Weekly Digest

Key Takeaway: Intraoperative intraosseous morphine (10 mg) added to a multimodal protocol including spinal anesthesia and adductor canal block produced no reduction in pain scores or MME consumption at any point over 14 days post-TKA (p=0.969 for pain, p=0.377 for MME).

Key Takeaway: UKA produced significantly greater improvements in sagittal hip (β=0.11 Nm/kg·height), knee (β=0.05), and ankle moments and smaller coronal knee moment changes (β=-0.12) than TKA at one year, despite equivalent PROM improvement.

Key Takeaway: At 5-year follow-up, volar locking plate fixation produced significantly better wrist ROM and PRWE scores than combined plating for AO Type C distal radius fractures, though differences did not reach MCID, and hardware removal was required in 64% of combined plating patients versus 30% of volar plate patients.

Key Takeaway: In 1,830 high-risk primary TJA patients followed to one year, vancomycin powder, dilute povidone-iodine lavage, or their combination produced no statistically significant reduction in PJI requiring septic revision compared to saline control (THA p=0.62, TKA p=0.05).

Key Takeaway: TEA yields a statistically significant but clinically marginal 9° greater flexion-extension arc versus ORIF in patients ≥65 with intra-articular distal humerus fractures, with no difference in DASH, MEPS, complications, infection, or revision rates.

Key Takeaway: Robotic UKA patients had lower opioid consumption through POD 21, higher daily step counts across all 90 days, and earlier walking-aid cessation compared to robotic TKA, though VAS pain scores converged by day 90.

Key Takeaway: Minimally invasive SIJ fusion yields pooled VAS improvement of 45.5 points and ODI improvement of 23.3 points at mean 27.8 months, both exceeding MCID, with a 3% reoperation rate across 1,181 fusions.

Key Takeaway: At two years post-TKA, only 28% of patients returned to preoperative swelling levels, with mean BIA-measured swelling remaining significantly elevated at 5.4 ± 7.1% versus 2.06 ± 7.8% preoperatively.

Key Takeaway: A six-day oral methylprednisolone taper after primary TKA significantly reduced POD1 nausea (p<0.05) but produced only a non-significant trend toward reduced cumulative opioid consumption (95.47 vs 116.91 OME) without increasing complications.

Key Takeaway: Anterior deltoid atrophy occurred in 41.9% of RTSA patients and was significantly more common with the superolateral approach than deltopectoral (72.7% vs. 25%, p=0.021), with a 22° deficit in anterior flexion in affected patients.

Key Takeaway: In three-level cervical degenerative disease, hybrid ACDF-CDA constructs and three-level ACDF produce equivalent NDI, VAS, and JOA improvements, with hybrid surgery showing a non-significant trend toward greater ROM preservation (P=0.06) across 1,008 patients.

Key Takeaway: Perioperative ketorolac after ankle ORIF was associated with higher rates of surgical site infection and wound dehiscence at 90 days (n=29,920 matched pairs) but no difference in nonunion, malunion, or revision surgery at 2 years.

Key Takeaway: Concurrent sternal and thoracic spine fractures carry a 4.38-fold increased odds of requiring spinal decompression/fusion and 3.0-fold increased odds of thoracic surgery compared to isolated thoracic spine fractures.

Key Takeaway: VCR achieves superior 3-plane correction versus PSO (65.5% vs 56.9% major curve, 68.1% vs 61.5% segmental kyphosis, 48.5% vs 34.4% apical rotation) but carries a significantly higher neurological complication rate (15.5% vs 8.2%) and each additional degree of VCR correction confers a 1.6% increased complication risk.

Key Takeaway: PAD patients undergoing ankle ORIF face a 10.5-fold increased risk of below-knee amputation and 3.07-fold increased risk of nonunion at 2 years compared to propensity-matched controls.

Key Takeaway: Low-volume surgeons using technology assistance achieved a 90-day dislocation rate of 0.48% versus 0.42% for high-volume surgeons using conventional instrumentation (p=0.510, aOR 1.062), effectively eliminating the volume-dependent dislocation risk.

Key Takeaway: Among 202 patients undergoing isolated posterior lumbar decompression, 21.3% required fusion within 2 years, with Charlson Comorbidity Index (OR 1.32) as the only independent predictor — not MRI-based degeneration markers.

Key Takeaway: Diabetic TSA patients on SGLT-2 inhibitors had a 2.3-fold higher 90-day myocardial infarction rate compared to matched diabetic controls (2.03% vs 0.89%, P=0.001), with no difference in implant-related complications at 2 years.

Key Takeaway: Conversion TKA after HTO carries nearly twice the risk of manipulation under anesthesia (OR 1.95) and 57% higher all-cause revision risk at 2 years compared to conversion after UKA.

