Weekly Digest

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

Key Takeaway: NSAID exposure increases nonunion risk overall (OR 1.56, 95% CI 1.18–2.11), but short-term use ≤14 days was not associated with elevated risk, and the signal was absent in pediatric patients and spinal fusion.

Key Takeaway: At a Korean WTP threshold of USD 21,429/QALY, BESS had a 94.9% probability of cost-effectiveness versus microscopic surgery, with nearly identical total costs (USD 3,028 vs USD 3,080) and a 0.022 QALY advantage that did not reach statistical significance.

Key Takeaway: In 18 RCTs of 2,908 patients ≥65 years with displaced femoral neck fractures, THA conferred no clinically important functional benefit over hemiarthroplasty (HHS difference 5 points, below the 10-point MCID) and doubled dislocation risk (RR 0.57 favoring hemiarthroplasty, p=0.01).

Key Takeaway: Adding a lateral extra-articular procedure to primary ACLR with hamstring autograft significantly reduces graft failure (OR CI 0.235–0.580, p<0.001) and positive pivot-shift rates (OR CI 0.324–0.703, p<0.001) across 1,327 patients in 12 RCTs.

Key Takeaway: A combined model of preoperative gait parameters plus clinical variables achieved AUC=0.953 for discriminating surgical candidacy in hip OA, outperforming clinical variables alone.

Key Takeaway: A stepwise approach combining closed-fist percussion test (sensitivity 93%) and sitting lateral radiograph (vertebral-level specificity 99%, LR+ 51) increased posttest probability of acute VCF from 22% to 97%.

Key Takeaway: At mean 6.8-year follow-up, ESWT and ultrasound-guided needling produced equivalent Constant-Murley Scores (94.4 vs. 93.3, P=.67) with 94% of both groups achieving MCID for rotator cuff calcific tendinitis.

Key Takeaway: Over a median 10.5-year follow-up, only 7.1% of skeletally mature adolescents with lumbar spondylolysis or low-grade spondylolisthesis showed slip progression, but 56.5% demonstrated multidimensional progression driven primarily by disc degeneration (30.5%) and low back pain (44.2%).

Key Takeaway: Adding PSI to AI-assisted preoperative planning significantly improved tibial component positioning accuracy in medial UKA (all accuracy metrics P<0.001) compared to AI-assisted planning alone, but short-term OKS, VAS, and satisfaction scores did not differ between groups.

Key Takeaway: Among THAs with cup protrusion, acetabular component oversizing (diameter mismatch +1.7mm vs -1.8mm, OR 1.33) was the only independent predictor of symptomatic iliopsoas impingement.

Key Takeaway: A tailored de-implementation strategy reduced routine follow-up radiographs per patient by an additional 0.38 for malleolar fractures and 0.30 for distal radius fractures beyond what evidence dissemination alone achieved in non-WARRIOR-trial centers.

Key Takeaway: In 975,235 TKAs, 1.55% required MUA within 90 days, with perioperative dexamethasone (aOR 0.925), daily prednisone (aOR 0.433), and ARB use (aOR 0.882) independently reducing MUA risk.

Key Takeaway: Office-based kyphoplasty had lower rates of most medical complications versus inpatient and outpatient-ASC settings, but carried the highest odds of nerve injury and secondary fractures in a matched cohort of 71,084 patients.

Key Takeaway: Across 197 included articles, unaddressed psychological distress—most studied in ACL injury, general sport injuries, and AIS—negatively impacts return-to-sport and postoperative outcomes in pediatric orthopaedic patients.

Key Takeaway: An enhanced chlorhexidine removal protocol before 2-octyl cyanoacrylate mesh dressing application reduced hypersensitivity reactions from 14.5% to 2.6% (OR 0.16, 95% CI 0.04–0.70) in hip and knee arthroplasty patients.

Key Takeaway: Persistent bladder dysfunction occurs in 32.6% of patients at ≥12 months after surgical decompression for degenerative cauda equina syndrome, rising to 46.8% in those presenting with preoperative urinary retention.

Key Takeaway: Perfusion MRI achieves 90% sensitivity and 90% NPV for AVN detection in pediatric hip disorders across 538 patients, but specificity is only 60% with PPV of 58%, limiting its utility as a rule-in test.

Key Takeaway: Postoperative GNRI <109 confers a 13.19-fold increased odds of any complication and 6.21-fold increased odds of reoperation following TSA, despite equivalent long-term PROs and ROM.

