Weekly Digest

Key Takeaway: At 5 years, fully uncemented trabecular-metal TKA produced significantly fewer non-progressive radiolucent lines than cemented TKA (2 vs. 27 cases, RR 0.50, p<0.001) with equivalent PROMs and revision rates.

Key Takeaway: LR-PRP reduced partial CET tear size and soft tissue edema more than saline, but neither PRP formulation demonstrated overall superiority to saline injection at 6-month MRI follow-up in a double-blind RCT of 71 patients.

Key Takeaway: In a 2×2 factorial RCT of 303 TKA patients, robotic-assisted surgery and functional alignment each failed to improve KOOS-12 at two years compared to computer-assisted surgery and mechanical alignment (mean differences -2.8 and 0.3 points, respectively; both p>0.1).

Key Takeaway: Meta-analysis of 6 RCTs (n=374) found no significant difference between hamstring and quadriceps tendon autografts in re-rupture rate (RR 1.03, p=0.96), pivot-shift positivity (RR 0.42, p=0.42), IKDC, or Lysholm scores, with one study suggesting lower donor-site morbidity with quadriceps tendon.

Key Takeaway: Intraoperative surgeon bone-quality assessment correlates with CT Hounsfield units (r=0.66) with 84% sensitivity and 97% specificity for detecting abnormal bone quality across multiple anatomic sites.

Key Takeaway: Among 5,429 satisfied THA patients, 19% were misclassified as 'unsuccessful' by the CMS ≥22-point HOOS-JR improvement threshold, with every 10-point higher baseline HOOS-JR score increasing misclassification odds 2.7-fold.

Key Takeaway: Preoperative heel decubitus ulceration within 4 weeks of ORIF for rotational ankle fractures is associated with significantly elevated rates of 90-day SSI, sepsis, and mortality, as well as markedly higher 1- and 3-year rates of nonunion, revision surgery, and below-knee amputation (all P < 0.0125).

Key Takeaway: In 575 rotating-hinge TKAs at mean 6-year follow-up, 10-year survivorship free from aseptic loosening was 90%, but PJI-reimplantation cases carried double the revision risk (HR=2) with only 73% survivorship free from re-infection at 10 years.

Key Takeaway: rTSA dominates all other PHF treatment strategies in patients ≥65, producing 7.16 QALYs at 10 years with an ICER of $6,374/QALY—well below the $50,000/QALY willingness-to-pay threshold.

Key Takeaway: MRI-to-synthetic CT navigation eliminated preoperative CT radiation (saving 19.6 mSv) while matching CT-based navigation intraoperative fluoroscopy time (~47–48 seconds) and effective dose (~0.55–0.57 mSv) in pediatric AIS fusion.

Key Takeaway: 3D CT analysis of 100 failed shoulder arthroplasties identified two distinct glenoid defect clusters differing significantly in 6 morphologic parameters, with Cluster A showing greater height, thickness, retroversion, and smaller radii of curvature than Cluster B.

Key Takeaway: Four machine learning models predicted MI (AUC 0.82–0.91) and cardiac arrest (AUC 0.76–0.94) following periprosthetic fracture surgery using preoperative labs, with elevated creatinine, WBC, and sodium and lower BMI as the dominant predictors.

Key Takeaway: rTSA for GHOA with intact cuff yields 47% lower revision rate (OR 0.53) and 43% lower overall complication rate (OR 0.57) compared to cuff-deficient indications across 20,924 patients.

Key Takeaway: Neither proximal nor total screw density is associated with reoperation to promote union in lateral bridge plating of distal femur fractures, with mean TSD of 0.60 vs. 0.61 (p=0.98) between union and nonunion groups across 1,272 patients.

Key Takeaway: 88.9% of golfers returned to play after shoulder arthroplasty at mean 24.3 months, with no significant difference in return rate or performance between rTSA (95.6%) and aTSA (90.0%), though revision arthroplasty independently predicted worse perceived golf performance.

Key Takeaway: GPT-4o and o4-mini aligned with institutional consult criteria in 92.4% and 94.9% of proximal humerus fracture cases respectively, versus 32.7% for ED providers, potentially eliminating 183 of 240 consults over two years.

Key Takeaway: A threshold of ≥2 preoperative instability episodes predicts recurrent anterior shoulder instability after arthroscopic Bankart repair with an AUC of 0.72 and OR of 9.70 (95% CI, 2.63–35.70).

Key Takeaway: Syndesmotic repair rates in trimalleolar ORIF increased from 10.1% to 29.3% over 2010–2021 regardless of posterior malleolus fixation status, refuting the hypothesis that posterior lip fixation reduces syndesmotic repair frequency.

