Int Orthop. 2026 Apr 23. doi: 10.1007/s00264-026-06803-5. Online ahead of print.

ABSTRACT

BACKGROUND: Lumbar tuberculosis (LTB) is a significant global health concern, often requiring surgical intervention when medical treatment is insufficient. Retroperitoneoscopic debridement offers a minimally invasive approach to manage LTB, potentially reducing complications and recovery time compared to traditional open surgery. However, its efficacy and safety remain understudied. This retrospective cohort study aims to evaluate the clinical outcomes, complication rates, and long-term effectiveness of retroperitoneoscopic debridement in patients with LTB.

METHODS: This retrospective cohort study analyzed patients with LTB and treated with retroperitoneoscopic debridement at our institution from July 2022 to July 2023. Baseline patient characteristics, operative time, operative blood loss, changes in inflammatory markers (e.g., CRP, ESR), complication rates, the visual analog scale (VAS) scores of the back, Oswestry Disability Index (ODI) scores, kyphotic angle changes in infective level and radiological follow-up outcomes were recorded.

RESULTS: Twenty patients with LTB were finally included. The mean operative time, operative blood loss, and postoperative drainage volume were 88.42 ± 7.07 min, 26.32 ± 10.61 ml, and 58.00 ± 11.31 ml, respectively. The mean follow-up time was 20.21 ± 1.41 months. During the follow-up, both VAS score and ODI score were significantly improved at one month, three months postoperative, and the final follow-up, compared with preoperative (P < 0.001). At the final follow-up, the kyphotic angle in the infective level remained good in all patients and no spinal instability was observed. Bone graft fusion rate at the final follow-up was 100%. Compared with preoperative, ESR and CRP were both showed significant decrease at one and three months postoperative (P < 0.001). One patient was found with postoperative complications, and cured after active treatment.

CONCLUSION: Retroperitoneoscopic debridement appears to be a safe and effective minimally invasive approach for treating LTB. However, long-term efficacy requires further validation through prospective studies with larger sample sizes and extended follow-up periods.

PMID:42024256 | DOI:10.1007/s00264-026-06803-5

Int Orthop. 2026 Apr 23. doi: 10.1007/s00264-026-06804-4. Online ahead of print.

ABSTRACT

PURPOSE: To assess the incidence of anterior deltoid atrophy following reverse total shoulder arthroplasty (RTSA) for rotator cuff arthropathy (RCA), to investigate its association with the surgical approach and neurophysiological injury of the anterior branch of the axillary nerve, and to determine its impact on postoperative shoulder flexion.

METHODS: Prospective observational cohort study of 31 patients (mean age 77.9 ± 5.4 years; 85% female) with RCA undergoing RTSA at a single tertiary centre (2014-2017). Two approaches were used: deltopectoral (DP, n = 20) and superolateral (SL, n = 11). Neurophysiological evaluation (electroneurography + quantitative needle EMG) of the axillary and suprascapular nerves was performed preoperatively and at three and six months postoperatively by a single experienced neurophysiologist. Anterior deltoid atrophy was assessed at 12 months using a pre-specified standardised clinical inspection protocol: visible anterior deltoid contour concavity at rest, confirmed on active elevation against gravity, graded as present or absent by a single blinded examiner. Convergent support was provided by the observed difference in shoulder flexion between groups and by the EMG data. Shoulder flexion and the Constant-Murley Score (CMS) were recorded at baseline and 12 months.

RESULTS: Preoperative axillary nerve injury was present in 77.4% of patients, predominantly affecting the anterior branch (48.4%). Acute postoperative axillary nerve injury occurred in 25.8% of the overall cohort. At 12 months, anterior deltoid atrophy was identified in 13/31 patients (41.9%), with a significantly higher rate in the SL group (72.7% vs 25%; p = 0.021). The rate of acute postoperative injury to the anterior axillary nerve branch did not differ significantly between patients with and without deltoid atrophy (23.1% vs 22.2%; p = n.s.). Patients with atrophy achieved a mean anterior flexion of 115° (SD 8.7°) versus 137° (SD 7.4°) in those without (difference 22°; 95% CI 1.5-31.2; p = 0.066; Cohen's d = 0.87). Both groups improved significantly from baseline.

CONCLUSION: Anterior deltoid atrophy is common after RTSA (42%) and is significantly associated with the superolateral approach. The absence of a neurophysiological correlate is consistent with a mechanical aetiology related to deltoid reinsertion technique, although causality cannot be established from this observational study. These findings generate a testable hypothesis warranting prospective evaluation of bony acromial flap reinsertion in future comparative studies.

