Weekly Digest

Key Takeaway: Animal-assisted therapy (therapy dog presence) reduced patient-reported pain scores by 55% during office pin removal after supracondylar humerus fracture fixation (FACES: 2.9 vs. 6.4, P<0.01) in a 52-patient RCT.

Key Takeaway: Multimodal symptom-targeted treatment (Concussion Essentials) achieved full recovery in 62.5% of pediatric PPCS patients vs. 37.0% with usual care, an adjusted risk difference of 25.5% at 8 weeks.

Key Takeaway: Posterior fusion rates for single-level ASF/PSF were 98% for iliac bone autograft, 94% for BMP, 85% for BMA, and 50–67% for cellular allograft options, yet clinical outcomes improved equivalently across all groups when anterior interbody fusion was solid.

Key Takeaway: CARTA-guided individualized treatment reduced rerupture rates by 73% versus non-operative care (3% vs 11%, p=0.03) while performing 36% fewer surgeries than routine operative treatment, without improving the primary functional outcome (HRWT) at 12 months.

Key Takeaway: Adding intraosseous liposomal bupivacaine to standard periarticular LIA reduced VAS pain scores at rest and with ambulation on POD1 and POD3, and extended PCEA use time from 14.8 to 18.7 hours in TKA patients aged 65–90.

Key Takeaway: Mixed-mode maintenance interventions after exercise therapy improved health-related quality of life (SMD 0.22, moderate certainty) and objective physical activity (SMD 2.14, low certainty) across chronic conditions, but in-person booster sessions showed no benefit.

Key Takeaway: Large-head (32/36 mm) ceramic-on-ceramic THA achieved 99.1% revision-free survival at 12 years with zero ceramic fractures and only 0.5% focal osteolysis, but a 5.5% articular noise rate and late instability from lumbar degenerative kyphosis remain concerns.

Key Takeaway: A history of bilateral native ACL rupture independently increases graft failure risk after primary ACLR by 34% (OR 1.34, 95% CI 1.03–1.73) in a cohort of 7718 patients.

Key Takeaway: Among DCM patients with baseline sensory deficits, 50% demonstrated mJOA sensory subdomain improvement at 12 months, independently associated with +1.98-point PCS and +2.34-point MCS gains on SF-12.

Key Takeaway: In 3,813 DCM patients, Tc-MEP monitoring demonstrated an NPV of 99.4% across all surgical approaches, but PPV was only 10.6% overall, with fusion surgery carrying a 4.62-fold higher odds of true-positive alerts versus decompression alone.

Key Takeaway: Six weeks of cryo-compression after UKA reduced oxycodone consumption by 46% (absolute difference: 3.5 five-mg tablets total) with no difference in NRS pain at rest (mean difference 0.1 points).

Key Takeaway: In 265 critically ill hip fracture ICU patients, elevated BUN/albumin ratio independently predicted 1-year mortality (aHR 2.67 for highest tertile vs lowest), while higher albumin/ALP ratio was protective (aHR 0.13).

Key Takeaway: Arthroplasty devices had a median 5.8-year delay from first adverse event report to Class I recall, significantly longer than spine devices at 1.8 years (P=0.014).

Key Takeaway: CIBERSORTx transcriptomic deconvolution identified 5 immune cell types significantly elevated in PJI versus aseptic failure, and a CD8+/Treg ratio above the median predicted lower infection recurrence (log-rank p=0.0252).

Key Takeaway: Over 20 years, an estimated 55,653 pediatric orthopaedic e-scooter injuries were recorded nationally, with fractures comprising 71.7% and an average annual incidence of 204 injuries per 100,000 children.

Key Takeaway: GLP-1RA use in nondiabetic overweight/obese patients was associated with a 19% increased odds of fracture within 1 year (OR 1.19, NNH=227), with dramatically higher risk in patients aged 78–88 years (OR 4.99, NNH=24).

Key Takeaway: Higher ADI neighborhood deprivation is independently associated with increased healthcare utilization, worse absolute PROMs, greater medical complication rates, and early signals of inferior implant survivorship after primary THA and TKA across 16 included studies.

Key Takeaway: In secondary chondrosarcoma arising from osteochondroma, mean cartilage cap thickness was 35 mm in grade 1 versus 76 mm in grade 2/3 disease (p<0.001), but CCT did not predict overall survival, local recurrence, or distant recurrence.

