EFORT Open Rev. 2025 Oct 1;10(10):733-744. doi: 10.1530/EOR-2023-0179.

ABSTRACT

Hip pain can be caused by extra-articular conditions such as subspine impingement, iliopsoas impingement, and ischiofemoral impingement. These syndromes are frequently secondary to underlying pathologies involving the hip joint or lumbar spine. While most cases are managed conservatively through activity modification and physiotherapy, surgical intervention is considered for refractory cases. Imaging, such as computed tomography (CT) scans and magnetic resonance imaging (MRI) is crucial for diagnosing these conditions, as clinical symptoms can be nonspecific. CT scans help identify predisposing factors such as acetabular morphology, femoral version, and acetabular version, while MRI is useful for ruling out other conditions and detecting soft tissue pathology. Although positive treatment outcomes are generally observed, there are variations in results and procedures, and long-term follow-up studies are lacking. Complications of the treatments are a concern, but most reported complications are minor in nature.

PMID:41031635 | PMC:PMC12494060 | DOI:10.1530/EOR-2023-0179

EFORT Open Rev. 2025 Oct 1;10(10):771-781. doi: 10.1530/EOR-2025-0027.

ABSTRACT

PURPOSE: This study aimed to systematically evaluate the efficacy and safety of oral versus intravenous tranexamic acid (TXA) in total knee arthroplasty (TKA).

METHODS: The review process was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines. PubMed, EMBASE, Web of Science, and the Cochrane Library were searched. Data extraction and quality assessment were performed independently by two investigators. The primary outcomes were hemoglobin (Hb) decrease and blood loss, while secondary outcomes included transfusion rate, operation time, hospital stay, and complications. The analysis used random-effects models and assessed heterogeneity with I 2 values.

RESULTS: Nine studies were included in the meta-analysis, comprising a total of 1,227 participants. Across the included studies, oral TXA was most commonly administered as 1.95-2 g given 1-2 h before surgery, with some regimens including postoperative doses. Intravenous TXA was typically given as 1 g before surgery, sometimes with additional doses before wound closure or after surgery. The results showed no significant difference between oral and intravenous TXA in terms of Hb decrease and transfusion rates. Similarly, there was no significant difference in complications, operation time, and length of hospital stay. Comparable findings were observed in both RCTs and non-RCTs. Sensitivity analysis demonstrated that the overall results remained robust, with no single study exerting a substantial influence on the pooled estimates.

CONCLUSIONS: Based on available evidence, there is no significant difference observed between oral and intravenous TXA in patients undergoing TKA. However, the wide confidence intervals for several outcomes indicate important uncertainty, and further high-quality studies are needed to confirm the comparative effectiveness and safety.

PMID:41031630 | PMC:PMC12495541 | DOI:10.1530/EOR-2025-0027

EFORT Open Rev. 2025 Oct 1;10(10):815-828. doi: 10.1530/EOR-2025-0041.

ABSTRACT

OBJECTIVE: Primary spondylodiscitis poses significant diagnostic and therapeutic challenges, with delayed diagnosis or improper treatment potentially resulting in severe complications. This systematic review aimed to summarize the latest diagnostic and therapeutic approaches for primary spondylodiscitis.

METHODS: Adhering to PRISMA 2020 guidelines, we conducted a systematic literature review. PubMed was comprehensively searched for English-language original studies from January 1, 1990, to October 31, 2024. Structured queries combined keywords and MeSH terms relevant to spondylodiscitis, vertebral osteomyelitis, spinal infection, and associated treatments. Two reviewers independently screened titles, abstracts, and full texts, with manual bibliography searches as a supplement. A total of 147 articles were finally included.

RESULTS: The literature indicates that diagnosis can be based on clinical suspicion, using serological, radiological, and microbiological tests. Newer methods such as metagenomics next-generation sequencing (mNGS) and positron emission tomography-computed tomography (PET-CT) can enhance diagnostic sensitivity and specificity. For confirmed cases, appropriate antibiotic therapy is crucial. Surgical treatment can benefit patients with neurological deficits, sepsis, spinal instability/deformity, epidural abscesses, or failed conservative treatment, accelerating recovery and reducing complications. Minimally invasive surgical approaches may also serve as an alternative to open surgery for select patients.