Key Takeaway: Revision THA for instability increased from 9,870 to 16,228 cases annually in the U.S. from 2012 to 2022, with projected volume of 28,830 cases and cumulative hospital charges of $533 million by 2035.

Key Takeaway: An attention-guided deep learning model (U-Net++ segmentation + EfficientNet B1 classifier) detected SCFE on pelvic radiographs with AUC 0.893, 93.3% sensitivity, and 90.0% specificity on a 35-image test set.

Key Takeaway: Total shoulder arthroplasty volume increased 212% from 55,245 to 172,559 procedures between 2012 and 2022, with projected volumes reaching 334,000–905,000 by 2035—a growth rate exceeding both THA (45%) and TKA (25%) over the same period.

Key Takeaway: Fixed-bearing medial UKA in patients >80 years yields OKS improvement equivalent to patients ≤70 years at 5 years, with a non-significant revision risk ratio of 0.57 (95% CI 0.174–1.876).

Key Takeaway: Glenoid rotation of as little as 5 degrees from the mathematically true en-face view produces statistically significant errors in best-fit circle diameter, position, and calculated bone loss percentage in AI-generated CT reconstructions of 40 instability patients.

Key Takeaway: Pooled analysis of 18,103,890 participants yields a non-significant risk ratio of 0.88 (95% CI, 0.77–1.01), indicating hormonal contraceptives do not meaningfully reduce ACL injury risk in females.

Key Takeaway: Among 44 failure cases after one-stage revision TKA for chronic PJI, history of multiple prior failed surgeries (OR 13.27) and operative time >150 minutes (OR 5.11) were independent risk factors for both failure and reinfection, with 84.1% of failures occurring within two years.

Key Takeaway: Psychiatric diagnoses are associated with 2.53x higher odds of hip arthroscopy revision (OR 2.53; 95% CI 1.87–3.43) and 1.76x higher odds of arthroscopy failure, but no increased conversion to THA.

Key Takeaway: Femoral component rotation within 3° of internal or external rotation (relative to PCA) produced significantly better Forgotten Joint Scores, KOOS-JR improvement, and ROM compared to components rotated >3° externally, with lateral patellar translation minimized specifically in the 0–3° internal rotation group (P=0.002).

Key Takeaway: High baseline resilience (BRS ≥3.7) independently predicted 12.4-point better PROMIS Global Mental Health and 6.7-point better Physical Function at 6 months following operative acetabular fracture fixation.

Key Takeaway: Intraoperative fractures during primary TKA occur at 0.21% incidence (43/20,089) but yield 5-year reoperation-free survival of 93% versus 91% in matched controls (HR 0.97).

Key Takeaway: Throwing exposure increased capitellar subchondral bone density (mean HU 962 vs 884, p=0.044) in collegiate baseball players, but batting handedness produced no detectable side-specific capitellar loading difference.

Key Takeaway: Black patients had a 29% higher unadjusted PJI incidence after TKA versus White patients, but this disparity disappeared after propensity score matching (HR 1.11, p=0.119), implicating comorbidity burden rather than race as the independent driver.

Key Takeaway: In 54 transfemoral amputees undergoing osseointegration, lower limb-loss-adjusted BMI was the strongest predictor of improved patient-reported outcomes and fewer infections at 2 years, explaining up to 26% of variance in PROMIS Pain scores (R²=0.26, p<0.001).

Key Takeaway: High-volume RA-TKA centers (≥12 cases/month) achieved mean operative times of 85.9 minutes and 66.8% efficiency benchmark attainment, versus 100.4 minutes and 39.7% at low-volume centers across 156,347 cases.

Key Takeaway: Despite ORIF carrying higher 90-day mortality (5.2% vs 3.5%, OR 1.5) and acute THA carrying higher 2-year implant complication rates (PJI 6.8% vs 3.8%, instability 7.7% vs 3.0%), cumulative reoperation rates were statistically equivalent through 10 years (p=0.53 at 2 years).

Key Takeaway: After ACDF, 69.5% of preoperative opioid users and 70.9% of gabapentinoid users ceased repeated purchases within the first postoperative year, while new strong-opioid initiation occurred in only 2.2% of previously opioid-naïve patients.

Key Takeaway: At 6 months post-acetabular ORIF, female sex and nonwhite race—not fracture complexity or ISS >16—independently predicted worse PROMIS scores across multiple domains including pain interference, global physical health, depression, and anxiety.

