Int Orthop. 2026 Mar 12. doi: 10.1007/s00264-026-06774-7. Online ahead of print.

ABSTRACT

PURPOSE: Robotic assistance has recently been introduced for reverse shoulder arthroplasty (RSA) with the goal of improving the accuracy and consistency of implant positioning, but the additional workflow steps required for its use may prolong operative time. Whether operative time returns to a conventional benchmark after an initial learning period remains uncertain. This study sought to characterize the operative time learning curve for robotic-assisted RSA using the Mako robotic system (Stryker, Kalamazoo, MI).

METHODS: We conducted a retrospective observational study of 30 consecutive elective robotic-assisted primary RSA cases performed by a single shoulder fellowship-trained surgeon using the Mako robotic system at an academic ambulatory surgery centre between October 2025 and February 2026. The operative time benchmark was defined a priori as all consecutive conventional primary RSA cases performed at the same surgery centre from its opening in July 2025 through October 2025 (n = 16). Operative time was defined as incision start to incision closure. Learning curve behaviour among robotic cases was assessed using linear regression of operative time on sequential robotic case number. Robotic cases were also grouped into three prespecified 10-case blocks (1-10, 11-20, 21-30).

RESULTS: Mean operative time for conventional RSA was 74.9 min (95% CI, 67.3-82.5; range, 55-105). Across robotic-assisted cases, mean operative time was 88.6 min (95% CI, 79.8-97.4; range, 55-170). Operative time decreased with increasing robotic experience (- 1.85 min per case; p = 0.00010; R2 = 0.42), and the fitted regression reached the conventional benchmark mean at approximately robotic case 23. Mean operative time declined across prespecified adoption phases from 105.5 min (cases 1-10; 95% CI, 89.3-121.7), to 92.6 min (cases 11-20; 95% CI, 79.4-105.8), and to 67.8 min (cases 21-30; 95% CI, 62.6-73.0; p = 0.0034). The final 10 robotic cases had a shorter mean operative time than the conventional benchmark (67.8 vs 74.9 min) but this difference was not statistically significant (p = 0.37).

CONCLUSION: In a single-surgeon ambulatory surgery centre series, robotic-assisted RSA showed a clear learning curve and achieved operative time neutrality relative to conventional RSA after approximately two dozen cases. These findings support the feasibility of integrating robotic workflows into RSA without a persistent operative time penalty after early adoption, and provide practical expectations for surgeons and institutions planning implementation.

PMID:41820603 | DOI:10.1007/s00264-026-06774-7

Int Orthop. 2026 Mar 12. doi: 10.1007/s00264-026-06777-4. Online ahead of print.

NO ABSTRACT

PMID:41817760 | DOI:10.1007/s00264-026-06777-4

Int Orthop. 2026 Mar 12. doi: 10.1007/s00264-026-06776-5. Online ahead of print.

NO ABSTRACT

PMID:41817759 | DOI:10.1007/s00264-026-06776-5

Int Orthop. 2026 Mar 10. doi: 10.1007/s00264-026-06775-6. Online ahead of print.

NO ABSTRACT

PMID:41805855 | DOI:10.1007/s00264-026-06775-6

Int Orthop. 2026 Mar 10. doi: 10.1007/s00264-026-06770-x. Online ahead of print.

NO ABSTRACT

PMID:41805854 | DOI:10.1007/s00264-026-06770-x

Int Orthop. 2026 Mar 9. doi: 10.1007/s00264-026-06771-w. Online ahead of print.

ABSTRACT

BACKGROUND: In an era of healthcare cost containment, this study introduces a novel closed reduction technique using the Ilizarov circular external fixator for comminuted tibial fractures (AO/OTA 42C2-3), minimizing operative interventions and costs compared to internal fixation.

METHODS: We conducted a retrospective analysis of 20 consecutive patients with high-energy tibial fractures managed with a single Ilizarov frame. Postoperative deformities (angulation, translation, rotation) were corrected painlessly in outpatient settings without anaesthesia.

RESULTS: Eighteen patients (90%) achieved union with one frame application; median time to union (injury to frame removal) was 150 days. Two patients had delayed union resolving conservatively. All injuries resulted from road traffic collisions (42C2/42C3). No amputations or compartment syndromes occurred. Pin-tract infections in two patients (10%) required wire exchange. No malunions necessitated reoperation, though two patients (10%) suffered refractures requiring repeat Ilizarov treatment. Per modified ASAMI scores, most achieved excellent/good functional outcomes.

