Weekly Digest

Key Takeaway: Incisional liposomal bupivacaine infiltration failed to reduce the primary endpoint of resting VAS pain at 48 hours (median 0 both groups, p=0.143) in geriatric hip fracture arthroplasty, despite significant reductions in activity pain at 8, 24, and 48 hours and oral rescue opioid use (25 vs. 50 MME median).

Key Takeaway: Over 20 years, patellar resurfacing during TKR produced no significant difference in Oxford Knee Score (marginal difference 0.76, p=0.076) but yielded significantly more QALYs (7.295 vs 6.884, difference 0.380, p=0.020) at equivalent total cost (£10,825 vs £10,889).

Key Takeaway: In a 50-patient RCT comparing KA-TKA vs MA-TKA, alignment strategy was not an independent predictor of outcomes, while extension coronal gap angle (β=2.85, p<0.01) and quadriceps strength loss (β=0.56, p=0.03) independently predicted KSS 2011 satisfaction and functional activity, respectively.

Key Takeaway: Attachment-sparing hamstring autograft achieved complete MRI graft maturation (Figueroa score 5) in 100% of patients at 9 months versus only 10% in free graft controls, with earlier ligamentization detectable as early as 3 months.

Key Takeaway: In high-risk primary THA patients randomized to dual-mobility vs. single-bearing constructs, dislocation rates were 0.7% vs. 2.1% at median 23 months—a threefold difference that failed to reach statistical significance (P=0.29).

Key Takeaway: PRP and BMAC augmentation of hamstring autograft ACLR produced no improvement in Lysholm, IKDC, or Marx scores at 2 years, and BMAC was associated with worse MRI signal intensity of the graft.

Key Takeaway: Full endoscopic discectomy reduces return-to-work time by 22.68 days and wound-related complications (infection RR 0.30, hematoma RR 0.47) versus microscopic discectomy, but increases fluoroscopic radiation exposure (MD +0.92 units) with no consistent long-term superiority in pain or ODI.

Key Takeaway: MC and UC tibial inserts produced equivalent KSS scores (172.2 vs 174.0) and satisfaction rates (94.7% vs 92.1%) at 1 year, with no statistically significant difference on any outcome measure.

Key Takeaway: Trabecular Titanium acetabular cups demonstrated 17% higher periprosthetic metabolic activity (SUV) at 4 weeks postoperatively compared to hydroxyapatite-coated cups, suggesting earlier osseointegration with TT surfaces.

Key Takeaway: Across 18 studies and 3,346 patients with up to 19.4 years follow-up, lumbar TDA provides durable pain and functional improvement with index-level revision rates of 0.67–19.9%, but surgically defined ASD rates of 0.8–5.1% do not demonstrate a definitive protective effect over fusion.

Key Takeaway: Intraoperative single-dose zoledronic acid produced distinct circulating miRNA profiles at 2 days post-repair—including significantly lower miR-140-3p in the treatment group and preserved miR-29a-3p, miR-21-5p, miR-192-5p, and miR-146a-5p versus controls—suggesting reduced enthesis inflammation/fibrosis and enhanced collagen synthesis as the molecular mechanism behind previously observed retear reduction.

Key Takeaway: At mean 7.5-year follow-up, RSA produced a significantly higher Constant score (62 vs 51, P=.039) compared to nonoperative treatment for displaced 3- or 4-part PHFs in patients aged ≥80 years.

Key Takeaway: Nearly half of primary THA patients (47.5% at 1 year, 48.6% at 2 years) hit the EQ-5D-3L ceiling score, with a preoperative EQ-5D ≥0.534 predicting ceiling attainment (AUC 65.6%).

Key Takeaway: In 267 Japanese TKA patients, one-year postoperative PCS independently predicted KSS satisfaction (β = -0.390, p < 0.001) even after controlling for VAS pain, and six-month PCS independently predicted one-year satisfaction (β = -0.241, p = 0.014).

Key Takeaway: Surgical fixation of Jones fractures yields a significantly lower nonunion rate (3.3% vs 11.6%) and higher AOFAS scores (96.5 vs 84.1) compared to conservative management across 998 patients.

Key Takeaway: Early periprosthetic femoral fracture within 30 days of primary THA carries a 2-year reoperation-free survivorship of only 48.5%, compared to 97.6% in matched non-fracture controls.

Key Takeaway: Nonoperatively managed Z-type clavicle fractures had a 17% rate of surgery to promote healing—identical to non-Z-type fractures—but surgical fixation reduced that rate to 1.1%, while excluding implant removal revealed a significantly higher unplanned reoperation burden in the nonsurgical group (20% vs. 4.2%, P=0.009).

