Int Orthop. 2025 Oct 15. doi: 10.1007/s00264-025-06672-4. Online ahead of print.

ABSTRACT

PURPOSE: Registry data suggests that robotic-assisted unicompartmental knee arthroplasty (rUKA) significantly reduces all-cause revisions compared to conventional implantation (cUKA). This study aims to compare joint line-related parameters and their reconstruction accuracy between rUKA and cUKA.

METHODS: Five databases were searched using a pre-defined strategy and inclusion criteria: (1) comparative studies reporting radiological outcomes, (2) human studies, (3) English language, and (4) meta-analyses for cross-referencing. Cadaveric or saw-bone studies were excluded. Data extracted included demographics data, pre- and postoperative radiological parameters (HKA, MPTA, LDFA, posterior tibial slope, femoral sagittal angle, joint line height, implant congruency), and outliers. A random-effects meta-analysis was conducted using mean difference (MD) and odds ratio (OR) as main effect estimators. Risk of bias was assessed using the Newcastle-Ottawa Scale (NOS), and publication bias was evaluated with funnel plots.

RESULTS: A total of 18 studies assessing 2470 patients (1112 rUKA, 1358 cUKA) were included in the analysis. No significant baseline differences were found in age, sex, BMI, follow-up period, MPTA, LDFA, or tibial slope. Postoperative radiological parameters showed no significant differences between groups for HKA, LDFA, MPTA, or tibial slope (p > 0.05). Joint line height was significantly lower in cUKA compared to rUKA (MD = -1.37 mm, 95% CI: -2.06 to -0.69, p < 0.001). Outlier analysis revealed that rUKA had significantly fewer outliers across relevant radiological parameters, including HKA, joint line height, tibial slope, femoral flexion, femoral implant congruency, and medial, anterior, and posterior tibial congruency.

CONCLUSION: Reporting pre- and postoperative mean alignment parameters undermines patient-specific anatomy reconstruction with advanced technologies. Outlier reporting showed significant variability, with limited evidence supporting its clinical relevance. Future studies should focus on patient-specific reconstruction and define clinical thresholds for outliers.

PMID:41091159 | DOI:10.1007/s00264-025-06672-4

Int Orthop. 2025 Oct 15. doi: 10.1007/s00264-025-06670-6. Online ahead of print.

NO ABSTRACT

PMID:41087774 | DOI:10.1007/s00264-025-06670-6

Int Orthop. 2025 Oct 15. doi: 10.1007/s00264-025-06666-2. Online ahead of print.

NO ABSTRACT

PMID:41087773 | DOI:10.1007/s00264-025-06666-2

Int Orthop. 2025 Oct 9. doi: 10.1007/s00264-025-06665-3. Online ahead of print.

ABSTRACT

PURPOSE: Conserving the subscapularis tendon during reverse shoulder arthroplasty (RSA) has proven its impact on postoperative outcomes, particularly regarding stability and range of motion. A subscapularis preserving approach has been developed: the Anterior Muscle Sparing (AMS) approach that enables not to violate the subscapularis tendon. Our aim was to compare this approach with the conventional approach, which consists of reinserting the subscapularis at the end of the procedure, with a specific focus on intraoperative complications and postoperative position of the implants.

METHODS: A retrospective consecutive study was performed of patients undergoing a primary RSA between January 2021 and December 2024 performed by the same surgeon. We included 32 patients receiving the standard approach (SA) and 24 patients receiving the AMS approach. Implant positioning was assessed through three different variables: the glenoid implant inclination relative to the floor of the supraspinatus fossa; the glenoid implant height described as the distance between the inferior border of the glenoid bone surface and the inferior part of the glenoid baseplate; and the humeral stem alignment relative to the intramedullary humeral shaft axis.

