Weekly Digest

Key Takeaway: Dual mobility THA reduced dislocation risk by 73% versus standard THA in displaced femoral neck fractures (1.3% vs 4.2%; aHR 0.27, 95% CI 0.13–0.56) at one year.

Key Takeaway: Single-shot epidural ropivacaine with opioid-free IV-PCA reduced fentanyl consumption by 1345 µg (fusion) and 1005 µg (decompression) versus conventional fentanyl IV-PCA without a clinically important difference in NRS pain scores.

Key Takeaway: Adding dexamethasone 0.1 mg/kg to erector spinae plane block in pediatric posterior spinal fusion extended time to first rescue opioid from 5.2 to 13.0 hours and reduced 48-hour morphine consumption by 34% (27.3 vs 18.1 mg MEq).

Key Takeaway: Adding thoracic extension exercises or kinesio taping to shoulder exercises produced greater improvements in pectoralis major pressure pain threshold and shoulder abductor/adductor strength than shoulder exercises alone, but all three groups achieved clinically meaningful pain reduction (~3.1–4.4 cm VAS) and DASH improvement (~20–23 points) at 3 weeks.

Key Takeaway: Surgeon-performed intraoperative adductor canal blocks achieved non-inferior time to discharge (209.5 vs 231.1 minutes, P=0.06) compared to anesthesiologist-performed blocks in 200 same-day discharge TKA patients.

Key Takeaway: Robotic closed reduction achieved excellent-to-good reduction (Matta criteria) in 96% of displaced pelvic fractures versus 48% with manual closed reduction (RR 2.00, 95% CI 1.47–2.72), with zero surgeon fluoroscopic exposures versus a median of 38.

Key Takeaway: Dronabinol 2.5 mg BID added to standard multimodal analgesia did not reduce opioid consumption at two weeks post-TKA (383.6 vs 367.6 MME, P=0.717).

Key Takeaway: At five years, constitutionally aligned robotic arm-assisted bi-UKA produced no significant difference in Oxford Knee Score, Forgotten Joint Score, EQ-5D-3L, UCLA, New KSS, or VAS pain/stiffness versus mechanically aligned conventional TKA across all 80 randomized patients.

Key Takeaway: Among 604 patients undergoing lower extremity endoprosthetic reconstruction, Asian patients had higher absolute MSTS-93 and TESS scores but similar delta scores to other ethnicities, while women achieved higher TESS MCID rates at all postoperative timepoints despite lower baseline function than men.

Key Takeaway: Formal activity restrictions after pediatric distal radius buckle fractures increased QuickDASH scores (20.3 vs. 9.1) and parental worry without improving healing outcomes in any of 157 patients.

Key Takeaway: Children with Sprengel's deformity demonstrate mean shoulder abduction of 113° and forward elevation of 120°—significantly below normative values—with Cavendish grade III being the most common presentation (50.8%) and higher grades correlating with worse PODCI Transfer scores.

Key Takeaway: Extended-duration VTE prophylaxis after THA reduces symptomatic DVT by 47% (OR 1.87) and PE by 44% (OR 1.80) versus short-duration, with DOAC-long showing the lowest DVT risk across all five regimens.

Key Takeaway: The 12-item SPINE survey demonstrated excellent internal consistency (Cronbach's α=0.93) and no floor or ceiling effects in lumbar radiculopathy patients, with running, squatting, and kneeling identified as the most limited activities.

Key Takeaway: IMN for pathologic diaphyseal tibial fractures achieved 1-year survival of 48.7% and reduced median VAS pain scores from 38 to 6 at one month, with 73% achieving full weight-bearing by 3 months.

Key Takeaway: Minimal movement restrictions after THA produced a 90-day dislocation rate of 1.93% versus 1.46% with strict restrictions — a non-significant difference (p=0.093) across 10,357 hips.

Key Takeaway: Surgical fixation of bicortical scaphoid waist fractures halved nonunion risk (8.4% vs 17.5%) but increased complications sevenfold (14.1% vs 2.0%), with a DASH improvement of only -4.2 points at 52 weeks—below the 10-15 point MCID.

Key Takeaway: Over 24 years, resistant organisms caused 19-24% of knee PJIs with no significant temporal increase, and vancomycin plus gram-negative coverage achieved >90% empirical coverage across all Tsukayama PJI classes.

Key Takeaway: Dementia independently increased 1-year mortality (16.25% vs. 8.02%) and dislocation rate (6.25% vs. 2.21%) after hemiarthroplasty for displaced femoral neck fracture in propensity-matched elderly patients.

Key Takeaway: 4-in-1 surgery achieved equivalent initial union (90.8% vs 88.9%) but a significantly lower refracture rate (11.8% vs 37.0%, P<0.001) compared to combined intramedullary nailing/Ilizarov/bone graft for Crawford Type IV congenital tibial pseudarthrosis.

