Weekly Digest

Key Takeaway: Robotic-arm-assisted TKR (Mako) produced a mean Forgotten Joint Score of 49.2 versus 50.2 for conventional TKR at 12 months (adjusted difference -1.5, 95% CI -7.5 to 4.5; p=0.62), failing to reach the prespecified 12-point minimum clinically important difference.

Key Takeaway: This Lancet review covers psoriasis epidemiology, immunopathology, and treatment but contains no original data, outcome metrics, or quantitative findings relevant to orthopaedic practice.

Key Takeaway: Among three immobilization devices (Velpeau bandage, standard sling, padded sling) for conservatively managed proximal humerus fractures, no significant differences were found in any functional outcome score or malunion rate (21% overall) across 105 evaluable patients.

Key Takeaway: Unrestricted kinematic alignment TKA yields 4.58° greater postoperative flexion and 66% fewer intraoperative soft-tissue releases (RR 0.34) versus mechanical alignment, with no significant difference in patellofemoral complications or revision rate.

Key Takeaway: Modular dual-mobility bearings in primary THA achieved zero dislocations and zero MDM-related revisions at 10-year follow-up in 92 hips, with HOOS JR improving from 24.91 to 78.41.

Key Takeaway: A web-based, mastery-learning intervention improved pediatric MSK radiograph risk stratification accuracy by 20.5% among orthopaedic trainees, with 78% reaching a 90% performance standard in a median of 141 cases per body region.

Key Takeaway: WFR (AUC 0.623) added no incremental diagnostic value over wrist CSA alone (AUC 0.813) for CTS diagnosis, while CTS-6 outperformed both ultrasound measures (AUC 0.977).

Key Takeaway: Geriatric proximal femur fracture patients had significantly elevated preoperative IL-6 and IL-6/IL-10 ratios compared to elective THA controls, but elective THA produced a stronger acute postoperative IL-6 surge.

Key Takeaway: In an unselected population of 1,440 middle-aged adults (age 45–47), focal disc protrusions were present in 38.2% and central stenosis in 99.1% of cases, with severity predominantly mild across all pathology categories.

Key Takeaway: At 12 months post-ACLR with ST4 hamstring autograft, pediatric patients had a mean adjusted SNQ of 5.1 versus 1.5 in adults (p<0.001), indicating significantly slower graft remodelling.

Key Takeaway: Perioperative anabolic pharmacotherapy (predominantly teriparatide) is associated with a 49% reduction in odds of PJK (OR 0.51, 95% CI 0.30–0.86) and a 64% reduction in reoperation for mechanical failure (OR 0.36, 95% CI 0.14–0.88) after adult spinal deformity surgery across 2,247 patients.

Key Takeaway: A new cementless tibial baseplate in KA-TKA achieved mean 6-month MTPM of 0.93 mm, significantly below the 1.15 mm RSA stability threshold predictive of low long-term loosening risk (p=0.015), with stabilization by 3 months.

Key Takeaway: High-volume THA surgeons had significantly lower 1-month readmission (OR 1.6, p=0.033) and 3-month mortality (OR 1.8, p=0.008) compared to low-volume surgeons, but revision rates at 3 and 12 months were not significantly different across 796,061 patients.

Key Takeaway: Late sarcoma specialist consultation (>2 months) after unplanned excision independently increased 5-year metastasis odds 7-fold (OR=7.11) and mortality odds 11-fold (OR=11.29) compared to early consultation (≤2 months).

Key Takeaway: Diagnosed/treated diabetics with HbA1c ≥8.0% had significantly higher rates of revision surgery, superficial SSI, and organ-space infection after ankle ORIF than undiagnosed/untreated patients with equivalent HbA1c elevation (all p<0.05).

Key Takeaway: ADA contribution to HVA increases from 43.3% in mild to 69.3% in severe hallux valgus, establishing the geometric identity HVA = DMAA + DASA + ADA across all severity grades.

Key Takeaway: Trimalleolar ankle fracture ORIF generates the lowest hourly reimbursement ($296.1/hr) despite the longest operative time (105.0 min), while unimalleolar fixation yields the highest wRVU/hr (10.7) and $/hr ($361.9), demonstrating an inverse relationship between surgical complexity and proportional compensation.

Key Takeaway: In 450 patients with recurrent lumbar disc herniation, instrumented fusion reduced reoperation risk to 15.7% versus 36.7% for repeat microdiscectomy (p<0.001) over minimum 5-year follow-up, though functional outcomes did not differ significantly after propensity-score matching.

