Int Orthop. 2026 May 8. doi: 10.1007/s00264-026-06831-1. Online ahead of print.

ABSTRACT

BACKGROUND: Magnetic resonance imaging (MRI) is widely used to evaluate meniscal healing after surgical repair; however, the extent to which postoperative MRI findings reflect clinically meaningful recovery remains uncertain. This study aimed to examine the relationship between MRI-based healing appearance and patient-reported functional outcomes after meniscal repair.

METHODS: This retrospective observational study included adult patients who underwent arthroscopic meniscal repair between January 2018 and December 2024 at a tertiary care centre. Patients with at least 12 months of follow-up, available postoperative MRI, and complete clinical outcome data were included. Postoperative MRI was obtained at a mean of 18.6 ± 7.4 months after surgery (range: 12-36 months). Meniscal healing on MRI was classified as complete healing, partial healing, or failed healing/retear. Clinical outcomes were assessed using the International Knee Documentation Committee (IKDC), Lysholm, and Tegner scores. Clinical success was defined as IKDC ≥ 80 and Lysholm ≥ 85. The association between MRI healing status and clinical outcomes was evaluated using group comparisons and correlation analyses.

RESULTS: A total of 240 patients (mean age 27.4 ± 6.8 years; 71.7% male) were analyzed. MRI demonstrated complete healing in 40.8% of patients, partial healing in 31.7%, and failed healing or retear in 27.5%. Mean IKDC, Lysholm, and Tegner scores differed significantly across MRI groups (all p ≤ 0.002), with lower scores observed in patients with MRI-defined failure. However, 63.6% of patients classified as having failed healing on MRI met the criteria for clinical success. MRI healing status showed moderate correlations with IKDC (r = 0.42), Lysholm (r = 0.39), and Tegner (r = 0.31) scores (all p < 0.001). The MRI-IKDC correlation was higher in patients who underwent concomitant anterior cruciate ligament reconstruction than in those who underwent isolated meniscal repair.

CONCLUSIONS: Postoperative MRI appearance after meniscal repair is associated with patient-reported and functional outcomes, but the strength of this relationship is limited. MRI-defined structural abnormalities may persist despite satisfactory clinical recovery, indicating that MRI has restricted specificity for identifying clinically meaningful failure. These findings suggest that MRI should be interpreted in conjunction with clinical assessment rather than used as a standalone indicator of postoperative success.

PMID:42103885 | DOI:10.1007/s00264-026-06831-1

Int Orthop. 2026 May 7. doi: 10.1007/s00264-026-06828-w. Online ahead of print.

ABSTRACT

BACKGROUND: Anterior impaction pilon fractures (AIPs) are a distinct subtype of tibial pilon fractures caused by axial loading of the ankle in dorsiflexion and are associated with severe anterior plafond comminution, anterior talar subluxation, and a high risk of post-traumatic osteoarthritis (PTOA). Optimal surgical strategies for AIP remain unclear.

METHODS: This retrospective case series included 23 consecutive patients with AIP treated surgically between 2013 and 2023 with a minimum follow-up of one year. The treatment strategy consisted of anatomical reduction of the impacted anterior tibial plafond and rafting fixation using an anterolateral distal tibial plate, with supplementary fixation and bone grafting as required. Anterior talar subluxation was assessed using the lateral talar station (LTS) as the difference between injured and contralateral ankles immediately postoperatively (ΔLTS-1) and at one year (ΔLTS-2). Clinical outcomes included bone union, the American Orthopaedic Foot & Ankle Society (AOFAS) Ankle-Hindfoot score, ankle range of motion, PTOA graded by the modified Kellgren-Lawrence scale, and complications.

RESULTS: Mean ΔLTS-1 and ΔLTS-2 were 0.77 ± 1.8 mm and 0.5 ± 2.3 mm, respectively, with no significant difference (p = 0.33). Bone union was achieved in all cases. PTOA developed in 9 patients, with a mean modified Kellgren-Lawrence grade of 0.8 ± 1.2. The mean AOFAS score was 91.6 ± 9.6. Deep infection occurred in three patients, and five required soft-tissue reconstruction.

CONCLUSION: Anatomical reduction of the anterior plafond combined with stable anterolateral rafting fixation maintained talar alignment and produced favourable short-term clinical outcomes in patients with AIP.

