Int Orthop. 2026 May 18. doi: 10.1007/s00264-026-06860-w. Online ahead of print.

ABSTRACT

PURPOSE: To clarify differences in hip-specific function, satisfaction, and patient preference between transposition osteotomy of the acetabulum (TOA) and contralateral total hip arthroplasty (THA) in the same patients with bilateral hip dysplasia.

METHODS: Among 689 patients who underwent TOA between 1998 and 2019, 32 patients who also underwent contralateral THA were included. Median age at surgery was 46 years for TOA and 50 years for THA (p = 0.008), and median follow-up was 14 and 12 years, respectively (p = 0.049). Postoperative patient-reported outcome measures included pain and satisfaction visual analogue scales (VAS), the Forgotten Joint Score-12 (FJS-12), and the Hip disability and Osteoarthritis Outcome Score (HOOS). Patients were also asked which hip they preferred.

RESULTS: Preoperative modified Harris Hip Score (mHHS) was higher in TOA hips than in THA hips (64 vs. 43; p < 0.001), whereas the latest mHHS was lower in TOA hips (92 vs. 96; p = 0.007). Although pain VAS, FJS-12, and all HOOS subscales were comparable between TOA and THA, satisfaction VAS was higher in THA hips (98 vs. 93; p = 0.029). Fifteen patients (47%) preferred THA, nine (28%) reported no difference, and eight (25%) preferred TOA. The most common reason for preferring THA was less pain (10 of 15 patients, 67%).

CONCLUSIONS: In middle-aged patients with bilateral hip dysplasia, TOA and contralateral THA yielded comparable functional outcomes; however, satisfaction was higher after THA, and 47% preferred THA. These findings may inform shared decision-making regarding joint-preserving surgery and arthroplasty.

PMID:42144483 | DOI:10.1007/s00264-026-06860-w

Int Orthop. 2026 May 17. doi: 10.1007/s00264-026-06854-8. Online ahead of print.

ABSTRACT

BACKGROUND: Operating rooms contribute disproportionately to healthcare-related greenhouse gas emissions and waste generation. Total Hip Arthroplasty (THA) and Total Knee Arthroplasty (TKA) are high-volume procedures with increasing global incidence, yet pooled data on their environmental impact are lacking.

METHODS: A systematic review and pooled analysis were conducted in accordance with PRISMA guidelines (PROSPERO: CRD420261297449). PubMed, Embase, and Scopus were searched through October 31, 2025, for studies reporting total waste, recyclable waste, and carbon dioxide equivalent (CO₂e) emissions associated with primary THA and TKA. Seventeen studies, including 394 procedures, were included. Data extraction covered waste quantity, recyclable proportion, and carbon footprint. Random-effects models with inverse variance weighting were used to calculate pooled mean estimates. Standard deviations were estimated from reported ranges when not provided. Heterogeneity was assessed using I2 statistics.

RESULTS: Pooled mean total waste per arthroplasty was 12.27 kg (95% CI, 10.88-13.66). Recyclable waste averaged 1.97 kg per procedure (95% CI, 1.64-2.31), representing 14.5% of total waste (95% CI, 11.99-17.02), and indicating substantial unrealized recycling potential. Carbon footprint estimates varied substantially by accounting methodology. Studies measuring waste-disposal emissions alone reported a pooled mean of 13.7 kg CO₂e per case (95% CI, 11.32-16.08), whereas comprehensive life-cycle assessment (LCA) studies reported a pooled mean of 135.37 kg CO₂e per case (95% CI, 74.91-195.83). Considerable inter-study heterogeneity reflected differences in waste segregation, recycling infrastructure, and carbon accounting methodologies.

CONCLUSIONS: Primary THA and TKA generate substantial waste and carbon emissions, with low recycling rates across institutions. These findings provide benchmark data to inform sustainability initiatives, optimize resource use, and guide standardized environmental assessment frameworks in arthroplasty.