RESULTS: There were no significant differences in terms of glenoid implant inclination (-4.71 ± 6.3° Vs -3.8 ± 7.17°; p = 0.68), glenoid implant height (0.608 ± 1.94 mm Vs 0.315 ± 0.896 mm ; p = 0.655), and PERFORM® humeral stem alignment ( 1.34 ± 4.11° Vs 1.89° ± 4.63°; p = 0.715) between the two groups. The intraoperative complication rate was not significant different between the groups, with only two cases within the AMS approach group (p = 0.181). The mean operative times were not significantly different between the groups (94.06 min ± 18,71 Vs 81,73 min. ±16,58; p = 0,06). Since September 2023, when the senior author started performing RSAs with the described technique only one patient was converted from an AMS to a traditional approach during surgery due to an intraoperative complication.

CONCLUSION: When compared to the standard approach, the AMS showed no significant difference in terms of implant positioning, surgical operative times and intraoperative complication rate. An attempt to preserve the subscapularis tendon seems to be always justified, as this method is a safe and reliable alternative to the traditional approach.

LEVEL OF EVIDENCE: Level III, Retrospective Cohort Comparison Treatment study.

PMID:41065821 | DOI:10.1007/s00264-025-06665-3

Int Orthop. 2025 Oct 8. doi: 10.1007/s00264-025-06668-0. Online ahead of print.

NO ABSTRACT

PMID:41060390 | DOI:10.1007/s00264-025-06668-0

Int Orthop. 2025 Oct 7. doi: 10.1007/s00264-025-06667-1. Online ahead of print.

NO ABSTRACT

PMID:41055733 | DOI:10.1007/s00264-025-06667-1

Int Orthop. 2025 Oct 1. doi: 10.1007/s00264-025-06661-7. Online ahead of print.

ABSTRACT

PURPOSE: In shoulder arthroplasty, three-dimensional computed tomography (3D CT) has become the gold standard for preoperative version assessment. Meanwhile, postoperative version is usually evaluated using radiographs (XR), in particular an axillary view, in which the view of the scapular body is often truncated, preventing the scapular plane from being used as a reference. This study introduces the posterolateral acromion-to-coracoid (PLAC) line, which can be assessed on a standard truncated axillary radiograph.

MATERIALS AND METHODS: Forty-six shoulders were studied. Four angles were measured including 3D CT (CT Version), 3D CT PLAC line to glenoid face angle (CT PLAC-GFA), 2) radiographic PLAC line to glenoid face angle (XR PLAC-GFA), and 3) the radiographic glenoid vault line to glenoid face angle (XR GV-GFA). Variation and linear relationship between these angles were calculated.

RESULTS: The mean difference between CT PLAC-GFA and XR PLAC-GFA was 1.0º (95% CI -0.7 to 2.8)(IQR = 8.5º, -3.0º to 5.4º), with a strong correlation on linear regression (R2 = 0.76, p < 0.001). XR PLAC-GFA and XR GV-GFA demonstrated strong correlations with CT measured version (R2 = 0.72 and 0.70, respectively; p < 0.001). Inter-rater reliability was excellent for all metrics (ICC ≥ 0.93).

CONCLUSIONS: The PLAC and the glenoid vault lines are highly reproducible references on truncated axillary views. These alternative reference lines allow accurate comparison of preoperative and postoperative glenoid orientation using standard axillary radiographs.

PMID:41032114 | DOI:10.1007/s00264-025-06661-7

Int Orthop. 2025 Oct 1. doi: 10.1007/s00264-025-06664-4. Online ahead of print.

ABSTRACT

BACKGROUND: Posturography is a diagnostic technique that quantifies postural control through Centre of Pressure (CoP) displacement analysis on a force platform. Footwear characteristics, particularly heel-to-toe drop, may influence balance by modifying plantar pressure distribution and proprioceptive feedback. The aim of this study was to evaluate the impact of different footwear drops (0 mm, 5 mm, 10 mm) on postural control in healthy young adults, considering sex, BMI, and shoe size.

METHODS: A cross-sectional study was conducted in 117 participants (56 men, 61 women) using the Dinascan/IBV® platform and the Romberg test. CoP displacement and velocity were analyzed.

