EFORT Open Rev. 2026 Mar 2;11(3):224-232. doi: 10.1530/EOR-2025-0176.

ABSTRACT

PURPOSE: Although female sex is a known risk factor for developmental dysplasia of the hip (DDH), limited data exist regarding sex-specific differences in treatment outcomes. This study aimed to analyze whether being male represents a risk factor for unfavorable outcomes in DDH treatment.

METHODS: A systematic search was conducted across PubMed, Embase, and Cochrane Library databases to identify studies comparing DDH treatment outcomes between males and females. The review adhered to PRISMA and PROSPERO guidelines, including studies published from 1995 to 2023.

RESULTS: Out of 327 initially identified articles, 23 met the selection criteria, describing 10,307 total DDH cases (5,296 males; 4,700 females). Only six articles clearly reported outcomes stratified by sex. Our analysis focused on establishing whether male sex was a risk factor for Pavlik harness failure and the incidence of avascular necrosis (AVN). For Pavlik harness failure, the meta-analysis included 93 male and 630 female hips, with failure in 32 male (34%) and 148 female (23%) hips. The meta-analysis indicated a significant association between male sex and Pavlik harness failure (P = 0.03). Pooling data from relevant articles for AVN showed that AVN occurred in 32 out of 91 male (35%) and 77 out of 355 female (22%) hips, suggesting a significant association between male sex and AVN (P = 0.008).

CONCLUSIONS: Overall, male patients exhibited a higher failure rate in Pavlik harness treatment. The pooled analysis of AVN data further suggests that males may demonstrate a poorer prognosis compared to female patients in DDH treatment.

PMID:41770058 | DOI:10.1530/EOR-2025-0176

EFORT Open Rev. 2026 Mar 2;11(3):156-166. doi: 10.1530/EOR-2025-0001.

ABSTRACT

Computed tomography (CT) enables 3D surgical planning for implant size and position, patient-specific instruments, and robotic-assisted lower limb joint replacement. Orthopaedic companies provide CT protocols tailored to specific implant systems and designs, including off-the-shelf and custom-made implants, leading to substantial variability in imaging guidelines for centres and hospitals. This study aims to consolidate CT imaging workflows through harmonised protocols that minimise ambiguity and enhance clarity, clinical practice and patient safety. A multidisciplinary team critically reviewed all 17 hip and 12 knee CT protocols that were available. Imaging elements were assessed, highlighting deficiencies and inconsistencies. These protocols informed the recommendation of five harmonised CT protocols through informal consensus: i) primary hip, ii) revision hip, iii) primary knee, iv) revision knee and v) total femoral replacement. Significant variability was found among company guidelines regarding scan volume, X-ray tube current, voltage and other parameters, resulting in inconsistent image quality and radiation exposure. Lack of harmonisation can lead to scan rejections and repeat imaging. The harmonised protocols prioritise high-resolution imaging with optimal parameters, reduced scan volume and minimal metal artefacts. Designed to be clear, concise, consistent and comprehensive, these user-friendly protocols effectively capture key anatomical structures, landmarks and alignment details crucial for planning and monitoring lower limb arthroplasty. The protocols are sufficiently flexible to accommodate both standard and customised implant planning requirements. These protocols streamline the imaging process, fostering alignment across companies by consolidating existing protocols; they reduce duplication and eliminate inconsistencies, without redefining the content or intent of the original protocols.

PMID:41770057 | DOI:10.1530/EOR-2025-0001

EFORT Open Rev. 2026 Mar 2;11(3):183-190. doi: 10.1530/EOR-2024-0149.

ABSTRACT

Femoral neck fractures remain a significant challenge in orthopaedic surgery, particularly among elderly patients. This review synthesizes the current peer-reviewed literature on initial management strategies, with a particular emphasis on the use of skin traction. Skin traction, which involves the application of adhesive tape, a crepe bandage, and a calibrated pulley system with precise weights, is analysed in terms of its efficacy in clinical practice. The review discusses the benefits and drawbacks of skin traction, drawing on recent studies to assess its role in fracture management. The goal is to provide nuanced scientific insights into the ongoing discourse surrounding the management of femoral neck fractures.

PMID:41770055 | DOI:10.1530/EOR-2024-0149

EFORT Open Rev. 2026 Mar 2;11(3):175-182. doi: 10.1530/EOR-2025-0026.