PMID:42143633 | DOI:10.1007/s00264-026-06854-8

Int Orthop. 2026 May 16. doi: 10.1007/s00264-026-06856-6. Online ahead of print.

ABSTRACT

OBJECTIVE: The optimal management of AO/OTA 33-C3 distal femoral fractures combined with symptomatic medial compartment knee osteoarthritis remains uncertain. This preliminary feasibility series explored whether metaphyseal comminution could be used as a "natural osteotomy" window to permit intentional valgus alignment correction during dual-plate fixation, while maintaining anatomical articular reconstruction and fracture stability.

METHODS: This retrospective preliminary feasibility series included 17 patients with AO/OTA 33-C3 distal femoral fractures complicated by Kellgren-Lawrence grade 3 or 4 medial compartment knee osteoarthritis. All patients underwent anatomical reconstruction of the articular surface, intentional mild valgus alignment correction using the metaphyseal comminuted zone as a "natural osteotomy," and medial-lateral dual-plate fixation. The primary feasibility outcomes included successful articular reconstruction, achievement and maintenance of planned valgus alignment, fracture union, and absence of early mechanical failure or reoperation. Operative time, intraoperative blood loss, articular step-off and gap, healing time, complications, mLDFA, and HKA angle were assessed. Pain, range of motion, Knee Society Score, and ambulatory status were evaluated as exploratory clinical outcomes.

RESULTS: Mean operative time was 148.18 ± 10.01 min and blood loss 351.18 ± 30.18 mL. Anatomical articular reduction (step-off ≤ 2 mm) was achieved in all patients, with mean step-off 0.97 ± 0.20 mm and gap 0.98 ± 0.16 mm. All fractures united (mean healing time 29.76 ± 3.42 weeks), with no nonunion, implant failure, or reoperation within years. mLDFA changed from contralateral baseline 93.09° ± 0.65°to postoperative 85.03° ± 0.50°(P < 0.001); HKA changed from varus -9.12° ± 1.41°to valgus 2.47° ± 0.80°(P < 0.001). At final follow‑up, VAS pain score decreased from 7.47 ± 0.87 to 1.18 ± 0.39 (P < 0.001). KSS knee score increased from 34.12 ± 3.64 to 89.76 ± 3.21 (P < 0.001), and KSS function score from 43.82 ± 4.85 to 81.65 ± 2.80 (P < 0.001). Mean maximum knee flexion was 99.29° ± 4.22°at final follow‑up. Independent ambulation was achieved in 16 patients (94.1%).

CONCLUSION: In this small single-center preliminary feasibility series, intentional valgus alignment correction using the metaphyseal comminuted zone as a "natural osteotomy" during dual-plate fixation was technically feasible in selected patients with AO/OTA 33-C3 distal femoral fractures and medial compartment knee osteoarthritis. This approach achieved fracture union, maintained coronal alignment, and showed favorable exploratory pain and functional outcomes at mid-term follow-up. These preliminary findings support this joint-preserving concept and warrant further validation in prospective comparative studies with longer follow-up.

PMID:42142134 | DOI:10.1007/s00264-026-06856-6

Int Orthop. 2026 May 15. doi: 10.1007/s00264-026-06852-w. Online ahead of print.

ABSTRACT

PURPOSE: Septic arthritis (SA) of the native knee is a severe and increasingly prevalent condition, particularly among elderly and comorbid patients. When associated with end-stage degenerative joint disease, a two-stage total knee arthroplasty (TKA) with an antibiotic-loaded articulating spacer is commonly adopted. However, evidence directly comparing different spacer designs is limited. The aim of this study was to compare the clinical and functional outcomes of two two-stage strategies: a preformed cement articulating spacer and a Hofmann-type metal-on-polyethylene articulating spacer.

