Weekly Digest

Key Takeaway: In a Bayesian NMA of 44 RCTs, QTB ranked highest for IKDC (SUCRA 90.1%), rotational stability, and graft survival, with a 74% lower risk of grade 2+ pivot-shift versus 4SST (RR 0.26).

Key Takeaway: Concomitant remplissage equalizes redislocation rates between ALPSA and non-ALPSA repairs (5.3% vs 5.6%), but Type C ALPSA lesions achieve WOSI PASS in only 23.1% of patients versus 100% for Types A/B.

Key Takeaway: Concomitant fibular fixation in extra-articular distal tibial fractures treated with IMN showed no significant difference in malunion (11.8% vs 18.6%), nonunion (5.9% vs 4.7%), or functional outcomes at one year.

Key Takeaway: Conventional Fitmore B rasp systems produce significant overstuffing of 1.2 ± 0.5 mm compared to the Optimys stem instrument system, which an optimized Fitmore B rasp eliminates.

Key Takeaway: Marker screw technique achieved 94.5% pedicle screw accuracy vs 99.1% for 3D navigation (P=.04), yet met the pre-specified non-inferiority margin with no breach-related neurologic or vascular complications.

Key Takeaway: Cemented composite beam stems carry a 3.4–3.6x lower periprosthetic femur fracture hazard compared to cementless tapered wedge or fit-and-fill stems in hemiarthroplasty for femoral neck fracture in patients ≥70 years.

Key Takeaway: TKA patients who develop PJI within 1 year face a 4.66-fold higher 10-year mortality risk compared to matched non-PJI controls (7.2% vs. 1.6%).

Key Takeaway: An acromion-to-lateral humerus distance >9.78 mm postoperatively and lower Hamada grade (1–3) preoperatively together predicted scapular stress fracture after rTSA with 80.4% accuracy.

Key Takeaway: 16% of lumbar diskectomy patients required unplanned revision surgery at minimum 4-year follow-up, with BMI the only independent predictor (OR 1.042 per unit, p=0.005).

Key Takeaway: Combined clinical exam (FABER/FADIR/resisted SLR all positive) achieved 94% sensitivity and 100% specificity for labral tears versus MRA sensitivity of only 67% in 224 FAI patients.

Key Takeaway: Reclassifying oncologic endoprosthetic PJI surgical strategies by standardized definitions increased DAIR-plus success rates from 45.8% to 63.1% and one-stage revision from 60.2% to 75%, while DAIR alone dropped from 51.8% to 39.7%.

Key Takeaway: AS patients undergoing TKA showed no increased MUA rates at 90 days (2.36% vs 2.90%), 1 year (3.42% vs 3.95%), or 2 years (3.62% vs 4.08%) compared to propensity-matched non-AS controls, but had higher rates of postoperative anemia (6.44% vs 5.40%) and UTI (4.53% vs 3.47%).

Key Takeaway: In 6,047 patients across 27 studies, LLIF reduced blood loss by 88.3 mL and surgical time by 14.3 minutes while achieving superior disk height restoration (+2.21 mm at late follow-up) and lower subsidence risk (OR 0.40), but TLIF provided greater immediate canal decompression (+49.8 mm²) and marginally better late leg pain scores.

Key Takeaway: TKA in postpolio residual paralysis carries a pooled complication rate of 16% and revision rate of 8%, with instability/recurvatum (5%) and periprosthetic fracture (2%) as the dominant failure modes.

Key Takeaway: A triple-tapered noncemented collared stem reduced 2-year periprosthetic femur fracture incidence threefold versus noncemented collarless stems (0.19% vs. 0.65%, P<0.001) and matched cemented stem performance (0.20%) in patients over 65.

Key Takeaway: In revision shoulder arthroplasty with severe glenoid bone loss, custom glenoid implants produced the greatest functional gains (ASES MD 42.4, Constant MD 35.8) and pain relief (MD 5.79), while bone grafting with rTSA yielded superior range of motion recovery (ER MD 21.0°, FF MD 67.4°).

Key Takeaway: Cementless TKA costs $256 more than cemented over 20 years, but becomes cost-neutral if implant markup is ≤19% or OR time savings reach 13 minutes.

Key Takeaway: In surgically treated proximal humerus fractures, higher Social Vulnerability Index percentile independently predicted ED return (OR 1.023) and readmission (OR 1.028) after ORIF, but not after rTSA.

Key Takeaway: Cannulated screw fixation for isolated radial styloid fractures achieved faster union (6.7 vs 7.6 weeks) and shorter operative time (34.4 vs 50.6 minutes) compared to radial plate fixation.