Key Takeaway: Outpatient in-situ fixation for stable SCFE costs $3,232 less than ED-admission management ($10,052 vs $13,285) with no difference in 90-day complications.

Key Takeaway: Revision rTSA for failed primary rTSA achieves only 59.5% survivorship at 10 years, significantly worse than revision for failed aTSA (82.1%) or failed HA (74.2%), with fewer than half of all revision rTSA patients achieving PASS at one year.

Key Takeaway: Systemic hormonal contraceptive use is associated with up to 2.0× greater odds of rotator cuff tears and 1.8× greater odds of superior labral tears compared to matched controls over 5 years.

Key Takeaway: Selective glenoid medialization in high-risk patients reduced acromial stress fracture (ASF) rate from 9.2% to 2.3%, with glenoid lateralization carrying an OR of 14.5 for ASF on multivariate analysis.

Key Takeaway: Changing surgical approach during PJI treatment occurred in 23.8% of cases and did not affect infection eradication success (87.2% overall) or dislocation rate (2.6%).

Key Takeaway: In ASD patients with low pelvic incidence (PI ≤41°), the SSS-LLMC correction strategy reduced mechanical complications to 8.6% versus 47.4% in undercorrected and 56.8% in insufficient sacral slope patients.

Key Takeaway: In primary THA, 36-mm ceramic heads with titanium sleeves carry a 34% higher all-cause revision risk (HR 1.34) versus 36-mm heads without sleeves, while ≥40-mm heads with titanium sleeves show no difference in revision risk compared to 36-mm heads without sleeves.

Key Takeaway: Complete deltoid insertion resection carries a 16.67-fold increased odds of postoperative dislocation after rTSA for proximal humerus oncological resection, with instability accounting for 13 of 17 total complications.

Key Takeaway: Cementless TKA achieved 99.5% 5-year all-cause revision survivorship versus 98.5% for cemented TKA using the same contemporary implant design, with no difference in aseptic loosening or radiolucent line prevalence.

Key Takeaway: Lower trapezius transfer achieves comparable final ASES scores (74.0 vs 70.0) and Constant scores (64.5 vs 63.9) regardless of subscapularis integrity, but patients with repaired Lafosse type II–III tears show significantly smaller internal rotation gains postoperatively (P<0.001).

Key Takeaway: Direct anterior approach for isolated head and liner exchange reduces dislocation risk 7.68-fold compared to posterolateral approach at one year (2.4% vs. 12.4%, p=0.04).

Key Takeaway: A preoperative MRI C/D signal ratio (tendon stump/deltoid) ≥1.09 independently predicts healing failure after medium-sized rotator cuff repair with an AUC of 0.82 and adjusted OR of 11.5.

Key Takeaway: In 173,834 primary arthroplasties, 90-day deep infection risk begins rising at BMI >30 for THA but remains relatively stable until BMI >40 for TKA, challenging uniform institutional BMI cutoffs.

Key Takeaway: Median 25(OH)D was 54.4 nmol/L in IS versus 67.0 nmol/L in controls, but polygenic risk scores for vitamin D and BMD did not differ between groups, implicating environmental rather than genetic drivers of vitamin D deficiency in idiopathic scoliosis.

Key Takeaway: Revision TKA for periprosthetic femoral fracture required the longest duration of postoperative opioid use, while acute infection and stage-1 spacer implantation generated the highest in-hospital MME (>200 MME), with opioid pill count within 3 months varying significantly by revision etiology (P=0.0001).

Key Takeaway: TSA surgeon-level case concentration (HHI) fell from 10.97 to 4.52 over 2013–2023 as the performing surgeon pool grew from 1,351 to 3,439, yet entrant surgeons' volume share declined from 30.4% to 23.0%.

Key Takeaway: Preoperatively active TKA patients had lower revision surgery risk at 1, 2, and 3 years but paradoxically higher hardware failure risk at 2 and 3 years compared to inactive patients in a propensity-matched cohort of 4,090.

Key Takeaway: Internal rotational tibial subluxation >5.5 mm on MRI predicts high-grade pivot shift under anesthesia with an AUC of 0.756, and a multivariable model incorporating IRTS, time-to-surgery, Beighton score ≥4, posterior lateral meniscus horn injury, and lateral femoral condyle ratio achieves AUC 0.861.

Key Takeaway: Aspirin monotherapy was associated with 40% lower odds of PJI after arthroplasty (OR 0.60, 95% CI 0.45–0.81) versus non-aspirin regimens, with warfarin carrying an 8-fold increased PJI risk in THA specifically.