METHODS: We retrospectively reviewed 15 consecutive patients treated between June 2022 and December 2024 at a tertiary referralcentre. Inclusion criteria were native knee SA with end-stage arthritis managed with planned two-stage TKA and minimum 12-month follow-up. Seven patients received a Hofmann spacer and eight a preformed cement spacer. The primary endpoint was septic failure, defined as recurrent infection requiring surgical intervention; secondary endpoints included functional outcomes (Knee Society Score [KSS], Oxford Knee Score [OKS], Forgotten Joint Score [FJS]), pain (VAS), and range of motion (ROM) during the interstage period and after reimplantation.

RESULTS: Mean follow-up was 24.2 months. Infection eradication was comparable between groups, with one reinfection (6.7%) occurring in the cement spacer group (p = 1). During the interstage period, the Hofmann group demonstrated significantly superior KSS, OKS, FJS, VAS, and ROM (p = 0.001). After reimplantation, functional outcomes remained significantly better in the Hofmann group, with greater ROM and higher patient-reported scores. Two patients in the Hofmann group elected spacer retention due to satisfactory function.

CONCLUSION: Both strategies achieved effective infection control. However, the Hofmann articulating spacer provided superior functional recovery without compromising septic eradication, supporting its use in selected patients with native septic knee arthritis and advanced degeneration.

PMID:42141126 | DOI:10.1007/s00264-026-06852-w

Int Orthop. 2026 May 15. doi: 10.1007/s00264-026-06845-9. Online ahead of print.

ABSTRACT

PURPOSE: Osteoarthritis (OA) is now understood as a heterogeneous syndrome driven by diverse biological, biomechanical, metabolic, genetic, and molecular mechanisms. This variability explains differences in disease progression and treatment response, challenging the traditional "one-size-fits-all" approach. This review highlights OA phenotyping as a key step toward precision medicine, focusing on clinical, structural, and molecular classifications that inform individualized care.

METHODS: A narrative review was conducted using a non-systematic search of major databases and Osteoarthritis Research Society International sources (2010-2026). Evidence was thematically synthesized across clinical, imaging, and molecular domains to characterize OA phenotypes and their potential relevance to precision medicine.

RESULTS: Multiple OA phenotypes were identified: inflammatory, metabolic, biomechanical, cartilage-subchondral, pain-sensitization, and aging/senescence. These exhibit distinct clinical features, risk factors, and therapeutic responses. Imaging-based phenotypes (e.g., inflammatory, meniscus-cartilage, subchondral bone, atrophic, hypertrophic) and molecular endotypes (low turnover, structural damage, systemic inflammation) further refine stratification. Pain-structure discordance is notable in sensitization phenotypes and may predict poorer surgical outcomes. Joint-specific variations and emerging genomic and epigenetic insights underscore disease complexity. Advances in imaging, biomarkers, and machine learning may enable earlier detection and patient clustering, though clinical application remains limited.

CONCLUSION: Phenotype- and endotype-based classification represents a critical advancement toward precision OA management. Tailored interventions based on stratification hold promise for improving outcomes; however, clinical translation remains limited by overlapping phenotypes, lack of validated biomarkers, and inconsistent results from phenotype-driven trials. Wider clinical adoption requires standardized definitions, validation across joints, and integration of multimodal diagnostic tools into routine practice.

PMID:42141125 | DOI:10.1007/s00264-026-06845-9

Int Orthop. 2026 May 15. doi: 10.1007/s00264-026-06849-5. Online ahead of print.

ABSTRACT

PURPOSE: This study aimed to evaluate the accuracy of two imageless navigation systems for restoring leg length change (LLC) and global offset change (GOC) in total hip arthroplasty (THA) using two-dimensional (2D) radiographic and three-dimensional computed tomography (3D CT)-based assessment methods.

METHODS: Patients undergoing primary cementless THA were divided into two groups based on the imageless navigation system used: a large-console group (n = 120) and a portable handheld group (n = 83). Intraoperative navigation measurements of the LLC and GOC were compared with values derived from preoperative and postoperative assessments, and absolute measurement errors were calculated. Accuracy was evaluated using 2D radiographic and 3D CT-based measurements. Between-system differences and discrepancies between 2 and 3D assessment methods were analyzed.