CONCLUSION: Although new technologies have improved diagnostic accuracy and treatment success rates for primary spondylodiscitis, establishing a robust staging system is vital to ensure patients receive effective, evidence-based treatment options.

PMID:41031628 | PMC:PMC12495883 | DOI:10.1530/EOR-2025-0041

EFORT Open Rev. 2025 Oct 1;10(10):756-762. doi: 10.1530/EOR-2024-0179.

ABSTRACT

PURPOSE: The surgical reconstruction of the medial patellofemoral ligament (MPFL) is a commonly used treatment for recurrent patellar dislocations. A surgical method which is frequently used is the dynamic reconstruction of the MPFL (dMPFLr), which involves attaching the released end of a hamstring muscle to the medial patella using a pulley. The aim of this systematic review and meta-analysis is to evaluate the evidence of this method in terms of patient-reported outcomes, the rate of recurrent instabilities, and other complications.

METHODS: MEDLINE® and Web of Science™ were used to identify eligible studies. We used a random-effects meta-analysis to estimate the pooled rates of the Kujala scores, rates of recurrent instabilities, and complication rates.

RESULTS: A total of 1,087 studies were screened for eligibility. Six studies, comprising a total of 267 treated knees, met the inclusion criteria and were included. All the publications included were retrospective analyses (level of evidence III). The random-effects model showed an overall mean postoperative Kujala score of 86.74 (95% CI: 79.37-94.11; heterogeneity: I 2 = 94%), a recurrent instability rate of 13% (95% CI: 9-18%; heterogeneity: I 2 = 0%), and additional complications mentioned at a rate of 9% (95% CI: 5-16%; heterogeneity: I 2 = 0%).

CONCLUSION: Although good results are achieved with regard to the patient-reported outcomes and complication rates, there is a high rate of recurrent instabilities. Despite these results, dMPFLr can be considered an option for the treatment of skeletally immature patients, as it avoids the need for intraoperative fluoroscopy and the risk of epiphyseal joint injury due to femoral fixation.

PMID:41031627 | PMC:PMC12494057 | DOI:10.1530/EOR-2024-0179

EFORT Open Rev. 2025 Oct 1;10(10):782-795. doi: 10.1530/EOR-2025-0022.

ABSTRACT

PURPOSE: To quantify the response to intra-articular saline administration in terms of pain, function, and quality of life, with a focus on the evolution of placebo response over time and the identification of influencing factors on the placebo response to knee osteoarthritis injections.

METHODS: After registration on PROSPERO, a systematic review was conducted following PRISMA guidelines to identify double-blind, placebo-controlled randomised clinical trials on intra-articular knee injections for knee osteoarthritis. The placebo response was evaluated through meta-analyses of VAS pain, WOMAC, KOOS, and responder rates at 1-, 3-, 6-, and 12-months on placebo arms of included trials. The evolution of placebo response over time was assessed, and meta-regression was conducted. Risk of bias and quality of evidence were assessed following Cochrane guidelines.

RESULTS: From the initial 2,746 records, 73 articles on 5,895 patients were included. The meta-analysis demonstrated statistically and clinically significant improvements at the 1-, 3-, and 6-month follow-ups. At the 12-month follow-up, placebo response declined and was no longer clinically significant for some sub-scores. Responder rates exceeded 50% at 1-, 3-, and 6-months. The placebo response was stronger in studies with a higher proportion of female participants and in more recently published trials.

CONCLUSIONS: Placebo response to intra-articular injections is statistically and clinically significant in knee osteoarthritis for pain, function improvement, and patients' quality of life, with responses peaking at 4-8 months but evidence up to 12 months. Among influencing factors, female sex and recent publications seem to present stronger placebo responses, emphasising the importance of placebo-controlled trials to evaluate knee osteoarthritis treatments.

PMID:41031623 | PMC:PMC12495556 | DOI:10.1530/EOR-2025-0022

EFORT Open Rev. 2025 Oct 1;10(10):806-814. doi: 10.1530/EOR-2025-0010.

