoperative nutritional optimization—including protein supplementation, vitamin D correction, and carbohydrate loading—is associated with improved fusion rates, lower infection risk, and shorter hospital stays in spine surgery patients, though no single biomarker reliably identifies at-risk patients.

Key Takeaway: All three LET fixation methods (suture anchor, interference screw, metallic staple) restored internal rotational stability to near-native levels after 2000 cycles of 5 N·m loading, though suture anchors showed significantly greater rotational change under cyclic loading versus screws (7.2% ± 2.3% vs -1.3% ± 2.6%, P=.011).

Key Takeaway: Zero of 61 Spanish-language online sources on pediatric scoliosis met the recommended <6th-grade reading level, and only 36% achieved adequate quality by Brief DISCERN criteria.

Key Takeaway: Inferior leaflet resection of medial meniscus HCTs significantly increases peak contact stress during midstance (19–30% of gait cycle) and decreases contact area across early, mid, and late stance, while HCT repair restores mechanics equivalent to the intact meniscus.

Key Takeaway: In a rat model, combined resection of the rotator cuff, superior capsule, and LHB tendon produced ~1,100 μm of superior humeral head migration, with superior capsule loss contributing more than LHB resection to total displacement.

Key Takeaway: Modified MacIntosh ACLR increases lateral compartment peak contact stress by 0.31–0.35 MPa and anteriorizes the center of contact stress by 1.3–3.3 mm versus intact knee, while the intra-articular graft carries only 27–36 N (51–65% less than native ACL force) during simulated pivot shift.

Key Takeaway: This AAHKS 2025 symposium provides a narrative overview of revision THA decision-making and technique without reporting original outcome data or specific quantitative findings.

Key Takeaway: ACLR with ramp repair restores ATT to intact-knee levels at all tested slopes, but ACLR with subtotal medial meniscectomy produces significantly increased ATT at PTS >12°, supporting slope-correcting osteotomy in that subset.

Key Takeaway: Synovial MCP-1/CCR2-MAPK/ERK-driven M1 macrophage polarization is mechanistically responsible for accelerated rotator cuff degeneration in diabetes, with synovium-specific Ccl2 knockout and pharmacological MCP-1 inhibition both attenuating this degenerative progression in a murine model.

Key Takeaway: Mean load-to-shear failure of cemented patellar components in well-functioning postmortem TKAs was 1,881 ± 621 N, with failure strength inversely associated with implant-to-bone surface area coverage ratio.

Key Takeaway: A 37-expert international Delphi panel reached consensus on 25 clinical and radiological criteria for diagnosing aseptic loosening in THA, with PJI exclusion unanimously designated as the mandatory first diagnostic step.