RESULTS: Absolute LLC error in the large-console group was 2.7 ± 3.3 mm on 2D radiographic evaluation and 2.5 ± 3.3 mm on 3D CT-based evaluation, compared with 2.9 ± 2.7 mm and 3.0 ± 2.8 mm, respectively, in the portable handheld group. LLC error was significantly lower in the large-console group on 3D evaluation (p = 0.004). Absolute GOC error did not differ significantly between groups. No differences were observed between 2 and 3D evaluations for LLC, whereas most GOC-related parameters differed significantly between methods.

CONCLUSION: Imageless navigation systems achieved favorable accuracy for LLC and GOC in THA. While radiographic assessment is sufficient for evaluating leg length, 3D CT-based evaluation provides a more consistent and less position-dependent assessment of global offset.

PMID:42141124 | DOI:10.1007/s00264-026-06849-5

Int Orthop. 2026 May 14. doi: 10.1007/s00264-026-06855-7. Online ahead of print.

ABSTRACT

PURPOSE: To evaluate fracture table availability and functional usability in Nigerian orthopaedic practice and their influence on surgical decision-making, including referral practices, to inform strategies for improving access within existing surgical infrastructure.

METHODS: A nationwide cross-sectional survey was conducted among 77 orthopaedic surgeons across 46 hospitals in 25 Nigerian states, representing all six geopolitical zones and the Federal Capital Territory. Participants were recruited via a national WhatsApp group of practising orthopaedic surgeons, enabling broad geographic representation, although the sample was non-probability. A structured questionnaire captured respondent demographics, institutional characteristics, fracture table availability and functional usability, barriers to use, and qualitative suggestions for improving access. Quantitative data were analysed descriptively, with associations assessed using chi-square tests, interpreted cautiously in the context of potential structural dependencies. Open-ended responses underwent thematic qualitative analysis.

RESULTS: Sixty-one per cent of respondents reported the presence of fracture tables at their primary workplaces, with private hospitals showing the highest availability (85.7%). However, consistent usability was limited; only 19.1% of surgeons with access reported 'always' using the equipment when indicated, highlighting a gap between availability and functional readiness. Reported barriers included malfunction (34.0%), lack of perceived need (21.3%), and insufficient training (12.8%). While higher utilisation was associated with reported availability (p < 0.001), this relationship likely reflects underlying differences in institutional resources. Formal training was associated with increased self-reported confidence (p < 0.001). Notably, the availability of fracture tables alone was not clearly associated with reported changes in surgical planning, suggesting that broader contextual constraints may influence decision-making. Respondents proposed financing strategies, training initiatives, maintenance systems, and policy measures to improve access.

CONCLUSION: In Nigeria, the presence of fracture tables does not necessarily translate to functional usability. Constraints related to maintenance, training, and institutional capacity limit effective use and may attenuate their influence on surgical decision-making. Strengthening orthopaedic care will require coordinated system-level interventions that prioritise not only the provision of equipment but also sustainability, workforce capacity, and context-appropriate surgical planning.

PMID:42132946 | DOI:10.1007/s00264-026-06855-7

Int Orthop. 2026 May 14. doi: 10.1007/s00264-026-06848-6. Online ahead of print.

ABSTRACT

PURPOSE: Combined anteversion (CA), integrating acetabular (AA) and femoral anteversion (FA), is crucial for total hip arthroplasty (THA) stability. We evaluated CA distribution in natural Asian hips, AA and FA contributions to CA variance, and sex and age effects.

METHODS: We retrospectively analysed 200 normal contralateral hips from patients with femoral neck fractures. Using CT-based 3D models, we calculated AA and FA. CA was determined using the Widmer equation (CA = AA + 0.7 × FA). We evaluated sex and age differences and used standardised regression coefficients to identify CA variance determinants.