ABSTRACT

Teardrop fractures of the cervical spine are characterized by a triangular-shaped fragment located in the anteroinferior corner of the vertebral body. Flexion-type teardrop fractures are highly unstable injuries resulting from a flexion-compression mechanism. A notable feature of these injuries is retrolisthesis of the vertebral body, which is often associated with a high risk of neurological compromise. The anterior approach is the most commonly used surgical treatment for flexion-type teardrop fractures. In contrast, extension-type teardrop fractures primarily affect the axis vertebral body and are generally stable injuries that can be treated nonoperatively.

PMID:41031621 | DOI:10.1530/EOR-2025-0010

EFORT Open Rev. 2025 Oct 1;10(10):745-755. doi: 10.1530/EOR-2024-0155.

ABSTRACT

This review presents a standardized, stepwise method for biplanar radiographic analysis of knee alignment, integrating both coronal and sagittal measurements for use in arthritic and non-arthritic knees. It critically compares leading classification systems, including the coronal plane alignment of the knee (CPAK) and the functional knee phenotype classifications. While CPAK provides a simplified 2D coronal model, the functional phenotype system offers a more granular, 3D approach that includes segmental deformities and has recently been expanded to incorporate laxity parameters. Sagittal plane parameters - including posterior tibial slope and femoral component flexion/extension - are essential for comprehensive alignment assessment. These factors influence implant positioning, knee kinematics, and postoperative function. The review outlines preferred measurement techniques, highlighting the value of long-leg weight-bearing radiographs and discussing the limitations and variability of 2D versus 3D imaging approaches. Incorporating both alignment and soft tissue behavior provides a more individualized approach to total knee arthroplasty planning and may lead to improved outcomes by better replicating native knee biomechanics.

PMID:41031620 | PMC:PMC12494059 | DOI:10.1530/EOR-2024-0155

EFORT Open Rev. 2025 Oct 1;10(10):726-732. doi: 10.1530/EOR-2024-0056.

ABSTRACT

PURPOSE: To synthesize and critically appraise the literature on long-term outcomes of proximal osteotomies of the first metatarsal (M1) to treat HV without inflammatory disease or degenerative arthritis and to assess the long-term HV recurrence rates of studies with a minimum follow-up of 5 years.

METHODS: This systematic review conforms to the PRISMA guidelines. The authors conducted a search using PubMed, Embase®, and Cochrane Central Register of Controlled Trials databases. Studies that report outcomes of proximal osteotomies of the M1 for non-inflammatory and non-degenerative HV at a minimum follow-up of 5 years were included. We found four eligible studies comprising four datasets, and all assessed proximal osteotomies with a mean follow-up that ranged from 8 to 18 years.

RESULTS: The systematic search returned 7,918 records, of which 2,693 were duplicates, leaving 5,225 for screening. Of these, four studies were included, covering a total of 158 feet with a mean follow-up that ranged from 8 to 18 years. The pooled HVA following proximal osteotomies was 20.4° (CI: 11.3°-29.4°; I 2 = 95%), pooled IMA was 8.8° (CI: 3.3°-14.2°; I 2 = 98%), and pooled AOFAS was 82.1 (CI: 62.4-101.8; I 2 = 97%).

CONCLUSIONS: At a minimum follow-up of 8 years following proximal osteotomies of M1, the HVA was 20.4° and the IMA was 8.8°. Furthermore, the recurrence rates considering the various thresholds of HVA were 12% having >30°, 73% having >20°, and 13% if recurrence is a >10° increase in HVA.

LEVEL OF EVIDENCE: Meta-analysis, level IV.

PMID:41031617 | PMC:PMC12493268 | DOI:10.1530/EOR-2024-0056

EFORT Open Rev. 2025 Oct 1;10(10):763-770. doi: 10.1530/EOR-2024-0213.

ABSTRACT

In patients with knee osteoarthritis, tibial stress fractures are mostly associated with osteoporosis and lower limb malalignment. Nonoperative management may lead to knee stiffness (due to prolonged immobilization), persistence of pain (due to the underlying knee osteoarthritis), and fracture nonunion. Acute unstable tibial stress fractures can be managed with long-stem total knee arthroplasty. Exposing the fracture site should be avoided as much as possible because it may be associated with skin necrosis and delayed union. In irreducible cases or fractures with persistent gaps, fibular osteotomy, by increasing the mobility and compression across the fracture site, may help with fracture reduction and decrease the rate of nonunion.