Key Takeaway: Metabolic syndrome independently increases the 2-year odds of periprosthetic fracture by 2.84-fold and all-cause revision by 2.25-fold following TKA in a cohort of 1,255,079 patients.

Key Takeaway: Staged cervical-first surgery for tandem spinal stenosis produced the greatest JOA improvement (SMD 4.31), while lumbar-first staging showed statistically negligible benefit (SMD 1.94; 95% CI -1.69 to 5.56).

Key Takeaway: In patients >50 years with MMPRT and KL grade ≤3 OA, UKA achieved MCID for total KOOS by 6 weeks versus 6 months for meniscal root repair, with 6% of MRR patients requiring conversion to TKA at one year.

Key Takeaway: GLP-1RA use in metformin-treated diabetic patients undergoing TKA reduced 90-day readmission in both obese (OR 0.776) and nonobese (OR 0.514) cohorts, with additional reduction in aseptic loosening at 2 years only in obese patients (OR 0.498).

Key Takeaway: Five of 21 cement formulations used in primary THA were associated with significantly higher revision rates compared to Palacos R+G high-viscosity, with DePuy CMW3 medium-viscosity with gentamicin carrying the highest risk (IRR 2.21).

Key Takeaway: TEAM-participant hospitals have $1,590 higher adjusted 30-day episode costs for inpatient spinal fusion than nonparticipants (p=0.001), with procedure-level variation ranging from $254 to $5,699 higher depending on fusion type and comorbidity tier.

Key Takeaway: Median post-traumatic OA incidence after isolated olecranon fracture is 19% at 41 months, rising to 50% in Mayo Type 3 (unstable) fractures, yet median MEPS remains 92-93 regardless of OA presence.

Key Takeaway: UKA patients with preoperative flexion contracture ≥10° had a 10.9% revision rate versus 0% in matched TKA and UKA controls, with 3.6° less contracture correction and inferior final KSS objective scores (88.5 vs. 94.9).

Key Takeaway: Preoperative supraspinatus/infraspinatus shear wave elastography (SWE) stiffness was the strongest independent predictor of intraoperative irreparability in large/massive rotator cuff tears (p=0.01), outperforming both MRI tear size (p=0.04) and Goutallier fatty infiltration stage (p=0.25) on multivariate logistic regression in 102 patients.

Key Takeaway: At minimum 5-year follow-up, revision hip arthroscopic labral reconstruction achieved PRO improvements and clinically meaningful threshold attainment comparable to primary labral reconstruction in propensity-matched patients (n=36 per group).

Key Takeaway: Tönnis grade 1 patients undergoing hip arthroscopy for FAIS had a 31.25% combined failure rate (THA conversion 15.63%, revision 15.63%) versus 3.13% in Tönnis grade 0 patients at minimum 10-year follow-up, despite equivalent PRO improvements in survivors.

Key Takeaway: The modified RUST score demonstrates excellent multicenter interobserver reliability (ICC 0.915–0.926) and intraobserver reliability (ICC 0.860–0.994) for assessing tibial fracture and osteotomy healing in osteogenesis imperfecta patients.

Key Takeaway: UKA patients failing to achieve MCID on PROMIS-PF10a have a 5-year conversion rate to TKA of 6.9% versus 1.3% in MCID achievers (OR 2.5, p=0.02).

Key Takeaway: Coexisting spine pathology reduces hip arthroscopy outcomes by 6–10 points across all functional PRO scales and doubles revision arthroscopy risk (OR 2.56) compared to spine-intact patients.

Key Takeaway: rhBMP-2 was used in 96.1% of anterior lumbar/thoracic fusions and 97.4% of LLIF cases but only 0.3% of anterior cervical fusions, with wound dehiscence as the sole significantly elevated complication in posterior lumbar/thoracic fusion with rhBMP-2.

Key Takeaway: ORIF with olecranon osteotomy for AO/OTA 13C distal humerus fractures resulted in TEA conversion in only 2.0% of patients overall (3.9% in those ≥65 years), with 98% osteotomy union at a median follow-up across a 14-year cohort.

Key Takeaway: VBT achieved 26° coronal correction (49° to 23°) while maintaining sagittal alignment, with T4-L1 mismatch falling within adult normal prediction intervals in 70.1% of patients at 2 years versus 56.3% preoperatively.

Key Takeaway: Allograft reconstruction for irreparable hip abductor tears improved mean abduction strength from 2.7/5 to 3.9/5 (p<0.001) with a 5.3% complication rate and 1.3% revision rate across 76 patients.