RESULTS: Mean values were AA 16.3° ± 5.4°, FA 18.8° ± 11.2°, and CA 29.4° ± 9.6°. Standardised regression coefficients for CA variance were β = 0.822 for FA and β = 0.580 for AA. Women had significantly higher AA, FA, and CA than men (mean CA: 30.7° vs 24.4°). Sex-specific coefficients confirmed FA as the dominant determinant (men: FA β = 0.889, AA β = 0.595; women: FA β = 0.817, AA β = 0.587). With age, AA increased (0.12°/year, P = 0.006) and FA decreased (-0.30°/year, P = 0.001), but CA remained unchanged (P = 0.256).

CONCLUSION: Mean CA in natural Asian hips (29.4°) is lower than conventional THA targets. CA variance is predominantly determined by FA. While AA and FA change with age, CA remains stable. Optimising CA in THA requires individualised strategies emphasising sex differences.

PMID:42132945 | DOI:10.1007/s00264-026-06848-6

Int Orthop. 2026 May 14. doi: 10.1007/s00264-026-06858-4. Online ahead of print.

ABSTRACT

PURPOSE: This study aimed to evaluate the association of oxidized regenerated cellulose (ORC) powder in perioperative blood management during total knee arthroplasty (TKA) using a subvastus approach with limited tourniquet use.

METHODS: We retrospectively analyzed 140 patients who underwent primary TKA using the subvastus approach at our institution between January 2023 and December 2025. The Patients were divided into ORC (n = 69) and non-ORC (n = 71) groups based on the intraoperative application of ORC powder. All patients received local tranexamic acid (TXA), and the tourniquets were inflated only during cementation. To account for potential confounding, multivariable linear regression analysis was performed. The primary outcomes were estimated total blood loss (eTBL) and hidden blood loss (HBL). Secondary outcomes included postoperative pain (numeric rating scale, NRS) and the incidence of postoperative complications.

RESULTS: The ORC group demonstrated significantly lower eTBL (599.2 ± 211.9 vs. 713.4 ± 273.3 mL, p = 0.007) and HBL (398.3 ± 207.6 vs. 485.8 ± 273.0 mL, p = 0.03) compared to the non-ORC group. Multivariable analysis confirmed that ORC use was independently associated with lower eTBL (β = -117.2; p = 0.009) and HBL (p = 0.02), though it was not an independent predictor for pain reduction on postoperative day seven (p = 0.15). There were no significant differences in operative time, or the incidence of postoperative complications.

CONCLUSION: The adjunctive use of ORC powder during TKA was associated with lower eTBL and HBL.

PMID:42132944 | DOI:10.1007/s00264-026-06858-4

Int Orthop. 2026 May 14. doi: 10.1007/s00264-026-06841-z. Online ahead of print.

ABSTRACT

PURPOSE: Third-generation alumina is being replaced with fourth-generation alumina matrix composite (AMC) in ceramic-on-ceramic total hip arthroplasty (THA), however, comparative clinical studies at a long-term are lacking. We aimed to compare third- and fourth-generation ceramic-on-ceramic THA at a minimum follow-up of ten years.

METHODS: A total of 332 third-generation ceramic-on-ceramic THAs (302 patients) performed between 2010 and 2015 were compared with 185 fourth-generation (165 patients) during the same time period. Changes in the Harris Hip Score (HHS), Euro Qol-5D (EQ-5D), Visual Analogue Scale (VAS) satisfaction instruments, complications, survival rates for reoperation and the radiographic results were compared.

RESULTS: At the latest follow-up, the mean HHS, EQ-5D and VAS scores were similar between the groups. There were four dislocations (1.2%) in the alumina group (one with a 28-mm and three with a 32-mm femoral head), and two (1.1%) in the AMC group (all with a 36-mm). Four (1.2%) patients in the alumina group and eight (2.1%) in the AMC group reported occasional noises but no squeaking. One 28-mm femoral head fractured in the alumina group. The 15-year survival rate for any reoperation was 95.8% (95% confidence interval [CI]: 93.6% to 97.9%) for alumina-on-alumina THAs, and 96.3% (95% CI: 93.5-99.0) for the AMC group (p = 0.8).

