Weekly Digest

Key Takeaway: At mean 63-month follow-up, VBT achieved a final instrumented Cobb angle of 25.7° from a preoperative mean of 47.9°, but 66% had radiographic tether breakage and 21.6% required unplanned return to the OR.

Key Takeaway: Combined iPACK + ACB reduced 48-hour opioid consumption by 3.2 mg MME versus two-level lumbar-sacral ESPB (9.7 vs 12.9 mg MME; p=0.035) in elderly TKA patients.

Key Takeaway: 72.4% of TKA patients achieved MCID on KOOS JR by 12 months, but 9.9% were delayed achievers (by 24 months) and 11.0% failed to maintain early MCID gains.

Key Takeaway: Serial MRI at 3 and 8 months post-IFN showed peroneal tendon thickness equivalent to healthy controls (brevis 2.9 vs 2.8 mm, longus 3.4 vs 3.4 mm; TOST p<0.001) with zero MRI-detectable pathology across 102 patients.

Key Takeaway: In geriatric patients undergoing THA or TKA, median Geriatric Depression Scale scores declined from 8.5 to 4 at 3 months in those with elevated baseline symptoms (GDS 6–15), with most improvement occurring in the early postoperative period.

Key Takeaway: Pooled pelvic insufficiency fracture incidence after pelvic radiotherapy is 17% (95% CI: 15–20%) across 11,272 female patients, with sacral/SI joint involvement in 71% of cases and definitive RT carrying a 25% fracture rate versus 6% with adjuvant RT.

Key Takeaway: Late sarcoma specialist consultation (>2 months) after unplanned excision independently increased the odds of 5-year metastasis 7.1-fold (OR=7.11) and mortality 11.3-fold (OR=11.29) compared to consultation within 2 months.

Key Takeaway: Adding lower trapezius transfer to LHBT-based superior capsular reconstruction improves postoperative external rotation by 14.7° (35.3° vs 20.6°, p<0.001) and reduces infraspinatus retear rate from 27.8% to 5.6% (OR=0.11) in massive posterosuperior irreparable rotator cuff tears with Goutallier ≥3 fatty infiltration.

Key Takeaway: Dual mobility THA reduced 5-year dislocation incidence from 4.8% to 0.5% compared to conventional THA in femoral neck fracture patients without increasing overall revision rates.

Key Takeaway: Spinal opioid and epidural analgesia reduce total opioid consumption by more than 50% compared to PCA (1.7 and 1.9 vs. 4.1 OME/kg) after posterior spinal fusion for AIS, without improving pain scores, complication rates, or length of stay.

Key Takeaway: All three patella-related complications (including two reoperations) in 932 RA-TKA cases occurred exclusively in the valgus-internal rotation femoral component cohort (Val-IR, 15% of cases), despite no significant difference in KOOS JR or PROMIS scores at one year across alignment groups.

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) of any major arthroplasty.

Key Takeaway: Early dislocation within 90 days of primary THA carries a 29.0% rate of recurrent dislocation or aseptic revision by 2 years versus 1.3% in controls, with HR 22.6 for all-cause revision.

Key Takeaway: Iliopsoas tunnel deepening achieved 78.8% resolution of painful internal snapping at minimum 2-year follow-up, equivalent to the 81.8% resolution seen with fractional lengthening (P=.76).

Key Takeaway: Ischiopubic synchondrosis fusion before age 5 years is associated with an 82.9% rate of residual acetabular dysplasia after closed reduction for DDH, versus 63.2% in those fusing at age 5 or older.

Key Takeaway: Excessive femoral anteversion (>25°) is associated with significantly worse 2-year PROMs after hip arthroscopy for FAIS, including iHOT12 scores of 79.1 vs 95.1, and a 75% vs 29.4% prevalence of anteroinferior labral tears.

Key Takeaway: High-risk TJA patients (Elixhauser Index ≥95th percentile) are concentrated at teaching hospitals at a significantly higher rate than non-teaching hospitals (7.39% vs. 6.16%, p<0.001), with teaching hospital comorbidity burden increasing while non-teaching hospitals decreased by 0.2 EI points from 2016–2023.

Key Takeaway: Surgical reconstruction of cleft foot in 101 feet reduced forefoot splay angle from 36.14° to 21.39° (P<0.001) with an 8% revision rate over mean 3.7-year follow-up.

Key Takeaway: PJI patients presenting with concomitant sepsis had 81.4% all-cause mortality during follow-up versus 50.6% in non-septic PJI patients, with hip sepsis patients reaching only 42% one-year survival.