RESULTS: Significant differences were observed in CoP total displacement (p < 0.001), mean velocity (p < 0.001), and medio-lateral dispersion (p = 0.024) when comparing 0 mm to 5 mm and 10 mm drops. Sex differences were significant at 0 mm drop for maximum medio-lateral force (p < 0.001) and mean velocity (p = 0.042), with men exhibiting greater values. At 5 mm drop, men showed significantly higher swept area (p = 0.029) and anteroposterior displacement (p = 0.007) than women.

CONCLUSIONS: Small variations in footwear drop can affect postural control, particularly in the medio-lateral plane. Sex and BMI significantly influence CoP behavior, suggesting the need to consider these factors in footwear design and clinical balance assessments.

PMID:41032113 | DOI:10.1007/s00264-025-06664-4

Int Orthop. 2025 Sep 30. doi: 10.1007/s00264-025-06634-w. Online ahead of print.

NO ABSTRACT

PMID:41026200 | DOI:10.1007/s00264-025-06634-w

Int Orthop. 2025 Sep 29. doi: 10.1007/s00264-025-06639-5. Online ahead of print.

ABSTRACT

This study evaluated the outcomes of double mobility trapeziometacarpal prostheses for treating osteoarthritis (OA) of the trapeziometacarpal (TMC) joint. A prospective observational analysis was conducted on 150 implants with a maximum follow-up of four years, including a clinical and radiographic assessment and an evaluation of complications. The results indicate a prosthesis survival rate of 97.9% after the first two years post-surgery, calculated using the Kaplan-Meier method. Significant improvements were observed in pain reduction (mean VAS at 3 months post-surgery 2,9 and 1.5 after 6 months), hand grip strength (25.93 kg at 6 months post-surgery), and range of motion (Kapandji score from 8.8 to 9.2, comparing the preoperative mean with the mean after the first postoperative month). The complication rate was low, with only two cases of cup migration and one case of trapezium resorption. Patient satisfaction was high due to the rapid functional recovery and reduced invasiveness compared to traditional techniques. Double-mobility prostheses offer a highly effective treatment for stage II and III TMC OA according to the Eaton-Littler classification, with minimal need for revision surgeries.

PMID:41020960 | DOI:10.1007/s00264-025-06639-5

Int Orthop. 2025 Sep 29. doi: 10.1007/s00264-025-06663-5. Online ahead of print.

ABSTRACT

PURPOSE: Calcium pyrophosphate dihydrate (CPPD) deposition, often visible radiographically as chondrocalcinosis, frequently accompanies knee osteoarthritis and is usually encountered at the time of arthroplasty. Whether its presence influences the outcome of patellofemoral arthroplasty (PFA) remains uncertain.

METHODS: We reviewed 100 PFAs performed in 82 patients between 1997 and 2005, and followed them for an average of 22 years (range, 20-25 years). At surgery, 35 knees showed radiographic chondrocalcinosis, and an additional 33 developed calcification during follow-up.

RESULTS: Fifteen knees (15%) required revision to total knee arthroplasty (TKA) at a mean of 12 years after PFA. The main reasons for revision were tibiofemoral osteoarthritis progression (6 knees), patellar malalignment (7 knees), one implant loosening, and one patella fracture. The 20-year survival rates were 87% for knees without chondrocalcinosis and 90% for those with chondrocalcinosis, with no significant difference in revision timing between groups (log-rank p = 0.64).

CONCLUSION: Although chondrocalcinosis became more prevalent with age and follow-up, it did not increase the risk of conversion to TKA. These findings suggest that PFA remains a suitable option in carefully selected patients, regardless of the presence of chondrocalcinosis.

PMID:41020959 | DOI:10.1007/s00264-025-06663-5

Int Orthop. 2025 Sep 29. doi: 10.1007/s00264-025-06662-6. Online ahead of print.