Key Takeaway: Across 368 robot-assisted THA patients, spino-pelvic mismatch (PI-LL > -10°), absence of low back pain, and Tönnis grade 3 were the only three preoperative factors independently associated with achieving PASS on all four PROMs at 12 months.

Key Takeaway: Teres minor trophicity (hypertrophic, normal, or hypotrophic) does not significantly affect postoperative VAS, Constant, or ASES scores after arthroscopically-assisted lower trapezius tendon transfer for irreparable posterosuperior rotator cuff tears at mean 45.3 months follow-up.

Key Takeaway: Inflation-adjusted cost per inpatient revision THA for aseptic loosening rose from $28,810 in 2012 to $31,461 in 2022 and is projected to reach $36,424 by 2032, while annual case volume declined from 11,070 to 9,650 pre-pandemic and collapsed to 5,894 in 2021.

Key Takeaway: Arthroscopic subspine decompression concurrent with FAI correction yields 94.7% survivorship at minimum 5-year follow-up, with MCID and PASS achievement rates statistically equivalent to matched FAI-only controls.

Key Takeaway: Revision TKA for aseptic loosening is projected to reach 30,605 cases/year by 2032, with total inpatient costs approaching $927 million annually—a 95% increase from 2012.

Key Takeaway: In revision hip arthroscopy, labral reconstruction and labral repair achieve comparable MCID and PASS rates across all PROs at minimum 5-year follow-up, with no significant difference in re-revision or conversion to arthroplasty rates.

Key Takeaway: No-tourniquet TKA was associated with +211.3 mL greater calculated blood loss and 3.05x higher transfusion odds versus incision-to-cementation tourniquet use, though NNT to prevent one transfusion was approximately 250 in the TXA era.

Key Takeaway: Calcaneal lengthening osteotomy in CP achieves equivalent radiographic correction and revision rates (11.8% vs 7.1%, p>0.05) regardless of whether surgery is performed before or after age 8.

Key Takeaway: Collar-calcar gap in collared HA-coated cementless stems was present in 4.1% of Dorr C femora and accounted for 100% of early periprosthetic fractures (18.8% vs 0%) and the majority of subsidence events (12.5% vs 0.5%).

Key Takeaway: Suture-only MAT fixation carries a 31.3% meniscus-specific reoperation rate versus 8.9% (bone bridge-in-slot) and 10.9% (bone plug), a statistically significant difference (P=.006) over mean 6.6-year follow-up.

Key Takeaway: Absorbable intradermal staples reduced wound complication rates from 8.1% to 2.8% compared to barbed sutures in DAA THA, though obese patients remained at elevated risk in both groups.

Key Takeaway: Three- and four-level ACDF without posterior fixation achieved an overall pseudarthrosis rate of 13.6% (symptomatic 6.3%), with rhBMP-2 use independently associated with 6.7-fold lower odds of nonunion (OR=0.15) but 2.7-fold higher complication odds.

Key Takeaway: Only 4% of TKA-PJI cases in the US are managed by a high-volume surgeon (>11 cases/year) at a high-volume institution (>40 cases/year), with a median institutional annual volume of just 4 PJI cases.

Key Takeaway: Low vitamin D prevalence was 52% among pediatric fracture patients overall, with no significant difference between ASD (54%) and non-ASD (48%) cohorts, while orthopaedic services ordered only 5% of vitamin D tests.

Key Takeaway: Joint-specific recovery (HOOS JR/KOOS JR) correlates moderately with physical health (THA r=0.63, TKA r=0.56) but only weakly with mental health (THA r=0.33, TKA r=0.24) and QOL (THA ρ=0.31, TKA ρ=0.22) at one year post-arthroplasty.

Key Takeaway: Spine surgery is the only orthopaedic fellowship with a positive lifetime NPV at a 5% discount rate, achieving break-even 6 years post-fellowship, while military-funded education (HPSP/USUHS) reduces lifetime earnings by approximately $1.7M and $3.0M respectively versus civilian general orthopaedic practice.

Key Takeaway: After a second THA dislocation, revision risk reaches 93.9% (OR 7.70 vs. one dislocation), and late dislocations (>90 days) carry 97.0% revision risk—challenging the historical three-dislocation threshold for surgical intervention.

Key Takeaway: Presurgical serial casting before relapse surgery reduced surgical complexity by 40.0% versus 1.9% in uncasted patients (P=0.001) and lowered high-complexity surgery rates from 80.6% to 53.3% (P=0.004).