Key Takeaway: Gravity varus stress CT reduced the false-negative rate for detecting instability in isolated coronoid fractures from 82% (static CT) to 11% (p<0.001).

Key Takeaway: Osteoporotic UKA patients had significantly lower KSS functional scores and FJS than normal-BMD patients at mean 32-month follow-up, and within the osteoporotic cohort, mobile-bearing prostheses outperformed fixed-bearing on KSS functional score (P=0.007) and FJS (P=0.026).

Key Takeaway: Patients with the highest preoperative anxiety/depression scores achieved MCID on iHOT-12 at significantly lower rates than those without (47% vs 63%, P=.031) after hip arthroscopy for FAI syndrome.

Key Takeaway: PsA patients undergoing THA carry a 4.7-fold increased odds of 90-day sepsis and 2.9-fold increased odds of deep SSI compared to controls, while PsC patients show a 2.3-fold increased superficial SSI risk and 2.8-fold sepsis risk.

Key Takeaway: In propensity-matched elderly patients with acetabular fractures, ORIF carries a 69% higher relative risk of revision arthroplasty at 2 years compared to acute THA (10.4% vs 6.1%), but acute THA has significantly higher early infection (7.1% vs 4.5%) and dislocation (5.7% vs 4.3%) rates.

Key Takeaway: In 161,326 patients with concomitant lumbar fusion and THA, operative order (SAHA vs. HASA) produced no significant difference in hip dislocation, mechanical loosening, periprosthetic fracture, DVT, infection, or revision rates (3.6% vs. 2.6%, P=0.5).

Key Takeaway: CMT cavovarus demonstrates forefoot adduction 3× greater than controls and a significantly lower transverse arch plantar angle (94.2°) versus idiopathic cavus (100.5°) and controls (102.7°), confirming quantifiable multiplanar morphologic distinctions on WBCT.

Key Takeaway: Patient-specific CT-derived finite element models predict TLIF cage subsidence with AUC=0.809 (average trabecular intermediate strain), outperforming cage length (AUC=0.797), cage width (AUC=0.750), and cage height (AUC=0.698).

Key Takeaway: AOPT for large cystic OLTs yields equivalent FAOS improvement (~35 points) and MOCART 2.0 scores (~73) regardless of lesion laterality at mean 84.6 months follow-up.

Key Takeaway: Outpatient single-level ALIF/LLIF demonstrated higher 5-year revision-free survival (log-rank P=0.007) and 40% lower median 90-day global reimbursements ($5,169 vs. $6,779) compared to matched inpatient controls.

Key Takeaway: CFL injury on preoperative MRI independently predicts recurrent instability after arthroscopic ATFL repair with an OR of 9.00 (95% CI 1.95–56.22), with thin-type CFL morphology carrying a 31.5% recurrence rate.

Key Takeaway: Primary displacement ≥3 mm carries a 6.7-fold increased odds of complications in pediatric proximal radius fractures, with surgical treatment itself associated with 5.0-fold greater odds of unfavorable functional outcome.

Key Takeaway: Soft bandage management of pediatric distal radius torus fractures reduced total societal cost by 33–47% compared to short and long arm splints ($23.46 vs $34.82 vs $44.06), with a projected $7,773 combined saving over the study period.

Key Takeaway: WNT7B is the most strongly upregulated gene in fracture and PTOA synovium, with WNT pathway activation significantly broader in PTOA than in nontraumatic OA, supporting a molecularly distinct PTOA subtype.

Key Takeaway: Stem subsidence (≥5 mm) occurred in 13.2% of RSA press-fit short stems, with metaphyseal filling ratio <70% (OR 0.90) and osteoporosis (OR 3.2) as independent predictors.

Key Takeaway: Despite statistically significant reductions in preoperative EQ-5D-5L scores during COVID-19, the adjusted mean difference was ≤0.03 points—not clinically meaningful—while THA and TKA patient satisfaction paradoxically increased by approximately 5 percentage points during the pandemic.

Key Takeaway: EOS and lateral pelvic radiographs agreed on only 9 of 24 total high-risk patients identified (37.5% overlap), with a mean sit-to-stand sacral slope discrepancy of 7.2° between modalities.

Key Takeaway: The overall incidence rate of pediatric extremity fractures in Denmark was 3,164 per 100,000 persons/year over 20 years, with forearm fractures most common and upper/lower leg fractures the only anatomical sites showing a declining trend.

Key Takeaway: MIS and open talonavicular arthrodesis produced equivalent AOFAS gains (36.2 vs. 30.9 points) at mean 361-day follow-up with no significant difference in operative time (59.2 vs. 69.6 min).

