Weekly Digest

Key Takeaway: At 10-year follow-up, hypoallergenic-coated and standard TKA implants demonstrated identical 98% implant survival with no significant difference in Oxford Knee Score, SF-36, or serum metal levels.

Key Takeaway: Autologous impaction bone grafting with cemented acetabular THA in patients under 60 is noninferior to standard cemented fixation at one year (HOOS-ADL mean difference 1.9 points, 95% CI -4.85 to 8.7) and produces significantly fewer radiolucent lines at the bone-cement interface.

Key Takeaway: Liposomal bupivacaine ACB did not reduce the primary endpoint of moderate-to-severe pain with movement at 48h vs ropivacaine+dexamethasone (47.2% vs 63.9%, RR 0.71, p=0.149), but did lower NRS scores and opioid consumption at 24 and 48h.

Key Takeaway: Across 27 RCTs, no single TKA surgical approach consistently outperforms standard medial parapatellar in ROM, PROMs, or reoperation rates, though subvastus was favored in 3 ROM studies and 3 PROM studies.

Key Takeaway: Hydrodilatation achieved greater external rotation than corticosteroid injection alone at 12 weeks (SMD 0.61) but produced no significant differences in pain VAS, SPADI, abduction, or forward flexion, with high heterogeneity (I² 81.6%) undermining confidence in even that finding.

Key Takeaway: PAI alone produced outcomes equivalent to combined ACB+IPACK+PAI in primary TKA, with the only statistically significant difference being a 0.6-point lower VAS on POD1 in the PAI-only group—below the pre-specified 1.0-point threshold for clinical significance.

Key Takeaway: Across all WRIST trial subanalyses, no treatment (casting, CRPP, EFX, or VLPS) demonstrated superior functional outcomes at 12 months, though VLPS produced faster recovery at 6 weeks and casting was the most cost-effective option.

Key Takeaway: Glenohumeral arthritis reduces overhead flexion by 38° (84° vs. 122°) and drives compensatory lumbar rotation tripling (9° vs. 3°) and elbow flexion increase of 22° (26° vs. 4°) compared to the contralateral asymptomatic shoulder.

Key Takeaway: PGY-1 residents who received formal teaching with a 3D-printed unstable distal radius fracture model scored significantly better on global rating scale assessment (P<0.05) compared to untrained PGY-1 controls, supporting construct validity of the model.

Key Takeaway: IMN and locked plating produce equivalent functional outcomes (DASH, ASES, Constant-Murley) and comparable complication and reoperation rates across 1,039 patients with displaced proximal humerus fractures at 6 and 12 months.

Key Takeaway: Liposomal bupivacaine in periarticular injection improved early postoperative pain in 5 of 8 RCTs and reduced opioid consumption across 1,334 TKA patients without increased adverse events.

Key Takeaway: IELD produced greater short-term functional improvement over TELD at 6 months (ODI difference -6.14 points, p<0.001), but differences converged by 12 months, with surgical approach accounting for only 2–3% of outcome variance.

Key Takeaway: In 150 children with lower limb deformities, LLRS-AIM complexity correlated most strongly with sports/physical activity PODCI scores (r = -0.59), yet adolescent self-reported happiness was equivalent to general pediatric population norms despite significant functional deficits.

Key Takeaway: In patients ≥60 years undergoing multilevel ASD fusion (≥5 levels), the proportion able to walk ≥1 mile increased from 26% to 63.1% at 2 years and was maintained at 58.7% at 5 years.

Key Takeaway: At minimum 15-year follow-up, rTSA achieves a reoperation-free survival of 84% with maintained Constant score of 64 and SSV of 80%, but complication-free survival drops to 76% by 15 years.

Key Takeaway: Expert-rated good surgical technique in humeral shaft fracture fixation was associated with nonunion rates of 3% versus 26% for poor technique, and complication rates of 16% versus 35% compared to nonoperative treatment.

Key Takeaway: HTO achieves ~90% survivorship at mean 17.8 years, with TKA conversion rising to 22% by 20 years and BMI independently predicting conversion risk (RR 1.13 per unit increase, 95% CI 1.04–1.23).

Key Takeaway: Robotic-assisted revision TKA demonstrated a 52% higher hazard of mechanical implant-related complications in the manual group at 1 year (HR 1.52) and a significantly higher 3-year revision rate in manual cases (13.5% vs. 11.4%, OR 1.22).