ABSTRACT

PURPOSE: Recurrent hip dislocation after total hip arthroplasty is among the most distressing complications for patients, often reshaping their everyday lives. Beyond the immediate physical consequences, repeated instability generates fear of movement, social withdrawal, and emotional strain. Yet, the extent of this burden has rarely been quantified using patient-centered methods.

METHODS: We evaluated 170 patients who had experienced at least three dislocations and were scheduled for revision surgery. To capture the impact on health-related quality of life (HRQoL), patients completed a Time Trade-Off (TTO) assessment, estimating how many years of life they would exchange for a dislocation-free state. A parallel measure, the Survival Implant TTO, explored whether patients would sacrifice implant longevity in favor of greater stability. Their preferences were compared with surgeons' attitudes toward balancing implant durability and stability.

RESULTS: Patients consistently described instability as a devastating experience, with many reporting restrictions in daily activities and a loss of independence. On average, patients were prepared to exchange nearly one quarter of their remaining life expectancy for stability and were also willing to shorten projected implant survival if this reduced the likelihood of further dislocations. In contrast, surgeons-particularly when treating younger patients-often emphasized implant durability over stability.

CONCLUSIONS: Recurrent hip dislocation has a far-reaching impact on quality of life, comparable to or exceeding that of chronic systemic diseases. Importantly, patient priorities differ from those of surgeons: stability is consistently valued over implant longevity. Incorporating these perspectives into revision planning is essential for truly patient-centered care.

PMID:41020958 | DOI:10.1007/s00264-025-06662-6

Int Orthop. 2025 Sep 26. doi: 10.1007/s00264-025-06655-5. Online ahead of print.

NO ABSTRACT

PMID:41003786 | DOI:10.1007/s00264-025-06655-5

Int Orthop. 2025 Sep 26. doi: 10.1007/s00264-025-06653-7. Online ahead of print.

ABSTRACT

PURPOSE: We examined The Seven Works of Mercy, painted by the Master of Alkmaar in 1504, through the lens of orthopaedic pathology. This study approaches the panels from a medical perspective, aiming to uncover visual indicators of disease and disability. The findings offer insight into how physical abnormalities were observed and depicted in the early sixteenth century. To our knowledge, this is the first study to explore orthopaedic pathology in the Seven Works of Mercy.

METHODS: An interdisciplinary analysis of The Seven Works of Mercy was undertaken, with a focus on the visual representation of illness and physical disabilities. The seven panels were examined to identify physical abnormalities. The findings were compared with clinical features of the suggested illnesses and disabilities and with known medical conditions prevalent in the fifteenth and sixteenth century in Europe.

RESULTS: Several depicted orthopaedic disabilities were suggested in the panels of The Seven Works of Mercy. Possible underlying conditions included clubfeet, spinal tuberculosis (Pott's disease), syphilis, poliomyelitis, ergotism, and genu recurvatum. The physical deformities, depicted with remarkable anatomical detail, were cross-referenced with known clinical presentations. In several cases, assistive devices and posture supported the proposed diagnoses.

CONCLUSION: The Seven Works of Mercy by the Master of Alkmaar is a mirror of society in the early sixteenth century, in which a number of depicted orthopaedic conditions were identified. While artistic interpretation must be considered, several physical deformities and disabilities are reproduced with remarkable detail. The artist captured in this masterpiece, a gallery of orthopaedic pathologies common in his time.

PMID:41003785 | DOI:10.1007/s00264-025-06653-7

Int Orthop. 2025 Sep 25. doi: 10.1007/s00264-025-06658-2. Online ahead of print.

ABSTRACT

PURPOSE: This study compared the demographics and outcomes of patients with Parkinson's disease (PD) undergoing total knee arthroplasty (TKA) to those without PD. Additionally, it aimed to assess the impact of implant design on TKA survival in PD patients.