Key Takeaway: Bipolar patellofemoral OCA transplantation had a 25% structural graft failure rate versus 0% for unipolar, but cumulative lesion area—not bipolarity per se—was the independent predictor of failure (OR 1.005 per mm²).

Key Takeaway: Cementing a polyethylene liner into Harris-Galante II shells yielded 77% survivorship free from acetabular cup revision at 15 years with a 39% overall complication rate.

Key Takeaway: Quadriceps tendon autograft ACLR demonstrates graft failure rates of 0–24% and anterior knee pain rates of 0–5% at 5–23 year follow-up across 662 reconstructions.

Key Takeaway: MRI-based synthetic CT techniques (ZTE, UTE, 3D-GRE, and deep learning-based sCT) demonstrate high agreement with conventional CT across multiple anatomical sites, with deep learning models showing the strongest improvement trajectory despite limited training datasets.

Key Takeaway: Arthroscopic posterior labral repair in active-duty military patients yields 92.3% return to full military duty and 87.2% return to sport at mean 11.7 years, with ASES improving from 46.7 to 87.8.

Key Takeaway: Open supracondylar humerus fractures represent 1.1% of all pediatric SCH fractures and carry a 20.6% nerve injury rate and 26.5% reoperation rate.

Key Takeaway: PJI after TAA occurred at 1.3% (12/955 patients, 5.4 per 1000 person-years), with only 50% overall implant retention and 2 of 5 chronic PJI patients ultimately requiring below-knee amputation.

Key Takeaway: Anterior harvest deltoid osteomuscular transfer (DOT) from the distal clavicle significantly suppressed humeral head superior translation versus massive irreparable rotator cuff tear (MRCT) alone at 0° and 30° of glenohumeral elevation across all applied force conditions (0–30 N).

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: Both tibia-based suture anchor and capsular-based side-to-side repair of type 3 lateral meniscal oblique radial tears restored lateral compartment contact mechanics, meniscal extrusion, and anterior root forces to intact-state values, while debridement failed to do so across all four flexion angles tested.

Key Takeaway: A biomimetic hematoma scaffold delivering 42 µg rhBMP-2 achieved superior predicted torsional strength (highest pMOI, p<0.0001) in a 2.5 cm goat tibial defect compared to ACS delivering 50-fold higher dose (2.1 mg rhBMP-2).

Key Takeaway: In a rat ACLT model, detectable macroscopic joint changes and peak M1 macrophage infiltration occur by day 7, with osteoclast activity elevated from day 3, establishing a PTOA intervention window within 1 week of injury.

Key Takeaway: Lateral UKA via medial parapatellar approach achieved 97.2% 7-year survivorship with 99.0% of patients meeting KSS-Knee PASS thresholds at mean 47.6 months in 108 patients.

Key Takeaway: Modified Broström using absorbable sutures alone achieved mean AOFAS improvement of 21.4 points (66.84→88.20) with 6.3% recurrence and 1.2% reoperation rate at mean follow-up not specified.

Key Takeaway: Basicervical hip fractures (AO/OTA 31B3) show comparable long-term outcomes to intertrochanteric and valgus femoral neck fractures but carry significantly higher rates of minor in-hospital complications even after multivariate adjustment, with no significant difference in outcomes across fixation constructs within the basicervical cohort.

Key Takeaway: Preoperative anxiety (APAIS >11) in ACL reconstruction patients was associated with a 2.5-fold increase in level 2 analgesic use and a 7-fold increase in locoregional anesthesia requirement in the recovery room, but did not predict flexion contracture at 3 weeks.

Key Takeaway: A rat femur fracture model inoculated with biofilm-derived S. aureus (10⁴–10⁵ CFU/mL) and stabilized with stainless-steel hardware produced >10⁶ CFU/mL on both bone and implant at 3 weeks despite surgical debridement and cefazolin, with no significant difference in bacterial burden between compartments.

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

Key Takeaway: Protective plating with screw overlap (short or long) beyond the innermost nail interlocking screws significantly reduces interimplant femoral strains versus no-overlap or no-plate configurations under 200 N axial load in osteoporotic synthetic bone.

Key Takeaway: The Next-AR intraoperative navigation platform achieved implant alignment within a mean bias ≤1.5° of target across all six alignment parameters in cadaveric medially-stabilized TKA, with RMSE ≤2.3°.

Key Takeaway: Hyperselective neurectomy and tendon lengthening each address upper limb spasticity tone management through distinct mechanisms, but no high-level evidence currently establishes superiority of one over the other in functional or non-functional hands.