Weekly Digest

Key Takeaway: SuperPATH THA produced significantly less quadratus femoris fatty infiltration than posterolateral approach at 12 months (7.3% vs 85.4%, P<0.001), though 1-year HHS and VAS scores were equivalent.

Key Takeaway: FA-RATKA produced statistically significant improvements over MA-CTKA across multiple PROMs at 2 years, with effect sizes ranging from r=0.117 to r=0.214 (small to small-medium magnitude).

Key Takeaway: UBE-ULBD and Endo-ULBD produce equivalent 12-month clinical outcomes for Schizas grade C/D lumbar stenosis, with modified Macnab satisfaction rates of 90.9% vs 89.1% (P=0.92), though UBE-ULBD has shorter operative time and Endo-ULBD has shorter hospital stay.

Key Takeaway: In 54 studies of 10,055 chronic PJI patients, 1.5-stage revision achieved the highest infection control success versus two-stage (OR 1.64) but carried a 4.8-fold increased risk of aseptic loosening.

Key Takeaway: ASC-based TKA volumes increased 413.6% from 2018 to 2022 and are projected to exceed 2.1 million cases annually by 2040, driven largely by Medicare's removal of TKA from the inpatient-only list.

Key Takeaway: Non-oncologic proximal femoral replacement carries more than double the revision rate of oncologic PFR (13% vs 6%, P=0.03) and higher dislocation rates (9% vs 5%, P=0.04), despite similar overall complication rates of 27%.

Key Takeaway: Adults with idiopathic scoliosis carry 11–72% increased odds of cardiac comorbidities (OR 1.11–1.72), while neuromuscular scoliosis patients carry 17–330% increased odds (OR 1.17–4.30) across all measured cardiac endpoints.

Key Takeaway: A PT-LTR distance ≥4.6 mm is 92% specific for patellofemoral instability, outperforming TT-TG in specificity with an AUC of 0.80.

Key Takeaway: Preoperative frailty (CFS >3) independently predicted lateral compartment OA progression after Oxford Phase III mUKA with an OR of 4.36 (95% CI 1.37–13.90) at mean 70-month follow-up.

Key Takeaway: rhBMP-2 increased index encounter costs by 14% ($4,543.51 attributable to the biologic) in single-level P/TLIF without reducing 90-day readmission, 2-year revision fusion (2.7% vs 3.2%), or 2-year post-discharge costs compared to non-rhBMP-2 controls.

Key Takeaway: Across 23 orthopaedic trainees, assessing patient comprehension was completed by only 13% and shared decision-making by only 39%, with no performance improvement across PGY levels despite all trainees rating informed consent as extremely important.

Key Takeaway: After-hours hemiarthroplasty for femoral neck fracture carries a 4.78-fold increased PJI risk and 3.20-fold increased revision risk compared to in-hours cases, independent of admission-to-surgery interval or surgeon subspecialty.

Key Takeaway: Two 3.5 mm bicortical screws for tibial tubercle osteotomy carry a 7.9% fixation failure rate versus 1.4% with 4.5 mm screws (OR 8.1, 95% CI 1.1–59.8).

Key Takeaway: Incidental cervical stenosis prevalence at C3-C4 was 21.4% in Black patients versus 15.4% in White patients among 381 trauma patients with unremarkable cervical CT scans.

Key Takeaway: Patients reporting ≥2 patient-reported allergies before aTSA were significantly more likely to fail to achieve MCID improvement in %MPI compared to those with zero or one allergy (p=0.002 and p=0.030, respectively).

Key Takeaway: South Korean vertebral augmentation volume nearly doubled over 15 years (30,190 to 59,556 procedures; AAPC +4.4%), driven by vertebroplasty growth to 91.3% market share, contrasting sharply with post-2009 US decline toward kyphoplasty predominance.

Key Takeaway: Concomitant latissimus dorsi transfer with rTSA using a lateralized glenosphere provided no additional gain in external rotation (ΔER 33° vs. 36°, P=0.635) but was associated with proximal humeral osseous erosion in 96% of transfer cases versus 4% of rTSA-alone cases.

Key Takeaway: High resilience (BRS ≥3.67) was associated with 11.2 percentage points greater normal function at 6 months (51.7% vs 40.5%, p=0.040) and superior PROMIS scores across all mental health domains at every timepoint following operative pilon fracture fixation.

Key Takeaway: Primary TEA carries a 21% reoperation rate at mean 4.4 years, driven predominantly by infection (39% of reoperations) and humeral component loosening (20%).