PMID:42024255 | DOI:10.1007/s00264-026-06804-4

Int Orthop. 2026 Apr 23. doi: 10.1007/s00264-026-06816-0. Online ahead of print.

ABSTRACT

INTRODUCTION: Premature ovarian insufficiency (POI) and early menopause (EM) lead to prolonged estrogen deficiency, which can affect musculoskeletal disorders (MSDs) and pain, including neuropathic pain. This study investigated the impact of POI/EM on MSDs, pain, and physical function in community-dwelling women.

METHODS: We conducted a cross-sectional study using data from 172 postmenopausal women who participated in a community-based health checkup in Yakumo town, Japan. Participants were categorized by age at menopause: control (45-50 years, n = 118), POI (< 40 years, n = 19), and EM (40-44 years, n = 35). We evaluated MSDs (knee osteoarthritis, spinal alignment, and osteoporosis), pain (Visual Analogue Scale for low back, lower limb, and knee pain; and painDETECT scores), and physical function (muscle strength, walking ability, locomotive syndrome). Locomotive syndrome was evaluated using the stand-up test, two-step test, and the 25-question Geriatric Locomotive Function Scale (GLFS-25).

RESULTS: The POI group exhibited a significantly higher prevalence of knee osteoarthritis and severe knee pain compared to the control and EM groups. The prevalence of neuropathic pain was also significantly higher in the POI group. Regarding physical function, no significant differences were observed in muscle strength or walking ability among the groups. However, the POI group had significantly higher scores on the GLFS-25 pain subscale and total score, indicating worse locomotive function.

CONCLUSIONS: Women with POI had a higher prevalence of knee osteoarthritis, knee pain, and neuropathic pain. Although objective physical performance was preserved, subjective locomotive function was impaired. Therefore, early therapeutic intervention and a multifaceted approach addressing not only physical function but also pain are necessary for women with POI/EM.

PMID:42024254 | DOI:10.1007/s00264-026-06816-0

Int Orthop. 2026 Apr 21. doi: 10.1007/s00264-026-06802-6. Online ahead of print.

ABSTRACT

PURPOSE: Our retrospective study focused on long-term outcomes of converting a fused hip to a cementless metaphyseal-fitting anatomic hip system including: (1) validated clinical scores; (2) radiographic assessment; (3) impact on neighbouring joints; (4) osteolysis and revision rates; (5) complication profiles; (6) implant survivorship; and (7) patient satisfaction.

METHODS: We reviewed 96 THAs in 88 patients (mean age, 42.3 years [range, 21 to 74]) who underwent conversion of fused hip through a posterolateral approach to a cementless a metaphyseal-fitting anatomic cementless total hip system, performed by one surgeon. The third generation Biolox Forte at 28 mm as the bearing surface was used in all hips. The mean follow-up was 23.5 years (range, 14 to 30 years).

RESULTS: At the final follow-up, the mean Harris hip score was 91.2 points (range, 52 to 100 points). Mean hip flexion was 89° (range, 70° to 120°). Three acetabular (3%) and five femoral components (5%) that were revised. About 70 to 80% of patients expressed overall satisfaction and 66% of patients reported marked improvement in quality of life. A Kaplan-Meier survivorship analysis at 23.5 years showed a 97% survival rate (95% CI, 93 to100%) for the acetabular component and 91% (95% CI, 89 to 98%) for the femoral component.

CONCLUSIONS: Conversion of hip fusion to THA using metaphyseal-fitting anatomic cementless hip system appears to provide good long-term outcomes. The risk for postoperative complication including abductor dysfunction and nerve injury should be carefully discussed with patients prior to surgery.

PMID:42012520 | DOI:10.1007/s00264-026-06802-6

Int Orthop. 2026 Apr 20. doi: 10.1007/s00264-026-06812-4. Online ahead of print.

NO ABSTRACT

PMID:42008188 | DOI:10.1007/s00264-026-06812-4

Int Orthop. 2026 Apr 18. doi: 10.1007/s00264-026-06809-z. Online ahead of print.

ABSTRACT

BACKGROUND: Medial opening wedge high tibial osteotomy (MOWHTO) is a widely used procedure for treating varus knee osteoarthritis. While achieving an appropriate postoperative coronal alignment is considered important, it is not well established whether optimal alignment actually translates into better patient-reported outcomes.