CONCLUSION: This technique delivers reliable union with outpatient, anaesthesia-free deformity correction, avoiding internal fixation's risks (deep infection, compartment syndrome, malrotation) while optimizing cost-effectiveness. Multicenter validation is warranted.

PMID:41801363 | DOI:10.1007/s00264-026-06771-w

Int Orthop. 2026 Mar 9. doi: 10.1007/s00264-026-06769-4. Online ahead of print.

NO ABSTRACT

PMID:41796240 | DOI:10.1007/s00264-026-06769-4

Int Orthop. 2026 Mar 3. doi: 10.1007/s00264-026-06767-6. Online ahead of print.

ABSTRACT

PURPOSE: Regarding patellar resurfacing in total knee arthroplasty (TKA), no consensus has been reached, but most studies have not addressed specific pathological circumstances. Evidence on the roles of patellar resurfacing and synovectomy in managing postoperative effusion in patients with severe chondrocalcinosis is limited.

MATERIAL AND METHODS: This single-centre observational cohort study included 160 patients who underwent the same TKA for osteoarthritis with severe chondrocalcinosis (grade 4) between January 2000 and December 2010. A matched design created four comparable groups of 40 patients each: (1) TKA without patellar resurfacing or synovectomy, (2) TKA with patellar resurfacing alone, (3) TKA with synovectomy alone, and (4) TKA with both patellar resurfacing and synovectomy. Severe chondrocalcinosis (advanced calcium pyrophosphate deposition disease) was confirmed through radiographic findings, synovial fluid analysis using polarized light microscopy, and histology. Significant postoperative effusion was diagnosed with ultrasound, quantified by sterile joint aspiration, and classified as stage I (10-20 cm3), stage II (21-30 cm3), or stage III (> 30 cm3).

RESULTS: Postoperative joint effusion varied significantly between the strategies. In the patellar resurfacing group, 25% (10/40) of patients developed only stage I effusion without synovectomy. Conversely, 45% (18/40) of patients in the synovectomy-only group developed stage II effusion, while 62.5% (25/40) of patients without either procedure developed stage III effusion (p < 0.0001). TKA with both patella resurfacing and synovectomy resulted in either stage I (7/40) or stage II effusion (6/40). Multivariate regression confirmed patellar resurfacing as an independent protective factor against postoperative effusion (p < 0.01). Average aspirated effusion volumes further supported these findings: 39 ± 6 cm3 for TKA without additional procedures, 18 ± 8 cm3 with synovectomy, 6 ± 4 cm3 with patellar resurfacing, and 7 ± 4 cm3 with both patellar resurfacing and synovectomy. The results showed that as total knee effusion volume increased, inflammatory markers (C-reactive protein level) increased, and range of motion decreased.

CONCLUSION: In severe chondrocalcinosis, patellar resurfacing may be appropriate to prevent joint effusion after TKA.

PMID:41775911 | DOI:10.1007/s00264-026-06767-6

Int Orthop. 2026 Mar 3. doi: 10.1007/s00264-026-06764-9. Online ahead of print.

ABSTRACT

PURPOSE: Intraoperative calcar fracture (IOCF) can compromise initial stability, leading to stem subsidence and instability. We aimed to compare 2-year complications and revision rates between patients who sustained IOCF and matched controls without IOCF using short stem total hip arthroplasty (THA).

METHOD: Patients who underwent short stem THA from November 2010 to October 2023 were included. They were categorized into those who sustained IOCF and were treated intraoperatively with double-loops cerclage wiring, and those without IOCF. Propensity score matching was performed to balance baseline characteristics between the two groups. The following outcomes were evaluated at two years: femoral stem subsidence, periprosthetic femoral fracture (PFF), periprosthetic joint infection (PJI), dislocation, aseptic femoral loosening, and revision.

RESULTS: Initially, 844 cases were identified. After matching, 80 and 640 cases were included in IOCF and non-IOCF groups respectively. There was one case (1.25%) of stem subsidence in the IOCF group and 11 cases (1.72%) in the non-IOCF group, with no significant difference (p = 0.76). PFF occurred in one case (1.25%) of the IOCF group and four cases (0.63%) of the non-IOCF group; the difference was not significant (p = 0.53). In the non-IOCF group, there were five cases (0.78%) of PJI, 11 cases (1.72%) of dislocation, one case (0.16%) of aseptic femoral loosening and 13 cases (2%) of revisions. There was no revision in the IOCF group.

CONCLUSION: Short stem THA complicated by IOCF, when promptly recognized and treated intraoperatively, did not increase complications or revision rates at two years.

