Weekly Digest

Key Takeaway: Hip precautions after posterior approach THA with capsular repair produced no difference in dislocation rate (0.88% overall; OR 0.60, 95% CI 0.17–2.17) but significantly worsened HOOS-JR scores at 6 weeks and 3–6 months in the restricted group.

Key Takeaway: Robotic-arm-assisted medial UKA achieved superior component position accuracy (p<0.001 for both femoral and tibial components) and higher Forgotten Joint Scores at 2 years compared to conventional jig-based UKA, though standard PROMs (OKS, KOOS, WOMAC) did not differ.

Key Takeaway: Intraosseous multimodal analgesic cocktail injection reduced VAS pain scores at rest and with motion at 4, 6, and 12 hours and 2 weeks post-TKA compared to periarticular injection, with faster Timed Up and Go at 48 hours but no difference in morphine consumption or discharge timing.

Key Takeaway: Locking plate fixation achieved clinically meaningful superiority over tension-band wiring in 3 of 5 KOOS subscales at 12 months (symptoms −10.4, sport/recreation −14.1, quality of life −10.9 points), with lower rates of hardware removal, fixation failure, and reoperation.

Key Takeaway: Seven RCTs comparing biceps tenotomy versus tenodesis yielded a mean reverse continuous fragility index of 17.7, indicating moderate robustness of nonsignificant findings, though 57% of studies would flip to tenodesis superiority if rCFI threshold were crossed.

Key Takeaway: Skip-level fixation in open-door cervical laminoplasty reduced two-year direct medical costs by USD 1,460 versus all-level fixation with no significant QALY difference, yielding an 86.3% probability of cost-effectiveness at a WTP threshold of USD 45,900/QALY.

Key Takeaway: In a synthetic bone model TAA study, CAN achieved superior tibial resection accuracy over PSI and SRG (p<0.001), while PSI outperformed CAN on talar slope and axial cut height (p≤0.002), with CAN demonstrating the lowest implant placement variability (±0.47 mm, ±0.62°).

Key Takeaway: Intra-articular vancomycin combined with EACA maintained higher local vancomycin concentrations at 8 and 24 hours versus vancomycin alone while preserving EACA's antifibrinolytic effect, with no enhancement of antibacterial activity and no cases of AKI, ototoxicity, or anaphylaxis across 141 TKAs.

Key Takeaway: Among 14 upper extremity trauma surgery patients with high financial distress, 36% were uninsured and qualitative analysis identified three core burden domains: community/personal impact, insurance and legal struggles, and catastrophic debt.

Key Takeaway: Infrapatellar fat pad preservation in TKA reduces early complications by 76% (RR=0.24) and patellar tendon shortening is 2.68 mm greater with resection at 12 months, though functional scores do not differ.

Key Takeaway: In 10,693 Swedish football players, graft type did not predict revision ACLR, but quadriceps tendon autograft was associated with nearly double the hazard of contralateral ACLR in women (HR 1.98, 95% CI 1.17–3.36).

Key Takeaway: Total outpatient costs at one year did not differ significantly across anterior ($1,321 CDN), posterior ($1,095 CDN), and lateral ($1,153 CDN) THA approaches (P=0.114), though anterior approach generated higher allied health costs ($361 vs $207 posterior, P=0.028).

Key Takeaway: First-degree relatives of spinal stenosis patients carry a familial hazard ratio of 2.47 for developing hospital-treated spinal stenosis, with twins showing an afHR of 5.12, confirming significant hereditary contribution.

Key Takeaway: Prospective surgeon-reported data captured a significantly higher stiffness rate (4.8% vs. 3.6%, p=0.0013) and reoperation rate (3.7% vs. 1.8%, p<0.0001) after pediatric ACLR compared to the retrospective ABOS Part II database, while overall complication rates were equivalent (11.6% vs. 11.1%).

Key Takeaway: Quantitative water-fat MRI hypo-fatty marrow involvement in Modic change-affected endplates associates with worse ODI at a medium effect size (Cohen's f²=0.26, p=0.0007), whereas conventional Modic type classification shows no association with any patient-reported outcome (p>0.25).

Key Takeaway: Latent class analysis of 247 Dutch BAP patients identified 3 distinct preference subgroups, with QoL driving 26–53% of decision weight across classes and long-term complications dominating Class 3 (24% of patients, predominantly male, lower education, pre-surgical).

Key Takeaway: Robotic-assisted navigation for posterior spinal fusion in idiopathic scoliosis produces a 25-fold greater cumulative perioperative radiation dose to the patient (12.5 vs 0.5 mSv) compared to freehand technique, despite a 1.5-fold reduction in intraoperative fluoroscopy dose.