Key Takeaway: MIS-TLIF with intraoperative table hinging and bilateral Smith-Petersen osteotomies achieved mean segmental lordosis correction of 5.0° at 1-level and 4.6° at 2-level fusions, maintained at 6 months.

Key Takeaway: Anatomic TSA achieves 97% implant survivorship at 10 years but drops to 72% at 20 years, with ASES scores improving from 34.8 to 72.6 at mean 15-year follow-up.

Key Takeaway: L1PA offset outperformed PI-LL and age-adjusted PI-LL in calibration for predicting PJK (Brier score 0.196 vs 0.211 and 0.210), though AUCs were statistically similar across all three parameters (0.704 vs 0.638 and 0.648).

Key Takeaway: IM nail constructs achieved 91.7% union vs 50.0% with traditional beaming (p=0.004) and lower hardware failure (12.5% vs 66.7%, p<0.001) in midfoot Charcot reconstruction.

Key Takeaway: Goutallier grade fatty infiltration of the sternocleidomastoid independently increases odds of pseudarthrosis after ACDF by 3.46-fold (OR 3.46, P=0.009), with a 33.7% overall pseudarthrosis rate in this cohort.

Key Takeaway: Moderate-to-severe cirrhosis (MELD ≥10) is associated with a 30% rate of 30-day and 90-day PJI-related readmission after THA, compared to 2.6–2.9% in non-cirrhotic and mild cirrhotic patients.

Key Takeaway: Among preoperatively coronally aligned (Qiu type A) ASD patients undergoing cMIS-LLIF, 27.9% develop postoperative coronal malalignment at 2 years, associated with worse SF-36 PCS (34.78 vs. 37.42) and SRS-22r function/activity (3.03 vs. 3.36) but no difference in reoperation or complication rates.

Key Takeaway: THA use for ONFH increased from 72.6% to 90.6% of all surgical cases in Japan between 2012 and 2022, with arthroplasty now comprising >50% of procedures even in patients aged ≤20 years.

Key Takeaway: In 904 ASD patients, taller height (peak risk ~179 cm) was an independent predictor of PJK (14% incidence, p=0.03), while weight and BMI were not.

Key Takeaway: MOWHTO reduces sagittal TT-TG distance by a mean of 2.51 mm (6.25 to 3.74 mm, p=.009), anteriorizing the tibial tubercle, with postoperative medial PTS and CDI as independent predictors (adjusted R²=0.697).

Key Takeaway: Lateral locking plate fixation without a lag screw achieved 93.33% union within 12 weeks for Weber B fibular fractures, not significantly different from the 97.56% union rate with plate-plus-lag-screw fixation (p=0.38).

Key Takeaway: Perioperative TXA in pelvic osteotomy reduced cumulative 3-day transfusion volume by 130 g (598.8 vs. 728.6 g) without increasing DVT, PE, infection, or reoperation rates in a propensity-matched cohort of 7,084 patients.

Key Takeaway: Hip arthroscopy in athletes with generalized ligamentous laxity (Beighton ≥4) yields 83% return-to-sport and mHHS improvement from 66.1 to 86.7 at minimum 5-year follow-up, with no significant difference in outcomes versus non-lax controls.

Key Takeaway: Preoperative SSRI/SNRI use is associated with 2.55-fold increased odds of intraoperative transfusion and 2.78-fold increased odds of post-hemorrhagic anemia at 7 days after TSA, with risks normalizing by 3 months.

Key Takeaway: Modified hip transposition with a customized 3D-printed femoral prosthesis achieved a median MSTS-93 score of 24/30 and median LLD of 1.0 cm in 6 surviving patients after zone I+II±IV pelvic tumor resection.

Key Takeaway: Latest-generation thumb CMC prostheses show low loosening and dislocation rates with faster rehabilitation compared to resection arthroplasty, though both provide effective pain relief and high patient satisfaction.

Key Takeaway: Rigid intramedullary nailing through the proximal tibial physis produced recurvatum deformity in 2 of 43 skeletally immature patients (4.7%), with a statistically significant mean posterior slope increase of 2.3° across the cohort.

Key Takeaway: CTA within 24 hours of acute posterior sternoclavicular joint injury demonstrated zero vascular injuries (0/24 patients), challenging the historically cited ~30% incidence of associated retrosternal vascular injury.

Key Takeaway: A locally led TKA program in Honduras achieved a mean KOOS Jr. improvement of 55.3 points with a 2.0% PJI rate, both comparable to national registry benchmarks.