ABSTRACT

Femoral head fractures are complex and severe injuries, usually associated with hip dislocation. They typically result from high-energy trauma. Therefore, a low index of suspicion is required for diagnosis in these contexts. Initial presentation can vary depending on coexisting injuries but is typically an emergency and requires immediate reduction of the joint. Delays result in worse outcomes for patients. Pelvic radiographs are recommended before and after joint reduction, with Judet, inlet and outlet views to identify any associated acetabular fracture and pelvic ring injury. Computed tomography helps determine the fracture configuration and classification, commonly using the Pipkin classification. Definitive fracture management depends on patient demographics, fracture pattern and associated injuries. Pipkin type I and II fractures with minimal displacement and an anatomically congruent hip joint may be treated conservatively. Otherwise, surgical open reduction internal fixation via the anterior approach is recommended. Young patients with Pipkin type III injuries usually require open reduction internal fixation via the anterior or posterior approach, while elderly patients may need total hip arthroplasty. Pipkin type IV fractures may require a combination of open reduction internal fixation approaches with or without trochanteric flip osteotomy. Femoral head fractures often have poor outcomes, with type III and IV fractures having worse outcomes than types I and II. Early complications include infection and sciatic nerve palsy. Late complications include avascular necrosis, heterotopic ossification and post-traumatic arthritis. This article considers the anatomy, diagnosis and evidence-based management strategies for femoral head fractures.

PMID:41770054 | DOI:10.1530/EOR-2025-0026

EFORT Open Rev. 2026 Mar 2;11(3):199-207. doi: 10.1530/EOR-2025-0181.

ABSTRACT

Langerhans cell histiocytosis (LCH) is a myeloid neoplastic disorder in which bone is the commonly affected organ system. While treatment for its symptomatic bone lesions varies, modern minimally invasive techniques show significant advantages over traditional approaches. Conventional therapies present notable limitations. Curettage, while frequently used, is associated with local recurrence. The efficacy of intralesional corticosteroid injections remains uncertain, especially for lesions in the extremities or pelvis. Although effective, low-dose radiation therapy carries long-term risks and is reserved for specific cases. Systemic chemotherapy, the standard for multifocal disease, is associated with toxicity and high relapse rates. Radiofrequency ablation (RFA) has emerged as a superior alternative that fills this therapeutic gap. RFA is a minimally invasive procedure that uses targeted heat (60-100°C) to destroy tumor cells with curative intent. Validating prior case reports, our recent study of ten patients confirmed that RFA provides complete pain relief with no residual disease or recurrence on follow-up MRI. Importantly, no significant complications were observed in our cohort or have been reported in the literature for LCH patients treated with RFA. In conclusion, RFA offers a safe, rapid, and durable solution for painful LCH lesions. It should be considered a primary curative treatment for symptomatic LCH of the bone, avoiding the risks of more invasive procedures and systemic therapies.

PMID:41770053 | DOI:10.1530/EOR-2025-0181

EFORT Open Rev. 2026 Mar 2;11(3):167-174. doi: 10.1530/EOR-2025-0134.

ABSTRACT

PURPOSE: Locking plates are well established as a powerful plating concept, especially in low-density bone. Construct strength is dependent on the fixation between the screw head and the plate; however, the influence of variations in the torque used to engage the screw head into the plate hole is unclear. The aim of this study was to systematically review the effect of insertion torque on the performance of locking screws.

METHODS: A systematic review was performed with electronic searches of four databases using free and MeSH search terms. Systematic evaluation and data extraction was performed up to 2 April 2025. The principal outcome was the difference in failure load for the locking plate construct following variation of the insertion torque.

RESULTS: The initial search identified 894 potentially relevant studies, of which six were eligible for inclusion. All were in vitro, biomechanical studies. Both stainless steel and titanium plates were tested. The former material showed no consistent performance increase with increased insertion torque in either pushout or cantilever testing. Titanium plates showed an increased pushout force and cantilever strength with more torque for some, but not all designs. Once screw head engagement in the plate hole was achieved, further torque was not clearly beneficial.

CONCLUSION: Increased insertion torque, beyond that required to seat the screw head, did not consistently show performance benefits. Most studies were underpowered and may not be representative of clinical failures. Further work to define optimum torque ranges for locking plate systems is required.