Key Takeaway: Nonacademic centers had 31% higher odds of pseudoarthrosis or mechanical failure at 1 year (OR=1.314) and more than double the 30-day readmission rate (OR=2.211) compared to academic centers after long-segment posterior lumbar fusion.

Key Takeaway: The Talar Index identifies residual clubfoot equinus with 95.9% sensitivity and 90.5% specificity (AUC 0.929) against the lateral tibiocalcaneal angle as reference standard.

Key Takeaway: A dedicated spine team reduced operative time by 67.7 minutes (138.5 vs 206.2 min) and postoperative PCA morphine usage compared to a nondedicated team in posterior spinal fusion for idiopathic scoliosis.

Key Takeaway: Failure rates after bony hip reconstruction in CP range from 1.8% to 74% across 27 studies due to inconsistent definitions, with Reimer Migration Percentage (63%) and revision surgery (48%) being the most commonly used but non-interchangeable endpoints.

Key Takeaway: Antidepressant use is associated with a 53% increase in pseudarthrosis odds after spinal fusion (OR 1.53, 95% CI 1.17–2.01), rising to a 2.26-fold increase for serotonergic agents specifically.

Key Takeaway: Among 39,723 revision TKAs, the re-revision rate was 13.5%, with PJI accounting for 27.5% of failures—nearly double the rate of instability (13.6%) or aseptic loosening (12.8%).

Key Takeaway: GLP-1 receptor agonists were associated with a 27% reduction in 90-day surgical complications (RR 0.73) after THA and TKA, with a stronger effect in THA (RR 0.63) than TKA.

Key Takeaway: A multifaceted dissemination strategy increased iodine povacrylex use from 0.8% to 86% within one month and sustained that adoption over 17 months without additional intervention.

Key Takeaway: Dual-plate ORIF for proximal humerus fractures reduced reoperation rate from 22.7% to 5.4% compared to single-plate fixation (OR 0.16, p=0.02).

Key Takeaway: In plasma cell neoplasm and lymphoma spinal lesions, SINS score independently predicts instability (OR 1.38 per point) and VCF progression (OR 1.45 per point), but the 'possibly unstable' threshold (7–12) does not reliably reflect true instability in these radiosensitive histologies.

Key Takeaway: Operative treatment of femoral shaft fractures in 4-to-6-year-olds increased 94% at age 5 and 61% at age 6 from 2013–2024, with operative management reducing early ED visits (RR 0.64) but increasing late postreduction procedures (RR 4.20) compared to spica casting.

Key Takeaway: Postoperative SMI decline ≥15% independently predicted median survival of 284 vs 730 days (HR 4.78), and preoperative sarcopenia—present in one-third of patients—independently predicted mortality with HR 4.01 after surgical stabilization for spinal metastases.

Key Takeaway: Rigid nail fixation achieved 0% malalignment (>10°) at 3 months versus 31% for flexible nails and 33% for plating, though differences were not statistically significant (P=0.25) in this underpowered series of 31 pediatric subtrochanteric femur fractures.

Key Takeaway: In older adults with isolated distal humerus fractures, 2-year mortality was 19.5%, with preinjury community ambulation status (4.4% vs. 32.4% mortality) being a more robust independent predictor than operative treatment after CCI adjustment.

Key Takeaway: Qualitative assessment of talar dome morphology achieves substantial inter-rater agreement (κ=0.80) in Ponseti-treated clubfeet, outperforming the best quantitative discriminator—talar radius (AUC=0.88, ICC=0.40)—in reproducibility.

Key Takeaway: Intraoperative hip arthrography reduced concomitant pelvic osteotomy rate by 34% (82% to 48%) in CP hip reconstruction without increasing resubluxation failure rates (6.3% IHA vs. 8.7% NIHA, p=0.59).

Key Takeaway: In 714 inflammatory arthritis shoulder arthroplasties, aTSA achieved higher Oxford Shoulder Scores than rTSA at all time points (41.9 vs. 35.4 at 10 years, P=.021) with equivalent 10-year revision-free survival (90.8% vs. 92.0%).

Key Takeaway: Pelvic tilt, sacral slope, pelvic incidence, and lumbar lordosis did not change significantly after either unilateral or bilateral PAO in 31 skeletally mature patients with hip dysplasia.

Key Takeaway: TEA for distal humerus fracture demonstrated the lowest revision rate at 0.40 per 100 component-years compared to 0.98 for rheumatoid arthritis and 1.86 for osteoarthritis over a 22-year national registry period.