Key Takeaway: Across 5,482 patients, all imaging-derived bone quality metrics (HU, CT-BMD, VBQ, EBQ, DEXA T-score) showed moderate-to-good discrimination for cage subsidence with pooled AUCs of 0.77–0.85, but no single metric was statistically superior.

Key Takeaway: Percutaneous ultrasound-guided ganglion fenestration (PUGG) cost $2,217 versus $116,456 for surgical excision in pediatric wrist ganglia, with a lower revision rate (15% vs. 22%) but shorter time to revision (303 vs. 1,610 days).

Key Takeaway: Radiographic tether breakage occurred in 50% of AIS patients undergoing VBT with no significant difference between first- and second-generation devices (52% vs. 44%, P=0.46), despite a dramatic drop in surgeon-reported breakage from 21% to 2%.

Key Takeaway: Propensity-matched Crowe I DDH and primary OA patients achieved equivalent mHHS, HOOS-JR, VAS, and UCLA scores at minimum 2-year follow-up, with MCID achieved in >92% of both cohorts and revision rates of 3.8% vs 2.9% (P=1.0).

Key Takeaway: Arthroscopic repair of ALPSA lesions achieves labral heights of 6.3 mm at 3 weeks and 5.7 mm at 6 months — statistically indistinguishable from Bankart repairs — with equivalent Rowe scores and recurrence rates at mean 41-month follow-up.

Key Takeaway: DAA THA dislocation rate was 0.5% overall, but women with 28mm heads had a 7.5x higher dislocation hazard ratio compared to men with larger heads.

Key Takeaway: Prophylactic concave-side decompression and spinal cord medialization (PCDM) before three-column osteotomy reduced permanent neurological deficits from 6.7% to 1.5% (p=0.046) in severe kyphoscoliosis with type 3 cord morphology.

Key Takeaway: Robotic THA in 192 atypical hip anatomy cases achieved acetabular positioning within Lewinnek safe zones in 94.7% and 5-year implant survivorship of 98.8%.

Key Takeaway: Five-year cumulative healthcare costs after traumatic SCI reached a median of CA$204,924, ranging from $440,383 for complete cervical to $191,273 for incomplete lumbar injuries, with each 100 additional days alive and at home reducing two-year costs by 10%.

Key Takeaway: Only 25.8% of PROMs were completed at 2 years post-THA, with non-English speakers showing the largest independent reduction in compliance (OR 0.202).

Key Takeaway: Surgeons performing ≥20 distal radius fracture fixations annually had a 37% lower hazard of composite complications (HR 0.63) versus those performing <5/year, with revision surgery risk plateauing at the lower threshold of ~10 cases/year (HR 0.44, 56% reduction).

Key Takeaway: Medicare TKA inpatients require a KOOS-JR improvement of 29.3 points to achieve substantial clinical benefit, nearly 8 points higher than the 21.5-point threshold derived for outpatients.

Key Takeaway: Delayed surgery for pediatric medial epicondyle fractures correlates strongly with permanent ROM restriction (ρ=-0.631, P=0.002), though overall long-term outcomes are excellent with 100% union and mean QuickDASH of 11.05.

Key Takeaway: Concurrent NSAID plus DOAC therapy after primary TKA increased surgical site infection risk (OR 1.71) and 2-year revision risk (OR 1.52) while reducing manipulation under anesthesia rates (OR 0.69) compared to DOAC alone.

Key Takeaway: Plate removal for pediatric femoral shaft fractures required the longest OR time (63 min) and greatest EBL, while rigid nail removal had significantly more bony overgrowth and 19 total intraoperative/postoperative complications versus zero for plate removal.

Key Takeaway: Among 6,128 obese TJA candidates, only 1.6% received nutrition services and 2.6% underwent bariatric surgery preoperatively, with higher socioeconomic deprivation (ADI quartiles 3–4) independently associated with 1.4–1.9x increased odds of BMI ≥40.

Key Takeaway: Preoperative rotator cuff GFDI ≥1.875 predicts a six-fold increased odds of corticosteroid injection failure for post-RCR adhesive capsulitis (OR 6.020, P=0.049).