PMID:41770050 | DOI:10.1530/EOR-2025-0134

EFORT Open Rev. 2026 Mar 2;11(3):145-155. doi: 10.1530/EOR-2025-0136.

ABSTRACT

Musculoskeletal infections (MSIs) pose formidable challenges to healthcare resources. Surgical wound irrigation is a crucial step in reducing microbial bioburden in open orthopaedic procedures, yet there remains ambiguity regarding optimal use of lavage agents. For tactical selection of irrigants, orthopaedic wounds can be classified into three major categories (aseptic, acute septic and chronic septic) based upon microbial bioload and presence or absence of biofilm upon implanted hardware and/or musculoskeletal tissues. Irrigant products can be stratified based upon their modes of action: single modal (dilutional), dual modal (dilutional and chemical) and multi-modal (dilutional with multiple mechanisms). Host toxicity is commensurate with increased complexity of an irrigant product. A tailored, stepwise strategy of irrigant selection aligned with wound type is recommended, escalating from simple low toxicity dilutional lavage for low microbial bioloads to potent multi-modal chemical agents for biofilm-laden chronic infections. The method of irrigant delivery and selected volume are integral to wound lavage. The difference between methods is the impact pressure to host tissues and the depth of fluid penetration. Higher impact pressures clear adherent bacteria and foreign debris albeit the cost of host tissue damage.

PMID:41770049 | DOI:10.1530/EOR-2025-0136

EFORT Open Rev. 2026 Mar 2;11(3):191-198. doi: 10.1530/EOR-2025-0163.

ABSTRACT

Partial lateral patellar facetectomy (PLPF) is a surgical procedure that consists in removing a part of the lateral facet of the patella. It has been first described as a surgical treatment for isolated external patellofemoral osteoarthritis. Following the same biomechanical effects, some authors proposed to perform PLPF in primary total knee arthroplasty to enhance patellar tracking and reduce the risk of anterior knee pain, whether the patella resurfaced or not. According to few studies of low level of evidence, functional scores are not improved when performing systematic PLPF. Current data are controversial regarding the role of systematic PLPF in enhancing patellar tracking. No evidence exists that PLPF protects un-resurfaced patella from revision for PF issues after TKA. In light of the available literature, PLPF cannot be recommended systematically in primary or revision TKA. However, precise relevant indications can be proposed.

PMID:41770047 | DOI:10.1530/EOR-2025-0163

EFORT Open Rev. 2026 Mar 2;11(3):208-223. doi: 10.1530/EOR-2025-0114.

ABSTRACT

PURPOSE: Children with cerebral palsy (CP) are at a high risk of progressive hip displacement, defined as lateral migration of the femoral head measured by the Reimers migration percentage. This condition may impair quality of life, highlighting the need for improved hip care. This umbrella review assessed current evidence on the evaluation, prevention, and treatment of hip displacement in children with CP by synthesizing systematic reviews.

METHODS: Systematic reviews published in English between 2004 and 2024 were included, focusing on children with CP aged 0-18 years. Searches were conducted in nine databases: PubMed, MEDLINE, Web of Science, Scopus, BVS, CINAHL, Cochrane Library, PEDro, LILACS, and EMBASE. Methodological quality was assessed using AMSTAR 2 for interventional studies and JBI criteria for non-interventional studies. This review has been registered at PROSPERO (registration number: CRD42024618645).

RESULTS: In total, 25 systematic reviews addressed key aspects of hip management, including hip surveillance; tone management; preventive, reconstructive, and salvage procedures; and antifibrinolytic use. Hip surveillance reduced hip dislocation rates and the need for salvage surgery, whereas postural and tone management showed no consistent preventive effect. Combined pelvic and femoral osteotomies achieved better outcomes than isolated procedures, while soft-tissue surgeries had high recurrence rates. Proximal femoral hemiepiphysiodesis improved radiographic outcomes but frequently required revision. Salvage procedures such as valgus osteotomy and femoral head resection relieved pain, whereas hip arthrodesis showed poor outcomes. Total hip arthroplasty improved pain and function but was associated with high complication rates.

CONCLUSIONS: This umbrella review highlights evidence-based practices and important knowledge gaps in the management of hip instability in children with CP, supporting future research and improved clinical care.