CONCLUSIONS: Both third- and fourth-generation ceramic-on-ceramic THA can provide excellent results in most patients. Although no ceramic-related complications occurred in the AMC group, fourth-generation bearings were not found to be superior to third-generation alumina bearings overall. A thorough understanding of implant characteristics and surgical technique is essential for an accurate clinical interpretation when assessing different brands in THA.

PMID:42128932 | DOI:10.1007/s00264-026-06841-z

Int Orthop. 2026 May 13. doi: 10.1007/s00264-026-06846-8. Online ahead of print.

NO ABSTRACT

PMID:42126585 | DOI:10.1007/s00264-026-06846-8

Int Orthop. 2026 May 13. doi: 10.1007/s00264-026-06844-w. Online ahead of print.

ABSTRACT

INTRODUCTION: The iliopsoas muscle passes immediately anterior to the hip joint and lies in close proximity to the acetabular labrum at the level of the psoas valley. This anatomical relationship suggests that local muscle morphology may be associated with symptomatic hip pathology. The present study investigated the association between iliopsoas cross-sectional area at the psoas valley, adjacent osseous morphology, and surgically treated symptomatic hip-pathologies.

METHODS: In this retrospective case-control study, 92 adult patients who underwent hip arthroscopy between 2019 and 2024 and had preoperative computed tomography (CT) imaging were compared with 50 age- and sex-matched controls without documented hip pain who had CT scans obtained for non-hip-related indications. Three-dimensional CT reconstructions were used to measure retroinguinal and psoas-valley morphometric parameters, including iliopsoas crosssectional area at the level of the psoas valley. Multivariable logistic regression adjusted for age and body mass index was performed for variables that differed between groups.

RESULTS: The groups did not differ significantly in age, sex, body mass index, or side. The lacuna musculorum ratio was higher in the surgical cohort than in controls (0.5 ± 0.1 vs. 0.4 ± 0.1; p < 0.001). Iliopsoas cross-sectional area at the psoas valley was smaller in the surgical cohort (12.5 ± 3.2 cm2 vs. 13.7 ± 2.8 cm2; p = 0.025). In multivariable analysis, a higher lacuna musculorum ratio (OR:1.094, 95% CI 1.026-1.167; p = 0.006) and a smaller iliopsoas cross-sectional area (OR:0.998, 95% CI 0.996-1.000; p = 0.039) remained associated with membership in the surgically treated cohort.

CONCLUSION: Smaller iliopsoas cross-sectional area at the psoas valley was more often associated with surgically treated hip pathologies. These findings support a possible anatomical relationship between anterior hip soft-tissue morphology and symptomatic hip pathology, but they do not establish a protective causal effect of greater iliopsoas muscle bulk against labral injury.

PMID:42126584 | DOI:10.1007/s00264-026-06844-w

Int Orthop. 2026 May 13. doi: 10.1007/s00264-026-06843-x. Online ahead of print.

ABSTRACT

PURPOSE: Spinal tuberculosis (TB) remains a major cause of morbidity in low- and middle-income countries. This study evaluated the epidemiological profile, management strategies, and neurological outcomes of spinal TB at a tertiary orthopaedic centre in Nigeria.

METHODS: A retrospective review of patients treated between January 2021 and October 2025 was conducted. Diagnosis was based on clinical, radiological, microbiological, or histopathological criteria. Demographic and neurological data using the ASIA impairment scale were extracted. Changes in neurological status between presentation and final follow-up were analysed using the Wilcoxon signed-rank test, with significance set at p < 0.05.

RESULTS: A total of 223 patients were identified; 61% were male (n = 137) with a mean age of 45.2 years (range 4-81). All patients received anti-tuberculous therapy. Non-operative management was undertaken in 203 patients (91%), while 20 patients (9%) underwent adjunctive surgery for neurological deficit, instability, or deformity. Among conservatively managed patients with documented orthopaedic follow-up (n = 95), 75 presented with neurological deficits; 62 (82.7%) improved by at least one ASIA grade, including 51 (68.0%) who recovered to ASIA E (median improvement D to E; p < 0.001). Twelve surgical patients had neurological deficits; 83.3% improved postoperatively, with 33.3% achieving complete recovery (exact p = 0.002). Surgical complication rate was 15%, with no mortality.