Key Takeaway: Hip arthroscopy in acetabular dysplasia yields durable PRO improvements at mean 9.6–12 years follow-up, with THA conversion rates of 2.6–23.7% comparable to nondysplastic cohorts across all 4 comparative studies.

Key Takeaway: Revision rTSA yields significantly worse postoperative forward elevation (120° vs. 145°), patient satisfaction (80% vs. 92%), and a fivefold higher complication rate (31% vs. 6%) compared to matched primary rTSA.

Key Takeaway: Early MMPRT repair (<3 months) yields the greatest functional gains (IKDC +39.0, Lysholm +44), but delayed repair (>6 months) still achieves clinically meaningful improvements (IKDC +22.9, Lysholm +33–36) in properly selected patients.

Key Takeaway: Revision TSA incidence increased 5.6-fold from 223 to 1,247 cases per 100,000 person-years between 2015 and 2024, with ARIMA modeling projecting a further rise to 1,929 cases per 100,000 person-years by 2030.

Key Takeaway: CC ligament reconstruction for Rockwood III-V AC dislocations achieves 87.7% return to preinjury sport and 93.1% satisfaction at a weighted mean follow-up of 98 months, with a 5.2% recurrence rate.

Key Takeaway: Attaching the navigation reference array to the occipital plate after occipital fixation enabled complication-free intraoperative navigation for subaxial screw placement in 3 pediatric occipitocervical fusion cases.

Key Takeaway: A 3D best-fit sphere reference system distinguishes normal shoulders from GHOA and CTA using coronal plane angles: HDA 66.9° (normal) vs 73.6° (GHOA) vs 62.7° (CTA), and VDA 42.2° (normal) vs 54.7° (CTA).

Key Takeaway: Physeal bar formation occurred in 30.4% of pediatric Salter-Harris III and IV medial malleolus fractures, with greater fracture displacement (5.4 vs. 3.3 mm) and coronal plane physeal involvement (23.6% vs. 17.8%) as significant predictors.

Key Takeaway: Prior nonarthroplasty shoulder surgery increases revision risk after primary shoulder arthroplasty by 48% (HR 1.48, 95% CI 1.31–1.68), with prior osteosynthesis (HR 1.58) and rotator cuff repair (HR 1.47) carrying the highest implant failure risk.

Key Takeaway: Wrist arthroscopy achieves articular step-off reduction to <2 mm in 85-100% of intra-articular distal radius fractures and improves scapholunate ligament staging accuracy over MRI alone, though long-term functional superiority over fluoroscopic-assisted fixation remains unproven.

Key Takeaway: In isolated greater tuberosity fractures, involvement of all 3 rotator cuff attachment facets is the strongest independent predictor of ≥5 mm displacement (OR 7.72; 95% CI 3.06–19.44), outweighing the presence of anterior dislocation.

Key Takeaway: ASD occurs at 2–3% per year post-lumbar fusion with 20–30% cumulative incidence at 10 years, driven by PI-LL mismatch, BMI, and preexisting adjacent-level degeneration.

Key Takeaway: Structural bone grafting achieves graft incorporation in ~96% of primary and ~94% of revision rTSA cases, but baseplate loosening occurs more than twice as often in revision versus primary rTSA (11.5% vs 5.4%, p=0.001).

Key Takeaway: A 24-member international Delphi panel achieved 96.8% consensus (60/62 statements) on orthobiologic use across most musculoskeletal indications, but failed to reach consensus on PRP for rotator cuff repair augmentation and autologous cell-based therapies.

Key Takeaway: In kissing OCD of the radiocapitellar joint, failure to reconstruct both articular surfaces with OAT resulted in defect enlargement requiring salvage surgery in 2 of 5 patients (40%).

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

Key Takeaway: At mean 44 months, the Nexel TEA yielded 5 revisions (5%) and 6 radiographic suspected aseptic loosenings (6/96 non-revised cases) with 81% good-to-excellent Mayo Elbow Performance Scores.

Key Takeaway: Flexible forearm nails are routinely removed by 90.8% of POSNA members, while clavicle plates are removed by only 31.6%, with 43% of surgeons citing 'routine practice' rather than evidence as the primary justification.

Key Takeaway: Bulk femoral head allograft for severe glenoid defects in revision RSA achieved 93.1% 2-year and 90.9% 5-year all-cause implant survival with only 10.3% glenoid-sided complications despite mean native bone contact of only 47.3%.