Key Takeaway: After ASD spinopelvic fusion, L1PA increases by ~3° and T4PA by ~4.4° between intraoperative prone and 6-week postoperative standing radiographs, a phenomenon termed 'VPA settling.'

Key Takeaway: In Danis-Weber Type A fractures managed nonoperatively, medial soft-tissue compromise (Subtype A2) drives union failure (83% vs. 98%) and severe pain (35% vs. 20%) independent of fracture displacement.

Key Takeaway: After posterior lumbar decompression and fusion, patients ≥80 years had a 21.17x higher odds of non-home discharge (OR=21.17, P<0.001) but achieved equivalent mortality, readmission, revision rates, and PROM improvement compared to younger cohorts.

Key Takeaway: A Firth's regression-derived prediction calculator for CT-occult ASIA D spinal cord injury achieved 97.3% sensitivity and 94.7% NPV at a 7-point threshold in a cohort where 31% of TSCI patients had no CT-evident vertebral injury.

Key Takeaway: In varus TKA patients at 5 years, inverse kinematic alignment produced a clinically meaningful 4-point higher Oxford Knee Score (44.2 vs 40.2) and 19-point higher Forgotten Joint Score (78.5 vs 59.4) compared to adjusted mechanical alignment.

Key Takeaway: Selective superficial deltoid ligament repair in SER IV ankle fractures with residual medial clear space 5–10 mm after syndesmotic fixation yielded AOFAS scores of 92.1 vs 72.1 at minimum 4-year follow-up (p<0.001), with absence of repair independently predicting poor outcome (adjusted OR 16.4).

Key Takeaway: Each step-change in joint line obliquity disruption after TKA was associated with a 3.98-point worse WOMAC score (p=0.02) and 3.15-fold increased aseptic revision risk (p=0.04), while change in aHKA was not associated with either outcome.

Key Takeaway: Diabetes mellitus increases deep infection risk 5.4-fold and nonunion risk 2.67-fold after ORIF of open ankle fractures, with complicated DM driving deep infection risk to 7.67-fold versus non-diabetic patients.

Key Takeaway: Lower-limb CMCT correlated positively with MRI Contrast Ratio (r=0.209, p=0.01), and multivariate analysis identified male sex, intramedullary signal change, and lower JOA score as independent predictors of surgical intervention in DCM.

Key Takeaway: In 58 patients treated with MIPPO for distal tibial metaphyseal fractures, time to weight-bearing was not an independent predictor of 12-month AOFAS scores; fracture complexity (AO 43-A3) and higher BMI were the dominant outcome predictors.

Key Takeaway: The HBA-3 score (HU <131, BMI >30, age ≥60) stratifies cage subsidence risk from 12.5% to 50.0% after single-level TLIF, but subsidence did not correlate with ODI, EQ-5D, or satisfaction at 12 months.

Key Takeaway: Contemporary THA for SCFE sequelae achieves 98% 15-year survivorship free of aseptic revision with Harris Hip Score improving from 57.1 to 89.2 at 10 years.

Key Takeaway: Robot-assisted mono-segment fixation with vertebral body grafting achieved equivalent 12-month sagittal Cobb angle correction (mean difference -0.07°, 95% CI within ±2.0° MCID) versus short-segment fixation while reducing operative time by 27 minutes and blood loss by 44 mL.

Key Takeaway: Double-sided VBT in skeletally immature AIS patients with double curves achieved 87% thoracic (48° to 6°) and 91% lumbar (45° to 4°) curve correction at mean 5.4-year follow-up, with 2/13 patients requiring conversion to posterior spinal fusion for overcorrection.

Key Takeaway: At mean 82.2 months follow-up, zero of 45 shoulders required revision for symptomatic glenoid loosening after aTSA with an Arthrosurface inlay glenoid, with no significant radiolucency progression on radiographs in 30 patients with 5-year imaging.

Key Takeaway: Suture anchor repair of posterior medial meniscal root tears achieves a clinical failure load of 48.6–74.0 N versus 19.9–56.7 N for transtibial pull-out, with superior cyclic displacement, stiffness, and contact area across all 7 included biomechanical studies.

Key Takeaway: In Favard E3 glenoids, peak cortical and trabecular bone density concentrates in the peripheral superior-anterior quadrant (rings 8–9), while the peripheral inferior-posterior quadrant shows the lowest density (both p<0.001).

Key Takeaway: In nonoperative clavicle fractures in children aged 1–10, only 3.2% required a management change, with 81% of those changes occurring after the first follow-up radiograph, supporting elimination of routine second follow-up imaging.