CONCLUSION: Protocol-driven spinal TB management combining universal chemotherapy with selective surgery yields favourable neurological outcomes in endemic resource-limited settings.

PMID:42126583 | DOI:10.1007/s00264-026-06843-x

Int Orthop. 2026 May 12. doi: 10.1007/s00264-026-06851-x. Online ahead of print.

NO ABSTRACT

PMID:42118305 | DOI:10.1007/s00264-026-06851-x

Int Orthop. 2026 May 12. doi: 10.1007/s00264-026-06834-y. Online ahead of print.

ABSTRACT

PURPOSE: Total hip arthroplasty (THA) presents unique technical challenges in patients who have morbid obesity, and benefits of imageless navigation in this population remain unclear. This study compared complications, thromboembolic events, and emergency department utilization between imageless navigation-assisted and manual THA in patients who have morbid obesity.

METHODS: A retrospective cohort study was performed using the PearlDiver database. Patients who have morbid obesity (BMI ≥ 40) undergoing elective primary THA between 2010 and 2021 were identified. Cases performed with robotic assistance or image-based navigation were excluded. Patients were stratified by intraoperative technique into manual and imageless navigation cohorts and matched 1:3 on age, sex, year of procedure, and comorbidities. Surgical complications, thromboembolic events, revision procedures, and emergency department visits were evaluated at multiple postoperative time points and compared using univariable regression.

RESULTS: After matching, 4,499 patients who have morbid obesity were included, comprising 3,367 manual (74.8%) and 1,132 imageless navigation (25.2%) cases. No significant differences were observed between cohorts in rates of surgical complications, including infection, dislocation, periprosthetic fracture, mechanical loosening, chronic pain, or leg length discrepancy at any evaluated time point (P > 0.05). Thromboembolic events were uncommon and did not differ between groups at 30 or 90 days. Emergency department visits and revision rates were also similar at all time points.

CONCLUSIONS: Among patients who have morbid obesity undergoing primary THA, imageless navigation was not associated with improved outcomes compared with manual techniques, suggesting postoperative risk is driven primarily by obesity-related factors. Surgeons should weigh resource utilization and patient characteristics when selecting operative technique.

PMID:42118304 | DOI:10.1007/s00264-026-06834-y

Int Orthop. 2026 May 12. doi: 10.1007/s00264-026-06836-w. Online ahead of print.

ABSTRACT

PURPOSE: To identify preoperative physical performance and muscle quality factors associated with independent ambulation one week after total hip arthroplasty (THA).

METHODS: This retrospective study included 102 patients (102 hips) who underwent primary unilateral THA via a posterior approach between June 2024 and June 2025. Patients were classified into independent (n = 54) and dependent (n = 48) ambulation groups according to their ability to walk 50 m without walking aids one week after THA. Preoperative assessments included the 30-s chair-stand test, two-step test, one-leg stance time, and Timed Up and Go test, as well as computed tomography-derived muscle attenuation values. Multivariable logistic regression was performed to identify independent predictors of independent ambulation.

RESULTS: The independent ambulation group was younger and performed better on all four physical function tests (all p < 0.05). Muscle attenuation values differed only for the rectus femoris (p = 0.003). In multivariable analysis, the two-step value was the sole independent predictor of independent ambulation (per 0.1-unit increase: OR 1.33; 95% CI 1.02-1.74; p = 0.026). The optimal cutoff value was 0.95, with a sensitivity of 75%, specificity of 76%, and area under the receiver operating characteristic curve of 0.81.

CONCLUSION: Preoperative two-step test performance independently predicted independent ambulation one week after THA. A two-step value of 0.95 may help identify patients at risk of delayed walking recovery and facilitate preoperative risk stratification.