PMID:42098440 | DOI:10.1007/s00264-026-06828-w

Int Orthop. 2026 May 7. doi: 10.1007/s00264-026-06832-0. Online ahead of print.

NO ABSTRACT

PMID:42096080 | DOI:10.1007/s00264-026-06832-0

Int Orthop. 2026 May 7. doi: 10.1007/s00264-026-06811-5. Online ahead of print.

NO ABSTRACT

PMID:42096079 | DOI:10.1007/s00264-026-06811-5

Int Orthop. 2026 May 7. doi: 10.1007/s00264-026-06827-x. Online ahead of print.

ABSTRACT

BACKGROUND: Tibial plateau fractures (TPFs) remain challenging injuries due to their complex three-dimensional morphology, frequent posterior column involvement, and high incidence of associated soft-tissue lesions.

PURPOSE: Flexion-type fractures represent a distinct and often under recognized entity that is inadequately addressed using traditional classification systems. Flexion-valgus and flexion-varus mechanisms generate fundamentally different fracture configurations and soft-tissue injury profiles, with important implications for surgical management and prognosis. This narrative review provides a practical, literature- and experience-based overview of the distinguishing features of flexion-valgus and flexion-varus tibial plateau fractures, focusing on fracture morphology, associated ligamentous and meniscal injuries, and key treatment principles.

RESULTS: Flexion-valgus injuries predominantly involve the posterolateral tibial plateau, commonly presenting as split-depression or rim impaction fractures, and are frequently associated with anterior cruciate ligament (ACL) and lateral meniscal pathology. In contrast, flexion-varus injuries typically result in posteromedial shear fractures with metaphyseal comminution, often extending into the posterolateral central segment, demonstrating significantly higher rates of concomitant ligamentous and meniscal injuries, poorer functional outcomes, and increased risk of conversion to total knee arthroplasty (TKA).

CONCLUSION: Accurate recognition of the underlying injury mechanism and fracture morphology, distinguishing flexion-valgus from flexion-varus injuries, is essential to guide preoperative planning, surgical exposure, fixation strategy, and soft-tissue management, with the goal of optimising clinical outcomes.

PMID:42091624 | DOI:10.1007/s00264-026-06827-x

Int Orthop. 2026 May 6. doi: 10.1007/s00264-026-06833-z. Online ahead of print.

NO ABSTRACT

PMID:42089984 | DOI:10.1007/s00264-026-06833-z

Int Orthop. 2026 May 6. doi: 10.1007/s00264-026-06825-z. Online ahead of print.

ABSTRACT

PURPOSE: The representation of anatomical variations in Renaissance art offers a unique opportunity to explore the historical perception of normality and deformity. This study aims to analyse a previously undescribed anatomical feature in the marble statue of Adam (c. 1490-1495) by Tullio Lombardo.

METHODS: A detailed visual and morphological analysis of the statue was performed, focusing on the lateral aspect of the forefoot. The observed features were compared with current clinical descriptions of bunionette deformity and interpreted within the broader context of Renaissance anatomical representation.

RESULTS: The statue shows a prominence of the fifth metatarsal head associated with a varus deviation of the fifth toe, consistent with a bunionette (tailor's bunion). The anatomical precision of Lombardo's work suggests that this feature is unlikely to be accidental or due to technical limitations, but rather represents a deliberate inclusion within an otherwise idealized figure. Comparable variations in foot anatomy have been reported in other Renaissance artworks.

CONCLUSION: Although bunionette deformity is currently associated with mechanical stress and external factors, its presence in an idealized nude figure suggests that such variations may not have been perceived as pathological in their original context. This case highlights the limitations of applying modern diagnostic categories to historical representations and supports the view that minor anatomical variations could be incorporated into Renaissance depictions of the human body without implying disease.

PMID:42089983 | DOI:10.1007/s00264-026-06825-z

Int Orthop. 2026 May 4. doi: 10.1007/s00264-026-06824-0. Online ahead of print.

ABSTRACT

Morton's neuroma is one of the most common forefoot pathologies. In recent years, radiofrequency ablation has emerged as a minimally invasive alternative to surgical excision, aiming to relieve symptoms while reducing morbidity.