Key Takeaway: Chlorohexidine soaking achieved complete disinfection (0 CFU/mL) of S. aureus-contaminated cortical bone fragments without compromising mechanical properties, while autoclave sterilization reduced maximum force to failure by 16% (84 vs. 100 N).

Key Takeaway: Custom 3D-printed hemi-elbow prosthesis for distal humeral tumor reconstruction achieved a mean arc of motion of 111° and mean MEPS of 97 at mean 33.4-month follow-up in 5 patients.

Key Takeaway: Concurrent suprascapular nerve release improved maximum load at 8 weeks and histological healing scores at both 4 and 8 weeks versus repair alone in a rat chronic massive rotator cuff tear model, with SSN entrapment detected in 70% (7/10) of shoulders after 4-week tendon transection.

Key Takeaway: Brief-early compression (70 N for 2 minutes followed by undisturbed curing) produced 273 mm³ greater cement-bone interdigitation volume than intermittent compression and 1.5% lower cement porosity, outperforming intermittent compression on all significant interface metrics in an ovine glenoid model.

Key Takeaway: Only 47% of Level-1 Pediatric Trauma Centers achieve <1-hour antibiotic administration in 81–100% of open fracture cases, and there is no consensus on antibiotic selection for Gustilo-Anderson Type III fractures across 17 surveyed institutions.

Key Takeaway: Revision Latarjet fixation with malleolar screws after all-suture cerclage failure achieves biomechanical primary stability noninferior to primary screw fixation across all cyclic load levels up to 300 N.

Key Takeaway: A laterally applied femoral distractor enabled multiplanar reduction (coronal, sagittal, and axial) of a displaced intra-articular calcaneus fracture in a single 29-year-old patient via a minimally invasive approach.

Key Takeaway: An international Delphi consensus of 98 AO faculty identified 43 parameters for assessing tension band wiring competence, with 'anatomical fracture reduction' scoring highest at 9.7/10 and a near-perfect importance-to-score correlation (r=0.91).

Key Takeaway: A single-case technique report demonstrates retrograde fibular intramedullary screw plus medial mini-fragment antiglide plate with cancellous allograft backfilling for supination-adduction ankle fracture with anteromedial plafond impaction.

Key Takeaway: Isotretinoin (7 mg/kg/day x 6 weeks) improved tendon-bone interface tensile strength and stiffness while reducing supraspinatus fatty infiltration in a rat rotator cuff repair model via GATA6-Caveolin-1-PKA/CREB signaling.

Key Takeaway: A single case of isolated ankle syndesmotic injury with concomitant posterior tibial tendon rupture was managed with primary repair of both structures, highlighting a rare injury pattern requiring heightened soft-tissue vigilance.

Key Takeaway: Posterior tibial tendon transfer through the interosseous membrane combined with percutaneous Achilles tendon lengthening restored ankle dorsiflexion in a single case of chronic post-traumatic foot drop from irreversible peroneal nerve injury.

Key Takeaway: Valgus stress radiography at 60° flexion with a Telos device (50 N load) detects significant ulnohumeral joint gapping after MCL and common flexor tendon transection, with supination reducing measurable laxity compared to pronation and neutral rotation.

Key Takeaway: A lateral tibial osteotomy provided direct visualization and anatomic reduction of a depressed lateral articular surface in a single case of bicondylar tibial plateau fracture without an associated cortical split.

Key Takeaway: Leukocyte-poor PRP reduces rotator cuff retear risk by 26% overall (RR 0.74, 95% CI 0.55–0.99), with the strongest effect in medium-sized tears (RR 0.68) and an NNT of 9 when LP-PRP is isolated.

Key Takeaway: PRP injections for rotator cuff pathology carry a significantly higher rate of adhesive capsulitis than comparator injectables (P=.01), despite equivalent overall complication rates of 9.41% vs. 10.13%.

Key Takeaway: Five or more pre-operative corticosteroid injections before total shoulder arthroplasty are associated with a 60% increased odds of 5-year revision (OR 1.60, NNH 71.4) and a 2.03% compounding increased revision risk per additional injection.

Key Takeaway: After propensity score matching for comorbidities, minority patients were 26% less likely to undergo rotator cuff repair and 24% less likely to receive a corticosteroid injection compared to non-Hispanic White patients across 1,406,127 patients.

Key Takeaway: Among 113 Korean shoulder surgeons, 92.9% adjust immobilization duration by tear size (r=0.648, p<0.001), but only 43.4% initiate any rehabilitation during immobilization for medium-sized tears, revealing substantial protocol heterogeneity.