METHODS: We retrospectively evaluated 203 knees in 173 patients, who underwent MOWHTO. Based on postoperative hip-knee-ankle (HKA) alignment, patients were classified into optimal and non-optimal groups. Clinical outcomes were assessed using the Knee Society Score, Knee Society Functional Score, Oxford Knee Score and WOMAC. Conversion to Total Knee Arthroplasty (TKA) was defined as failure. Surgical survivorship was analysed using Kaplan-Meier method and the log-rank test. Patient Related Outcome Measures (PROM) analysis included only patients who retained their native knee at final follow-up.

RESULTS: Preoperative and early postoperative HKA angles were similar between groups. However, at a mean follow-up period of approximately 11.5 years, patients in the non-optimal group showed significantly greater loss of correction, reflected by a higher ΔHKA (p < 0.001). Among patients who did not undergo TKA, postoperative PROMs were comparable between the two groups. Although the overall rate of conversion to TKA was similar, survivorship analysis showed that failure occurred significantly earlier in the non-optimal alignment group (log-rank χ2 = 29.11, p < 0.001).

CONCLUSION: While optimal alignment after MOWHTO does not appear to improve patient-reported outcomes, it is associated with better long-term survivorship of the osteotomy. In contrast, non-optimal alignment is linked to earlier failure and earlier conversion to TKA, suggesting that alignment accuracy primarily influences longevity rather than long-term function.

PMID:42000869 | DOI:10.1007/s00264-026-06809-z

Int Orthop. 2026 Apr 18. doi: 10.1007/s00264-026-06813-3. Online ahead of print.

NO ABSTRACT

PMID:41999423 | DOI:10.1007/s00264-026-06813-3

Int Orthop. 2026 Apr 15. doi: 10.1007/s00264-026-06799-y. Online ahead of print.

ABSTRACT

PURPOSE: To investigate anterior cruciate ligament (ACL) injury associated meniscal and cartilage lesions and to evaluate the independent effects of sports activity level and surgical timing on their distribution.

METHODS: A retrospective cohort analysis was conducted on all primary ACL reconstructions performed at a specialized sports medicine hospital between 2018 and 2022. The primary outcome was the prevalence of ACL-associated injuries. Secondary outcomes included classification of associated injuries, differences according to sports activity level, and injury-to-surgery time. Multivariate logistic regression was used as the main analysis.

RESULTS: A total of 582 patients were included, with a median age of 26.0 years. Of these, 321 (55%) had at least one meniscal tear. Cartilage lesions were identified in 93 patients (16%), most commonly affecting the medial femoral condyle (MFC). Registration in a professional sports club was associated with increased odds of lateral meniscus posterior horn tears. Surgical delay showed increasing odds of chondral lesions, particularly involving the MFC, as well as medial meniscal tears. Surgeries performed more than 30 days after injury were associated with significantly lower odds of identifying ramp lesions.

CONCLUSION: ACL injuries are frequently associated with a range of concomitant intra-articular lesions. Medial compartment lesions are primarily associated with surgical timing, independent of sports activity level. In contrast, lateral meniscus posterior horn tears were more common among professional athletes. Surgeries performed within 30 days of injury were associated with higher odds of detecting ramp lesions, regardless of sports activity level.

PMID:41986481 | DOI:10.1007/s00264-026-06799-y

Int Orthop. 2026 Apr 15. doi: 10.1007/s00264-026-06806-2. Online ahead of print.

ABSTRACT

BACKGROUND: Large language model based chatbots are increasingly used by patients seeking information about periprosthetic joint infection (PJI) and revision strategies, yet the quality of patient-facing answers for one-stage revision remains uncertain.

METHODS: This expert based, cross sectional exploratory study evaluated ChatGPT generated answers to 12 patient-oriented questions on one-stage revision arthroplasty for PJI. Questions were purposively selected from a pool of 30 commonly asked items to maximize topic coverage while minimizing redundancy. All questions were entered ad verbatim into ChatGPT on January 3, 2026 (freely accessible web interface; GPT-5.2), using a new session per question; only the first response was recorded without follow-up prompts or browsing. Four raters (two senior orthopaedic surgeons, one junior orthopaedic surgeon, one infectious diseases specialist) independently graded each response using a predefined ordinal rubric and recorded brief comments when limitations were identified. Inter-rater reliability was assessed using Krippendorff's alpha (ordinal).