PMID:41774120 | DOI:10.1007/s00264-026-06764-9

Int Orthop. 2026 Mar 3. doi: 10.1007/s00264-026-06761-y. Online ahead of print.

ABSTRACT

PURPOSE: To compare lesion debridement with bone grafting (LDBG) versus core decompression (CD) in preventing femoral head collapse in early glucocorticoid-associated osteonecrosis (GA-ONFH).

METHODS: This single-center, superiority randomized controlled trial (Level I) enrolled 86 patients (18-60 years) with ARCO stage II GA-ONFH, randomized to CD or LDBG.

PRIMARY OUTCOME: proportion maintaining ARCO stage II at 24 months.

SECONDARY OUTCOMES: interval-specific progression to collapse (0-6, 6-12, 12-24 months) and Harris Hip Scores (HHS) among non-collapsed hips. Safety outcomes included perioperative blood loss, hospital stay, and surgery-related adverse events.

RESULTS: Of 86 patients, 81 completed follow-up. At 24 months, ARCO stage II was maintained in 70% (28/40) of LDBG vs. 41% (17/41) of CD patients (P = 0.010; RR = 1.69; NNT = 4). CD had better HHS at six months (P < 0.001), but no difference at 12/24 months among non-collapsed hips. CD involved less blood loss (P < 0.001) and shorter hospital stays (P = 0.002); serious adverse events were similar (P = 0.72). Prespecified subgroup analyses showed consistent LDBG benefit, especially in females, patients with BMI < 23.9, high glucocorticoid dose, and non-manual occupations.

CONCLUSION: LDBG significantly reduces collapse risk versus CD in early GA-ONFH, with comparable mid-term function and safety, supporting its use as a preferred joint-preserving strategy, particularly for females, patients with lower BMI (< 23.9), high glucocorticoid exposure, and non-manual occupations.

PMID:41774119 | DOI:10.1007/s00264-026-06761-y

Int Orthop. 2026 Mar 2. doi: 10.1007/s00264-026-06763-w. Online ahead of print.

ABSTRACT

PURPOSE: Waste management in hospitals is important for environmental sustainability, as disposal of operations waste causes substantial greenhouse gas emissions. This study aimed to identify factors influencing waste generation in orthopaedics and traumatology.

METHODS: In this prospective study, the weight of waste and drapes from 272 orthopaedic and trauma operations was measured. Waste production was analyzed regarding to anatomical region, operation type, and duration.

RESULTS: Analysing all operations, the amount of waste differed significantly between anatomical regions (p < 0.001). When separating drapes, no significant differences between anatomical regions were found in waste, but in drapes (p < 0.001). The amount of waste differed significantly between operation types and correlated significantly with the operation duration (p < 0.001).

CONCLUSION: Operating room waste is influenced by anatomical regions and the drapes required for it. Operation duration significantly increases the amount of waste. These findings can support the development of targeted strategies to reduce waste in operating rooms.

PMID:41772124 | DOI:10.1007/s00264-026-06763-w

Int Orthop. 2026 Feb 28. doi: 10.1007/s00264-026-06765-8. Online ahead of print.

NO ABSTRACT

PMID:41762244 | DOI:10.1007/s00264-026-06765-8

Int Orthop. 2026 Feb 25. doi: 10.1007/s00264-026-06760-z. Online ahead of print.

ABSTRACT

PURPOSE: This study aimed to explore the biomechanical interrelationships in Progressive Collapsing Foot Deformity (PCFD), also known as flatfoot, with concurrent hallux valgus (HV), first metatarsal pronation and sesamoid bone displacement. The primary purposes were to quantify correlations between arch collapse, first metatarsal rotation, HVA (hallux valgus angle), and sesamoid displacement using weight-bearing computed tomography (WBCT), which provides superior three-dimensional insights compared to traditional radiographs. The central research question was: How is M1 rotation related to alterations in arch angles in PCFD and to sesamoid malposition, and is it independent?

METHODS: A retrospective analysis was conducted on WBCT scans from 22 patients (aged 18-65) with symptomatic PCFD, collected between 2023 and 2025. Inclusion required arch angle > 131°; exclusions included prior surgery or systemic conditions. Scans used a cone-beam system (96 kV, 7.5 mAs, 0.4 mm slices) in bipedal stance. Two observers measured: forefoot arch angle (FAA) for PCFD severity, alpha angle for metatarsal rotation, HVA via axial axes, and sesamoid displacement graded as 0-3 on axial views. Inter-observer reliability was assessed with intraclass correlation coefficients (ICC > 0.8). Spearman's correlations evaluated relationships, with p < 0.05 significant, using SPSS.