Key Takeaway: First-time revision THA for instability yields 73.6% all-cause re-revision-free survival at 10 years, with constrained liners carrying a 2.7x higher hazard of instability-related re-revision compared to dual-mobility constructs.

Key Takeaway: Three radiographic LLD measurement methods (true length, apparent length, femoral head height difference) are statistically comparable, but true length overestimates apparent length by a mean of 0.5 mm total and up to 1.5 mm at the femoral segment, with discrepancies correlating with coronal plane deformity.

Key Takeaway: Jumbo femoral heads (40/44 mm) reduced dislocation risk during the first postoperative year (HR 0.20, 95% CI 0.05–0.79) compared to 36 mm heads, but this advantage was not sustained at final follow-up (HR 0.55, 95% CI 0.13–2.34).

Key Takeaway: Unplanned STS excision independently increases 15-year mortality risk (HR 1.77, 43% vs 74% OS) and local recurrence (HR 1.74, 40% vs 69% LRFS), with survival divergence emerging only after 10 years.

Key Takeaway: Anterior approach THA reduces total OR time by 10.6 minutes (156.7 vs 167.4 min) compared to posterior approach, driven by shorter setup (-2.0 min), closure (-7.5 min), and take-down (-3.6 min) times, though implantation time is 3.3 minutes longer.

Key Takeaway: Foot ulceration—diabetic or non-diabetic—independently predicts spinal infection within 2 years, with diabetic foot ulcer conferring OR 2.55 for spinal infection and OR 3.29 specifically for spinal osteomyelitis versus diabetic patients without ulcers.

Key Takeaway: 3D-printed highly porous cups had a significantly higher initial gap rate than HA-coated non-highly-porous cups (27.3% vs 12.1%, P=0.027), but both demonstrated equivalent clinical scores and zero migration or loosening at 2 years.

Key Takeaway: Untargeted UHPLC-MS/MS identified 831 significant metabolites (VIP >1) that distinguish physiological disc aging from degeneration, with degeneration specifically characterized by suppression of resolvins and disrupted sphingolipid metabolism rather than the oxidative drift seen in normal aging.

Key Takeaway: In THA patients with prior hematologic malignancy, aspirin was associated with 75% lower 90-day DVT odds versus non-aspirin anticoagulation (OR 0.25; P=0.03), with warfarin and LMWH showing 9–10x higher VTE odds compared to aspirin.

Key Takeaway: All-suture anchors produced perianchor fluid collection in only 11.8% of cases versus 38.2% for PEEK anchors (p=0.023), and fluid collection correlated with repair integrity only in the PEEK group (r=0.606).

Key Takeaway: High-volume fellowship-trained arthroplasty surgeons achieved lower 2-year dislocation rates (1.2% vs. 1.3–1.7%) and lower aseptic revision and PJI rates compared to all non-fellowship-trained volume cohorts, with no NFT volume threshold replicating these outcomes.

Key Takeaway: Only 10% of patients ≥50 years old with low-energy thoracic or lumbar fractures received appropriate bone health medication within 90 days, with surgical intervention conferring a 3.35-fold increase in treatment odds.

Key Takeaway: Simultaneous bilateral THA in 92 carefully selected patients achieved 95.7% implant survivorship at median 4.6-year follow-up with a 6.5% overall hip-level complication rate.

Key Takeaway: Pedicle enhancement on contrast-enhanced MRI predicts progressive collapse in acute osteoporotic compression fractures, with an SNR cutoff of 89.3 yielding AUC 0.781 (71.1% sensitivity, 78.7% specificity).

Key Takeaway: 30.8% of patients (48/156) who underwent Stage I Masquelet cement spacer placement for acute long bone fractures never proceeded to Stage II bone grafting.

Key Takeaway: Moderate anemia at discharge (Hgb 8–10 g/dL) after TLIF was associated with a 14% 90-day readmission rate versus 0% in non-anemic patients, and significantly worse ODI and leg pain trajectories at 3 months and 1 year.

Key Takeaway: Following the PARITY RCT, the proportion of musculoskeletal oncologists limiting perioperative antibiotics to 24 hours doubled from 25% to 51% (P<0.001), yet 60% reported no meaningful practice change.