RESULTS: Responses were rated positively overall. Answers addressing procedural steps, postoperative antibiotic management, and recovery expectations received the most consistently high ratings. Clarification was most frequently requested in domains where decision making is conditional or evolving, including indications/contraindications and patient selection, culture-negative PJI framing, protocol dependent weight bearing recommendations, and management options after failure. Inter-rater agreement was modest (α = 0.375; 95% CI - 0.012 to 0.651).

CONCLUSION: In this exploratory study, ChatGPT provided generally clear patient-facing explanations for one-stage revision PJI topics, with stronger performance in standardized and procedural domains and more limited performance in areas requiring individualized clinical judgment. These findings suggest that it may have a supportive role in patient education, although clinician oversight remains important to ensure appropriate contextualization and to avoid overgeneralization.

PMID:41986480 | DOI:10.1007/s00264-026-06806-2

Int Orthop. 2026 Apr 15. doi: 10.1007/s00264-026-06801-7. Online ahead of print.

ABSTRACT

PURPOSE: In PJI revision surgery, prolonged wound drainage (PWD) is a common concern associated with increased periprosthetic joint infection (PJI), yet no clinical guidelines exist, guiding when intervention should occur. This study aimed to quantify the association between PWD and treatment failure following hip PJI surgery, and which factors were associated with those results.

METHODS: A retrospective cohort study of hip PJI patients was conducted from March 2019 to January 2023. Univariate and multivariate logistic regression was performed to identify risk factors associated with PWD and failure of treatment (per modified Delphi criteria) Statistical significance was considered for p<0.05.

RESULTS: 164 patients were identified: 98 women (59.8%) and 66 men (40.2%), with a mean age of 69.3±13.9 years, Univariate analysis demonstrated that wound leakage duration was associated with treatment failure (OR:1.1, 95% CI 1.0-1.1, p=0.0024). Multivariate analysis demonstrated that leakage >14 days was the strongest predictor of treatment failure (OR 2.8, 95% CI 1.3-6.0, p=0.0064) Factors associated with leakage >14 days included malnutrition (p=0.0042), number of previous PJI surgeries (p=0.0214), and McPherson host grade 2 (p=0.0230). Gram-negative (p= 0.0266) and polymicrobial hip cultures (p=0.0128) were also associated with prolonged leakage. Univariate associations remained significant with multivariate analysis.

CONCLUSION: Wound drainage >14 days is associated with an elevated risk of failure after PJI surgery. Surgeons should consider early repeat surgery on patients with PWD by two weeks following PJI revision surgery. Previous PJI surgery and malnutrition are risk factors for PWD and should prompt early consultation with nutritional services.

PMID:41984159 | DOI:10.1007/s00264-026-06801-7

Int Orthop. 2026 Apr 14. doi: 10.1007/s00264-026-06805-3. Online ahead of print.

ABSTRACT

PURPOSE: Acute Achilles tendon rupture with delayed treatment more than four weeks is referred to as chronic, which can lead to severe functional impairment. The literature advocates surgical reconstruction to restore ankle joint push-off strength. This study aims to introduce the technique and clinical outcomes of endoscopic autologous tendon suspension fixation for chronic insertional Achilles tendon rupture.

METHODS: Twenty-two patients (16 males, 6 females) with a mean age (range) of 49.2 ± 10.3 (30-67) years underwent Achilles tendon reconstruction surgery using all-endoscopic autologous tendon suspension fixation. Patients were evaluated at the last follow-up, with assessment indicators including Visual analogue scale (VAS), American Orthopaedic Foot & Ankle Society Ankle Hindfoot Scale (AOFAS-AH), Achilles tendon total rupture score (ATRS), Foot and Ankle Ability Measure (FAAM), Range of motion (ROM) and maximum calf circumference.