PMID:42118303 | DOI:10.1007/s00264-026-06836-w

Int Orthop. 2026 May 11. doi: 10.1007/s00264-026-06847-7. Online ahead of print.

NO ABSTRACT

PMID:42113279 | DOI:10.1007/s00264-026-06847-7

Int Orthop. 2026 May 11. doi: 10.1007/s00264-026-06837-9. Online ahead of print.

ABSTRACT

BACKGROUND: Conventional traction therapy for LDH is widely used but has inconsistent efficacy in relieving pain and restoring motor function. Therefore, we designed and evaluated MTD that combines traction and rotation.

METHODS: A prospective randomized controlled trial with a follow-up period from January 2022 to July 2024.Patients with LDH were randomly allocated to receive either treatment with a multifunctional traction device combining traction and twisting (MTD group), or conventional lumbar traction therapy (Control group). A total of 47 patients (MTD, n = 23; Control, n = 24) completed the study and were included in the final analysis. The major outcome was assessing changes from baseline to post-treatment in Visual Analog Scale (VAS) scores, Oswestry Disability Index (ODI) scores, Japanese Orthopaedic Association (JOA) scores and magnetic resonance imaging (MRI) evaluations.

RESULTS: A total of 47 patients were included, with 23 in the MTD group and 24 in the control group. There were no specific differences between the two groups in terms of gender, age, height, weight, BMI, ODI, JOA or VAS scores at baseline date. Generalized estimating equation (GEE) analysis showed that ODI and VAS scores in the MTD group were lower compared to baseline (P < 0.05). MRI evaluation showed no notable differences between the groups in terms of Pfirrmann grading and disc protrusion severity (P > 0.05).

CONCLUSIONS: The MTD treatment is more effective in reducing low back pain and enhancing daily function than conventional treatment in patients with LDH.

TRIAL REGISTRATION: This study has been registered in the Chinese Clinical Trial Registry (ChiCTR2100053940, https://www.chictr.org.cn ).

PMID:42113278 | DOI:10.1007/s00264-026-06837-9

Int Orthop. 2026 May 11. doi: 10.1007/s00264-026-06838-8. Online ahead of print.

ABSTRACT

PURPOSE: Non-surgical phases of operating room (OR) time represent potentially modifiable sources of inefficiency. This study analysed OR workflow patterns across orthopaedic subspecialties and identified independent risk factors for phase-specific delays.

METHODS: This retrospective cohort study included 12,568 orthopaedic procedures at a tertiary academic centre (2012-2019). Procedures were classified into upper extremity (UE), lower extremity (LE), spine (Sp), and tumour (Tu). OR time was divided into preparation (Phase 1), surgical procedure (Phase 2), and exit (Phase 3). Phase durations were compared using one-way ANOVA with Bonferroni correction; effect size was assessed using eta squared (η2). Logistic regression was used to identify independent predictors of preparation delay (defined as Phase 1 duration > 55 min, the overall 75th percentile) and exit delay (Phase 3 duration > 37 min), with UE as the reference subspecialty.

RESULTS: Mean preparation, surgical, and exit times were 47 ± 14, 123 ± 97, and 31 ± 19 min, respectively. LE had the highest preparation phase ratio (31.5%); Sp had the longest exit time (η2 = 0.055). On logistic regression, LE independently predicted preparation delay (OR 2.42, 95%CI 2.10-2.79), and Sp predicted exit delay (OR 2.83, 95%CI 2.46-3.27).

CONCLUSION: OR workflow differs significantly across orthopaedic subspecialties. Subspecialty-specific delay patterns suggest actionable targets for perioperative efficiency improvement, and systematic monitoring of non-surgical OR phases may help foster an efficiency-conscious culture in academic orthopaedic departments.

PMID:42108330 | DOI:10.1007/s00264-026-06838-8

Int Orthop. 2026 May 9. doi: 10.1007/s00264-026-06826-y. Online ahead of print.

NO ABSTRACT

PMID:42104988 | DOI:10.1007/s00264-026-06826-y