PMID:41770043 | DOI:10.1530/EOR-2025-0114

EFORT Open Rev. 2026 Mar 2;11(3):233-242. doi: 10.1530/EOR-2024-0107.

ABSTRACT

Proximal femoral fractures are common in the elderly population and are associated with significant morbidity, mortality, and major functional consequences. Their management represents an ongoing challenge. Care for this frail population must be coordinated, standardized, and multidisciplinary. These fractures represent a significant public health concern, prompting numerous studies to explore organizational strategies and risk factors aimed at minimizing related complications. This article reviews current recommendations for the management of proximal femoral fractures in the elderly, including definitions of geriatric and frail patients, service organizations, and clinical pathways. It also provides an overview of the latest recommendations for the management of medical problems and anticoagulation in elderly patients with proximal femur fractures.

PMID:41770042 | DOI:10.1530/EOR-2024-0107

EFORT Open Rev. 2026 Feb 4;11(2):119-130. doi: 10.1530/EOR-2025-0139.

ABSTRACT

BACKGROUND: Stress shielding of the proximal humerus represents an increasing challenge for the implantation of total shoulder arthroplasty (TSA). The literature on this topic is heterogeneous, and many studies analysing its clinical impact are underpowered, justifying a systematic review of current evidence.

MATERIALS AND METHODS: On 1 September 2024, the Cochrane Library, PubMed, and Web of Science were searched for studies on stress shielding in shoulder arthroplasty. All studies meeting inclusion criteria were included in the qualitative review. Clinical significance was assessed through a meta-analysis of studies comparing patients with and without stress shielding using Constant-Murley score (CS) and American Shoulder and Elbow Surgeons (ASES) score.

RESULTS: Of 299 identified studies, 58 studies were included in the qualitative review and 13 studies were included in the meta-analysis. Key risk factors consistently associated with stress shielding were press-fit or long stems and high stem-to-humerus filling ratios (FRs), with threshold values of <0.7 or <0.8. Other potential risk factors include older age, poor bone quality, fracture arthroplasty, and stem length. The meta-analysis showed a statistically significant 5.6-point improvement in Constant scores for the non-stress shielding group at two years, although this fell below the minimal clinically important difference threshold and did not affect revision rates at mid-term follow-up.

CONCLUSION: Stress shielding is a frequent radiographic finding in TSA and RTSA. Although statistically significant, its clinical impact appears limited, and revision rates remain unaffected in the mid-term. Avoiding high FRs and careful implant selection may help reduce its occurrence and preserve bone stock.

PMID:41636254 | PMC:PMC12881896 | DOI:10.1530/EOR-2025-0139

EFORT Open Rev. 2026 Feb 4;11(2):96-106. doi: 10.1530/EOR-2024-0060.

ABSTRACT

PURPOSE: To conduct a meta-analysis of clinical studies evaluating the efficacy and safety of minimally invasive (MIS) posterior/posterolateral approaches and traditional posterolateral approaches in total hip arthroplasty (THA).

METHODS: The review process was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Two independent reviewers conducted literature searches based on the PRISMA guidelines. PubMed, Embase, Web of Science, and the Cochrane Library were searched for studies comparing MIS and traditional posterolateral approaches in THA. Harris Hip Score (HHS), visual analog scale (VAS), operation time, incision length, intraoperative blood loss, and complications were analyzed.

RESULTS: Twenty studies with 1,713 patients were included in our meta-analysis. The pooled results showed that MIS approaches resulted in significantly higher HHSs, lower VAS scores, reduced intraoperative blood loss, and shorter incision length compared to the traditional posterolateral approach. While no significant difference was found in operation time and complication between the two groups.

CONCLUSION: Based on current evidence, MIS approaches appear to offer superior efficacy compared to traditional posterolateral approaches in THA.

PMID:41636253 | PMC:PMC12880965 | DOI:10.1530/EOR-2024-0060

EFORT Open Rev. 2026 Feb 4;11(2):107-118. doi: 10.1530/EOR-2024-0146.