PMID:41031615 | PMC:PMC12494058 | DOI:10.1530/EOR-2024-0213

EFORT Open Rev. 2025 Sep 4;10(9):679-685. doi: 10.1530/EOR-2024-0040.

ABSTRACT

The normal functioning of the shoulder is characterized by the harmonious coordination between the glenohumeral joint and the scapulothoracic complex, a phenomenon commonly referred to as scapulohumeral rhythm (SHR). Reverse total shoulder arthroplasty (rTSA) shoulders exhibit distinct kinematics compared to normal shoulders. Reduced scapulohumeral rhythm (SHR) in rTSA shoulders implies a greater reliance on scapulothoracic motion over glenohumeral motion for arm elevation. Dynamic analyses suggest heightened scapulothoracic movement after rTSA, implying alterations in rotational movements across various planes. Utilization of reliable tools to measure preoperative scapulothoracic motion and forecast postoperative SHR in rTSA may improve functional results. Posture types and scapulothoracic orientation play an important role in optimal implant configuration and positioning, as well as clinical outcome, and should therefore be considered during patient selection, preoperative planning, and implantation of an rTSA. Recognizing the static position and kinematic changes of the scapulothoracic joint is vital for postoperative rehabilitation and optimizing outcomes in rTSA patients.

PMID:40905937 | PMC:PMC12412366 | DOI:10.1530/EOR-2024-0040

EFORT Open Rev. 2025 Sep 4;10(9):686-694. doi: 10.1530/EOR-2024-0218.

ABSTRACT

The results of our survey conducted among the members of the European Society for Surgery of the Shoulder and the Elbow is presented in this article. The two most important features of frozen shoulder are movement restriction and pain. Frozen shoulder is considered secondary if it occurs after surgery or trauma. Corticosteroid injections are recommended as the first choice of pharmacological therapy. Patient education and physical therapy are the first choice of non-surgical therapy. The rate of remaining symptoms was observed in less than 20% of patients.

PMID:40905931 | PMC:PMC12412373 | DOI:10.1530/EOR-2024-0218

EFORT Open Rev. 2025 Sep 4;10(9):660-670. doi: 10.1530/EOR-2024-0139.

ABSTRACT

Rotator cuff tears are prevalent, affecting 20% of the general population, with massive tears accounting for 40% of these cases. Massive tears, those larger than 5 cm or involving several tendons, pose substantial clinical problems, including poorer surgical outcomes and increased recurrence rates. Multiple classification systems offer varied definitions, complicating treatment strategies. The irreparability of these tears, exacerbated by conditions such as tendon atrophy and advanced imaging abnormalities, can further complicate management. Surgical options include superior capsular reconstruction (SCR) and tendon transfers. SCR, which involves attaching a graft to the superior glenoid and greater tuberosity, has shown promise in individuals with intact subscapularis tendons and minimal arthritis. Graft alternatives include fascia lata (FL) autografts, human dermal allografts, and long head of the biceps tendon (LHBT) autografts. Each graft type has distinct advantages and disadvantages, with FL autografts providing greater results despite donor site morbidity. Tendon transfers, such as latissimus dorsi and lower trapezius transfers, offer alternative treatments, especially for younger, more active individuals. This review thoroughly reviews different therapeutic options, emphasizing the most recent evidence and clinical outcomes to help guide the best management of massive posterosuperior irreparable rotator cuff injuries.

PMID:40905927 | PMC:PMC12412289 | DOI:10.1530/EOR-2024-0139

EFORT Open Rev. 2025 Sep 4;10(9):718-725. doi: 10.1530/EOR-2024-0191.

ABSTRACT

PURPOSE: While the incidence of acetabular fractures keeps rising among our older patient population, age-specific rehabilitation guidelines are lacking. Post-surgery weight-bearing is often restricted for 8-12 weeks to avoid secondary fixation failure. However, non- or restricted weight-bearing commonly results in atrophy, and older patients are at additional risk of long-term mobility and functionality loss. Therefore, if the risk of secondary fracture failure proves to be lower than currently believed, early or permissive weight-bearing might actually be the preferred treatment choice to advance fracture healing and decrease recovery time. This study aims to review the current literature on early weight-bearing outcomes of acetabular fractures in older adults.

