Weekly Digest

Key Takeaway: Perioperative low-dose olanzapine (2.5 mg nightly × 5 days) reduced STAI-S anxiety scores, resting VAS pain scores on PODs 1–3, and opioid consumption compared to both alprazolam and placebo in anxious THA patients.

Key Takeaway: LTO repair after rTSA produced significantly higher ASES scores (90.4 vs 82.3, p=0.01) and 7-fold better odds of improved internal rotation at 2 years compared to no repair.

Key Takeaway: Adding ACB to LIA in ACLR did not reduce 24-hour opioid consumption (P=.109) or improve any secondary outcome versus LIA alone in this double-blind RCT of 100 patients.

Key Takeaway: Global pooled prevalence of AIS is 1.26% for Cobb ≥10° and 0.28% for Cobb ≥20°, with higher ambient temperature (OR=1.03), non-orthopaedic screeners (OR=2.04), and higher study quality (OR=1.40) independently associated with greater detected prevalence of curves ≥20°.

Key Takeaway: Pre-operative muscle strength (β = 0.42, P < 0.001) — not radiographic severity — is the strongest predictor of 12-month gait speed after THA and TKA in patients ≥70 years.

Key Takeaway: In ACL-reconstructed knees, steeper lateral posterior tibial slope correlates with greater internal tibial rotation during jump-landing (peak r = 0.75), but only in the subgroup with a flat medial tibial plateau (n=13), limiting the generalizability of slope-reducing osteotomy as an adjunct procedure.

Key Takeaway: In 196 children aged 9–18, increasing height velocity from 0 to 4 cm/yr was associated with decreasing kyphosis and lordosis in females, with a statistically significant sex difference for lordosis (p=0.02) but not kyphosis (p=0.07).

Key Takeaway: Preoperative tibia vara does not increase medial knee pain or worsen any patient-reported outcome at 2 years following cemented mobile-bearing UKA, with VAS scores of 0.2 vs 0.3 (p=0.25) between tibia vara and normal tibia groups.

Key Takeaway: MRI-measured median nerve CSA at the carpal tunnel inlet (cutoff 11.3 mm²) achieves only AUC 0.67 with 74% sensitivity and 60% specificity for EDX-confirmed CTS, indicating poor-to-fair diagnostic accuracy.

Key Takeaway: LLM-based extraction pipelines outperformed rules-based NLP algorithms for bearing surface identification (89% vs 74% accuracy) across 719 THA operative notes, with LLMs correctly inferring bearing surface in 80% of ambiguous notes.

Key Takeaway: CMS-proposed SCB thresholds of 22 points (HOOS JR) and 20 points (KOOS JR) are externally validated, with ROC-derived optimal thresholds of 24–26 points for THA and 21–24 points for TKA depending on anchor, and 20% of patients failed to meet CMS benchmarks.

Key Takeaway: Among 104,182 TKA patients on chronic antithrombotic therapy, warfarin was associated with greater blood loss, higher transfusion rates, longer hospitalization, and elevated MI and PE risk compared to antiplatelet agents and DOACs, while DOAC use correlated with lower rates of PJI and wound dehiscence.

Key Takeaway: Scapular stress fracture after rTSA (incidence 5.4%) does not impair patient-reported outcomes but reduces final forward flexion by 10.1° and abduction by 14.1° compared to matched controls, with Levy type III fractures carrying the worst ROM prognosis.

Key Takeaway: After propensity matching, robotic UKA produced longer operative times (86.1 vs 78.9 min) and shorter hospital stays (0.4 vs 0.6 days) but no significant difference in 30-day adverse events (3.4% vs 2.1%) compared to conventional UKA.

Key Takeaway: XLPE glenoids demonstrated 47.4% lower 15-year cumulative revision rate versus non-XLPE (6.0% vs 11.4%; HR 1.45), but this benefit was absent with ceramic heads and reversed with metal heads <44mm.

Key Takeaway: In morbidly obese THA patients (BMI ≥40), the direct anterior approach produced significantly shorter operative times (71 vs. 92 minutes) and lower revision risk on sensitivity analysis (OR 0.31), but overall 90-day complication rates were statistically equivalent between DA and PL after multivariate adjustment.

Key Takeaway: Preoperative proximal radial head migration >2.2 mm independently predicts suboptimal outcomes after OAT for capitellar OCD (adjusted OR 1.47 per 1-mm increase; AUC 0.72), with 28% of adolescent athletes failing to achieve a Timmerman-Andrews score ≥160.