ABSTRACT

PURPOSES: Femoral shortening osteotomy is a promising surgical intervention for patients with the sequelae of high hip dysplasia who need a THA. It offers potential benefits such as preserving limb length, reducing joint stiffness, and preventing neurovascular damage. However, it is considered a complex procedure with a high risk of complications. Various techniques are employed, and their relative safety remains unclear. What is the prevalence of complications (e.g. non-union and dislocations) and rates of revision associated with different techniques of femoral shortening osteotomy?

METHODS: A systematic review was conducted according to the PRISMA guidelines. Multiple databases were searched for studies reporting complications of various femoral shortening osteotomies. Two independent reviewers selected studies, extracted data, and assessed bias. Proportional meta-analysis was employed to estimate non-union rates, while other complications and revisions were described using alluvial diagrams. The study has been registered in the PROSPERO database (CRD42023488761).

RESULTS: In total, 53 studies (comprising 1,925 hips undergoing osteotomy) were included. The transverse subtrochanteric shortening osteotomy emerged as the most frequently utilized technique. There was an overlapping prevalence of non-union rates among the different osteotomy techniques, ranging from 0% (step-cut osteotomies) to 2% (transverse osteotomies). A higher non-union prevalence was observed with cemented stems in transverse osteotomies (4%, 95% CI: 0-9%). Dislocation rates were similar among techniques. The rate of stem aseptic loosening ranged from 7.14% (Z osteotomy) to 0% (step-cut and V-shaped osteotomies). Oblique osteotomy exhibited the highest infection rate (2.63%).

CONCLUSION: Overall, comparable rates of non-union were observed across osteotomy techniques. Heterogeneous results for other complications showed a low risk for all osteotomies.

LEVEL OF EVIDENCE: Level IV, therapeutic study.

PMID:41636252 | PMC:PMC12881905 | DOI:10.1530/EOR-2024-0146

EFORT Open Rev. 2026 Feb 4;11(2):72-84. doi: 10.1530/EOR-2025-0147.

ABSTRACT

Bone homeostasis, a dynamic equilibrium essential for skeletal development and repair, is coordinately regulated by osteoclasts, osteoblasts, and osteocytes. Hereditary metabolic bone diseases arise from genetic mutations that impair the function of these key bone cells, disrupting the homeostatic balance. This review specifically addresses four prevalent hereditary metabolic bone diseases: osteogenesis imperfecta, Paget's disease of bone, hypophosphatemic rickets, and osteopetrosis. Dysfunction in major signaling pathways - notably the Wnt/β-catenin, RANK/RANKL/OPG, and TGF-β/BMP pathways - plays a central role in the aberrant bone remodeling underlying these disorders. Elucidating the molecular mechanisms involving these cells and pathways is fundamental to understanding disease pathogenesis and is crucial for the development of novel therapeutic interventions, presenting significant promise for future research.

PMID:41636248 | PMC:PMC12881898 | DOI:10.1530/EOR-2025-0147

EFORT Open Rev. 2026 Feb 4;11(2):131-144. doi: 10.1530/EOR-2024-0136.

ABSTRACT

PURPOSE: There is a lack of consensus regarding the optimal intramedullary nailing (IMN) strategy for humeral shaft fractures (HSFs): both antegrade IMN (aIMN) and retrograde IMN (rIMN) are used. We aim to compare both strategies in terms of outcomes and complications.

METHODS: MEDLINE, Embase and Cochrane Central Register of Controlled Trials databases were searched for articles in English or Spanish from inception to Nov 23, 2023. All studies reporting on primary treatment of acute HSFs (OTA/AO 12A, 12B, and 12C) with rigid locked IMN, in patients aged 16 years or older, were analyzed. Two independent reviewers screened studies for eligibility, performed data extraction, and used RoB 2, ROBINS-I and JBI's critical appraisal tools to assess bias of the included studies. Stata 18.0 software for data analysis was used. Subgroup analysis was performed to explore heterogeneity. We applied GRADE to appraise our evidence.

RESULTS: Nine studies involving 565 fractures were included. aIMN showed significantly faster operative time than rIMN (MD = -14.40 min (95% CI: -17.75 to -11.04); I 2 = 0%; P < 0.001), and rIMN showed significantly higher odds of intraoperative fractures than aIMN (RD = 0.05% (95% CI: -0.08% to -0.02%); I 2 = 0%; P < 0.005). In contrast, aIMN showed significantly higher odds of worse shoulder function and pain complaints and worse Neer scores than rIMN (P = 0.02, P = 0.03 and P = 0.02, respectively).