METHODS: A systematic search of two databases was conducted following PRISMA guidelines. Eligible studies reported on early weight-bearing outcomes of older patients after surgical management. Data were showed in tables alongside a narrative synthesis. Critical appraisal and risk-of-bias tools assessed the study quality.

RESULTS: Six studies were included with a retrospective or observational design, with a total of 147 patients averaging 64 years old. The majority of studies discussed early weight-bearing protocols after percutaneous fixation (PF), with heterogeneity in terminology across protocols.

CONCLUSIONS: Albeit limited and low in evidence, the included studies suggest that early weight-bearing might be a possible alternative for non- or minimally displaced fractures and displaced fractures after PF and open reduction internal fixation, respectively. When risk assessments and functional outcomes are appropriately investigated, early weight-bearing may help patients, especially older adults, avoid suffering and prolonged rehabilitation periods.

PMID:40905923 | PMC:PMC12412364 | DOI:10.1530/EOR-2024-0191

EFORT Open Rev. 2025 Sep 4;10(9):709-717. doi: 10.1530/EOR-2024-0164.

ABSTRACT

PURPOSE: This study investigates the 1-year mortality of fragility fractures of the pelvis (FFP) in patients categorized under this system and treated with surgery or conservative methods, aiming to assess the algorithm's effectiveness.

METHODS: We systematically searched PubMed, Embase, Scopus, and Web of Science for English studies on the 1-year mortality of FFP, with no publication date restrictions. Study quality was assessed using the Newcastle-Ottawa Scale. Pooled 1-year mortality rates were calculated using random-effects models. In addition, if applicable, odds ratios with 95% confidence intervals were employed. PRISMA guidelines were followed for reporting, and the study was registered with PROSPERO.

RESULTS: Analysis of 22 studies encompassing 3,265 patients with FFP revealed a concerning overall 1-year mortality rate of 15.5%. Mortality varied by fracture type, with FFP IV having the lowest rate (7.5%) and FFP III having the highest (17.0%). All studies concurred on conservative treatment for FFP I. For other fracture types, mortality rates differed between conservative and surgical approaches. Conservative treatment resulted in rates of 14.9, 21.8, and 5.1% for FFP II, III, and IV, respectively. Conversely, surgical treatment yielded mortality rates of 16.8, 19.5, and 24.2% for FFP II, III, and IV, respectively.

CONCLUSION: Fragility fractures of the pelvis have high mortality, especially in FFP III. Conservative treatment may be suitable for FFP I, while surgery might be better for FFP III. The rarity of FFP IV fractures limits conclusions, and FFP II fractures lack a clear treatment consensus. Further research is needed to optimize management for these fracture types.

PMID:40905922 | PMC:PMC12412362 | DOI:10.1530/EOR-2024-0164

EFORT Open Rev. 2025 Sep 4;10(9):695-708. doi: 10.1530/EOR-2024-0216.

ABSTRACT

PURPOSE: This systematic review and meta-analysis assesses the comparative effectiveness of home-based and supervised rehabilitation protocols following anterior cruciate ligament reconstruction, with a focus on functional recovery and muscle strength.

METHODS: Registered in PROSPERO (CRD42024585478) and following PRISMA guidelines, we searched Web of Science, PubMed, Ovid MEDLINE, and Cochrane. For the quality assessment, the Cochrane Collaboration risk of bias (RoB) tool was used. Review Manager v5.4 was used for the analysis.

RESULTS: Twelve studies were included qualitatively, and seven quantitatively. Outcomes included subjective knee scores (Lysholm, Tegner, IKDC) and quadriceps/hamstring strength measures. Our findings indicated a 19% improvement in subjective knee scores for home-based protocols in some studies. However, for hamstring strength measures, the supervised protocol was superior (SMD = -0.48, P = 0.02).

CONCLUSION: Overall, home-based rehabilitation outcomes were comparable to supervised programs in functional recovery. However, supervised approaches slightly enhanced muscle strength. Supervised rehabilitation is recommended to optimize strength, especially for athletes, though further research is needed to assess its impact on return to sport.