Key Takeaway: All-arthroscopic autologous cancellous bone grafting from Gerdy's tubercle for large cystic OLTs (mean cyst diameter 13.5 mm, depth 8.4 mm) improved AOFAS from 53.9 to 88.2 and achieved complete defect filling on MRI in 71.8% of patients at mean 27.6 months.

Key Takeaway: Despite ICU admission and individualized MAP goals after intraoperative neuromonitoring changes, 95% of pediatric spine patients failed to continuously meet their MAP target, spending an average of 27% of the first 24 postoperative hours (6.4 hours) below goal.

Key Takeaway: The MPFL femoral attachment varies up to 13.6 mm in the AP direction across cadaveric studies, with a pooled range spanning 4.80 mm posterior to 8.80 mm anterior to the posterior cortical extension line, exceeding the 3 mm surgical tunnel radius threshold in multiple studies.

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

Key Takeaway: CBCT-guided cement-augmented percutaneous pelvic screw fixation achieved 100% technical success in 51 fragility fracture patients with a mean operative time of 51.3 minutes, but 2 of 76 screws required reintervention for hardware-related adverse events.

Key Takeaway: Pressed LHBT autograft augmentation increased ultimate load to failure by 63% at 6 weeks (51.5 N vs 31.5 N) in a rat infraspinatus repair model.

Key Takeaway: Knotless suture bridge repair matched knotted suture bridge biomechanical performance by 8 weeks while demonstrating superior histological tendon-to-bone integration—including fibrocartilage regeneration and collagen organization—at 4 and 8 weeks in a rabbit model.

Key Takeaway: Re-revision TKA management centers on four technical pillars—extensile exposure, impaction grafting, porous metal augmentation, and patella reconstruction—though no outcome data with specific numbers are reported in this symposium paper.

Key Takeaway: BMP-7 application in a rat rotator cuff repair model produced significantly higher stiffness and Young's modulus than LMWPS at 4 weeks (p=0.013 and p=0.011, respectively), while LMWPS increased vascularity but yielded the lowest stiffness among all groups.

Key Takeaway: Vitamin D deficiency affects 13–63% of TJA patients and is associated with increased complications, higher infection risk, and impaired functional scores, with targeted repletion showing favorable outcomes.

Key Takeaway: Ultrasound detected lateral hinge fractures after open wedge proximal tibial osteotomy with 100% sensitivity and 93.9% specificity versus CT, and dynamic hinge widening correlated with time to union (r=0.56).

Key Takeaway: Greater surgical experience with the CapFlex-PIP prosthesis was associated with an 83% reduced risk of implant-related problems and a 76% reduced risk of revision surgery over up to 10 years.

Key Takeaway: In FEA models of braced humeral shaft fractures, higher adipose-to-muscle ratio and smaller arm diameter both independently increased fracture site Perren strain, suggesting these patient factors may compromise healing during functional bracing.

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

Key Takeaway: The AFIS-CL posterior reduction technique achieved satisfactory radiographic reduction without neurovascular complications or secondary displacement in all 5 patients with vertically unstable pelvic ring injuries.

Key Takeaway: In a Sawbone model of biplanar MOWHTO, three sagittal cutting plane orientations (parallel, 10° anterior-inclined, 10° posterior-inclined) produced ΔPTS differences that never exceeded the 2.5° MCID threshold, with Bayesian equivalence assurance >86% across all comparisons.

Key Takeaway: Medial clear space cutoffs vary from >1 mm to >6 mm across deltoid ligament repair studies, rendering pooled analyses uninterpretable and functional outcome comparisons invalid.

Key Takeaway: Intramedullary double nail fixation of transverse patellar fractures produced 73% less fragment displacement (0.55 mm) than tension-band osteosynthesis (2.04 mm) over 1,000 simulated knee flexion cycles.

Key Takeaway: Metaphyseal cones and sleeves achieve bone ingrowth fixation that reduces reliance on diaphyseal stem engagement, with survivorship data supporting their use as a primary metaphyseal fixation strategy in revision TKA.

Key Takeaway: Palmar plate plus headless compression screw fixation of AO/OTA 23-C2.1 distal radius fractures produces significantly greater initial radial-shaft rotation (1.14° vs. 0.51°, p=0.02) and progressive ulnar-shaft rotation after cyclic loading compared to radiopalmar double plating, despite equivalent axial stiffness.

Key Takeaway: Post-traumatic Candida tenosynovitis caused bilateral wrist rice body formation requiring two-stage debridement on the recurrent side, with complete resolution only after radical re-excision at 6 months.