Key Takeaway: A CT-based radiographic scoring system using periacetabular bone destruction patterns achieves 95% sensitivity and 91% specificity (cutoff ≥3.0) for predicting protrusio acetabuli in osteolytic periacetabular metastases.

Key Takeaway: Across 14 studies and 731 pediatric pelvic fracture patients, >90% regained independent ambulation regardless of management strategy, with pelvic asymmetry (8.7%), limb length discrepancy (6.9%), and nonunion (1.1%) as the dominant structural complications.

Key Takeaway: rTSA for chronic anterior dislocation yields significantly lower PROMIS Upper Extremity scores versus matched PHF controls (36.2 vs. 56.6, p<0.001) despite equivalent range of motion.

Key Takeaway: Convergent caudal screw sagittal angulation (OR 0.893 per degree, p=0.003) independently predicts mechanical failure in PDDD for AIS, with an overall mechanical failure rate of 27% and construct breakage in 17% at mean 2.3-year follow-up.

Key Takeaway: Inferiorized and lateralized glenospheres in rTSA showed equivalent 36-month cumulative incidence of reoperation (4.9% vs. 4.4%) and equivalent ASES improvements (~46–50 points) with no significant difference in any outcome.

Key Takeaway: Open versus closed reduction of displaced femoral neck fractures in patients under 50 yielded statistically equivalent major complication rates (57.0% vs. 54.1%) across 290 patients at mean follow-up of 22–27 months.

Key Takeaway: Non-crosslinked polyethylene humeral cups in reverse TSA carry a 1.84x higher revision risk for osteoarthritis (HR=1.84, 95% CI 1.42–2.40) and 1.47x higher for rotator cuff arthropathy (HR=1.47, 95% CI 1.16–1.86) compared to highly crosslinked polyethylene on multivariable analysis.

Key Takeaway: Cementless collared metadiaphyseal-filling stems carry a 70% higher hazard of revision for periprosthetic femoral fracture compared to cemented stems in patients ≥65 years undergoing arthroplasty for femoral neck fracture (aHR 1.7, 95% CI 1.1–2.7).

Key Takeaway: The HBB Classification achieved near-perfect interobserver reliability (κ=0.945) after rTSA, significantly outperforming the traditional vertebral-level method (κ=0.599, Δκ=0.346, p<0.000001).

Key Takeaway: A four-variable nomogram (preoperative anticoagulant use, TXA use, surgical duration >120 min, preoperative hemoglobin) predicted post-THA transfusion risk with AUROC 0.90 in a cohort where 20.5% of patients required transfusion.

Key Takeaway: Patients with injection-confirmed subspine impingement achieved PASS rates approximately 15–20 percentage points higher across all PRO measures compared to CT-morphology-only selection after arthroscopic subspine decompression at minimum 2-year follow-up.

Key Takeaway: DDH prevalence in idiopathic clubfoot was 0.78% (4/515 patients), statistically comparable to population norms, arguing against routine hip ultrasound screening based on clubfoot diagnosis alone.

Key Takeaway: Patients with Outerbridge grade ≥3 patellofemoral chondrosis at the time of posterior medial meniscus root repair converted to UKA or TKA at a 7-fold higher rate than those without (14.9% vs 2.1%; P=.021) over a mean 6.2-year follow-up.

Key Takeaway: Psoriasis patients undergoing TKA face a 50% higher relative risk of PJI (RR 1.5, CI 1.1–2.1) and revision TKA (RR 1.5, CI 1.1–2.0) at two years compared to propensity-matched controls.

Key Takeaway: Global offset (mean 6.41 mm male, 5.53 mm female) varies independently of humeral head diameter and canal size, with no significant correlation in either sex, challenging the assumption that implant sizing from canal or head dimensions alone restores native geometry.

Key Takeaway: Optimal interstage duration in two-stage exchange arthroplasty varies by organism: 129 days for high-virulence pathogens, 117 days for MSSA, 98 days for culture-negative PJI, and 86 days for coagulase-negative Staphylococci, with exceeding these thresholds independently predicting treatment failure.

Key Takeaway: In patients ≤25 years with PTSmax ≥12°, adding LET to primary ACLR reduced revision rate from 21.0% to 9.2% (ARR 11.8%, NNT 9).

Key Takeaway: Navicular radiographic abnormalities occur in 3% of pediatric feet (64/2166), with dorsal pathology comprising 64% of findings, and 79.7% of these abnormalities deemed incidental to the presenting complaint.