Key Takeaway: Opioid stewardship interventions achieved 100% statistical significance across all 9 prescribing studies, while cost-reduction interventions succeeded in only 60% of studies and diagnostic ordering interventions in only 29%.

Key Takeaway: Surgical treatment for lumbar spondylolisthesis and stenosis within 6 months of diagnosis reduced 3-year metabolic burden risk by 6% (RR 0.94) compared to nonoperative care, though surgery was associated with 19% higher odds of active opioid prescription at 3 years.

Key Takeaway: Fassier-Duval telescopic rod revision rate was 36.69% at median 64-month follow-up, with age ≤30 months at surgery and OI type IV as independent predictors of earlier failure (HR 0.986 per additional month of age, p<0.001).

Key Takeaway: A six-variable nomogram predicts recurrent LDH after PELD with AUC 0.755 (training) and 0.831 (external validation), identifying Modic type II changes (OR 5.755) as the strongest independent predictor.

Key Takeaway: DTI metrics in post-traumatic distal tibial physeal bars correlate strongly with bar size, with ADC showing the strongest inverse correlation (ρ=-0.77) and radial diffusivity the strongest overall (ρ=-0.80), suggesting DTI can quantify residual physeal integrity beyond conventional MRI.

Key Takeaway: Registry and large database studies comparing cementless to cemented TKA show revision rate differences of less than 1%, but carry mean Modified Coleman Methodology scores of 35.5–36.0 (poor quality), versus a mean MCM score of 76.9 (good quality) in 27 RCTs on the same topic.

Key Takeaway: Across 4,040 hips, simultaneous bilateral, staged bilateral, and unilateral hip arthroscopy for FAI syndrome produced no statistically significant differences in mHHS, NAHS, iHOT-12, VAS, revision rate, or THA conversion rate.

Key Takeaway: Lateral femoral condyle angle (LFCA) independently predicts ACL graft rerupture with OR=1.46 and, combined with lateral condylar flexion curvature radius, achieves AUC=0.777 for rerupture prediction.

Key Takeaway: Circumferential labral reconstruction was associated with significantly lower conversion to THA compared to segmental reconstruction (P=.01), though functional outcomes were equivalent across 1,817 hips.

Key Takeaway: THA with subtrochanteric osteotomy for Crowe IV hips after Schanz osteotomy achieved 88.9% implant survivorship at 10 and 20 years and 90% patient satisfaction, with preoperative mobility aid use carrying a 13x odds of dissatisfaction.

Key Takeaway: Surgeon C, who assisted under a mature standardized rTSA workflow, reached operative efficiency plateau at 15–20 cases versus 30–40 cases for Surgeon A with no prior assistant exposure.

Key Takeaway: Across 39,743 primary THAs at four facility types, overall PJI rate was 1.07% with no significant difference between tertiary hospital centers, community hospitals, orthopaedic specialty hospitals, or ambulatory surgical centers on multivariable Cox regression.

Key Takeaway: A logistic regression ML model predicts acromial and scapular spine fractures after rTSA with AUROC 0.71, identifying medialized-distalized implant design, cuff tear arthropathy, older age, and osteoporosis as the strongest preoperative risk factors in a cohort with 4.1% overall ASSF incidence.

Key Takeaway: Klebsiella pneumoniae pneumonia within 2 years of TKA carries a 12.22-fold increased PJI odds ratio, and Staphylococcal pneumonia within 3 months of THA carries a 5.2-fold increased PJI odds ratio.

Key Takeaway: In ASA ≤2 patients under 80, simultaneous bilateral shoulder arthroplasty reduced total hospital stay by 4.1 days (3.4 vs 7.5 days, p<0.001) with zero complications and equivalent SSV scores (82 vs 83) compared to staged bilateral arthroplasty.

Key Takeaway: Pediatric nonscaphoid carpal fractures are rare and predominantly nonoperative, with hamate fractures comprising 33.3–33.9% of cases in national EHR databases and representing the most common bone requiring surgical intervention.

Key Takeaway: Ectatic humeral bone loss carries the highest revision risk (38%, OR 6.6) and humeral loosening rate (21%, OR 42.4) among all HUMBL classification patterns in shoulder arthroplasty.

Key Takeaway: In patients aged 18–60 with displaced femoral neck fractures treated operatively, overall failure rate was 30%, with cannulated screws carrying 3.7× higher odds of nonunion/fixation failure versus fixed-angle implants.

Key Takeaway: Conversion THA has an operative time of 124.3 minutes and reoperation risk intermediate between primary THA (93.5 min, lower reoperation risk, P=0.03) and revision THA (177.3 min, similar reoperation risk, P=0.42), supporting its classification as a distinct surgical category.