Key Takeaway: At mean 8-year follow-up, Latarjet coracoid grafts consolidated in 97% of patients with <5% preoperative glenoid bone loss, with mean glenoid surface augmentation of 20.9% despite consistent superomedial resorption on 3D CT.

Key Takeaway: At 12 months after severe open tibial shaft fracture, 34% had moderate-to-severe depression, 45% met PTSD criteria, and 49% reported moderate-to-severe pain interference, with none of these outcomes differing by fixation modality (external ring vs. internal fixation).

Key Takeaway: TSA incidence grew 248% from 2015–2025 (13.1 to 45.6 per 100,000) and is projected to increase by 73–397% by 2040, representing the highest proportional annual growth rate (12.4%/year by Poisson modeling) among TSA, THA, and TKA.

Key Takeaway: In 849 pediatric knees undergoing MPFL reconstruction, recurrent dislocation rates were statistically equivalent between autograft (5.5%) and allograft (9.1%), though allograft patients returned to sport at or above preoperative level more frequently (90.9% vs. 71.2%, p=0.0002).

Key Takeaway: Single-shot interscalene block (SSIB) achieves comparable 24-hour analgesia to continuous interscalene catheters (CIC) in shoulder arthroplasty while carrying a fourfold lower complication rate (0.4% vs. 4.6%) and substantially lower material cost ($24–$190 vs. $357–$474).

Key Takeaway: In 1,372 pediatric medial epicondyle fractures, nonoperative management carried a 29.9% nonunion rate but MEPS of 98.6, while operative management yielded 6.4% ulnar nerve symptoms, 13% secondary surgery rate, and MEPS of 95.2.

Key Takeaway: Deep SSI rates after IMN of open tibial shaft fractures escalate from 6.2% (G-A Type I) to 41.8% (G-A Type IIIC), with a pooled overall rate of 13.2% across 2,063 patients.

Key Takeaway: Inflation-adjusted Medicare physician reimbursement for lumbar spine surgery declined at a median CAGR of -2.00% per year across 11 studies, with cumulative losses approaching 33% over two decades despite a 94.6% rise in total fusion volume.

Key Takeaway: Surgeon-level factors (32.4%) and institutional factors (22.9%) account for more than half of variation in dual-mobility THA use, while patient-level characteristics explain only ~10% of variance across 238,455 primary THAs.

Key Takeaway: A PTS of 15° carries a 36.6% predicted rerupture probability at age 18 versus 3.9% at age 45, with age modulating absolute but not relative risk per degree of slope.

Key Takeaway: KneeFusionNet achieved external validation AUROCs of 0.888 (ACL), 0.867 (PCL), 0.862 (MCL), and 0.874 (LCL) for knee ligament injury detection on MRI, while AI assistance improved junior surgeon accuracy from 0.818 to 0.900 and reduced interpretation time by 14.73 seconds.

Key Takeaway: Among 441 hockey athletes, return-to-sport rates following spine surgery ranged from 75–90%, but postoperative declines in games played, scoring productivity, and performance indices were commonly observed across both cervical and lumbar procedures.

Key Takeaway: Preoperative medial meniscus extrusion ≥3 mm independently predicts varus correction loss after medial opening-wedge HTO, with pathological MME knees achieving a final WBL ratio of 55.8% versus 65.7% in non-pathological knees at mean 6.9 years.

Key Takeaway: Postoperative cervical hematoma requiring evacuation occurred in 0.41% of 6,084 ACDF/CDR cases, with male sex (aOR 2.99) and ≥4 surgical levels (aOR 3.20) as independent predictors, and Penrose drains associated with 9.15× higher odds versus no drain.

Key Takeaway: Secondary patellar resurfacing significantly improved VAS, KSS, and OKS scores (P<0.005) in patients with anterior knee pain after unresurfaced primary TKA, and a novel GC Index (AFO/APD ratio) identified these patients with 82.93% sensitivity and 85.37% specificity.

Key Takeaway: Sarcopenic patients with Type II odontoid fractures were less likely to fail non-operative management, suggesting lower muscle mass encodes frailty information beyond age and comorbidity burden alone.

Key Takeaway: Technology-assisted primary THA costs $1,783 more per episode-of-care than manual THA ($20,038 vs $18,254) with no compensatory reduction in 90-day postoperative costs despite marginally shorter LOS.

Key Takeaway: A K-wire-guided simplified talocalcaneal coalition excision technique halved tourniquet time (47.5 vs. 93.4 min) and total cost ($2,887 vs. $5,819) compared to traditional resection without increasing complications.

Key Takeaway: Unrestricted KA-TKA in patients with severe proximal tibial varus (mean MPTA 81.6°) achieved equivalent 2-year PROMs and satisfaction rates comparable to less-deformed KA patients and superior satisfaction versus MA-TKA (p=0.017).