PURPOSE: To compare the efficacy and safety of radiofrequency neurolysis and surgical excision for the treatment of Morton's neuroma at our institution.

METHODS: A single-center, observational, retrospective, and longitudinal study was conducted including patients treated between 2012 and 2022. Clinical data from patients who underwent either surgical excision or radiofrequency ablation were analyzed. Demographic characteristics, pain intensity assessed using the Visual Analog Scale (VAS), complication rates, and reintervention rates were recorded, with a minimum follow-up of two years. Statistical analysis was performed using SPSS version 25.

RESULTS: A total of 192 procedures were identified (110 surgical excisions and 82 radiofrequency ablations). For analyses focused on demographic and baseline characteristics, repeated procedures performed in the same patient were grouped, resulting in 144 unique cases (92 excisions and 52 radiofrequency ablations). Both techniques resulted in significant pain reduction. Surgical excision achieved greater VAS improvement (- 5.57) compared with radiofrequency ablation (- 4.3). Complications were more frequent after surgical excision (13%) than after radiofrequency ablation (3.7%). In the radiofrequency group, 26% of patients required subsequent surgical excision and 33% underwent repeat ablation. The use of radiofrequency increased from 20% during 2012-2017 to 57% during 2018-2022.

CONCLUSIONS: Radiofrequency ablation is a safe and effective treatment for Morton's neuroma, although its analgesic effect appears less durable than surgical excision. Its low complication rate and outpatient applicability make it a valuable alternative, particularly in selected patients.

PMID:42082717 | DOI:10.1007/s00264-026-06824-0

Int Orthop. 2026 May 4. doi: 10.1007/s00264-026-06820-4. Online ahead of print.

ABSTRACT

BACKGROUND: Evaluate the association between preoperative SIRI and early postoperative SSI and to assess its diagnostic performance.

METHODS: Retrospective cohort study was conducted including 500 consecutive adult patients who underwent posterior fusion lumbar spine surgery for degenerative pathology. Preoperative neutrophil, lymphocyte, and monocyte counts were used to calculate SIRI. The primary outcome was early acute deep postoperative SSI. Associations were analyzed using univariate and penalized multivariate logistic regression. Discriminatory performance was assessed using receiver operating characteristic curve analysis.

RESULTS: Early postoperative SSI occurred in 27 patients (5.4%). Patients who developed infection had significantly higher preoperative SIRI values than those without infection (median 1.78 [IQR, 1.02-3.41] vs. 1.12 [IQR, 0.62-2.04]; p = 0.031). In the multivariate logistic regression model, log-transformed SIRI remained independently associated with infection (adjusted OR 1.93; 95% CI 1.02-3.67; p = 0.044). Preoperative SIRI demonstrated moderate discriminatory ability for early SSI, with an AUC of 0.66 (95% CI, 0.54-0.77; p = 0.03). The optimal cutoff value of 1.29 yielded a sensitivity of 63.0% and a specificity of 68.3%.

CONCLUSIONS: Preoperative SIRI is independently associated with early postoperative SSI following instrumented lumbar spine surgery for degenerative pathology. Although its discriminatory performance is moderate, SIRI represents a simple, inexpensive, and readily available adjunctive marker for preoperative risk stratification, particularly useful for identifying patients at low risk of postoperative infection.

PMID:42080946 | DOI:10.1007/s00264-026-06820-4

Int Orthop. 2026 May 4. doi: 10.1007/s00264-026-06818-y. Online ahead of print.

ABSTRACT

BACKGROUND: Focal periphyseal edema (FOPE) is a characteristic magnetic resonance imaging (MRI) finding in adolescent knee joints with open physes. Although described as a benign and likely self-limiting condition, large population-based studies are scarce. The aim of this study was to retrospectively analyse the incidence and the epidemiological background of this MRI finding, and to correlate FOPE lesions with clinical symptoms and treatment.

METHODS: This retrospective case-control study included a total of 1201 knee MRI scans from 897 patients, performed between 2007-2016 at our institution in patients aged ten to 16 years. MRIs were screened for the presence of FOPE and other pathologies. FOPE severity was categorised as mild, moderate and severe, based on lesion size and MRI appearance. Patients' medical records were screened for symptoms, trauma history and treatment.