Key Takeaway: Conversion TKA after tibial plateau fracture ORIF carries a 2.73–3.18x increased risk of PJI and 2.29–2.50x increased risk of revision TKA compared to propensity-matched primary TKA at up to 3 years.

Key Takeaway: In 869 adolescents with back pain, behavioral health diagnoses—present in 37.7%—independently predicted symptom persistence (aOR 1.78, 95% CI 1.32–2.41), while structural diagnosis did not (aOR 0.89, p=0.48).

Key Takeaway: In unresurfaced TKA, PS designs produced patellar crepitus at more than twice the rate of CR designs (12.3% vs 5.7%, P=0.0002), though only 14 of 83 crepitus cases were symptomatic and only 6 required reoperation.

Key Takeaway: Quadriceps tendon autografts had a 19.2% overall reoperation rate at 2 years versus 8.9% for hamstring and 6.9% for BPTB, driven by a nearly twofold independent risk of reoperation for extension deficit or pain (OR 1.96).

Key Takeaway: The best-performing AI system achieved AUC 0.91 for dislocation and 0.90 for aseptic loosening prediction from first-day postoperative AP pelvic radiographs in primary THA at mean 11.6-year follow-up.

Key Takeaway: Primary ACL repair yielded significantly higher Forgotten Joint Score-12 values than hamstring autograft reconstruction (87.0 vs 77.5; mean difference 9.5 points, Cohen d=0.66) despite equivalent Lysholm, IKDC, Tegner, laxity, and return-to-sport outcomes.

Key Takeaway: Curved modular fluted tapered stems independently reduced intraoperative diaphyseal fracture risk and ≥5 mm stem subsidence compared to straight stems in periprosthetic femoral fracture revision, with 94.6% re-revision-free survivorship at 10 years.

Key Takeaway: Hip arthroscopy for moderate-to-global acetabular retroversion achieved 98.2% arthroplasty-free survivorship and 81% patient satisfaction at 5 years, with no conversions to PAO, equivalent to matched controls with focal retroversion only.

Key Takeaway: Delayed union or nonunion occurred in 19.2% of Crowe IV DDH hips after THA with subtrochanteric transverse osteotomy, with autogenous bone plate wiring reducing incidence from 36.1% to 13.8% compared to press-fit-only fixation.

Key Takeaway: Each additional day of postpresentation delay independently increased odds of high-grade cartilage injury by 0.4% (OR 1.004/day), and 38.6% of pediatric ACL patients experienced prolonged delay (>120 days), driven by race/ethnicity, public insurance, and lower neighborhood opportunity index.

Key Takeaway: DAIR failure rates reached 52.0% by clinical definition versus 44.8% by MSIS-ORT in a 184-episode cohort, with 12.5% of MSIS-ORT successes reclassified as failures under pragmatic clinical criteria.

Key Takeaway: PJK developed in 17.9% of EOS patients after dual growing rod surgery, with UIV at T3 or below and preoperative T2-T12 kyphosis ≥45° identified as independent risk factors on multivariate analysis.

Key Takeaway: Perioperative SGLT2 inhibitor use in diabetic ACDF patients was associated with a 27% reduction in 1-year pseudarthrosis (4.9% vs. 6.8%) and a 36% reduction in 5-year reoperation rates (2.2% vs. 3.5%) after propensity matching.

Key Takeaway: The SCARE score (Spinal Cord morphology, Angular ratio, Revision surgery, syndromic Etiology) predicts intraoperative neuromonitoring signal loss in pediatric spinal deformity surgery with an AUC of 0.74, stratifying risk from 3.3% (low) to 59.7% (high).

Key Takeaway: R0 revision resection after Enneking-inappropriate primary spine tumor surgery yielded 72.4% survival vs 23.1% for R1/R2 margins (P=0.04), but local recurrence still occurred in 37.5% of R0 cases.

Key Takeaway: Severely frail pediatric spinal deformity patients face 23-fold higher odds of severe adverse events (OR 23.17) compared to non-frail patients, with high surgical invasiveness independently adding an additional 2.1-fold risk.

Key Takeaway: A random forest model using five perioperative variables achieved AUROC 0.782 (internal) and 0.749 (external validation) for predicting radiographic adjacent segment degeneration after short-segment lumbar fusion, with preoperative intervertebral space height as the dominant predictor.

Key Takeaway: Perioperative GLP-1RA use was associated with 33–40% lower odds of pseudarthrosis following ACDF at 6, 12, and 24 months (OR 0.60–0.67).

Key Takeaway: Patellar fracture occurs at a pooled incidence of 1.17% (95% CI 0.76–1.68%) following MPFL reconstruction across 115,496 patients, with no significant difference between tunnel versus non-tunnel fixation techniques.