Key Takeaway: Arthroscopic pre-revision tissue biopsy for shoulder arthroplasty PJI demonstrated only 27.3% sensitivity and 60% NPV against 2018 ICM criteria, making a negative result clinically unreliable for ruling out infection.

Key Takeaway: Peri-incisional blistering occurred in 3.1% of primary TKAs and was associated with a 4.24-fold increased odds of PJI, exceeding smoking as a risk factor.

Key Takeaway: HO developed in 32.5% of complex elbow fracture-dislocations, with terrible triad injuries (OR 3.04), male sex (OR 2.8), and surgery delayed >5 days (OR 2.2) as independent predictors, and HO presence reduced flexion-extension arc by 12° compared to unaffected patients.

Key Takeaway: Prior GI bleeding within 2 years increased 2-year odds of revision surgery by 40% in both THA (OR 1.4) and TKA (OR 1.4), with TKA patients specifically showing 30% higher odds of PJI (OR 1.3) and THA patients showing 60% higher odds of mechanical loosening (OR 1.6).

Key Takeaway: After IPTW adjustment in 20,376 pediatric spinal deformity patients, cell saver use was not associated with increased 30-day all-cause morbidity, but high CS volume (≥3.5 mL/kg) was associated with 83% higher odds of intraoperative allogeneic transfusion (OR=1.83) while low CS volume reduced transfusion odds by 38% (OR=0.62).

Key Takeaway: In bilaterally well-aligned TKA patients with coronal spinal imbalance, 91.5% preferred the knee ipsilateral to the spinal shift versus only 29% showing side preference in the balanced-spine group (P<0.0001).

Key Takeaway: Non-traditional vehicles caused an estimated 66,750 ED visits for cervical spine injuries over 10 years, with a statistically significant increase of 564 visits/year (P=0.011), driven predominantly by ATVs (30.6%) in males aged 11–20.

Key Takeaway: Latent profile analysis of preoperative CT-derived quadriceps volumes identified three distinct muscle phenotypes in TKA patients, with the highest-volume class (n=27) achieving the best absolute WOMAC improvement (41.8 points) and the lowest-volume class (n=39) showing the least VAS improvement (2.8 points) at six months.

Key Takeaway: Elevated systemic immune-inflammation index (SII) independently predicts both MRI-defined intramedullary signal intensity and poorer mJOA recovery at 2 years in DCM patients undergoing decompression surgery, with ISI present in 45.4% of the surgical cohort and 14.7% of asymptomatic health-screening individuals.

Key Takeaway: Patients requiring both THA and LSF reach MCID for PROMIS Global Physical 0.76 months later than THA-alone controls (5.91 vs 5.15 months), with the delay driven entirely by the THA-first subgroup (7.35 months).

Key Takeaway: Symptomatic PE occurred in 10.8% of adults undergoing instrumented spinal fusion ≥6 hours, with fusion ≥8 segments (OR 3.81) and osseous bone-anchoring complications (OR 5.07) as the strongest independent predictors.

Key Takeaway: Retained periarticular hardware during conversion TKA did not increase reoperation risk (Fine-Gray p=0.162) despite significantly higher operative time and blood loss in the major hardware group.

Key Takeaway: In 98 axSpA patients, mSASSS structural damage and paraspinal muscle stiffness/elasticity were independently associated with reduced spinal mobility, with the strongest effects observed in the cervical spine.

Key Takeaway: Blade versus screw choice in cephalomedullary nailing for intertrochanteric fractures showed no difference in complications (5.7% vs. 5.4%) or reoperation (5.2% vs. 3.7%), while malreduction and patient factors—not implant type—drove adverse outcomes.

Key Takeaway: After propensity score matching, EDH and CDH patients achieved equivalent 12-month ODI (18.9 vs 17.4, p=NS) and satisfaction rates, despite EDH surgery requiring 17.9 additional operative minutes.

Key Takeaway: The Risk Analysis Index outperforms the Modified 5-Item Frailty Index for predicting 30-day mortality after arthroplasty for femoral neck fractures, with C-statistics of 0.84 vs 0.69 for THA and 0.74 vs 0.62 for hemiarthroplasty.

Key Takeaway: Initiating pharmacologic thromboprophylaxis within 48 hours of surgery (postoperative day 1) in acute SCI patients reduced in-hospital VTE from 5.9% to 4.7% (OR 1.26) and mortality from 4.9% to 4.0% (OR 1.28) without increasing return to OR for spine-related procedures.

Key Takeaway: Surgeons in the highest dual-eligibility quartile received $31 less per THA and $24 less per TKA compared to the lowest quartile, despite managing greater comorbidity burden.

Key Takeaway: A standardized NIBP protocol with capped inflation pressures (120 mmHg pediatric, 140 mmHg adult) and manual nurse assessment produced zero fractures across 50 OI patients with an average of 9.5 postoperative BP measurements each.