PMID:40905919 | PMC:PMC12412367 | DOI:10.1530/EOR-2024-0216

EFORT Open Rev. 2025 Sep 4;10(9):671-678. doi: 10.1530/EOR-2024-0067.

ABSTRACT

PURPOSE: To conduct a meta-analysis of clinical studies evaluating the efficacy and safety of arthroscopic and open surgery for the treatment of acute high-grade acromioclavicular joint (ACJ) dislocation using a suture button.

METHODS: The review process was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Two independent reviewers conducted the literature searches based on preferred reporting items from systematic reviews and meta-analyses. PubMed, EMBASE, Web of Science, and the Cochrane Library were searched for studies comparing arthroscopic and open surgery for the treatment of acute high-grade ACJ dislocation using a suture button. Constant score, visual analog scale, coracoclavicular distance, acromioclavicular distance, operation time, and occurrence of complications were analyzed.

RESULTS: Five studies comprising a total of 198 patients were included in this study. The findings revealed that, in comparison to open fixation, arthroscopic fixation resulted in longer surgical durations. However, there were no significant differences between the two techniques in terms of constant score, visual analog scale, coracoclavicular distance, acromioclavicular distance, or the occurrence of complications.

CONCLUSIONS: Based on current evidence, arthroscopic fixation demonstrates comparable postoperative outcomes to open fixation, albeit with longer surgical durations. With ongoing technological advancements and refinement of surgical techniques, the efficiency and accessibility of arthroscopy are expected to improve, potentially solidifying its role as a superior choice in the future.

PMID:40905916 | PMC:PMC12412284 | DOI:10.1530/EOR-2024-0067

EFORT Open Rev. 2025 Sep 4;10(9):646-659. doi: 10.1530/EOR-2025-0071.

ABSTRACT

PURPOSE: This study aimed to comprehensively review the current research status and trends of joint replacement for arthritis patients worldwide.

METHODS: Literature related to joint replacement for arthritis patients from 2004 to 2024 was extracted from the Web of Science Core Collection (WoSCC) database. A systematic qualitative and quantitative analysis of these publications was conducted. Visualization of results was achieved using CiteSpace and VOSviewer software.

RESULTS: In total, 14,349 publications met the inclusion and exclusion criteria and were selected for further research. Keyword analysis revealed a clinical emphasis on optimizing surgical outcomes through advancements in total knee arthroplasty, total hip arthroplasty, and patient-centered metrics. Emerging research hotspots since 2020 included precision techniques such as robotic-assisted surgery, strategies to address periprosthetic joint infection, and the role of psychological factors such as depression and patient satisfaction. Temporal trends highlighted evolving priorities, including personalized alignment protocols, where the burst intensities of kinematic alignment and mechanical alignment were 16.33 and 13.79, respectively, as well as functional recovery and complication prevention. Historical dominance of rheumatoid arthritis research has transitioned to broader exploration of osteoarthritis management and technological innovations in surgical precision.

CONCLUSION: This study revealed a marked transition from rheumatoid arthritis-focused studies to innovations in osteoarthritis management and precision surgical techniques. Clinically, these findings emphasize the need to integrate technological advancements with multidisciplinary frameworks to standardize infection control, optimize implant durability, and enhance rehabilitation outcomes. Future efforts should prioritize personalized alignment strategies, evidence-based infection control protocols, and multidisciplinary rehabilitation frameworks to improve long-term functional outcomes.

PMID:40905904 | PMC:PMC12412288 | DOI:10.1530/EOR-2025-0071

EFORT Open Rev. 2025 Aug 4;10(8):589-599. doi: 10.1530/EOR-2024-0105.

ABSTRACT

PURPOSE: The objective of this study was to assess the benefits of the PENG block on pain control and functional recovery.

METHODS: Randomized controlled trials in PubMed, Web of Science, Embase, and the Cochrane Library were selected, and data were meta-analyzed using a random-effects model to estimate mean difference (MD) or standardized mean differences (SMD).