Key Takeaway: Endplate junction failure (EPJF) was present in 69.2% of surgical LDH patients and was associated with a significantly lower 5-year symptomatic recurrence rate (4.7% vs 14.3%) compared to intact-endplate herniations.

Key Takeaway: Staple, plate-and-staple, and plate fixation produced equivalent radiographic fusion rates in first MTPJ arthrodesis, with smoking and postoperative noncompliance—not construct choice—as the dominant predictors of fusion failure.

Key Takeaway: MIS correction of adult spinal deformity across 413 patients achieved statistically significant improvement in all sagittal parameters and ODI/VAS scores, but carried a 35.4% major complication rate and 19.1% re-intervention rate.

Key Takeaway: External fixation achieved 100% infection eradication and the shortest time to union with zero amputations among three knee arthrodesis techniques for failed infected TKA, versus four amputations in the IMN and CP groups combined.

Key Takeaway: In AIS patients completing orthotic treatment, wearing ≥12 h/day produced significantly better outcomes than <12 h/day, but minimum effective wearing time varied from 9.3 to 21.6 h/day depending on Risser sign and target deterioration risk, and exceeded 24 h/day (clinically infeasible) for Risser 0 patients with baseline Cobb >30° at the 2% surgical deterioration risk threshold.

Key Takeaway: Iliac crest reference pin cortical perforation occurred in 35% of navigation-assisted THAs (70/200 hips) but did not affect cup positioning accuracy, with all hips landing within 10° of target inclination and anteversion.

Key Takeaway: A multimodal deep learning model using preoperative vertebral body CT images predicted pedicle screw loosening after single-level lumbar interbody fusion with AUC 0.823 and sensitivity 0.914 on external testing.

Key Takeaway: Arthroscopic single-anchor fixation achieved superior Lysholm scores (91 vs. 83), MOCART 2.0 scores (79.4 vs. 57.9), and Tegner activity levels (5.0 vs. 3.9) compared to microfracture at mean 93.7-month follow-up in adolescents and young adults with knee osteochondral fractures.

Key Takeaway: In propensity score-matched older patients, UKA reduced estimated blood loss by 46% (104.6 vs 195.7 mL) and achieved earlier single-cane ambulation and shorter hospital stay compared to TKA, with equivalent short-term KSS 2011 scores.

Key Takeaway: In octogenarians undergoing primary knee arthroplasty, all-cause mortality at minimum 5-year follow-up was 35.3% overall—3–5 times higher than registry-reported revision rates—with no significant difference between UKA (41.5%) and TKA (33.5%) (OR 1.41, 95% CI 0.75–2.63, p=0.329).

Key Takeaway: Fit-and-fill cementless stems carry a 4.86-fold higher adjusted odds of reoperation after periprosthetic femoral fracture compared to flat taper stems, driven by a predominance of Vancouver B1 fractures (53.7% vs. 12.5%).

Key Takeaway: Dementia independently increases 5-year mortality by 53.7% (RR 1.537) and hospital readmission to 71% vs 56% following ankle fracture fixation, without elevating reoperation, nonunion, or amputation rates.

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

Key Takeaway: 3D-printed personalized guide plates reduced operation time by ~9 minutes (35.4 vs 44.8 min) and cut intraoperative fluoroscopic exposures by more than half (1.58 vs 3.33) compared to conventional non-arthroscopic lateral ankle ligament reconstruction.

Key Takeaway: This systematic review of 10 retrospective studies identifies 11 significant risk factors for instability after rTSA, with loss of compression as the predominant mechanism and absence of subscapularis repair, cemented humeral stem, and glenosphere lateralization >9mm as implant-modifiable factors.

Key Takeaway: Across five femoral shortening osteotomy techniques in 117 THAs for Hartofilakidis Type C DDH, radiographic union was achieved in 100% of osteotomies with transient sciatic nerve palsy in only 2.6% and leg-length discrepancy ≤5 mm in all patients.

Key Takeaway: Radial head implant removal without re-implantation yielded subjective improvement in 84% (21/25) of patients at mean 7-year follow-up, with 76% of those with painful loosening reporting resolution of proximal radial-sided forearm pain.

Key Takeaway: Arthroscopic bioabsorbable fixation for unstable knee OCD achieves Lysholm scores of 85.3–98.9 with lower complication and revision rates than metal implants, which carry reoperation rates up to 22%.

Key Takeaway: This narrative review identifies two distinct AI failure classes—retrieval failures and reasoning failures—illustrated through orthopaedic clinical examples, but provides no quantitative performance benchmarks.