METHODS: Using data from the Emilia Romagna Registry of Orthopedic Prosthetic Implants, 551 TKA procedures in patients with PD were identified and compared to 52,022 TKAs in patients without PD. Kaplan-Meier survivorship analysis was used to compare implant survival, with revision surgery as the endpoint. Cox multivariate analysis was performed to assess the influence of age, gender, PD diagnosis, and implant design on implant failure.

RESULTS: The average age of PD patients was 72.2 years, with 66.2% being female. Implant survival was significantly lower in the PD group compared to the control group (p < 0.001). At 13 years, the survival rate was 88.8% in the PD group and 94.3% in the control group. PD patients had a 2.7 times higher risk of implant failure after adjusting for age and gender. Constrained implant designs were associated with a 1.7 times higher risk of failure compared to non-constrained designs in PD patients.

CONCLUSION: PD negatively affects implant survival in patients undergoing TKA. Careful consideration should be given to patient selection and implant design in this patient population.

PMID:40996522 | DOI:10.1007/s00264-025-06658-2

Int Orthop. 2025 Sep 25. doi: 10.1007/s00264-025-06656-4. Online ahead of print.

ABSTRACT

BACKGROUND: Osteoporotic vertebral compression fractures (OVCFs) are highly prevalent among the elderly. However, spinal metastases can also lead to pathological fractures that are often misdiagnosed as OVCFs. This study aimed to determine the prevalence of unsuspected malignant vertebral compression fractures (VCFs) among patients initially suspected to have OVCFs.

METHODS: From October 2020 to December 2023, 141 patients with suspected OVCFs underwent routine vertebral biopsy during percutaneous kyphoplasty (PKP) at our institution. All patients received standardized treatment and prospective clinical data collection. Follow-up questionnaires were completed in person or via telephone.

RESULTS: A total of 168 biopsy specimens were obtained from 141 patients, and all samples (100%) were successfully evaluated histopathologically. Unexpected spinal metastases were identified in six patients (4.3%). Of the 19 patients with a known history of malignancy but without characteristic radiographic features of pathological fracture, only two cases (10.5%) were confirmed as metastatic involvement from the primary cancer. Among the remaining 112 patients without a cancer history, four unexpected malignancies were identified (one lymphoma and three lung cancers). The overall prevalence of unsuspected malignant VCFs in this cohort was 4.3%.

CONCLUSIONS: Given the observed prevalence of unsuspected malignant VCFs, we recommend that routine vertebral biopsy be performed during every PKP procedure for patients with OVCFs to ensure early detection of occult malignancy.

PMID:40996521 | DOI:10.1007/s00264-025-06656-4

Int Orthop. 2025 Sep 23. doi: 10.1007/s00264-025-06660-8. Online ahead of print.

ABSTRACT

PURPOSE: Three-dimensional robotic planning may oblige the surgeon to accept an anterior overhang of the acetabular cup. Whether this planned overhang compromises short-term outcomes is unknown.

METHODS: We retrospectively reviewed 437 consecutive robotic total hip arthroplasties (THA) performed between November 2018 and March 2022; 192 hips with complete 3-D screenshots and 12-month follow-up formed the study cohort. Anterior overhang on the definitive plan was graded minor (≤ 2 mm), moderate (between 2 and 4 mm), or major (≥ 4 mm). Primary outcome was psoas pain at one year, defined by pain on resisted-hip-flexion testing; psoas impingement was confirmed if infiltration or tenotomy was performed. Secondary endpoints were Harris Hip Score (HHS), Oxford Hip Score (OHS) and Forgotten Joint Score (FJS-12).

RESULTS: Planned overhang occurred in 52 of 192 hips (27%): 33 minor, 18 moderate and one major. Psoas pain was more frequent with overhang (16% vs. 3.8%; p = 0.008); no differences were recorded for confirmed psoas impingement, groin pain, re-operation or revision of implants. Differences of mean HHS, OHS and FJS-12 at three and twelve months were non-significant between groups. Anterior wall index < 0.33, lateral center-edge angle < 25° and female sex are associated with overhang.