RESULTS: All patients successfully completed the surgery, with an operation time of 62.91 ± 8.82 (45-80) min, intraoperative blood loss of 15 (5-35) mL, and all surgical approaches healed in one stage, with no damage to important structures such as blood vessels, nerves, and tendons during the operation. Twenty-two patients were followed up for 16.23 ± 2.94 (12-23) months. Two patients reported weakness in single-leg heel raises, which subsequently improved with heel raise exercises. At the last follow-up, the AOFAS-AH score improved from 60.64 ± 8.83 (45-77) preoperatively to 94.18 ± 3.91 (88-100), while the ATRS score increased from 45.59 ± 5.85 (35-57) preoperatively to 93.18 ± 4.68 (83-100), and the VAS score decreased from 6 (1) to 1 (0), with all differences being statistically significant. Similarly, the FAAM- Activity of Daily Living (FAAM-ADL) score increased from 44.73 ± 8.79 (30-59) to 90.95 ± 4.62 (83-99), and the FAAM- -Sports (FAAM-S) score increased from 43.55 ± 7.14 (31-55) to 88.27 ± 8.18 (74-99). All differences were statistically significant. (all P < 0.001). The dorsiflexion angle of the affected side ankle joint (13.2 ± 1.9°), plantar flexion angle of the ankle joint (44.3 ± 1.6°), and maximum calf circumference (35.6 ± 1.5 cm) were compared with the healthy side (13.3 ± 1.9°, 44.5 ± 1.7°, 35.6 ± 1.6 cm), and there was no statistically significant difference (all P > 0.05). According to the Arner-Lindholm scoring assessment: excellent in 19 cases, good in three cases, with an excellent and good rate of 100% (22/22).

CONCLUSION: This study demonstrates that all-endoscopic autologous suspension fixation achieves satisfactory outcomes in patients with chronic Achilles tendon ruptures. This technique effectively restores distal ruptures, making it a viable option for Achilles tendon reconstruction.

PMID:41979664 | DOI:10.1007/s00264-026-06805-3

Int Orthop. 2026 Apr 14. doi: 10.1007/s00264-026-06800-8. Online ahead of print.

ABSTRACT

INTRODUCTION: Precise component positioning in total knee arthroplasty (TKA) influences tibiofemoral mechanics, patellofemoral tracking, and soft-tissue balance. Although robotic-assisted TKA improves alignment accuracy, most comparative studies emphasize mean alignment rather than surgical reproducibility. Variability and outlier rates may better reflect precision. This study compared alignment variability and the proportion of coronal and rotational outliers between robotic-assisted and conventional TKA performed under identical mechanical alignment targets.

METHODS: A retrospective comparative cohort included 300 primary TKAs (150 robotic-assisted, 150 conventional) performed by the same surgical team between 2022 and 2025. Postoperative hip-knee-ankle (HKA) alignment was measured on standardized long-leg radiographs. Rotational alignment was evaluated by computed tomography in a predefined subgroup. Variability was quantified using standard deviation and equality of variance tested with the Brown-Forsythe method. Outliers were defined as deviation > 3° from target alignment. Multivariable logistic regression identified predictors of outlier status.

RESULTS: Mean postoperative HKA did not differ between groups (0.4° ± 1.6° robotic vs. 0.6° ± 2.8° conventional; p = 0.41). Robotic-assisted TKA showed lower dispersion (SD 1.6° vs. 2.8°; p < 0.001). Coronal outliers occurred in 6.7% of robotic cases versus 21.3% of conventional cases (p < 0.001). Rotational mismatch > 3° was less frequent with robotic assistance (8.7% vs. 24.0%; p = 0.006).

CONCLUSIONS: Robotic-assisted TKA reduced alignment variability and outliers without altering mean alignment, suggesting improved surgical reproducibility.

PMID:41975083 | DOI:10.1007/s00264-026-06800-8

Int Orthop. 2026 Apr 13. doi: 10.1007/s00264-026-06807-1. Online ahead of print.

ABSTRACT

PURPOSE: Autologous osteoperiosteal transplantation (AOPT) from the iliac crest has been proposed as a potential treatment for large osteochondral lesions of the talus (OLTs). This single-arm study aims to prospectively evaluate the clinical, radiological, and arthroscopic outcomes of AOPT from the iliac crest in patients with large cystic OLTs.

METHODS: This is a prospective single-arm study. We evaluated 42 patients who underwent AOPT from the iliac crest for OLTs. The mean follow-up was 32.5 months. Clinical outcomes were assessed using the Visual Analog Scale (VAS), American Orthopaedic Foot and Ankle Society (AOFAS) scores, and Tegner activity scores. Radiologic outcomes were evaluated via X-ray, CT, and MRI. Arthroscopy was performed on a subset of patients for second-look evaluation.

RESULTS: Significant clinical improvements were observed, with VAS scores decreasing from 4.36 ± 1.76 to 0.45 ± 0.63, AOFAS scores increasing from 75.38 ± 13.52 to 95.33 ± 4.81, and Tegner scores increasing from 2.00 ± 0.99 to 4.10 ± 1.10. Postoperative imaging revealed the resolution of subchondral radiolucency, improvement of articular surface protrusion or collapse, graft integration with surrounding bone, and a reduction in marrow oedema. Follow-up arthroscopy demonstrated significant lesion repair, with cartilage-like tissue integrated into the talus. No complications, including infections or donor-site morbidity, were observed.