RESULTS: Eleven trials involving 1,135 patients were included. The PENG block was associated with significantly lower total opioid consumption than sham/no block (MD: -25.23, 95% CI: -27.01 to -23.45, I 2 = 0%), as well as better functional recovery. The PENG block was noninferior to the suprainguinal fascia iliaca block regarding postoperative pain scores and functional recovery and had a significant reduction in total opioid consumption (MD: -8.25, 95% CI: -16.48 to -0.02, I 2 = 68%). The PENG block was associated with similar total opioid consumption and functional recovery as the periarticular anesthetic infiltration (PAI), but worse static pain scores at 12 h (SMD: 0.41, 95% CI: 0.08-0.75, I 2 = 51%) and dynamic pain scores at 48 h after surgery (SMD: 0.36, 95% CI: 0.08-0.64, I 2 = 0%).

CONCLUSIONS: While current evidence supports the PENG block as a viable alternative to other types of peripheral analgesia in THA, existing data remain insufficient to conclude that the PENG block outperforms other peripheral analgesia when it comes to pain control or functional recovery. More well-designed randomized controlled trials are needed in the future to thoroughly explore whether the PENG block has superiority over other analgesic techniques.

PMID:40757814 | PMC:PMC12326972 | DOI:10.1530/EOR-2024-0105

EFORT Open Rev. 2025 Aug 4;10(8):574-588. doi: 10.1530/EOR-2024-0049.

ABSTRACT

PURPOSE: Diagnosing osteomyelitis in the foot/ankle region is challenging primarily due to anatomical constraints. While bone biopsy is the gold standard, non-invasive methods such as SPECT (single photon emission computed tomography) and MRI are sensitive but lack specificity. This study aims to evaluate SPECT/CT's potential, integrating functional and structural imaging, to improve osteomyelitis diagnosis in this region.

METHODS: A systematic review following PRISMA guidelines and the Cochrane Handbook was conducted, including comprehensive research across major databases (inception to October 2022). Diagnostic studies using SPECT/CT for suspected foot/ankle bone lesions or inflammation were included. We carried out descriptive analysis, SROC curve generation, and calculated mean sensitivities and specificities. Subgroup analyses were conducted for various tracers, CT resolutions, and evaluation strategies. Sensitivity and heterogeneity analyses, bias risk, and publication bias were assessed.

RESULTS: Eleven diagnostic studies (463 patients) were reviewed, with seven focusing on diabetic patients. Tracers included labeled leukocytes (WBC), antigranulocyte antibodies, phosphonates (BS), and gallium citrate. Clinical follow-up was the primary reference standard. Mean sensitivity of SPECT/CT for osteomyelitis diagnosis was 93.8% (95% CI: 89.7-96.4%), and specificity was 84.6% (95% CI: 65.1-94.2%). WBC SPECT/CT was more specific (79.4%) but less sensitive (89.2%) than BS SPECT/CT (specificity 46.5%, sensitivity 93.1%). Combined tracers yielded the highest mean specificity (96.4%).

CONCLUSION: SPECT/CT shows promising diagnostic performance for osteomyelitis in the foot/ankle region, especially when applying combined tracer methods. It is particularly advantageous in chronic, postoperative, and post-traumatic cases, offering added value compared to MRI.

PMID:40757813 | PMC:PMC12326970 | DOI:10.1530/EOR-2024-0049

EFORT Open Rev. 2025 Aug 4;10(8):623-635. doi: 10.1530/EOR-2024-0120.

ABSTRACT

Total knee arthroplasty is a highly effective intervention for end-stage osteoarthritis, yet nearly 20% of patients report dissatisfaction with clinical outcomes. This dissatisfaction is often linked to intraoperative parameters, particularly whole-leg alignment and component positioning, which might play a role in ensuring both satisfaction and long-term implant survival. Over the past two decades, alignment techniques have progressed from systematic, two-dimensional methods focused on the frontal plane to more personalized, three-dimensional approaches. This evolution has introduced inconsistencies and confusion among surgeons regarding alignment techniques, terminology, and application, underscoring the need for standardized definitions that can be universally adopted. This work provides standardized definitions for six main knee alignment techniques to enhance communication within the scientific community, particularly in clinical research. While not an exhaustive analysis of each method, this effort focuses on the foundational principles of these techniques, organized using a standardized framework to facilitate comparison and improve clarity in the field.

PMID:40757810 | PMC:PMC12326975 | DOI:10.1530/EOR-2024-0120