RESULTS: Out of the 1201 MRI scans, 97 FOPE lesions (10.8%) in 93 patients (10.4%) were identified. FOPE was significantly more frequent in girls than in boys (p = 0.007). FOPE was the main MRI finding in 53.6% of patients. Mild FOPE was most common (53.6%). Severe FOPE occurred only when FOPE was the main pathology (p = 0.005). Most FOPE patients (74.2%) were treated conservatively.

CONCLUSION: FOPE lesions are a common MRI finding in adolescents presenting with knee pain. They tend to be more severe when occurring as the sole finding and have a significantly higher incidence in females. In this large clinical cohort, FOPE was mainly managed conservatively, supporting its interpretation as a benign, self-limiting differential diagnosis of adolescent knee pain.

PMID:42080945 | DOI:10.1007/s00264-026-06818-y

Int Orthop. 2026 May 1. doi: 10.1007/s00264-026-06817-z. Online ahead of print.

ABSTRACT

PURPOSE: This scoping review aimed to collate and synthesize reports of bioinductive scaffold augmentation for patellar tendon pathology, focusing on indications, surgical techniques, and early outcomes. Additionally, it aimed to contextualize these findings through the more established rotator cuff literature and consider tendon property variation to inform future research and implant development.

METHODS: A scoping review was conducted in accordance with PRISMA-ScR guidance. PubMed, Embase, Scopus, and Web of Science were searched from inception to 25 December 2025 for human studies of bioinductive scaffold augmentation in patellar tendon pathology. Two reviewers screened studies and extracted data. Findings were synthesized narratively and in tables.

RESULTS: The search identified 633 records, with ten studies ultimately included (6 technical notes, 3 case reports, and 1 case series), published between 2019 and 2025. Across all reports, 47 patients were described (ages 17-50; 76% male where reported); most studies used scaffolds for acute patellar tendon rupture (7/10), with fewer addressing chronic tendinopathy (3/10). Augmentation was most often indicated for poor tissue quality in rupture settings, revision after re-rupture, or persistent symptoms after failed conservative management in tendinopathy. Implants comprised a bovine Achilles tendon-derived collagen scaffold (6 studies), a decellularized human dermal allograft (2), a collagen-PLLA composite scaffold (1), and an autologous platelet-rich fibrin matrix construct (1). Post-operative rehabilitation was variably reported. Reported clinical outcomes were limited but suggested some improvements in pain, functional scores and MRI appearance.

CONCLUSION: The adoption of bioinductive scaffold augmentation in patellar tendon surgery may be considered theoretically plausible. However, fundamental pre-clinical biomechanical and histological work in human(-cadaveric) models is not available at present, and longitudinal (comparative) clinical research is ultimately needed to investigate the effects of this application, and allow for the meaningful interpretation of results. The intrinsic mechanical and biological properties of the patellar tendon warrant a more nuanced consideration in technique standardization and future device iterations.

PMID:42065726 | DOI:10.1007/s00264-026-06817-z

Int Orthop. 2026 Apr 30. doi: 10.1007/s00264-026-06823-1. Online ahead of print.

ABSTRACT

PURPOSE: There are no long-term results (> 30 years) of cemented and cementless total knee arthroplasty (TKA) with respect to clinical outcomes, radiographic and computer tomographic (CT) findings, incidence of osteolysis, revision rates, and implant survivorship.

METHODS: A consecutive cohort of 210 patients (mean age, 62 ± 4.6 years) underwent simultaneous bilateral TKA during a single anaesthetic session using the same posterior-stabilized prosthetic design. In each patient, one knee received a cemented implant and the contralateral knee received a cementless implant. The mean duration of follow-up was 30.3 years (range, 29-31 years).

RESULTS: At the final evaluation, no statically significant differences were observed between the two groups. The mean Knee Society scores (92 vs 93 points), Western Ontario and McMaster Universities Osteoarthritis Index scores (21 vs 10 points), range of motion (125° vs 127°) were not significantly different between the two groups. Revision was required in 3.8% of cemented knees and 4.8% of cementless knees. Kaplan-Meier analysis demonstrated a 30.3-year survival rate of 96.2% (95% confidence interval ([CI], 90%-100%) in the cemented group and 95.2% (95% [CI], 90%-100%) in the cementless group.