Key Takeaway: Arthroscopic Latarjet with double-screw fixation achieved a 2.4% recurrent dislocation rate and median WOSI improvement from 51% to 79% at minimum 5-year follow-up, with HRQoL equivalent to age- and sex-matched population norms.

Key Takeaway: In primary thoracic AIS (Lenke 1–3), thoracic kyphosis T1–T12 is reduced by >8° and L1PA is elevated by >3° compared to normals, yet the global T4-to-hip axis remains preserved, supporting vertebropelvic angles as surgical alignment targets.

Key Takeaway: Scaphoid waist index (WI) was numerically lower in wrists with nonunion after scaphocapitate fusion for Kienböck disease (median 0.365 vs 0.429), but the bootstrap 95% CI crossed zero, leaving the association unconfirmed in this n=22 cohort.

Key Takeaway: Sarcopenia did not worsen 12-month ODI or complication rates after biportal endoscopic lumbar surgery, but sarcopenic fusion patients had a 3.1-day longer hospital stay (15.0 vs. 11.9 days, P=0.003).

Key Takeaway: Among 255,081 US clavicle fractures from 2015–2024, the incidence proportion rose 68.2% and the ORIF rate increased from 6.40% to a peak of 8.73% in 2021, with the highest surgical rates in the 20–29 age group (17.6–17.7%).

Key Takeaway: Partial-thickness quadriceps tendon autograft produced 26–31% greater quadriceps symmetry index at 3–6 months post-ACL reconstruction compared to full-thickness graft, with no difference at 12 months or in reinjury rate at 24 months.

Key Takeaway: The Zimmer Biomet Compress CPS device demonstrates a periprosthetic fracture rate of 2.7–3.9% in adults, concentrated within the first 2 years postoperatively, with preserved bone-implant interface stability in most fracture cases facilitating easier revision than cemented stems.

Key Takeaway: Triple-strand braided hamstring grafts independently predicted good functional outcome (IKDC ≥90) with OR 3.719 versus conventional quad-strand technique, and each 1 mm increase in graft diameter added OR 4.309 for the same endpoint.

Key Takeaway: HRA achieved 100% 15-year survivorship in primary OA and non-OA diagnoses, but DDH survivorship was 82.8%, with all five revisions occurring exclusively in female DDH patients receiving cups ≤50 mm.

Key Takeaway: Two distinct kinematic strategies enable hand-behind-back above T12 in controls—extension-dominant (extension 24°, IR 27°) and IR-dominant (extension 17°, IR 53°)—and neither bony anatomy nor a single ROM parameter predicted which strategy was used or whether RSA patients achieved functional HBB.

Key Takeaway: Among 945 arthroplasties performed on Friday the 13th, hazard ratios for aseptic revision (0.80), septic revision (0.83), and mortality (1.00) were not significantly different from control dates.

Key Takeaway: In 18 pediatric patients with spastic equinus, reintervention rates were 25% after TAL (2/8) and 20% after HSN (2/10) at approximately 2-year follow-up, with no standardized functional comparison possible between groups.

Key Takeaway: Trabecular metal cups achieved 100% 10-year survivorship free from aseptic loosening versus 88.2% for reconstruction cages in irradiated acetabula, with all-cause revision-free survivorship significantly favoring TM cups (100% vs 78.5%, p=0.040).

Key Takeaway: TRT use prior to single-level ACDF is associated with 30% higher odds of pseudoarthrosis, 70% higher odds of adjacent segment disease, and 50% higher odds of cervical reoperation at five years compared to propensity-matched controls.

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

Key Takeaway: The stemless Simpliciti humeral component achieves stable fixation by 12 months in 87% of cases, with median translation of <0.2 mm and rotation of <0.4° between 24 and 60 months, though 3 of 23 implants showed continuous migration without clinical consequence.

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

Key Takeaway: The arthroscopic 'mooring' technique for large anterior glenoid rim fractures (≥20% glenoid width, >5 mm displacement) achieved 100% bone union at 6 months and satisfactory reduction in 92.9% of 56 patients at mean 27.2-month follow-up.

Key Takeaway: One-stage repair of infected humeral nonunion achieved 86.7% ultimate union but required unplanned reoperation in 33.3% of patients, with Cutibacterium acnes identified as the causative organism in 80% of cultures.

Key Takeaway: Among 2,056 FDA MAUDE-reported all-inside meniscal repair device failures, device fracture dominated all-suture anchors (41.6%), device-device incompatibility was unique to rigid capsular-knot anchors (34.0%), and deployment errors (failure to fire 36.2%, simultaneous fire 19.9%) predominated in rigid meniscal-knot anchors.