Key Takeaway: Among morbidly obese THA patients who achieved BMI <40 kg/m² after bariatric surgery, major complication risk remained 84% higher (OR 1.84) and PJI risk 236% higher (OR 3.36) compared to non-bariatric patients with equivalent BMI.

Key Takeaway: Glenoid morphology in postcapsulorrhaphy arthropathy (PCA) is nearly identical to primary glenohumeral osteoarthritis across all measured parameters except superior inclination (7.5° vs. 4.3°, p<0.001), a difference unlikely to be clinically meaningful.

Key Takeaway: A fully automated deep learning system achieved 95.6% overall accuracy and macro-averaged F1 score of 0.862 for Lenke classification of AIS directly from spinal radiographs, with Cobb angle ICC of 0.969–0.976 versus expert measurement.

Key Takeaway: Single-stage exchange for chronic PJI costs 54% less than two-stage exchange for TKA ($79,548 vs. $171,592) and 58% less for THA ($79,349 vs. $187,251), driven primarily by a 4.3x difference in implant costs for TKA.

Key Takeaway: SALTO TALARIS TAA demonstrates 96.2% implant survival (revision of ≥1 metallic component) and 99% survival to arthrodesis conversion at 10 years across 144 ankles with minimum 10-year follow-up.

Key Takeaway: ALIF for degenerative spondylolisthesis carries fewer perioperative complications than PLF (composite adverse events OR 1.68 favoring ALIF) but costs $11,500 more per admission ($43,000 vs. $31,500).

Key Takeaway: Short leg casting achieves equivalent coronal and sagittal alignment to long leg casting in pediatric tibial fractures while reducing time to weight-bearing by 2.29 weeks and time to union by 1.21 weeks.

Key Takeaway: Early definitive ORIF of tibial plateau fractures within 72 hours reduces deep SSI risk by 46% compared to delayed fixation (8.7% vs 16.1%; RR 0.54).

Key Takeaway: Across 32 studies, no single criterion defines lumbar instability; >3 mm sagittal translation on flexion-extension radiographs remains the most historically cited radiographic threshold, but current literature supports a multidomain framework requiring at least two of three criteria (clinical, radiographic, questionnaire).

Key Takeaway: Rotating-hinge revision TKA for arthrofibrosis yields a pooled ROM improvement of 42.2° and a 17.5° advantage over non-hinged revision constructs without increased complications.

Key Takeaway: Risser staging overestimates skeletal maturity in AIS at a clinically significant rate, with Risser-mature/SMS-immature discordance occurring in 12.5% and Risser-mature/CVM-immature discordance in 24.3% of patients.

Key Takeaway: UKA survivorship at <5, 5–10, and ≥10 years does not differ significantly across non-obese, obese, and morbidly obese patients (95.5% vs 95.3% vs 95.8% at <5 years; 92.1% vs 92.9% vs 88.7% at ≥10 years), though morbidly obese patients show a non-significant trend toward lower mid-term survivorship (90.6% vs 95.3%, adjusted P=0.065).

Key Takeaway: Flat-top talus occurred in 68% of Ponseti-treated clubfeet undergoing radiographic evaluation, with prior surgery carrying a 4.29-fold increased odds of its presence.

Key Takeaway: Inter-rater reliability of mRUST in ballistic femoral and tibial shaft fractures is only moderate (ICC 0.64 and 0.61, respectively), and a 3-month mRUST score <8 predicts nonunion with 100% sensitivity for femur but only 71% sensitivity for tibia.

Key Takeaway: Medium-viscosity cement carries a 2.32-fold higher hazard of revision for aseptic loosening compared to low-viscosity cement in primary TKA, while antibiotic cement confers no protective effect against PJI revision.

Key Takeaway: Robot-assisted PLF carries 2.22x higher odds of organ/space SSI (with interbody) and mean 90-day episode costs of $67,400 versus $53,700 for conventional PLF.

Key Takeaway: Inactive patient portal use was the strongest predictor of 1-year PROM noncompletion after TJA (OR 5.85 for HOOS-JR, OR 3.28 for KOOS-JR), with overall 1-year completion rates peaking at only 44.1% (HOOS-JR) and 48.3% (KOOS-JR) despite >90% preoperative completion.

Key Takeaway: Lower preoperative LVEF independently predicts prolonged intubation after neuromuscular scoliosis correction (β=-0.11 per 1% LVEF, P=0.003), with ROC AUC of 0.78 in the CP subgroup.

Key Takeaway: Non-resolving NLR trajectory after hemiarthroplasty carries a 5.4-fold increased odds of mortality (15.3% vs. 1.8%) compared to a blunted inflammatory phenotype.