Key Takeaway: Preoperative malnutrition in tibial shaft fracture patients doubles the risk of infection, thromboembolic events, and sepsis (RR>2.0), and postoperative nutritional correction reduces but does not eliminate this risk—residual elevated risk for revision and infection persists (RR>1.4) even after normalization.

Key Takeaway: Patients without preoperative patellar OA who underwent patellar resurfacing reported significantly greater dissatisfaction with kneeling postoperatively compared to unresurfaced patients (P = 0.045), despite equivalent KOOS-JR scores across all three groups.

Key Takeaway: DAA hemiarthroplasty produced a smaller decline in Modified Barthel Index at discharge versus posterior approach (−49.85 vs −55.47, p=0.045), but this advantage was lost by 12 months with no difference in MBI, Parker Mobility Score, LOS, or 1-year mortality.

Key Takeaway: Labral hypoplasia on preoperative MRI predicts nearly 3x higher revision arthroscopy (28.6% vs 9.8%) and 4x higher conversion to THA (21.4% vs 4.9%) at 10-year follow-up after hip arthroscopy for FAIS.

Key Takeaway: In 174 TSS patients, posterior cervical plus lumbar fusion procedures cost 1.6× more than ACDF plus lumbar laminectomy, and posterior cervical procedures carried a 14× increased odds of surgical site infection.

Key Takeaway: Following FVO+GTA for LCPD, clinically significant hip abductor weakness (≥25% side-to-side deficit) occurred in 15% of patients (4/26), and all 4 were in the home exercise-only group versus 0/15 in the outpatient physiotherapy group.

Key Takeaway: PCF accounted for 93% of posterior cervical procedures (n=71,933 vs n=5,581 laminoplasty) and generated 33× greater total professional expenditure ($271.3M vs $8.09M) from 2015 to 2023.

Key Takeaway: Hip abduction brace achieves equivalent residual fracture angulation to Pavlik harness and spica cast for infant femur fractures, with 0% complication rate versus 10.3% femoral nerve palsy in Pavlik-treated infants ≤6 months.

Key Takeaway: In single-level lumbar discectomy, the most expensive case costs 3.6× the least expensive, with surgical time (ρ=0.78) and outpatient vs. inpatient setting (33% vs. 93% outpatient in high-cost patients) as the dominant cost drivers.

Key Takeaway: Risser 0 AIS patients braced with a Boston TLSO had a 5.6-fold higher risk of requiring surgery compared to those treated with Rigo-Cheneau or Providence nighttime braces (P=0.04).

Key Takeaway: Segmental lordosis change (∆SL) mediated 64.6% of the ASD risk difference between MIS-LLIF and TLIF (23.2% vs 9.5%), with each additional degree of ∆SL reducing ASD odds by 47% (OR 0.53).

Key Takeaway: In 140 pediatric olecranon fractures, a 3 mm intra-articular displacement threshold reliably stratified nonoperative (<3 mm, 97% managed conservatively) from operative treatment (≥3 mm, 89% ORIF), with equivalent PROMIS upper extremity scores at 9–12 weeks (44.3 vs. 45.9, P=0.710).

Key Takeaway: Lumbar OPLL patients had significantly higher BMI (median 27.5 vs 26.0 kg/m², p=.003) and independently higher whole-spine ossification index scores (regression coefficient 0.448, 95% CI 0.162–0.735) compared to non-lumbar OPLL patients, supporting L-OPLL as a distinct diffuse ossification phenotype.

Key Takeaway: In adolescent female flag football players requiring knee surgery, 87.5% sustained ACL tears, with game-related injury risk nearly quadrupling from 0.17 to 0.64 per 1,000 athlete exposures between the 2023 and 2024 CIF-sanctioned seasons.

Key Takeaway: Preoperative Modic changes (HR 1.86) and facet degeneration index (HR 1.43 per grade) independently predict reoperation for recurrent lumbar disc herniation within 3 years of primary discectomy.

Key Takeaway: Early discharge after mobilization was feasible in 15.4% of pSCHF patients, with 72.6% of those requiring additional follow-up doing so for stiffness rather than structural complications.

Key Takeaway: Endo-TLIF produced greater CSA expansion and lower complication rates (4.0% vs 9.68%) than OLIF-360 for degenerative lumbar spondylolisthesis, while OLIF-360 achieved superior disc height and segmental lordosis restoration at minimum 2-year follow-up.

Key Takeaway: In pediatric open forearm fractures, no-implant fixation (NIF) achieved equivalent union rates with 36 fewer operative minutes, shorter LOS, and fewer follow-up visits compared to implant fixation (IF), particularly in patients ≤10 years.