Key Takeaway: The AAOS AUC panel rated surgical versus nonsurgical treatment across 96 mid-shaft clavicle fracture scenarios, producing appropriateness designations (Appropriate, May Be Appropriate, Rarely Appropriate) to guide clinical decision-making.

Key Takeaway: Both hydroxyapatite/calcium sulfate and calcium sulfate antibiotic-loaded ceramic bone grafts released >98% of gentamicin within 6 hours and >99% within 24 hours in vivo, refuting the assumed 28-42 day sustained-release window.

Key Takeaway: Surgeon ASC equity ownership lacks standardized disclosure and risk-adjusted outcome reporting, creating unquantified conflicts of interest as arthroplasty site-of-service shifts accelerate.

Key Takeaway: Transosseous TFCC foveal repair combined with allogeneic tendon dorsal DRUJ reinforcement reduced mean VAS from 5.5 to 0.7 and improved modified Mayo wrist score from 68.9 to 90.3 at mean 44.5-month follow-up in 21 patients with chronic severe DRUJ instability.

Key Takeaway: This viewpoint presents no quantitative findings; it argues conceptually that rigid protocol adherence without individualized reasoning constitutes a failure of surgical professionalism.

Key Takeaway: ACS incidence remained stable at 33 ± 2.17 cases per million patients annually from 2015–2025, with 30-day readmission of 42% and 30-day mortality of 6% in a national cohort of 10,045 fasciotomy patients.

Key Takeaway: Primary hip arthroscopy with interportal capsulotomy without capsular repair achieved 90.7% survivorship and 76.0% PASS achievement for mHHS at mean 11.7-year follow-up in structurally stable FAIS.

Key Takeaway: Capitate-to-axis-of-radius distance (CARD) was the only independent radiographic predictor of flexor tendon rupture after volar plating, with mean CARD 9.8 mm in rupture cases versus 3.5 mm in controls.

Key Takeaway: IL-1β upregulates chemokines (CXCL1/3/5/6/8, CCL20), cytokines (IL-6, IL-33), and MMPs (MMP3/12) in ACL remnant fibroblasts, while TGF-β1 pretreatment suppresses 13 of 16 assessed chemokines by up to 50%.

Key Takeaway: 58% of U.S. adults preferred robotic-assisted shoulder arthroplasty over conventional surgery, but 62% would choose a high-volume non-robotic surgeon over a low-volume robotic surgeon, with perceived outcome improvement being the strongest predictor of robotic preference (OR 3.31).

Key Takeaway: After revision TSA, 66.1% of patients achieved MCID for PROMIS pain interference and 61.3% for PROMIS physical function compared to their pre-primary TSA baseline.

Key Takeaway: Dorsal ligament-sparing radiocarpal arthrotomy visualizes 77.3% of the distal radius articular surface versus 63.7% via volar arthrotomy, a statistically significant 13.5% difference (P=.008).

Key Takeaway: A 2-round modified-Delphi across 17 countries achieved high consensus (≥70% agreement) on 14 of 15 statements guiding operative versus non-operative hip fracture management, with only 24% of participating facilities having a formal non-operative protocol.

Key Takeaway: Suture button suspensionplasty reduces index metacarpal load-to-failure by 33% regardless of drill hole trajectory, with all specimens fracturing at the fixation site.

Key Takeaway: Reported complication rates for anterior closing-wedge high tibial osteotomy combined with ACLR range from 0% to 56.5%, but are uninterpretable due to inconsistent definitions across studies.

Key Takeaway: 88% of ASSH hand surgeons preferred operative treatment for displaced extra-articular distal radius fractures in a 72-year-old patient, directly contradicting AAOS strong recommendation for nonsurgical management in geriatric DRFs.

Key Takeaway: De novo ITP presenting intraoperatively during L2-5 PLIF caused platelet nadir of 1,000/µL on POD1, refractory to transfusion and IVIG/steroids, with recovery only after thrombopoietin receptor agonist therapy.

Key Takeaway: This narrative review traces DDH management from Hippocratic descriptions through Graf ultrasonographic classification and Pavlik harness adoption, identifying no new quantitative findings.

Key Takeaway: A novel strap-based proximal fixation method achieved the highest load-to-failure (114.58 N) among four techniques tested on sheep Achilles tendons, though it was not statistically superior to Krackow suture fixation after Bonferroni correction.