CONCLUSIONS: Compared with rIMN, aIMN demonstrated a significantly faster operative time and lower rates of intraoperative fractures. Conversely, rIMN demonstrated lower rates of shoulder pain complaints and better shoulder function and Neer score outcomes.

PMID:41636245 | PMC:PMC12881897 | DOI:10.1530/EOR-2024-0136

EFORT Open Rev. 2026 Feb 4;11(2):85-95. doi: 10.1530/EOR-2025-0165.

ABSTRACT

The need to collect objective outcome parameters digitally is increasing in both clinical practice and research. Step count is a frequently utilized digital mobility outcome (DMO) in orthopedic traumatology; however, its usefulness to monitor the patient recovery process remains unclear. The aim of this scoping review is to investigate the application and utility of daily patient step count as a DMO in musculoskeletal injuries. PubMed and consensus.app were queried. Eligibility criteria included the following: articles published within 20 years including patients with orthopedic trauma conditions and utilizing daily step count as an outcome. The type of study, case numbers, conditions investigated, use/usefulness of step count, duration of assessment, sensor use and location, and data harvesting specifics were assessed. Totally, 40 articles were analyzed, revealing an increasing trend in annual publications. The majority of studies were observational (93%), with a mean of 103 participants (range: 9-666). Proximal femur fractures (n = 7), anterior curciate ligament (ACL) injuries (n = 6), and joint replacement (n = 5) were the most frequently investigated conditions. Overall, 30% of studies used step count to demonstrate an association with patient-reported outcome measures, while 27% employed it to identify differences between study groups. Research-grade accelerometers/inertial measurement units (73%) were the most common sensors, with continuous measurement durations from 4 to 14 days. This review indicates an increasing use of step count as an objective DMO in the orthopedic trauma surgery literature. However, the implementation, application, setup, and data acquisition methodologies remain underexplored. This review highlights current trends and identifies key areas requiring further investigation in future research.

PMID:41636244 | PMC:PMC12881899 | DOI:10.1530/EOR-2025-0165

EFORT Open Rev. 2026 Jan 9;11(1):57-69. doi: 10.1530/EOR-2025-0032.

ABSTRACT

BACKGROUND: The efficacy and safety of robot-assisted pedicle screw placement versus freehand and computer-assisted navigation techniques remain debatable. This umbrella review synthesizes meta-analytic evidence on the associated accuracy, safety, and clinical outcomes.

METHODS: A comprehensive search was performed in PubMed, Embase, Scopus, Web of Science, Ovid, and Cochrane databases, from inception to October 2025, with no language restrictions. Researchers independently assessed meta-analyses that compared robot-assisted with freehand and computer-assisted navigation techniques. Methodological quality was assessed using the AMSTAR-2 tool, and evidence was graded using the GRADE framework. The primary outcomes included accuracy metrics (acceptable and perfect screw placement) and safety indicators (intraoperative blood loss, radiation exposure, and hospital stay). The protocol was registered with PROSPERO (registration number: CRD42024556304).

RESULTS: A total of 38 meta-analyses comprising 414 primary studies were included. Convincing evidence (class I) supported robotic superiority for acceptable placement versus freehand (eOR = 2.74; 95% CI: 2.33-3.22) and versus navigation (eOR = 2.36; 95% CI: 1.73-3.22), and for perfect placement versus navigation (eOR = 2.47; 95% CI: 1.84-3.32). Highly suggestive evidence (class II) supported superior perfect placement (vs freehand) and shorter hospital stays. Suggestive evidence (class III) indicated reductions in intraoperative blood loss and radiation exposure.

CONCLUSION: Robot-assisted pedicle screw placement demonstrates superior accuracy versus freehand and navigation-guided methods, supported by convincing (class I) evidence. Highly suggestive (class II) evidence also supports its superiority in perfect placement and shortening hospital stays, while suggestive (class III) evidence indicates reduced blood loss and radiation. These findings, supported by a robust evidence base, underscore the need for standardized clinical guidelines to maximize impact on patient outcomes.

PMID:41511896 | DOI:10.1530/EOR-2025-0032

EFORT Open Rev. 2026 Jan 9;11(1):17-33. doi: 10.1530/EOR-2025-0093.