Key Takeaway: The SPARC AI system detected 94.0% of consensus scoliosis curves with a mean absolute error of 3.01°±2.71°, outperforming initial specialist evaluation (86.4% detection, MAE 2.41°±3.24°) while achieving a tighter error range (±20.3° vs ±41.3°).

Key Takeaway: Postoperative fracture incidence following hardware removal after lower extremity osteotomy in arthrogryposis is 9.4% per patient (6.8% per procedure), significantly higher than a matched cerebral palsy cohort where zero fractures occurred.

Key Takeaway: A strain-based automated method classified 86% of posterolateral and 90% of posterolateral-plus-interbody fusion levels as Motion Compatible with Bridging by 60 months, with a CNN reducing uncertain classifications from 21% to 5%.

Key Takeaway: 93.1% of weightlifters returned to sport after shoulder arthroplasty at mean 23.3 months, with rTSA patients more likely to maintain or increase training frequency than aTSA patients (90.7% vs. 72.2%, P=.026).

Key Takeaway: Multiple-point pelvic fixation (≥3 fixation points with bilateral S2AI screws) in long-segment ASD surgery yields a reoperation rate for pelvic fixation failure of 3.1%, compared to higher rates reported with single-point fixation strategies.

Key Takeaway: 70.1% of shoulder arthroplasty patients returned to weightlifting without difficulty at mean 66.6 months, with no significant difference between anatomic and reverse cohorts (74.3% vs. 56.8%, p=0.10).

Key Takeaway: Among 67 osteosarcoma survivors who desired pregnancy, only 1 of 36 women (2.7%) and 4 of 31 men (12.9%) experienced chemotherapy-attributable fertility failure over a mean follow-up of 359 months.

Key Takeaway: OCAT was used in 80% of tibial plateau osteochondral lesion cases but carried a 30.1% failure rate, compared to 6.3% for both microfracture and OAT.

Key Takeaway: Custom uncemented distal humeral megaprosthesis with locked flange in revision TEA achieved mean Oxford Elbow Score improvement at 32-month follow-up with an 18% reoperation rate (2/11 patients) in a highly complex cohort averaging 6 prior procedures.

Key Takeaway: Periportal and puncture capsulotomy techniques produced statistically equivalent mHHS improvements (mean difference range 21.30–32.56) to interportal or T-capsulotomy with closure at 2-year follow-up across 1,961 hips.

Key Takeaway: Arthroscopic pectoralis minor tenotomy improved Constant score from 55.3 to 73.27 and reduced VAS from 7.51 to 2.62 at mean 19.9 months in 37 women with refractory scapular dyskinesis.

Key Takeaway: Full-duty RTW rates exceeded 90% after meniscectomy, meniscal repair, ACLR, and distal biceps repair, but fell to 74.2–76.7% after biceps tenodesis, rotator cuff repair, and hip arthroscopy, with WC status and higher occupational intensity consistently delaying RTW across all procedures.

Key Takeaway: Barrel-bone grafting achieved 100% union rate with zero refractures at mean 27-month follow-up in 17 recalcitrant CPT cases that had failed prior surgery.

Key Takeaway: Acromion lateralization to increase CSA (37.2° vs 29.7°) significantly impaired tendon-bone healing at 6 and 9 weeks post-repair, with lower ultimate failure load, higher MRI signal-to-noise quotient, reduced fibrocartilage formation, and elevated Piezo1 expression in a rat chronic rotator cuff tear model.

Key Takeaway: Growth-friendly surgery for scoliosis in CHARGE syndrome carries a 25% instrument-related complication rate, with curve correction regressing from 49° to 58° by 5 years, while spinal fusion achieved more durable correction (54° to 36°) with no reported complications.

Key Takeaway: Tibial BMSi outperformed total hip BMD in predicting femoral strength (r=0.62 vs r=0.45) and discriminated hip fracture susceptibility with AUC 0.75 where BMD failed entirely.

Key Takeaway: Senescent rabbit ADSCs upregulate MMP1, MMP3, and MMP13 while downregulating aggrecan, and intradiscal injection worsens collagen type II and aggrecan staining at 8 weeks compared to young ADSC injection.

Key Takeaway: A personalized treat-to-target postoperative physical therapy protocol produced no significant improvement in HOOS-PS or KOOS-PS at 3 months compared to usual care after THA/TKA (between-group difference <2 points for both).

Key Takeaway: CBT-I combined with structured rehabilitation produced significantly greater improvements in VAS pain scores, HSS scores, ROM, and PSQI sleep quality versus conventional analgesics from week 2 onward in patients with chronic post-TKA pain (P<0.05 at all follow-up points through 12 weeks).