Key Takeaway: MMPR histologic degeneration scores were 2.4-fold higher than LMPR (modified Pauli score 6.6 vs. 2.7, p<0.001), with varus alignment moderately correlated with MMPR degeneration severity (r=0.54) and male sex independently protective (β=-2.63).

Key Takeaway: Preoperative malnutrition (albumin ≤3.5 g/dL, transferrin ≤204 mg/dL, or TLC ≤1.5×10³/µL) triples the 2-year PJI rate after UKA (2.4% vs. 0.8%, RR 3.00) and reduces revision-free survival to 93.34% vs. 95.14%.

Key Takeaway: Intraoperative fluoroscopy during DAA THA reproduced standing pelvic tilt within ±7° in only 76% of patients, with a low correlation (r=0.294) between preoperative standing and intraoperative AP pelvic tilt.

Key Takeaway: Posterolateral foraminal osteophytes (OR 3.25) and superior articular process hooks (OR 2.82) independently predict postoperative radiculopathy in 18.1% of single-level ALIF patients.

Key Takeaway: In 1,764 propensity-matched primary TKA patients, patellar resurfacing produced no clinically meaningful difference in PROMs or complication rates compared to non-resurfacing, with only one isolated KOOS-PS score favoring the non-resurfaced group (73.2 vs 71.2, p=0.03).

Key Takeaway: Severe DCM patients (preoperative JOA <10) achieved severity-adjusted MCID (≥3-point improvement) in 66.9% of cases after ACDF, significantly exceeding the 49.0% MCID rate in mild-moderate patients.

Key Takeaway: Periarticular injection during knee PJI surgery reduced 24-hour opioid consumption by 40.2 MME (90.2 vs 130.4, p=0.004) without increasing 12-month reinfection rates (5.0% vs 8.0%, p=0.30).

Key Takeaway: In 100 preoperative ACDF patients, anterior cervical paraspinal muscle fat infiltration positively associated with VBQ scores (worse bone quality) across C2–T1, while posteromedial CSA positively associated with vBMD at C1 and C3 on QCT.

Key Takeaway: Conversion THA after failed cephalomedullary nailing carries a 3x higher medical complication rate (33% vs 11.1%, P=0.032) and nearly 3x greater intraoperative blood loss (803.8 vs 282.1 mL, P<0.0001) compared to primary THA for osteoarthritis.

Key Takeaway: Patients with BMI ≥40 undergoing total ankle replacement had 2.45× higher odds of 90-day major medical complications versus nonobese patients, while 5-year implant survival was statistically similar across BMI groups (86.4%–91.6%) but the study was underpowered to exclude clinically meaningful differences.

Key Takeaway: At 20 years, HXLPE achieved 94% all-cause revision-free survivorship versus 65% for conventional polyethylene, with zero wear-related revisions in the HXLPE group (HR 0.184, p<0.001).

Key Takeaway: At 5 years, kinematically aligned medial-pivot TKA (CR-MP and CS-MP) produced significantly better Kujala scores than ultracongruent designs (80.1/82.1 vs. 73.3, p<0.01), with CS-MP also yielding superior FJS (88.9 vs. 74.9, p=0.024).

Key Takeaway: SCR using the long biceps tendon plus infraspinatus partial repair achieved a Constant score of 71 vs. 57 points and preserved acromiohumeral distance (9.8 mm) compared to isolated biceps tenotomy (7.4 mm) at mean 28 months in massive irreparable rotator cuff tears.

Key Takeaway: Robotic-assisted TKA reduced anterior flange lift-off from 37.6% to 9.9% (p<0.001) and femoral notching from 16.6% to 8.2% (p=0.02) compared with navigation, with robotic assistance independently associated with lower lift-off odds (aOR 0.18).

Key Takeaway: Despite anatomic ORIF for Myerson Type B2 Lisfranc injuries, patients demonstrate persistent deficits in peak plantar flexion, sagittal ankle ROM, and ankle power generation (all p≤0.001) alongside reduced knee absorption power (p=0.031), even with a mean AOFAS midfoot score of 93.63.

Key Takeaway: Kerboull-type acetabular reinforcement plate reconstruction achieved 95.6% 10-year survival for re-revision, with younger age, morselized bone graft alone, and postoperative femoral head migration identified as independent predictors of failure.

Key Takeaway: After ORIF for Lisfranc injuries, overall complication rate was 70.0%, with open fractures (AOR 2.79) and high-energy mechanisms (AOR 2.13) as independent risk factors, while combined screw-and-plate fixation reduced complication risk by 77% (AOR 0.23).

Key Takeaway: Hinge preservation during Schwab grade 4-6 osteotomies reduced intraoperative neuromonitoring alerts from 59% to 18% (3.3-fold lower risk) without sacrificing radiographic correction.