RESULTS: Analysis revealed a strong positive correlation between increased arch angle and increased first metatarsal rotation (r = 0.72, p < 0.01), strong positive correlation between greater arch angle and HVA (r = 0.67, p < 0.01), and moderate positive correlation between greater M1 rotation and sesamoid bone displacement (r = 0.5, p < 0,01). No correlation was found between HVA and metatarsal rotation (r = 0.1, p > 0,01).

CONCLUSION: PCFD is strongly associated with hallux valgus deformity and first metatarsal rotation, which is closely linked to sesamoid displacement. Metatarsal rotation appears to be an independent and likely early component of HV deformity, related to foot pronation and sesamoid malposition, and should be specifically evaluated and addressed in both diagnosis and treatment. No significant association exists between hallux valgus angle and metatarsal rotation. Additionally, hallux valgus deformity is associated with increased arch angle, which should be considered in the management of both conditions.

PMID:41741891 | DOI:10.1007/s00264-026-06760-z

Int Orthop. 2026 Feb 25. doi: 10.1007/s00264-026-06759-6. Online ahead of print.

ABSTRACT

BACKGROUND: While curved intertrochanteric varus osteotomy is an effective treatment for osteonecrosis of the femoral head, whether this procedure is applicable to bilateral cases remains unclear. The aim of this study was to compare the clinical outcomes of bilateral curved intertrochanteric varus osteotomy and unilateral curved intertrochanteric varus osteotomy for osteonecrosis of the femoral head.

METHODS: This comparative study included 60 patients with osteonecrosis of the femoral head; 15 (30 hips) underwent bilateral curved intertrochanteric varus osteotomy (bilateral group) and 45 (45 hips) underwent unilateral curved intertrochanteric varus osteotomy (unilateral group). Patients in the bilateral group were followed up for a mean of 8.0 years, whereas those in the unilateral group were followed-up for a mean of 8.2 years. The Harris Hip Score, complication rates, radiographic parameters, and survival rates were assessed. Conversion to total hip arthroplasty and radiographic failure were the endpoints.

RESULTS: The postoperative Harris Hip Score was significantly lower in the bilateral group than in the unilateral group. Complication rates and radiographic parameters were not significantly different between the groups. Ten-year survival rates, with conversion to total hip arthroplasty and radiographic failure as endpoints, did not differ significantly between the groups. In bilateral curved intertrochanteric varus osteotomy, the survival rate, with radiographic failure as the endpoint, tended to be poorer on the contralateral side than on the initial side.

CONCLUSION: The clinical outcomes of bilateral curved intertrochanteric varus osteotomy were not necessarily favorable. When planning for bilateral curved intertrochanteric varus osteotomy, surgeons should ensure that the contralateral hip could undergo surgical intervention timeously.

PMID:41735567 | DOI:10.1007/s00264-026-06759-6

Int Orthop. 2026 Feb 24. doi: 10.1007/s00264-026-06762-x. Online ahead of print.

ABSTRACT

PURPOSE: To evaluate the incidence, magnitude, and risk factors for secondary angular deformity after tibial lengthening with a circular external fixator in skeletally immature patients. We hypothesized that younger age and low bone healing index would predispose to late valgus drift.

METHODS: A retrospective review was conducted on 98 children who underwent tibial lengthening using a circular external fixator, with a minimum follow-up of one year. Radiographic assessment included full-length standing AP radiographs and lateral tibial views obtained preoperatively, at fixator removal, six months post-removal, and at final follow-up. Measured parameters included the mechanical Medial Proximal Tibial Angle, Center of Rotation of Angulation, and Posterior Proximal Tibial Angle. Risk factors for secondary deformity were analyzed using independent T test, Chi-Square test, Pearson test and multivariate logistic regression.

RESULTS: A valgus deformity greater than 3° developed in 36 patients (37%), primarily within the first six months after frame removal. Younger age at surgery (p = 0.017) and a bone healing index ≤ 40 days/cm (OR 2.3; p = 0.049) were significantly associated with valgus drift. A progressive valgus shift in CORA correlated with a shorter consolidation index (p = 0.021). Sagittal alignment showed a small but significant early decrease.