Key Takeaway: Despite 61% of low-income Shanghai women aged 40–65 valuing bone health, only 12% used calcium supplementation, 9% used vitamin D, and 4% had ever undergone DEXA screening.

Key Takeaway: Children with boxer's fractures had a significantly lower 2D:4D digit ratio (0.888 vs. 0.939, P<0.001) and higher aggression scores, with ADHD subtypes independently associated with fist-mechanism fifth metacarpal neck fractures.

Key Takeaway: Postoperative pulmonary complications occurred in 11.9% of lung cancer spinal metastasis patients and were associated with a median survival of 4.43 vs 14.39 months and 30-day mortality of 26.0% vs 2.4% compared to those without PPC.

Key Takeaway: Hybrid, suture button, and screw fixation for syndesmotic stabilization in Weber B/C fibular fractures produced statistically equivalent 6-month OMAS scores (82.32 vs 79.35 vs 77.10, P=.091), with only a 3.15 percentage-point ROM advantage for suture button over screw at 12 months.

Key Takeaway: In geriatric odontoid fractures, surgical treatment was associated with improved 1-year survival, but conservatively treated survivors reported lower pain (VAS 2.5) and higher SF-36 scores, with 26.9% overall 1-year mortality across 93 patients.

Key Takeaway: Interbody devices account for 30.9% of 1-level and 40.9% of 2-level ACDF intraoperative supply costs, with OVI and UPO varying more than 2.5-fold across surgeons performing identical procedures.

Key Takeaway: Both under- and overcorrection of T4PA-L1PA mismatch independently increased mechanical complication risk in a nonlinear (U-shaped) fashion (OR 1.01 per unit increase in squared deviation, p<0.001), while normalization did not improve SRS-22r or ODI MCID attainment.

Key Takeaway: Multilevel laminoplasty was associated with 49% lower all-cause reoperation risk (HR=0.51) and 58% lower operative adjacent segment disease risk (HR=0.42) compared to laminectomy/fusion across 4,412 patients.

Key Takeaway: Traumatic posterior shoulder dislocation is associated with greater posterior acromial height (27.0 vs. 22.0 mm) and steeper posterior acromial tilt (65.8° vs. 58.9°) compared to anterior dislocation, with PAH and PAT as the strongest independent predictors on logistic regression.

Key Takeaway: Corpectomy-containing anterior cervical procedures carried a 38.1% perioperative local complication rate versus 16.5% for non-corpectomy procedures (OR 1.82, 95% CI 1.22–2.72), though this association attenuated after adjusting for surgical extent and OPLL.

Key Takeaway: Pooled prevalence of vertebral artery loops in unselected radiological populations is 1.71% (95% CI 0.87–2.55%), with V2 segment at C4–C6 as the predominant location and osseous signs serving as the key pre-test probability modifiers.

Key Takeaway: SLIL sectioning alone increases scapholunate gap by mean 1.7 mm and SL angle by 8°, but DISI deformity requires combined SLIL plus DIC (or STT complex) disruption.

Key Takeaway: Each 1-degree increase in residual post-operative acetabular roof obliquity after transposition osteotomy of the acetabulum was associated with a 10% increase in THA conversion risk (HR 1.10, 95% CI 1.03–1.18), with a data-derived 6.1-degree threshold separating 20-year survival of 92.4% vs 45.7%.

Key Takeaway: In double-curve AIS, high initial in-orthosis thoracic correction (≥38.3%) confers nearly 8-fold greater odds of treatment success, while thoracic curve progression accounts for 90.9% of all brace treatment failures.

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

Key Takeaway: Saucerization with or without repair for pediatric discoid lateral meniscus yields significant Lysholm score improvement across all techniques, with saucerization + repair carrying the highest reoperation rate at 8.9% versus 7.3% for saucerization alone.

Key Takeaway: In the largest North American cohort of STAC3 Disorder patients (n=23 with musculoskeletal data), scoliosis occurred in 83%, congenital foot deformity in 61%, and 57% required at least one orthopaedic procedure.

Key Takeaway: The AAOS Appropriate Use Criteria for mid-shaft clavicle fractures provide case-based guidance for surgical versus nonsurgical treatment decisions, though no outcome data or specific numerical thresholds are reported in this article.

Key Takeaway: In 6 ATD patients undergoing PSF at median age 14 years, median blood loss was 500 mL with a grade IIIb complication rate of 1/6 (17%), suggesting PSF is feasible despite severe restrictive lung disease and prior VEPTR surgery.