Key Takeaway: Multiple TXA doses did not reduce transfusion rates beyond a single dose (15.9% vs. 14.2%, p=0.791), while the multidose group had a higher VTE rate than the single-dose group (2.7% vs. 0.9%, p=0.040).

Key Takeaway: In 370 PS-TKA patients at mean 64.6 months follow-up, neither the direction nor magnitude of posterior tibial slope change (mean absolute change 5.47°) was associated with postoperative pain, functional scores, or ROM in any clinically meaningful way.

Key Takeaway: Psychiatric comorbidity was present in 30% of hip arthroscopy patients and independently associated with a 23.3% failure rate versus 5.3% in those without, and reduced 10-year failure-free survivorship (11.49 vs 13.68 years).

Key Takeaway: The age-adjusted Charlson Comorbidity Index (aCCI) outperformed ECI, mFI-5, and HRQoL-CI in predicting 90-day overall readmissions after simultaneous bilateral TKA (AUC 0.778 vs. 0.680, 0.654, and 0.698, respectively).

Key Takeaway: Hip arthroscopy for FAI in patients with Beighton score 8-9 yields 52.2% PASS achievement at 3 months versus 76.0% in controls, but outcomes normalize by mid-term follow-up.

Key Takeaway: High-dose GLP-1 RA therapy was not associated with increased pseudarthrosis (4.0% vs 3.8%, p=0.822) or any measured perioperative complication compared to standard-dose GLP-1 RA after ACDF, while both dose groups showed lower pseudarthrosis rates than matched non-users.

Key Takeaway: A three-tier risk-adapted MoM surveillance model achieved sensitivity of 0.84 and AUROC of 0.67 while reducing annual follow-up burden from 69% to 53% of patients and saving £46,000–£59,000 per 1,000 patients annually compared to the MHRA protocol.

Key Takeaway: TT-TG distance achieved the highest diagnostic accuracy (AUC 0.965) for pathological tibial tubercle lateralization but had lower interobserver reliability (ICC >0.75) compared to TT-RA (ICC >0.85) and TT-ME (ICC >0.85), while TT-PCL showed no discriminatory value between patellar dislocation and control groups.

Key Takeaway: Cemented femoral fixation in FNF arthroplasty reduces periprosthetic fracture risk by 79% (HR 0.21) and all-cause revision by 25% (HR 0.75), yet is used in only 39.8% of US cases with up to 14-fold state-level variation.

Key Takeaway: Alcohol use disorder increases the odds of 90-day adverse events after arthroscopic rotator cuff repair by 6.47-fold (19.03% vs 3.38%), with pneumonia carrying the highest individual OR at 9.08.

Key Takeaway: Cementless TKA utilization grew from 2.4% to 9.9% (CAGR 26.7%) among Medicare beneficiaries 2016–2022, but Hispanic dual-eligible patients had 14% lower adjusted odds (OR 0.86) of receiving cementless fixation versus White non-dual-eligible patients.

Key Takeaway: A four-component SSI prevention bundle reduced surgical site infection after spinal fusion from 2.9% to 0.4% (absolute risk reduction 2.5%, p=0.033) in a single-center before-and-after study.

Key Takeaway: Preoperative SWE stiffness correlates with collagen disorganization (ρ=0.56, p=0.02) and cellularity grading (ρ=0.45, p=0.04) in torn supraspinatus tendons, but not with overall Bonar score.

Key Takeaway: PAO for borderline hip dysplasia achieves >95% MCID and PASS rates on mHHS and HOOS at mean ~47 months, with no additional benefit from concomitant hip arthroscopy across any clinical or radiographic outcome.

Key Takeaway: PT-LTR (AUC 0.903, cutoff 4 mm) and the novel PTIA (AUC 0.866, cutoff 16°) discriminate adolescent patellofemoral instability from controls with excellent diagnostic accuracy, including in knees with normal TT-TG distance.

Key Takeaway: Unplanned metastatic spine tumor surgery is associated with worse short-term survival (67% of studies) and higher complication rates (57% of studies), but long-term survival differences disappear beyond 3 months, while resource utilization remains persistently worse with 88% of studies reporting prolonged hospitalization.

Key Takeaway: GJL patients after ACLR have 2.62× higher odds of positive Lachman and 2.25× higher odds of positive pivot-shift versus non-GJL patients, with a non-significant trend toward higher graft failure (9.2% vs. 6.1%, OR=3.15, p=0.07).