CONCLUSION: Secondary valgus deformity is a common and under-recognized complication following tibial lengthening with a circular external fixator in skeletally immature patients. Younger age at surgery and low bone healing index are the principal risk factors for this late angular drift. Furthermore, they question the efficacy of intentional frontal overcorrection to reliably prevent secondary deformity and suggest that additional corrective strategies may be required.

PMID:41731236 | DOI:10.1007/s00264-026-06762-x

Int Orthop. 2026 Feb 19. doi: 10.1007/s00264-026-06753-y. Online ahead of print.

ABSTRACT

PURPOSE: To establish a national consensus on the minimum expected competencies that orthopaedic surgery residents in Chile should achieve by the end of training, providing a foundation for competency-based curriculum development in comparable training contexts.

METHODS: A multicentre modified Delphi study was conducted involving academic leaders from orthopaedic residency programmes across Chile. An initial round of open-ended questions among programme directors generated draft competency statements, which were refined through two subsequent rounds using a 5-point Likert scale. Consensus was predefined as ≥ 80% agreement (ratings of 4 or 5) with an interquartile range ≤ 1. Competencies were organised into six ACGME core competencies and one CanMEDS role.

RESULTS: Twenty-eight experts completed the final rounds. Consensus was achieved on 32 competency statements spanning patient care, medical knowledge, practice-based learning and improvement, interpersonal and communication skills, professionalism, system-based practice, and scholar-research. Agreement was observed for non-procedural competencies and foundational surgical skills. In contrast, consensus was not reached regarding autonomy, even under supervision, for advanced surgical procedures, particularly arthroplasty and selected soft-tissue procedures. Qualitative feedback attributed disagreement to patient-safety considerations, procedural complexity, and differing views on the boundary between residency and fellowship-level competence.

CONCLUSIONS: This national Delphi study establishes the first consensus-based definition of minimum expected competencies for orthopaedic surgery residency training in Chile. The resulting framework provides a shared reference aligned with international competency-based principles while remaining responsive to local training contexts, and is intended to inform educational development and accreditation discussions in similar training settings rather than mandate a uniform training model.

PMID:41714458 | DOI:10.1007/s00264-026-06753-y

Int Orthop. 2026 Feb 19. doi: 10.1007/s00264-026-06758-7. Online ahead of print.

ABSTRACT

PURPOSE: The measurement of glenoid and reverse total shoulder arthroplasty (rTSA) inclination has both clinical and research relevance. The purpose of this study was to better understand if and how much radiographic projection and scapula position affect the perception of glenoid inclination.

MATERIALS AND METHODS: Twenty computed-tomography (CT) scans of arthritic shoulders were used to create digitally reconstructed radiographs (DRR) through 3° increments of inclination, retraction and protraction on a scapular coordinate system. The reverse total shoulder arthroplasty (rTSA) and total shoulder arthroplasty (TSA) angles were measured on each image.

RESULTS: The mean range (difference between maximum and minimum values) of rTSA and TSA angle measurements based on simulation of scapula inclination was 14° and 17°, respectively. Nineteen of 20 cases showed a trend towards a higher rTSA and TSA angle with greater forward inclination. With simulated scapula retraction, the maximum difference between rTSA and TSA angle measurements was a mean 11° and 14°, respectively. With simulated scapula protraction, the maximum difference observed for rTSA and TSA angle measurements based was a mean 14° and 11°, respectively. Scapula protraction and retraction did not produce consistent or linear trends in rTSA or TSA angle measurement.

CONCLUSION: The radiographic measurement of rTSA and TSA angles is moderately variable based on scapula protraction, retraction and inclination. Forward inclination may increase the perception of superior tilt.

PMID:41711821 | DOI:10.1007/s00264-026-06758-7

Int Orthop. 2026 Feb 19. doi: 10.1007/s00264-026-06757-8. Online ahead of print.

ABSTRACT

BACKGROUND: Currently, the primary treatment for ulnar neuropathy at the elbow is open in-situ decompression surgery. The effectiveness of ultrasound localization therapy, especially small-incision surgery using ultrasound combined with SWE, remains unclear.

OBJECTIVES: To evaluate the effect of small-incision ulnar nerve release in treating ulnar neuropathy at the elbow by ultrasound combined with shear wave elastography (SWE).

METHODS: A retrospective analysis of 98 patients treated in our hospital for ulnar neuropathy at the elbow was conducted from June 2023 to March 2025. According to the treatment style, these patients were divided into a traditional open in-situ decompression surgery group (n = 51) and an ultrasound combined with SWE small-incision surgery group (n = 47). The maximum proximal Cross-sectional Area (CSA), Sensory Conduction Velocity (SCV), Motor Conduction Velocity (MCV), modified Bishop score, Quick-DASH score, and Visual Analogue Scale(VAS) score were compared between the two groups. Additionally, the amount of intraoperative blood loss, operation duration, hospital stay, patients' satisfaction with postoperative incision aesthetics, the postoperative complications of different operation methods, and the degree of damage to the medial cutaneous nerve of the forearm were studied.