CONCLUSIONS: Minor anterior cup overhang is common in robotic THA. It increases the likelihood of clinical psoas impingement but does not impair early hip function or raise revision risk. Accepting minor overhang is clinically acceptable when necessary, provided patients are counselled about increased psoas pain risk and high-risk anatomies are monitored.

PMID:40986041 | DOI:10.1007/s00264-025-06660-8

Int Orthop. 2025 Sep 23. doi: 10.1007/s00264-025-06657-3. Online ahead of print.

ABSTRACT

PURPOSE: To evaluate the effectiveness and safety of anterior scoliosis correction (ASC) in patients over 40 years of age.

METHODS: This prospective study included 29 patients (mean age 46.6 ± 8.8 years) with idiopathic or adult spinal deformity and a Cobb angle > 30°, who underwent ASC. The follow-up two to five years. Outcomes assessed were Cobb angle correction, quality of life (ODI, SRS-22, SF-36), and postoperative complications.

RESULTS: The mean Cobb angle correction was 59% (from 52.5° to 21.3°). At final follow-up (2.8 ± 1.1), a slight increase to 24.0° was observed, mainly due to curve subsidence. No complications occurred in 62% of patients. Subsidence > 5° was noted in 17% (n = 5), and loss of correction > 15° in 3% (n = 1). One patient experienced persistent pain managed conservatively. Higher risk of subsidence was associated with age > 50 years and preoperative Cobb angle > 50°. Quality of life improved across all measures: ODI decreased from 45% to 32%, SF-36 increased from 50 to 65, and SRS-22 declined slightly from 3.9 to 3.7 in patients with tether settling.

CONCLUSION: ASC demonstrates high effectiveness and acceptable safety for scoliosis correction in patients over 40 years. Subsidence is the primary adverse event, warranting further investigation and careful patient selection.

PMID:40986040 | DOI:10.1007/s00264-025-06657-3

Int Orthop. 2025 Sep 23. doi: 10.1007/s00264-025-06659-1. Online ahead of print.

ABSTRACT

INTRODUCTION: In medial opening wedge high tibial osteotomy (MOWHTO), the goal extends beyond lateralizing the mechanical axis; restoring a horizontal joint line is crucial for optimal biomechanics. The Coronal Plane Alignment of the Knee (CPAK) classification, which incorporates mechanical axis deviation and joint line obliquity (JLO), offers a phenotype-based framework, though its application in MOWHTO remains underexplored.

MATERIALS AND METHODS: A retrospective review included 147 knees from 123 patients undergoing MOWHTO with at least 24 months of follow-up. Radiographic parameters assessed were mFTA, MPTA, mLDFA, JLCA, aHKA, and JLO. Knees were categorized based on postoperative weight-bearing line (WBL) positions, and CPAK phenotypes were recorded pre- and postoperatively. Clinical outcomes were evaluated using the Hospital for Special Surgery (HSS) knee score.

RESULTS: Preoperatively, CPAK type I (varus, apex distal JLO) predominated (82.3%). Postoperatively, many transitioned to Types V (neutral, apex neutral JLO, 24.5%) and VI (valgus, apex neutral JLO, 17.7%), both yielding significantly higher HSS scores (p < 0.001). Optimal outcomes were observed with a WBL between 50% and 60%. The mean aHKA improved from - 7.35° to + 1.59°, while JLO corrected from 172.4° to 180.8°.

CONCLUSION: This study demonstrates that transitions to CPAK Types V-VI, with 50-60% WBL and horizontal joint line restoration, are linked to improved HSS scores, highlighting the CPAK classification's potential for guiding individualized correction strategies in MOWHTO.

LEVEL OF EVIDENCE: Level III (retrospective comparative study).

PMID:40986039 | DOI:10.1007/s00264-025-06659-1

Int Orthop. 2025 Sep 22. doi: 10.1007/s00264-025-06651-9. Online ahead of print.

NO ABSTRACT

PMID:40982037 | DOI:10.1007/s00264-025-06651-9