Key Takeaway: In work-related AO Spine type A1 thoracolumbar compression fractures, vertebroplasty was associated with a median sick-leave of 62 days versus 144.5 days for bracing and 178 days for arthrodesis—a 3.1-fold difference between the shortest and longest groups.

Key Takeaway: ACLR with LET was associated with a 2.24-fold higher hazard of ICD-coded knee osteoarthritis at 5 years and a 65% higher odds of arthrofibrosis-related procedures at 1 year compared to isolated ACLR in a propensity-matched cohort of 10,042 patients.

Key Takeaway: After anterior cervical fusion, radiographic ASD occurred in 35.2% of patients at mean 2.2 years, but MRI-confirmed compression, clinical ASD, and reoperation rates were 7.8%, 3.0%, and 2.3%, respectively, confirming a staged progression model.

Key Takeaway: Robot-assisted fracture reduction achieved better Matta reduction quality than manual closed reduction with navigation (adjusted OR 0.139 for worse grade, p=0.001) and a 2-point higher Parker Mobility Score at 1 year in FFP type III/IV patients.

Key Takeaway: In hip-spine syndrome, patients treated within 1 year between THA and lumbar fusion showed greater ODI improvement at 12 months (P=0.004) compared to those treated >1 year apart, despite similar final HOOS scores.

Key Takeaway: PPSF achieved a significantly lower Cobb angle than OPSF at two years (6.7° vs. 9.1°, P=0.049), with a difference that was not detectable at one year.

Key Takeaway: Each one-grade increase in preoperative Goutallier multifidus fatty infiltration reduces the odds of achieving ODI MCID by 27% (OR 0.73) at two years after LSS surgery.

Key Takeaway: Discontinuous thoracolumbar fractures account for 4.2% of all spinal fractures, and 44.1% of second fractures are initially missed at presentation, with 94.6% recognized within 48 hours.

Key Takeaway: Among 41 ECMO patients who developed atraumatic compartment syndrome, in-hospital mortality was 54%, amputation occurred in 16% of survivors, and 74% of survivors had persistent neurological deficits.

Key Takeaway: Surgeon-placed iliac fascia catheters (SIFBAF) reduced median 3-day morphine consumption to 5.0 mg versus 12.7 mg without regional analgesia, but this difference was not statistically significant (p=0.123).

Key Takeaway: Polyethylene inserts ≤7 mm carried a 3.05× higher reoperation rate (33.3% vs 19.3%, p=0.04), while talar downsizing showed no significant effect on revision risk (OR 0.66, p=0.36) at mean 4.1-year follow-up.

Key Takeaway: In PS-TKA, kneeling stress radiography (Δ-TPFA AUC 0.68, OR 1.30/mm) and the posterior sag sign (specificity 82.6%, OR 3.26) independently predict subjective flexion instability, while the 90° anterior drawer test does not discriminate (p=0.41).

Key Takeaway: In elite athletes with PTS ≥10° and failed ACLR, combining supratuberosity slope-reducing osteotomy with revision ACLR achieved 100% return to preinjury sport level at a mean of 12.1 months with no graft failures at mean 58.8-month follow-up.

Key Takeaway: K-wire-related osteomyelitis after pediatric closed fracture fixation carries a 73.3% rate of septic arthritis and 60% rate of premature physeal closure, yet all 16 patients achieved good functional outcomes at mean 2.1-year follow-up with aggressive surgical debridement and antibiotic-impregnated bone graft.

Key Takeaway: Competitive athletes undergoing combined hip arthroscopy and periacetabular osteotomy for dysplasia achieved a 93.2% return-to-sport rate, with 86.4% returning to the same or higher level of competition at mean 47.8 months follow-up.

Key Takeaway: Gluteus minimus indentation was present in 7% of hips with nontraumatic pain, occurring in 22% of dysplastic hips (LCEA <22°) versus 4% of non-dysplastic hips, and each 5° decrease in LCEA conferred 1.5× higher odds of its presence.

Key Takeaway: After medial open-wedge HTO with a mean coronal correction of 9.3°, patellofemoral coronal alignment changes were substantially smaller (patellar ridge 3.0°, quadriceps femoris 6.8°) and did not meaningfully correlate with KOOS subscales or ICRS cartilage grade changes.

Key Takeaway: A consensus-based confirmatory/suggestive diagnostic framework for fracture-related infection (FRI) now standardizes evaluation, replacing ad hoc criteria, though specific numerical thresholds for serum and synovial markers remain incompletely validated.