Key Takeaway: Microbial translocation through a compromised gut epithelial barrier and immune cell-mediated pathogen transport are proposed mechanisms linking gut dysbiosis to joint and spinal infections, though no quantitative clinical data are presented.

Key Takeaway: Virtual KA-based placement of a mechanically-aligned femoral component produced trochlear groove malpositioning (medial to the quadriceps line of force) in 41% of 85,604 knees, with ~30% requiring >3° of internal rotation.

Key Takeaway: No single diagnostic test achieves sufficient sensitivity and specificity for orthopaedic implant-related infection, necessitating multimodal diagnostic algorithms that vary by anatomic site and organism.

Key Takeaway: Antirheumatic medications disrupt wound healing at multiple stages, but evidence guiding perioperative management is largely limited to joint arthroplasty in RA patients, leaving significant gaps for newer biologics and non-arthroplasty procedures.

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

Key Takeaway: In 57 ballistic nerve injuries explored operatively, only 1.8% were amenable to direct repair, with neuroma-in-continuity found in 33.3% of cases—rising substantially with delayed exploration beyond 99 days.

Key Takeaway: FCL and ALL attachment distances decrease by 7.59 mm and 6.44 mm respectively from 0° to 90° flexion, while ITB Kaplan fiber distances demonstrate relative isometry with midflexion lengthening of 2–6 mm that returns to baseline at 90°.

Key Takeaway: The sternoclavicular joint reaches at least 25° of elevation and 35° of retraction, with peak joint forces reaching 75% of body weight during shoulder motion.

Key Takeaway: Suture material (absorbable vs. non-absorbable) showed no statistically significant effect on any clinical or radiological outcome after transtibial pull-out repair for medial meniscus posterior root tears across 647 patients, though TKA conversion trended higher with absorbable sutures (22% vs. 5%).

Key Takeaway: IgG4-related spinal hypertrophic pachymeningitis affects predominantly the cervical and thoracic spine in patients with a mean age of 49.2 years, with >50% showing elevated serum IgG4 and abnormal CSF, yet histopathology remains the only reliable diagnostic confirmation.

Key Takeaway: Capital realignment for SCFE yielded a 22% overall AVN rate (6/27), with 50% AVN in unstable slips versus 11% in stable slips, and zero AVN in the 8 cases with intraoperative epiphyseal perfusion monitoring.

Key Takeaway: PTM-based Sphereplasty for AO Spine A1/A3 thoracolumbar VCFs reduced median NRS from 8.0 to 4.0 and ODI from 66.35% to 28.45% at median 334-day follow-up, with significant anterior and middle vertebral body height restoration.

Key Takeaway: Reducing patellar button compression time from 600s to 30s increases micromotion 2.5-fold (0.015 vs 0.006 mm, p=0.028) despite equivalent cement morphology and ultimate shear strength (~2400 N in both groups).

Key Takeaway: Upper-limb bone stress injuries span the entire extremity from scapula to phalanges, with MRI being the most sensitive early diagnostic tool when plain radiographs are normal in athletes with subtle, non-specific symptoms.

Key Takeaway: A KA-optimized femoral component (PTA 20°) reduced patellar medialization by 2.0–2.5 mm versus a standard design (PTA 6°) in both valgus and varus cadaveric knees, but did not improve contact area, peak pressure, or quadriceps force.

Key Takeaway: Post-traumatic IJV thrombosis caused saddle pulmonary embolism on POD2 in a C6-C7 AO type C ASIA grade C patient despite negative lower-limb venous ultrasound, with complete IJV recanalization confirmed at 3 weeks after thrombolysis.

Key Takeaway: The German Knee Society Osteotomy Committee recommends infratuberositary anterior closing wedge osteotomy for pathologic posterior tibial slope (PTS) correction, with surgical indication based on individualized risk assessment rather than a single PTS cut-off value.

Key Takeaway: This narrative review traces TKA evolution across four historical phases from Gluck's 1890 ivory hinged prosthesis to modern robotic and kinematic alignment paradigms, without reporting original outcome data or specific comparative numbers.

Key Takeaway: French surgical pioneers contributed at least 10 distinct innovations to spinal surgery over 50 years, including Cotrel-Dubousset instrumentation, EOS imaging, vertebroplasty, disc arthroplasty, and PediGuard pedicle guidance, collectively reshaping global deformity, trauma, and stabilization practice.

Key Takeaway: Japanese spine surgeons developed laminoplasty (Hirabayashi open-door, Kurokawa double-door) as a direct response to high domestic OPLL prevalence, establishing techniques now used globally, though no comparative outcome data with specific numbers are reported in this review.