Key Takeaway: Postoperative physical therapy after single-level lumbar fusion did not reduce opioid consumption (MME), improve PROMs, or reduce complications in 365 patients at any time point within one year.

Key Takeaway: Outflow obstruction combined with dural disruption during endoscopic spine surgery can elevate intracranial pressure to 86–90 mmHg, and symptom onset correlates with pressures exceeding 37 mmHg (mean symptomatic pressure 52.9 ± 9.2 mmHg).

Key Takeaway: The SISS 'unstable' category predicted radiologic deformity progression with 94.5% specificity and 77.8% PPV/NPV (AUC=0.68), but SISS classification was not an independent predictor of functional outcome (mRS 4–6) in multivariate analysis.

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

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

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

Key Takeaway: Bicondylar femoral cone-hinge construct ('DFR downgrade') achieved 100% survivorship free from aseptic loosening and 85.1% survivorship free from any re-revision at one and two years in 20 patients with AORI IIB/III femoral bone loss.

Key Takeaway: Hook of hamate excision in baseball players yields a 90.7% weighted mean return-to-play rate at a median of 5.7 weeks, with only 0.5% requiring reoperation.

Key Takeaway: Conservative management of distal biceps tendon ruptures yields mean supination strength deficits of only 11% and DASH scores of 10.1 at mean 47.8 months, but heavy/repetitive manual workers had significantly worse functional outcomes (p=0.01 DASH, p=0.009 MEPS) and higher pain rates (p=0.0125).

Key Takeaway: Intraoperative fluoroscopy during DAA THA improves component positioning accuracy and reduces leg length discrepancy without increasing operative time or complication rates, based on current available evidence.

Key Takeaway: Romania relaunched its national arthroplasty register in 2025 and ranks among European countries with the highest hospital bed capacity per capita, though no quantitative outcome data are reported.

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

Key Takeaway: Among 24 cohort studies, standing AP radiographs combined with block/lift correction tests were the most reliable discriminators of limb-origin versus spine-origin pelvic obliquity, with persistent deformity after lift correction identifying spinal etiology.

Key Takeaway: At mean 8.9-year follow-up after MTP1 arthrodesis, 86% of patients showed IP joint OA progression (34/77 progressing ≥2 Kellgren-Lawrence grades), yet 90.9% reported good or excellent satisfaction with mean AOFAS HMI 79.9.

Key Takeaway: In 38 patients with L4-5 spondylolisthesis, increasing anterolisthesis was associated with localized bone density reduction specifically in the anterior, medial, and lateral regions of the L5 body and the L4-5 facet joints, while overall bone density changes did not correlate with any specific deformity measure.

Key Takeaway: Open reduction internal fixation with nonvascularized autograft achieved 95% union rate for scaphoid nonunion, with no difference in outcomes between corticocancellous and cancellous-only graft.

Key Takeaway: A statistically grounded random sampling strategy requires only 357 patients for hospitals performing 5,000 annual arthroplasties versus the current CMS requirement of 2,500, reducing reporting burden by 86% while maintaining statistical validity.

Key Takeaway: TCV-mediated revascularization via footprint freshening or oral D-sphingosine significantly improved rotator cuff tendon-to-bone biomechanical properties at 12 weeks compared to cortical bone preservation in a rat model (P < .05).

Key Takeaway: Persistent dissatisfaction in 10–20% of primary TKA patients despite technical success drives a paradigm shift toward individualized alignment, cementless fixation, expanded bearing options, and selective patellar resurfacing.

Key Takeaway: Across 310 RCTs on frozen shoulder, symptom duration was unreported in ~40% of trials and >60% cited no reference literature to justify diagnostic criteria, revealing pervasive definitional inconsistency.

Key Takeaway: Phase II FXI/XIa inhibitor trials in TKA demonstrated venographic VTE reductions of up to 72% versus enoxaparin with bleeding rates statistically indistinguishable from placebo, supporting two ongoing Phase III pivotal programs.

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

Key Takeaway: In cadaveric SER4b ankle fractures with fibular plate fixation, syndesmotic screw fixation restored lateral talar shift to within 0.2 mm of native but left valgus tilt 18.1° and external rotation 15.9° above native, whereas deltoid ligament repair reduced those deficits to 2.7° and 5.2° respectively.