RESULTS: All patients underwent surgical treatment, with preoperative ultrasonography confirming no ulnar nerve subluxation. No statistically significant differences in age, preoperative SCV, MCV, CSA, Quick-DASH score, or VAS score were found between the two groups. The postoperative and the last follow-up SCV, MCV, and CSA were similar in the two groups. In addition, the improved Bishop score, Quick-DASH score, VAS score, postoperative hematoma rate, elbow stiffness rate, and postoperative protection of the medial cutaneous nerve of the forearm in the ultrasound combined with SWE surgery group were better than those in the traditional open surgery group. What's more, compared with the traditional open surgery group, the ultrasound combined with SWE surgery reduced the amount of intraoperative blood loss, shortened the operation duration and hospital stay, and the patients were more satisfied with the scar of the incision.

CONCLUSIONS: For patients with ulnar neuropathy at the elbow who are amenable to in situ decompression, this study highlights the potential of preoperative ultrasound combined with SWE to guide a targeted, minimally invasive surgical approach.

PMID:41711820 | DOI:10.1007/s00264-026-06757-8

Int Orthop. 2026 Feb 19. doi: 10.1007/s00264-026-06752-z. Online ahead of print.

ABSTRACT

PURPOSE: Hip involvement in hereditary multiple exostoses (HME) may lead to coxa valga, femoral impingement and progressive hip subluxation. This study aimed to evaluate the outcomes of a single-stage technique combining proximal femoral varus osteotomy with femoral neck osteochondroma trimming performed through the osteotomy site.

METHODS: A retrospective series of fifteen patients (23 hips) with HME was reviewed. Clinical outcomes were assessed using the Postel-Merle d'Aubigné score. Radiographic evaluation included femoral and acetabular parameters assessed pre-operatively, immediately post-operatively and at latest follow-up.

RESULTS: Mean age at surgery was 10.1 years, with a mean follow-up of nine years. Surgery achieved immediate correction of the neck-shaft angle and improved femoral head containment. At latest follow-up, significant improvement was observed in both femoral and acetabular parameters, suggesting secondary acetabular remodelling. Clinical scores improved significantly, with resolution of pain. Four nonunions required revision surgery, highlighting the technical demands of fixation in compromised bone. Loss of correction tended to occur more frequently in younger patients, with age below nine years associated with a higher risk of secondary valgus recurrence. No cases of femoral head avascular necrosis were observed.

CONCLUSION: This combined femoral approach allows effective correction of proximal femoral deformity while facilitating osteochondroma resection, providing durable containment and favourable mid-term outcomes.

PMID:41711819 | DOI:10.1007/s00264-026-06752-z

Int Orthop. 2026 Feb 17. doi: 10.1007/s00264-026-06756-9. Online ahead of print.

ABSTRACT

INTRODUCTION: This study aims to determine whether distal femoral morphology (DFM) constitutes a risk factor for periprosthetic femoral fractures (PPFs) in a cohort of patients who underwent posterior-stabilized total knee arthroplasty (PS-TKA).

MATERIALS AND METHODS: Retrospective study of patients who had undergone primary PS-TKA, with a follow-up of minimum two years. Citak's ratio was calculated, and patients were classified according to DFM. Univariate and multivariate statistical analysis was performed to identify PPFs risk factors. ROC analysis was performed to evaluate the ability of DFM to distinguish patients at risk for PPFs.

RESULTS: A total of 2452 patients 1644 female, 808 male were included in the analysis. The mean age of the participants was 70.2 years (SD = 6.4). PPFs were detected in 33 patients (1.35%). According to the Citak classification, patients were categorized as Group A (4/33, 12.1%), Group B (8/33, 24.2%), and Group C (21/33, 63.7%). DFM was significantly related to the PPFs rate (p = 0.001). The ROC curve analysis yielded an Area Under the Curve (AUC) of 0.669 (CI 95% 0.580-0.758) for the DFM.

CONCLUSIONS: Preoperative evaluation of distal femoral morphology and management of osteoporosis may reduce the risk of fractures after PS-TKA.

PMID:41699317 | DOI:10.1007/s00264-026-06756-9