Key Takeaway: THA remains the most reliable treatment after femoral head collapse in nontraumatic osteonecrosis, while joint-preserving procedures are most effective only before structural collapse occurs.

Key Takeaway: Talonavicular arthrodesis with talocalcaneal stabilization achieved 0% nonunion rate and 83% family satisfaction at mean 4.5 years in ambulatory CP patients with tibialis posterior strength ≤3/5.

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

Key Takeaway: Normal lateral meniscal translation exceeds 20% in over half of pediatric specimens at the anterior horn (51.6%) and popliteal level (48.2%), compared to 0–20% for all medial meniscal horns.

Key Takeaway: OKS Question 1 ('overall pain') is the single strongest predictor of patient satisfaction after TKA and UKA, with ORs of 3.49–4.25 for TKA and 2.89–4.31 for UKA across all time points from 6 months to 15 years.

Key Takeaway: Among adolescent athletes with symptomatic Freiberg infraction, 84% achieved provider-cleared return-to-sport without surgery at a median of 3.7 months, while the 16% requiring operative intervention took a median of 8.8 months.

Key Takeaway: In 5 patients with combined external iliac artery injury and pelvic ring fracture, limb salvage failed in 100% of cases despite revascularization attempts in 2, with 4 of 5 ultimately requiring hemipelvectomy due to progressive necrosis and infection.

Key Takeaway: ASD, LSS, and CSM each produce distinct neuromuscular signatures on sEMG—ASD and LSS show increased RMSmax and decreased median frequency versus controls (P<0.001), while all three DSD subtypes demonstrate significantly higher bilateral muscle asymmetry indices than healthy elderly controls.

Key Takeaway: Combined BMS + PDGF produced a 7-fold increase in progenitor cell accumulation at the labral tear site versus BMS alone (27.46 vs 3.5 cells/0.01 mm², P<.001) in a rat Bankart model.

Key Takeaway: Of 199 studies on weight-loss strategies in hip/knee OA with obesity, only 36 (18.1%) assessed GLP-1 receptor agonists, and 80.6% of those were published in 2024–2025, with most being level 5 evidence.

Key Takeaway: 3T 3D-MRI consistently visualizes all four principal subtalar ligaments (IER, CL, ITCL, CFL) in asymptomatic ankles, providing normative morphometric reference values (e.g., ITCL width 10.0 ± 1.4 mm, CFL thickness 2.8 ± 0.6 mm) to benchmark against injured counterparts.

Key Takeaway: Across 20 expert-level TKA clinical questions, four frontier LLMs scored 4.62–4.77/5.0 on the QUEST framework with statistically significant but clinically narrow differences, and no single model dominated all evaluated domains.

Key Takeaway: Double both-column screw (dBCS) fixation achieved the lowest total deformation and fracture displacement values across all three physiological loading conditions compared to single plate, double plate, single BCS, and hybrid constructs in a finite element model of posterior acetabular column fractures.

Key Takeaway: Intraoperative structured-light 3D surface scanning captured distal femoral anatomy with ~0.2 mm accuracy in 40–60 seconds, demonstrating technical feasibility for real-time femoral component alignment assessment in TKA.

Key Takeaway: After TMT-I fusion, sectioning the C1-C2 intercuneiform ligament produced the largest single transverse-plane instability increment (mean 2.3°), while peroneus longus activation significantly compensated for cumulative ligamentous loss (P<0.001).

Key Takeaway: Anterior opening-wedge HTO achieves mean tibial slope increases of 9°–24° with 70%–90% good-to-excellent functional outcomes in PCL insufficiency and genu recurvatum, though supporting evidence remains predominantly Level III–IV.

Key Takeaway: Spinal hybrid peripheral nerve sheath tumors are exceedingly rare (only 9 cases in the literature plus 1 new case), with schwannoma-perineurioma comprising 66.7% of reported subtypes, and gross total resection associated with favorable outcomes and rare recurrence.

Key Takeaway: Robotic-assisted TKA improves implant positioning accuracy but has not demonstrated consistent improvement in patient-reported outcomes or implant survivorship, and the next decade of development should prioritize five unmet clinical domains over additional precision.

Key Takeaway: French innovations including dual mobility cups, alumina ceramic bearings, the Kerboull reinforcement ring, mobile-bearing total ankle arthroplasty, and the third-condyle TKA concept are reviewed as foundational contributions to modern lower limb arthroplasty, though no new quantitative outcomes data are reported.