Key Takeaway: Among shoulder arthroplasty patients achieving a SANE score ≥95, aTSA patients outperformed rTSA patients on all higher-demand functional metrics and ROM, and were more likely to reach that threshold (40% vs. 26%).

Key Takeaway: At mean 6.1-year follow-up, THA and HA revision rates were equivalent, but cumulative revision curves diverged in favor of THA at 5.5 years, driven by late HA failures from periprosthetic femoral fracture (27.8%) and acetabular erosion (16.7%).

Key Takeaway: Preoperative GLP-1 RA use in obese patients undergoing arthroscopic rotator cuff repair was associated with lower 2-year revision rates for left-sided repairs (4.0% vs 8.2%, OR 0.5) and lower retear rates in women with left-sided repairs (20.2% vs 33.5%, OR 0.5).

Key Takeaway: Maximizing bearing diameter in primary fixed-bearing THA yielded zero dislocations in 835 patients versus a 1.0% rate in those receiving non-maximized bearings (OR 0.14 on LASSO regression, P = 0.003).

Key Takeaway: Machine learning identified distinct risk factor profiles for moderate PJK (17.4%; driven by L1 tilt and relative hyperlordosis) versus severe PJK (11.0%; driven by lordosis distribution index maldistribution and construct rigidity) after ASD surgery.

Key Takeaway: The APAK classification, integrating distal femoral rotation and tibial coronal alignment at 90° flexion, showed a moderate-to-strong association with intraoperative flexion-gap patterns (Cramer's V = 0.481, p < 0.001), and functional alignment reduced medial-lateral gap differences at 90° by up to 2.63 mm compared to mechanical alignment across major APAK phenotypes.

Key Takeaway: Each 0.5-cm² decrease in geniohyoid muscle cross-sectional area on admission CT independently increased odds of 30-day respiratory complications by 2.29-fold (AUC 0.86) in 337 surgical cSCI patients.

Key Takeaway: Language-concordant preoperative education reduced 30-day readmission odds by 89% (DiD OR=0.11) and 90-day readmission odds by 82% (DiD OR=0.18) among Spanish-speaking TKA patients relative to English-speaking patients.

Key Takeaway: At 6 years, stemless aTSA (7.0% CPR) and rTSA (6.5% CPR) had statistically equivalent revision rates in patients under 55, while stemmed aTSA carried a 2.04-fold higher revision hazard than rTSA.

Key Takeaway: DAIR failure rates rise from 37.7% at ≤4 weeks to 55.2% at 10–12 weeks, with joinpoint regression identifying a critical inflection point at approximately 7 weeks post-arthroplasty beyond which failure risk accelerates disproportionately.

Key Takeaway: Pyrocarbon interposition shoulder arthroplasty achieves 87% survival at 10 years overall, but revision rate reaches 44% in Walch B2 glenoids versus 2% in type A glenoids (P=.002).

Key Takeaway: Inflation-adjusted Medicaid reimbursement for THA fell 31.9% (from $2,050 to $1,395) and for TKA fell 22.0% (from $2,024 to $1,579) between 2014 and 2022, with declines independent of Medicaid expansion status.

Key Takeaway: Acromial stress fractures/reactions occur in 11% of rTSA patients and are independently associated with corticosteroid use (aOR 9.6) and prior shoulder surgery (aOR 7.2), with significantly worse functional outcomes at final follow-up.

Key Takeaway: Patellar complications are the leading cause of first TKA revision (29%, 35.8/1,000 primaries), while infection drives re-revision, escalating from 15% of first revisions to nearly 65% of fourth-or-higher revisions.

Key Takeaway: Lateral distal tibial epiphyseal rod placement increases failure-to-telescope odds by 2.71-fold (OR 2.71; 95% CI 1.48–5.05) in pediatric OI patients undergoing Fassier-Duval tibial rodding.

Key Takeaway: RHK-pTKA guided by zonal fixation theory achieved 94.44% 5-year prosthesis survival in Charcot knee arthropathy, equivalent to non-Charcot controls (94.29%), despite greater bone defect burden and more frequent metal augmentation requirements.

Key Takeaway: Hybrid telerehabilitation adjunct to in-person PT after shoulder arthroplasty and rotator cuff repair achieved equivalent 6-month ASES, VAS, and ROM outcomes while reducing in-clinic PT visits by 5–6 sessions and PT duration by 5–6 weeks.

Key Takeaway: Preoperative fall history in patients ≥65 undergoing primary THA is independently associated with nearly doubled revision risk (RR 1.95), 2.33× dislocation risk, and 2.46× one-year mortality compared to propensity-matched controls.

Key Takeaway: In patients with a contralateral TKA, UKA achieves 7.4° greater ROM and 2.7x higher patient preference but carries a 5x higher revision risk (OR 0.2) compared to the contralateral TKA.