Key Takeaway: Neither screw diameter nor cannulated vs. solid screw type significantly affects return-to-play timing or complication rates in intramedullary fixation of Jones fractures across 8 studies.

Key Takeaway: Rotational gastrocnemius-Achilles flap combined with two-stage revision achieved composite functional success in 8/19 (42%) patients with the knee arthroplasty terrible triad, with a 16% above-knee amputation rate.

Key Takeaway: Maisonneuve fracture patients achieved clinical healing and return to full activity faster than other PER III/IV fractures requiring fibular fixation, with no significant difference in complication rates.

Key Takeaway: Conversion of HRA to THA with acetabular component retention achieves 100% acetabular component survivorship and 81.2% all-cause revision-free survivorship at 10 years, but carries a 7.5% PJI rate consistent with revision rather than primary THA benchmarks.

Key Takeaway: Arthroscopic Latarjet with anterior capsular reconstruction achieved 0% recurrent dislocation and 97.7% coracoid union at mean 7.1-year follow-up, with grade II subscapularis fatty infiltration independently predicting OA progression (OR 45.0).

Key Takeaway: Anterior latissimus dorsi and teres major tendon transfer for irreparable subscapularis tears achieved a 91.0% return-to-work rate at mean 5.4 months, with tendon integrity and lighter occupational demands as the strongest predictors of success.

Key Takeaway: LET added to primary hamstring autograft ACLR becomes cost-effective when the initial failure rate exceeds 18.7% (NNT=5), a threshold already exceeded by the 40% clinical failure rate reported in high-risk patients.

Key Takeaway: Preoperative pulmonary rehabilitation reduced early postoperative pulmonary complications after anterior vertebral body tethering from 14.6% to 3.5% (RR 4.21, 95% CI 1.35–13.11).

Key Takeaway: Periportal capsulotomy without capsular closure for hip arthroscopy in FAIS achieved MCID in 94.0%, PASS in 86.7%, and SCB in 80.1% of patients at minimum 5-year follow-up with zero cases of hip instability.

Key Takeaway: Ilizarov external fixation achieved 100% bone union and infection eradication in 17 patients with infected proximal tibial metaphyseal nonunions at minimum 30-month follow-up, with ASAMI excellent bone results in 76% (13/17).

Key Takeaway: In 23 patients with lateral calcaneal branch sural nerve neuropathy, targeted local anesthetic injection confirmed diagnosis and conservative management achieved significant AOFAS-hindfoot score improvement at 1 year, with 6 of 23 (26%) requiring surgical neurolysis.

Key Takeaway: In ACL-reconstructed cadaveric knees with concurrent lateral meniscus posterior root (LMPR) and Kaplan fiber injuries, adding a modified Lemaire lateral extra-articular tenodesis restored pivot-shift and internal rotation stability to intact-knee levels (all P > .086), while LMPR repair alone most effectively restored coupled valgus rotation during pivot shift.

Key Takeaway: A preoperative ΔPFA ≥110° identifies a high-risk subgroup with 10-fold greater odds of simulated impingement at 40/20° cup orientation (OR 10.02) and a median anteversion safe-zone width of only 4° versus 28° in lower-mobility patients.

Key Takeaway: APC reconstruction for extremity tumors carries a cumulative mechanical failure rate of 28.6% at 25 years, with allograft collapse (20%) and non-union (14%) as dominant complications.

Key Takeaway: After L4/L5 PSO with pre-contoured rods, postoperative lumbar lordosis consistently undershot rod curvature by a mean of 12–13.5°, with rod angulation being the strongest predictor of this mismatch (r = -0.593).

Key Takeaway: Conversion of hip fusion to cementless metaphyseal-fitting THA yields 97% acetabular and 91% femoral component survival at mean 23.5 years, with a mean Harris Hip Score of 91.2.

Key Takeaway: Brachialis-to-radial nerve intraneural fascicular transfer is anatomically feasible in 16/16 cadaveric specimens with a favorable median donor-to-recipient axon ratio of 0.71, while preserving at least one brachialis branch in 15/16 limbs.

Key Takeaway: Dual minifragment locked plating (2.5 mm + 2.0 mm orthogonal plates) achieves comparable axial, bending, and shear stiffness to a single 3.5 mm LCP for ulna shaft fractures, though angular displacement under cyclic torsional loading was significantly greater (P ≤ .018).

Key Takeaway: Retrograde IMS insertion in the thumb proximal phalanx violates 15.6–16.2% of extensor tendon width and 2.5–3.7% of articular surface depending on screw diameter (2.8–3.6 mm), with metacarpal fixation showing 9.3–14.8% tendon and 2.4–4.1% articular disruption with 3.6–4.1 mm screws.