CONCLUSIONS: Both cemented or cementless fixation methods demonstrated durable and favourable long-term outcomes at more than 30 years. However, cementless TKA did not show superior survivorship compared with cemented TKA. At present, the routine preference of cementless fixation over established cemented techniques remains unsupported by long-term evidence.

PMID:42060141 | DOI:10.1007/s00264-026-06823-1

Int Orthop. 2026 Apr 30. doi: 10.1007/s00264-026-06808-0. Online ahead of print.

ABSTRACT

PURPOSE: To define the 'patient acceptable symptom state' (PASS) and 'minimum important change' (MIC) for the Oxford Hip Score (OHS) following aseptic revision total hip arthroplasty (rTHA), and identify factors associated with their achievement.

METHODS: A prospective cohort of 135 patients (138 hips) undergoing aseptic rTHA at a single centre were followed up at one and two years postoperatively. Demographics, health-related quality of life (HRQoL; EQ-5D) and OHS were recorded at each timepoint. Anchor techniques were used to define the MIC and PASS. Regression models identified factors associated with PASS and MIC achievement.

RESULTS: The OHS PASS was 31.5 and 33.5 at one and two years postoperatively, respectively. The MIC was 8.5 at both timepoints. A greater preoperative EQ-5D was independently associated with PASS achievement at both timepoints. One-year MIC achievement was independently associated with lower BMI (p = 0.042) and lower preoperative OHS (p = 0.007), whilst lower preoperative OHS (p = 0.016) alone was independently associated with two year MIC achievement (p = 0.016). Lower preoperative EQ-5D and ASA grade 3 were associated with failure to achieve either PASS or MIC at one year (p = 0.030) and two years (p = 0.013) postoperatively, respectively.

CONCLUSION: The PASS and MIC thresholds for the OHS following aseptic rTHA contextualise the score and can inform study design. Greater preoperative HRQoL was independently associated with PASS achievement, whilst worse preoperative function was independently associated with MIC achievement. These thresholds should be considered in conjunction when assessing outcomes following aseptic rTHA.

PMID:42056500 | DOI:10.1007/s00264-026-06808-0

Int Orthop. 2026 Apr 29. doi: 10.1007/s00264-026-06815-1. Online ahead of print.

ABSTRACT

PURPOSE: To investigate the association between preoperative extracellular water-to-total body water ratio (ECW/TBW) and time to walking independence among female patients undergoing total hip arthroplasty (THA).

METHODS: This retrospective cohort study included female patients who underwent primary THA between January and December 2022. Preoperative ECW/TBW was measured using bioelectrical impedance analysis and dichotomized at 0.400. The primary outcome was time to walking independence within 14 postoperative days. Cox proportional hazards models assessed the association between ECW/TBW and walking independence, adjusting for age, comorbidities, nutritional status, skeletal muscle mass index, non-operated knee extensor strength, walking pain, and maximum walking speed. Model performance was evaluated using likelihood ratio tests, Harrell's C-index, and time-dependent area under the curve (AUC).

RESULTS: Among 142 patients, 118 (83.1%) achieved walking independence within 14 days. Patients with ECW/TBW ≥ 0.400 achieved walking independence later than those with ECW/TBW < 0.400 (log-rank p < 0.001). In multivariable analysis, ECW/TBW ≥ 0.400 was associated with delayed walking independence (hazard ratio 0.29, 95% CI 0.16-0.52). Including ECW/TBW improved model fit and increased the time-dependent AUC at postoperative day 14.

CONCLUSION: Higher preoperative ECW/TBW is associated with delayed walking independence after THA and may complement preoperative assessment when predicting early postoperative functional recovery.

PMID:42056499 | DOI:10.1007/s00264-026-06815-1

Int Orthop. 2026 Apr 29. doi: 10.1007/s00264-026-06810-6. Online ahead of print.

ABSTRACT

INTRODUCTION: Total hip arthroplasty (THA) for hip developmental dysplasia (DDH) carries a high perioperative complication rate, with dislocation representing the most frequent adverse event. Monoblock dual-mobility (DMM) cups have demonstrated promising results in reducing prosthetic instability while ensuring long-term implant survival. However, data specifically addressing DMM THA in low-grade DDH remain scarce. The aim of this study was to evaluate clinical outcomes and complication rates at a minimum ten-year follow-up in patients undergoing DMM THA for low-grade DDH.