Key Takeaway: In the largest reported ES cohort (n=20), 50% had intraspinal anomalies including 40% tethered cord, and VEPTR carried a 233% complication rate versus 33% for MCGR and 25% for PSF.

Key Takeaway: Both segmental and circumferential hip labral reconstruction yield favorable PROs at minimum 2-year follow-up, but only 1 of 9 included studies directly compared the two techniques, precluding definitive superiority claims.

Key Takeaway: VBT in patients with open triradiate cartilage achieved successful curve correction (<35°) in only 56% of cases, with undercorrection in 29% and overcorrection in 15%.

Key Takeaway: Across 1,172 adolescent athletes, the Latarjet procedure produced the lowest recurrent instability rate (0–8%) compared to arthroscopic Bankart (0–57%) and open Bankart (0–45%), though all three achieved high RTP rates.

Key Takeaway: Open transosseous tunnel repair for refractory medial and lateral epicondylitis achieved 94.5% patient-reported symptom resolution and 96% full return to work at mean 9.1-year follow-up across 200 operative cases.

Key Takeaway: Lumbar microdiscectomy in adolescents (n=26) produced durable improvement at 5 years, with ODI improving from 61.8 to 12.9 and EQ-5D from 0.456 to 0.942, with an 8% reoperation rate for recurrent herniation.

Key Takeaway: Inflation-adjusted Medicare reimbursement for four common lower extremity trauma procedures fell 33.7% from 2006 to 2024, with work RVU-based reimbursement declining 38.9%, and projections suggest a further 33–48% decline by 2029 under neutral-to-negative scenarios.

Key Takeaway: Skeletally mature patients with achondroplasia achieve a mean T1-T12 length of 27.8 cm and T1-S1 of 46.1 cm, both within expected adult ranges, with cardiopulmonary comorbidities present in only 9% of the cohort and not correlated with spinal length.

Key Takeaway: Intramedullary reaming biopsy achieved only 70% sensitivity for diagnosing metastatic disease in cancer patients undergoing IMN fixation of long bone lesions, leaving 30% without a tissue diagnosis.

Key Takeaway: Meniscal ramp lesions occur in 25.9% of pediatric ACLR patients, with contact pivot sports as a significant risk factor and a 22.6% reoperation rate on the medial meniscus at mean 55.5 months.

Key Takeaway: Acute arthroplasty use for femoral neck fractures is increasing, with cemented hemiarthroplasty demonstrating reduced revision rates and superior functional outcomes compared to uncemented constructs in elderly patients with displaced fractures.

Key Takeaway: Fragility fracture care gaps persist globally, with LMIC implementation failures driven by health-system constraints rather than evidence deficits, though no single quantitative outcome metric is reported in this narrative review.

Key Takeaway: A $53 3D-printed K-wire pinning simulator scored 4.8/5 for teaching triangulation and 4.4/5 for motor skill development based on expert content validation.

Key Takeaway: Computer simulation of rigid intramedullary nailing in adolescents aged 10–13 shows maximum proximal tibial physeal injury of 5.15% with a 12.0 mm reamer, remaining below the classically cited 7% threshold of concern across all reamer sizes and ossification stages.

Key Takeaway: Robotic-assisted rTSA requires an absolute risk reduction in early revision of 6.55% (1 revision prevented per 15 cases) to break even, which exceeds the observed baseline early revision rate of 2.1%, making routine economic justification impossible under current conditions.

Key Takeaway: Combined lateral meniscus posterior root tear and medial ramp lesion in an ACL-deficient knee produces significantly greater internal rotation, external rotation, and anterior tibial translation than ACL deficiency with either lesion in isolation across multiple flexion angles.

Key Takeaway: Lag screw (bi- and tri-cortical) and wire cerclage fixation generate significantly greater compressive force and contact area than suture-tape cerclage for humeral allograft strut fixation, with suture-tape showing greater strut translation beyond 50 N of cyclic loading (p<0.033).

Key Takeaway: Full-thickness double-blade quadriceps tendon grafts (DB-QT) achieved a mean CSA of 0.97 cm² and the highest load-to-failure, significantly exceeding both cylindrical-harvester QT grafts (0.64 cm²) and BTB grafts (0.44 cm²).

Key Takeaway: OpenEvidence achieved the highest concordance with ASES Neer Circle Delphi consensus for MIRCT surgical recommendations at 65.6–68.9% across four test conditions, while no LLM approached expert-level decision-making accuracy.

Key Takeaway: Humeral resting abduction angle (HARA) systematically alters LSA by up to 5° and DSA by up to 9° across the 10°–30° HARA range, with 95% of postoperative radiographs showing inter-visit HARA variability averaging 10°.