ABSTRACT

Staphylococcus aureus is the most common pathogen in periprosthetic joint infections (PJIs), capable of biofilm formation and resistance mechanisms, complicating diagnosis and treatment. PJIs remain a leading cause of total joint arthroplasty failure and are associated with significant morbidity, mortality, and healthcare and economic burdens. Biofilm formation by S. aureus on prosthetic materials is central to PJI persistence and antibiotic resistance. Novel treatment strategies, including copper-coated implants, show promise as adjunct therapies but require further clinical validation.

PMID:41511894 | DOI:10.1530/EOR-2025-0093

EFORT Open Rev. 2026 Jan 9;11(1):46-56. doi: 10.1530/EOR-2025-0076.

ABSTRACT

PURPOSE: The use of intravenous (IV) tranexamic acid (TXA) in arthroscopic shoulder surgery remains controversial. This meta-analysis aimed to evaluate the efficacy of IV TXA in improving perioperative outcomes during shoulder arthroscopy.

METHODS: The review process was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A comprehensive systematic search was conducted in PubMed, Embase, Cochrane Library, and Web of Science from inception to February 2025. Randomized-controlled trials (RCTs) comparing IV TXA with group without TXA in patients undergoing arthroscopic shoulder surgery were included. Data were synthesized using random-effects models, with results presented as weighted mean differences (WMDs) and standardized mean differences (SMDs), with 95% confidence intervals (CIs).

RESULTS: Eleven RCTs involving 904 patients were included. Overall, seven trials were rated as high quality, while four trials were rated as moderate quality. Pooled results showed no statistically differences between TXA and control groups in terms of visual clarity (SMD: 0.25, 95% CI: -0.21 to 0.70), visual analog scale score (WMD: -0.33, 95% CI: -0.76 to 0.10), operative time (WMD: -4.48 min, 95% CI: -10.25 to 1.28), irrigation volume (SMD: -0.14, 95% CI: -0.52 to 0.24), estimated blood loss (SMD: -0.62, 95% CI: -1.86 to 0.61), and mean arterial pressure (WMD: -0.10 mmHg, 95% CI: -3.05 to 2.86). No complications were reported in either group across six studies.

CONCLUSIONS: Current evidence does not support a significant clinical benefit of IV TXA in arthroscopic shoulder surgery. Further high-quality RCTs are needed to clarify its role under standardized protocols.

PMID:41511893 | DOI:10.1530/EOR-2025-0076

EFORT Open Rev. 2026 Jan 9;11(1):3-16. doi: 10.1530/EOR-2025-0038.

ABSTRACT

PURPOSE: Diagnosing ligament injuries remains a challenge for musculoskeletal clinicians due to the lack of standardized classification, evaluation, and management protocols. Machine learning (ML) and deep learning (DL) models offer potential to improve diagnostic accuracy. This study aimed to evaluate the diagnostic performance of various ML and DL models in identifying ligament injuries across different medical imaging modalities.

METHODS: A meta-analysis was conducted following the PRISMA 2020 checklist. Searches were performed in PubMed, SCOPUS, Web of Science, and the Cochrane Library. Study quality was assessed using the QUADAS-2 tool and Robvis software. Diagnostic performance measures - true positive, true negative, false positive, and false negative - were analyzed. A random-effects model was applied, and heterogeneity and subgroup analyses were conducted. Statistical and graphical analyses were performed using R. The study was registered in PROSPERO (CRD42025646317).

RESULTS: Fifty-nine ML and DL algorithms from 23 studies were analyzed. Pooled sensitivity and specificity were 0.890 (95% CI: 0.829-0.938) and 0.926 (95% CI: 0.820-0.959), respectively. Pooled estimates for PLR, NLR, lnDOR, and AUC were 1,644.37 (95% CI: 73.56-3,215.18), 0.179 (95% CI: 0.095-0.263), 4.130 (95% CI: 3.570-4.700), and 95%, respectively, with P < 0.001.

CONCLUSION: ML and DL models demonstrate high diagnostic accuracy in detecting ligament injuries. Their strong performance supports ongoing integration into clinical practice, offering valuable support for musculoskeletal specialists in image interpretation and diagnosis.

PMID:41511891 | DOI:10.1530/EOR-2025-0038