MATERIALS AND METHODS: A single-centre retrospective study was conducted, including all patients who underwent DMM THA for Crowe grade I or II DDH between 2008 and 2018. Clinical outcomes including the Harris Hip Score (HHS), Postel-Merle d'Aubigné (PMA) score, Devane score, visual analog scale (VAS), and range of motion (ROM) were assessed preoperatively, at one year, and at final follow-up. Implant survival was estimated using Kaplan-Meier analysis.

RESULTS: Thirty-one THAs were performed in 25 patients (mean age 55.1 ± 13.4 years; mean follow-up 10.06 ± 1,98 years). All functional scores improved significantly at final follow-up (HHS 48 to 98, PMA 11 to 17, Devane 3 to 4, all p < 0.001). No dislocation, loosening, periprosthetic fracture, or septic complication was recorded. Implant survival was 100% at ten years.

CONCLUSION: The DMM THA for low-grade DDH provides excellent long-term functional outcomes with a remarkably low complication profile, supporting the routine use of DMM cups in this indication.

PMID:42056498 | DOI:10.1007/s00264-026-06810-6

Int Orthop. 2026 Apr 29. doi: 10.1007/s00264-026-06822-2. Online ahead of print.

NO ABSTRACT

PMID:42053624 | DOI:10.1007/s00264-026-06822-2

Int Orthop. 2026 Apr 28. doi: 10.1007/s00264-026-06821-3. Online ahead of print.

ABSTRACT

INTRODUCTION: Popliteal artery injury (PAI) associated with proximal tibial fracture (PTF) is rare but limb-threatening, and its morphological characteristics remain poorly defined. This study aimed to investigate the fracture patterns, associated vascular and soft tissue injuries, and clinical outcomes of PTF with PAI.

METHODS: We retrospectively reviewed cases of PTF with PAI treated at a single institution. Based on previous reports and our experience, fractures were classified into isolated medial tibial plateau fracture (IMTPF), hyperextension bicondylar tibial plateau fracture (HBTPF), metaphyseal shearing fracture (MSF), and others. Clinical characteristics, treatment strategies, and outcomes were analyzed.

RESULTS: Among 336 patients with PTF, nine (2.7%) had associated PAI. Fracture patterns included IMTPF (n = 2), HBTPF (n = 2), MSF (n = 4), and others (n = 1). IMTPF and HBTPF were typically closed injuries associated with traction-induced vascular injury and demonstrated favorable clinical outcomes following timely revascularization and stable fixation. In contrast, MSF was characterized by anterior open wounds and direct vascular injury caused by posterior displacement of the distal fragment. Two MSF cases required soft tissue reconstruction with pedicled gastrocnemius flap, and one case resulted in amputation.

CONCLUSION: PTF with PAI is associated with specific fracture patterns that reflect distinct injury mechanisms and clinical courses. Recognition of these patterns, particularly MSF, may facilitate early diagnosis, guide treatment strategies, and improve clinical outcomes.

PMID:42050057 | DOI:10.1007/s00264-026-06821-3

Int Orthop. 2026 Apr 28. doi: 10.1007/s00264-026-06791-6. Online ahead of print.

ABSTRACT

PURPOSE: Chronic acromioclavicular joint instability (ACJI) remains challenging, and the optimal surgical technique is debated. Weaver-Dunn reconstruction is widely used, but modifications have been made to improve horizontal and vertical stability. This study addressed the clinical outcomes of a modified Weaver-Dunn procedure reinforced with a double EndoButton construct.

METHODS: This retrospective single-center study included 23 patients undergoing modified Weaver-Dunn reconstruction for chronic ACJI between 2012 and 2024, with a minimum follow-up of 12 months. Indications included symptomatic Rockwood grade 3 or higher after failed conservative management. Surgery was performed arthroscopically in most cases; five cases used an open approach. Clinical assessment included Constant-Murley score, Subjective Shoulder Value (SSV), Visual Analog Scale (VAS) for pain, ROM, piano-key sign, and clavicular drawer test. Radiographic evaluation included coracoclavicular distance, alignment, and loss of reduction. Complications and revisions were documented.