Key Takeaway: Manually contoured femoral head and neck allograft achieves 92% tibial and 78–82% femoral tunnel filling by CT at a mean of 123 days, with lower cost than prefabricated dowels.

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

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

Key Takeaway: Combined TAA with custom 3D-printed total talus replacement achieved 100% radiographic osseointegration at mean 36.8 months, with a 33.3% complication rate and 11.1% reoperation rate including one below-knee amputation.

Key Takeaway: Sports-related TSI nearly quadrupled during warm versus cold months (22 vs. 5 cases, p=0.001), driving a significant seasonal surge in overall TSI volume at a rural Lake Como trauma center.

Key Takeaway: A novel CT-based tibial tunnel classification system for failed ACLRs demonstrated reproducible categorization into 5 sagittal morphologies and 3 axial offset types, with 74.7% of tunnels within 2.5 mm of the native footprint (ICC=0.84).

Key Takeaway: Poor reduction (>10 mm residual displacement) independently reduced EQ-5D index score by 0.22 points at mean 6.7-year follow-up after operative fixation of AO/OTA 61B/C pelvic ring injuries.

Key Takeaway: In 127 symptomatic Japanese patients, talocalcaneal coalition was the most common type (56.7%), with posterior facet involvement predominating (73.6%), contrasting with Western and prior East Asian reports emphasizing middle facet or calcaneonavicular predominance.

Key Takeaway: A structured three-step anterior-only reduction strategy via deltopectoral approach achieved 100% fracture union and a mean Constant-Murley score of 85.4 in 16 patients with locked posterior proximal humerus fracture-dislocation, with zero AVN, recurrent dislocation, or reoperation at mean 21.2 months.

Key Takeaway: Across 39 TSA outcomes studies (n=19,674), the ASES score dominated reporting (66.7% of studies) but MCID, SCB, and PASS thresholds were derived with widespread methodological variability, preventing meaningful cross-study comparison.

Key Takeaway: Delphi consensus among 40 experts reached unanimous agreement that high-grade pivot shift and revision ACL surgery, and very strong consensus that high-risk pivoting-sport athletes, are indications for ALLR or LEAP augmentation.

Key Takeaway: International Delphi consensus (n=37 revision THA experts, 32 countries) reached agreement on only 15 of 48 statements, with visible component motion under compression, distraction, internal or external rotation as the sole strongly agreed-upon indicator of intraoperative loosening.

Key Takeaway: Simulated labral tear increased superior peak contact stress by 27% and reduced total contact area by 21%, while repair with 5 suture anchors restored contact area to within 10% of intact and reduced superior peak stress by 45% versus intact.

Key Takeaway: A radiographic method for measuring native femoral flexion on standard lateral knee radiographs achieves ICC 0.86 agreement with CT-based reference and a mean bias of only 0.35° in 48 knees.

Key Takeaway: In 55 EOS patients retained on growing rods without final fusion, 92.7% maintained satisfactory spinal balance at skeletal maturity with only 7.3% requiring unplanned definitive fusion.

Key Takeaway: Prosthetic revision for periprosthetic humeral fracture after rTSA carries a 3.7-fold higher complication risk versus nonoperative management with no difference in ASES, SSV, or Constant scores at mean 42-month follow-up.

Key Takeaway: Most hand surgery AI tools are validated only on training-similar datasets and lack post-deployment audit, prompting a four-part stewardship framework for responsible clinical adoption.

Key Takeaway: Two novel AOT assistive devices (sizing template + impactor rod) yielded VAS improvement from 7.1 to 1.4 and MOCART score of 72.6 at mean 69.1 months in 34 patients with large talar OLTs.

Key Takeaway: Across 9 included studies, only 23 of 594 patients were explicitly identified as undergoing revision ACLR after failed combined ACLR with a lateral extra-articular procedure, revealing a critical evidence gap in this increasingly common clinical scenario.

Key Takeaway: LP-PRP injection during rotator cuff repair reduced structural failure rate by 45% (15.9% vs 29.0%, OR 2.16) but produced no clinically meaningful improvement in any patient-reported outcome measure.

Key Takeaway: High ADI (≥75th percentile deprivation) was independently associated with a twofold increased risk of death (HR 2.0, 95% CI 1.1–3.9) and a 28-percentage-point lower 5-year overall survival (37% vs 65%) in pediatric and young adult osteosarcoma patients, while COI, poverty level, insurance type, and race/ethnicity showed no survival difference.