Key Takeaway: After arthroscopic margin convergence repair for massive rotator cuff tears, 68–83% of patients achieved MCID on ASES, but older age, longer symptom duration, and larger sagittal tear size independently reduced odds of reaching PASS and SCB.

Key Takeaway: Prevascularized BMSC sheets increased ultimate failure load by 40% (156.89 vs 111.67 N) and vessel density by 52% at the tendon-bone interface compared to standard BMSC sheets in a rabbit rotator cuff model at 6 weeks.

Key Takeaway: Unlinked TEA via the lateral para-olecranon approach achieved 97.1% implant survival at mean 73 months with zero triceps insufficiency in 40 RA elbows with Larsen grade III–IV disease.

Key Takeaway: Isolated hemivertebra excision with short-segment fusion is the mainstay for progressive congenital scoliosis curves <50° in young children, while definitive fusion is most reliable in patients ≥8–10 years old.

Key Takeaway: In a mouse Achilles tenotomy model, surgical repair with ankle immobilization at 160° plantar flexion produced superior histological healing and Scx+ progenitor cell recruitment versus non-repair, but biomechanical equivalence between repair and non-repair groups was achieved by 4 weeks when both were immobilized at 160°.

Key Takeaway: Custom implants and patient-specific instrumentation (PSI) in TSA improve glenoid component positioning accuracy in complex anatomy, though clinical outcome superiority over standard implants remains unproven in controlled studies.

Key Takeaway: Robotic-assisted MI-TLIF achieved 71.6% disc height improvement vs 22.5% with imaging-only navigation, while navigation produced greater lumbar lordosis restoration, with preoperative LL independently predicting postoperative LL (β=0.64).

Key Takeaway: En bloc resection with negative margins remains the primary treatment for spinal and sacral chordoma, yet late local recurrence occurs in up to 50% of cases within 10–15 years despite oncologically adequate surgery.

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

Key Takeaway: The sinus tarsi approach (STA) reduces wound complication rates compared to the extensile lateral approach (ELA), with STA wound complication rates reported as low as 0–4% versus ELA rates of 10–25%.

Key Takeaway: Modified Lambrinudi triple arthrodesis with X-shaped plate fixation achieved 100% union at 6 months in 14 equinovarus patients, with VAS improving from 6.7 to 1.4 and ICFSG score from 37.7 to 8.1.

Key Takeaway: In 5,317 consecutive pediatric spinal deformity cases, IONM alerts occurred in 4.2% and systematic corrective actions—most commonly hypotension correction—reduced permanent neurologic deficit to 0.15% at final follow-up.

Key Takeaway: First MTPJ arthrodesis for moderate-to-severe hallux valgus (mean HVA 40.2°, IMA 15.9°) yielded a 33.0-point MOxFQ improvement at 26 weeks sustained to 2 years, but carried a 19.4% overall complication rate including a 9.7% nonunion rate.

Key Takeaway: In computational rTSA modeling, humeral lateralization—not glenoid lateralization—significantly increases both subscapularis internal rotation and infraspinatus external rotation moment arms, while simultaneously augmenting antagonistic adductive moment arms during early abduction (0–80°).

Key Takeaway: Double-stranded rectus femoris (DRF) ultimate strength (1978 ± 338 N) is statistically equivalent to patellar tendon (1824 ± 557 N), and single-stranded rectus femoris (SRF) is equivalent to ITB (1445 ± 584 N vs. 819 ± 268 N), supporting rectus femoris as a single-donor source for combined ACL and anterolateral reconstruction.

Key Takeaway: A single Ilizarov circular external fixator achieved union in 90% of AO/OTA 42C2-3 tibial fractures at a median of 150 days, with all deformity corrections performed outpatient without anesthesia.

Key Takeaway: Large-head MoM THA using the Cormet prosthesis yielded a 25% revision rate and 38% pseudotumor prevalence at minimum 10-year follow-up.

Key Takeaway: The all-dorsal ECRB tendon autograft technique for chronic scapholunate reconstruction yielded non-significant improvements in pain (VAS 5→2) and DASH (58→48) at mean 39 months, with persistent radiographic malalignment (median SL angle 66°, static gap 3 mm) and a 42% anchor-site osteolysis rate.

Key Takeaway: Navigation-guided medial UKA targeting 2°–5° varus HKA achieved 96.5% Kaplan–Meier implant survival at mean 63.1 months with WOMAC improvement from 41.5 to 4.9.