Key Takeaway: Transfusion following aseptic revision TKA is independently associated with a 2.19-fold increased risk of PJI and a 1.89-fold increased risk of DVT at 90 days.

Key Takeaway: Arthroscopic-assisted lower trapezius transfer for irreparable posterosuperior rotator cuff tears achieves MCID in 70–79% of patients at mean 76.5 months, with teres minor trophicity the strongest predictor of functional PASS attainment (ρ = -0.743).

Key Takeaway: 76.8% of primary THA patients met the CMS-mandated 22-point HOOS JR SCB threshold at mean 22 months, and neither obesity nor chronic opioid use predicted failure to meet this benchmark.

Key Takeaway: First-time traumatic posterior dislocation produces mean posterior glenoid bone loss of ~11%, rising to ~13% with recurrent events, approaching thresholds for soft-tissue stabilization failure.

Key Takeaway: Triple-taper (Type 3C) femoral stems reduced aseptic revision risk by 53% versus single-taper stems (HR=0.47) and 61% versus dual-taper stems (HR=0.39) in obese THA patients at five years.

Key Takeaway: The coronal LCL sign was present in 64% of pediatric ACL-deficient knees and occurred at equal rates in hyperlax (Beighton ≥6, 62%) versus normal-laxity (64%) patients (P=1.0), confirming it as an ACL-specific instability marker independent of generalized ligamentous laxity.

Key Takeaway: In 1,486 primary HOPD TKA patients, spinal bupivacaine dose ≤1.6 mL was associated with a 6-hour shorter LOS versus >1.6 mL, with each 0.1 mL increase adding 49 minutes to LOS.

Key Takeaway: Pyrocarbon hemiarthroplasty with C2 corrective glenoid reaming for B2/B3 osteoarthritis achieved 95% prosthesis survival at mean 4.5 years with no revisions for painful glenoid erosion and adjusted Constant Score improvement from 43% to 97%.

Key Takeaway: When collared cemented stems are compared to metaphyseal-filling collared cementless stems via propensity matching, periprosthetic fracture rates (3% vs 2%) and BCIS rates are statistically equivalent across 213 matched pairs.

Key Takeaway: The 2018 MSIS serum criteria failed to discriminate infection from no-infection in transfemoral osseointegration patients (MSIS total score likelihood ratio χ² = 1.6, p = 0.21), while a novel 4-marker composite score achieved AUC = 0.84 with sensitivity 0.88 at a cutoff ≥ 2.

Key Takeaway: Cementless TKA in patients under 50 achieved 30-year femoral component survivorship of 100% and tibial baseplate survivorship of 97.3%, with polyethylene exchange (17.3%) as the dominant failure mode.

Key Takeaway: Citrate-based bioceramic interference devices (Citregen) showed 0% bone tunnel enlargement and near-complete osseous integration (76–100% along long axis) in 21 of 25 implants at median 36-month MRI follow-up.

Key Takeaway: Rotator cuff repair augmented with an autograft biceps patch ('Biceps Smash') achieved a 4% retear rate versus a modified Rotator Cuff Healing Index-predicted rate of 21.5% (p=0.0196) at mean 23.5-month follow-up.

Key Takeaway: A posterior tibial slope ≥8.3° on lateral radiograph is associated with lax (failed) healing after medial meniscus posterior root repair at 1-year second-look arthroscopy, with mean PTS 9.3° in lax versus 6.6° in nonlax repairs (p=0.001).

Key Takeaway: Corrective osteotomy for metacarpal and phalangeal malunion can address all three planes of deformity, with 3D-printed cutting guides and software-assisted planning improving surgical precision, though specific union or functional outcome rates are not reported.

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

Key Takeaway: Among 799 rTSA studies, the center of rotation was mentioned in 72.8% but clearly defined in only 19.4%, and 53% failed to specify the anatomical origin of lateralization.

Key Takeaway: An atelocollagen-loaded hyaluronic acid porous scaffold increased tendon stiffness to 42.2 ± 7.5 N/mm (p=0.005) and improved collagen fiber density (p=0.041) versus saline, HA-only, and atelocollagen-injection controls at 12 weeks in a rabbit chronic rotator cuff repair model.

Key Takeaway: In FE models, older bone density (age 60–80) increased bone-implant micromotions across all five stemless designs, but Global Icon- and Inhance-based implants showed the least sensitivity to age-related density decline.

Key Takeaway: An allogeneic ASC-based cell therapy medicinal product showed no toxicity or tumorigenicity across doses up to 1000× the clinical dose, but failed to improve histological scores (median 2 vs 1, p=0.811) or load to failure (51.99 N vs 50.97 N, p=0.770) over vehicle control in a chronic rat rotator cuff repair model.