RESULTS: At a mean follow-up of 79 months, pain improved significantly (VAS 2.9 to 0.4, p = 0.001). Constant score increased from 60 to 87 (p = 0.001), and SSV improved significantly. Forward flexion improved from 159° to 175° (p = 0.015), and abduction from 163° to 175° (p = 0.03). Clinical stability improved, with disappearance of the piano-key sign and drawer sign in 82% and 91% of cases. Four patients (17%) showed recurrent grade 3 or higher dislocation. Complications occurred in five patients (22%), including one coracoid fracture and one EndoButton migration.

CONCLUSION: Modified Weaver-Dunn reconstruction using two EndoButtons provided significant improvements in pain, function, ROM, and clinical stability with acceptable recurrence and complication rates.

PMID:42047728 | DOI:10.1007/s00264-026-06791-6

Int Orthop. 2026 Apr 27. doi: 10.1007/s00264-026-06814-2. Online ahead of print.

ABSTRACT

BACKGROUND: The Zweymüller femoral stem is a well-established design for cementless total hip arthroplasty (THA). However, long-term data are scarce on modified versions produced by different manufacturers. This study aimed to evaluate the ten year clinical and radiographic outcomes of the Elance stem, a modified Zweymüller-type prosthesis.

METHODS: We retrospectively reviewed 82 primary THAs performed between 2013 and 2015 using the Elance stem. This stem features an alkali- and heat-treated bioactive surface and lacks the traditional trochanteric shoulder. The target roughness of the stem surface was 1.0 to 2.5 µm. The primary endpoint was survivorship with revision for any reason; the secondary endpoint was the rate of the aseptic loosening of the Elance stem.

RESULTS: The 10-year survivorship rate with revision for any reason was 53% (95% CI: 40-63%). Forty-one hips (50%) underwent revision surgery, with 40 of these revisions (98%) due to aseptic stem loosening. Additionally, four stems demonstrated radiographic loosening but had not yet undergone revision, resulting in a total stem loosening rate of 54%.

CONCLUSIONS: The Elance femoral stem demonstrated unacceptably low year survivorship. Design modifications, specifically the omission of the trochanteric shoulder and a lower surface roughness compared to the original Zweymüller design, likely compromised initial stability and long-term osseointegration. These findings emphasize that bioactive surface treatments cannot compensate for suboptimal stem design and that caution is warranted when adopting modified orthopaedic implants without robust long-term evidence.

PMID:42043540 | DOI:10.1007/s00264-026-06814-2

Int Orthop. 2026 Apr 23. doi: 10.1007/s00264-026-06819-x. Online ahead of print.

ABSTRACT

PURPOSE: Allograft-prosthetic composites (APC) are used to reconstruct large periarticular defects following tumour resection, with potential advantages especially restoration of bone stock and ligamentous reattachment. While short- and mid-term outcomes have been reported on extensively, long-term clinical results remain limited. This study evaluated the incidence of mechanical and non-mechanical complications, risk factors for complications, and the cumulative incidence of reconstruction failure following APC reconstruction for extremity tumours with a minimum follow-up of ten years.

METHODS: We retrospectively reviewed 64 APC with at least ten years follow-up in our centre. Predominant diagnoses were osteosarcoma (40%) and chondrosarcoma (28%). Reconstructions involved the proximal femur (39%), distal femur (22%), proximal tibia (23%) and proximal humerus (16%). Median follow-up was 24.5 years (95%CI 23.6-25.4).

RESULTS: Instability occurred in nine reconstructions (14%). Non-union was observed in nine reconstructions (14%). Implant loosening occurred in seven reconstructions (11%) after a median of 14 years (range 2-18 years). Allograft collapse occurred in 13 reconstructions (20%) after a median of three years (range 1-15). Infection developed in five reconstructions (8%). Cumulative incidence of mechanical failure at five, ten and 25 years was 15.6% (95%CI 6.6-24.6), 21.9% (95%CI 11.6-32.1) and 28.6% (95%CI 17.2-39.9), respectively.

CONCLUSIONS: APC are associated with a considerable risk of both early and late complications. Non-union and infection predominate in the early postoperative period, whereas aseptic loosening and fractures are the main causes of late failure, occurring up to 18 years after surgery. These findings suggest that the routine use of APC for periarticular reconstruction after tumour resection should be reconsidered.

PMID:42026181 | DOI:10.1007/s00264-026-06819-x