CONCLUSION: AOPT from the iliac crest is associated with favourable short- to mid-term clinical, radiological, and arthroscopic outcomes, with no complications observed in this series. These findings provide prospective evidence supporting the potential of AOPT from the iliac crest as a treatment option for large talar osteochondral defects.

PMID:41973114 | DOI:10.1007/s00264-026-06807-1

Int Orthop. 2026 Apr 9. doi: 10.1007/s00264-026-06789-0. Online ahead of print.

ABSTRACT

BACKGROUND: Long-term prospective data on periacetabular osteotomy (PAO) from Middle Eastern populations are limited. This study evaluated ≥ seven year clinical, functional, and radiographic outcomes following PAO and identified predictors of survivorship.

METHODS: Thirty-six consecutive patients (34.6 ± 7.2 years; 78% female) undergoing PAO (2014-2018) were prospectively followed. Inclusion required symptomatic dysplasia with Tönnis 0-2. Outcomes included HHS, WOMAC, HOS, SF-36, radiographic parameters (LCEA, AI), complications, and THA conversion. Reliability, multivariate regression, and Kaplan-Meier analyses were performed.

RESULTS: At 7.8 ± 1.2 years, HHS improved from 63.5 ± 11.2 to 89.6 ± 7.8 (p < 0.001). LCEA increased from 16.2 ± 4.3° to 31.8 ± 3.9° and AI decreased from 22.8 ± 5.1° to 7.2 ± 3.6°. ICC for measurements was 0.92. Complications occurred in 16.7% (mostly minor). THA conversion was 5.6%, both with preoperative Tönnis 2 and correction < 12°. Magnitude of LCEA correction independently predicted HHS improvement (β = 0.41, p < 0.01).

CONCLUSIONS: PAO achieved durable correction and sustained functional improvement with low THA conversion at mid- to long-term follow-up. Preoperative cartilage status and adequacy of correction are key determinants of outcome.

PMID:41954625 | DOI:10.1007/s00264-026-06789-0

Int Orthop. 2026 Apr 9. doi: 10.1007/s00264-026-06797-0. Online ahead of print.

NO ABSTRACT

PMID:41951828 | DOI:10.1007/s00264-026-06797-0

Int Orthop. 2026 Apr 2. doi: 10.1007/s00264-026-06779-2. Online ahead of print.

ABSTRACT

BACKGROUND: ​ Gradual correction of genu varum using circular external fixators is well-established. Although the External Fixation Index (EFI) is widely used in linear bone lengthening, no standardized, time-normalized metric exists for angular deformity correction. This study introduces the angular External Fixation Index (aEFI) as a descriptive tool and evaluates internal consistency within a clinical cohort treated with oblique proximal tibial corticotomy (OPTC).

METHODS: ​ A prospective cohort study included 22 patients (30 knees) who underwent gradual genu varum correction using OPTC and circular external fixation. The aEFI was calculated as total duration of external fixation (weeks) divided by achieved angular correction (degrees). Radiographic evaluation included medial proximal tibial angle (MPTA) and hip-knee-ankle angle measured preoperatively and at final follow-up. Functional outcomes were assessed using the Western Ontario and McMaster Universities Osteoarthritis Index, and the Stanmore Limb Reconstruction Score.

RESULTS: At a mean follow-up of 16.5 ± 3.25 months, coronal alignment was restored in all knees. Mean fixation duration was 27.4 ± 6.2 weeks, with a mean aEFI of 1.89 ± 0.41 weeks/degree. An inverse association was observed between correction magnitude and aEFI (r = -0.88, p < 0.001), reflecting the reduced proportional effect of fixed treatment phases with larger corrections. Functional scores improved, and minor pin-tract infections occurred in 20% of knees and resolved conservatively.

CONCLUSION: ​ The proposed aEFI serves as a standardized, descriptive, time-normalized metric for reporting treatment duration relative to angular correction. External validation across different constructs and deformity patterns is warranted.

PMID:41925755 | DOI:10.1007/s00264-026-06779-2

Int Orthop. 2026 Apr 2. doi: 10.1007/s00264-026-06798-z. Online ahead of print.

NO ABSTRACT

PMID:41925754 | DOI:10.1007/s00264-026-06798-z

Int Orthop. 2026 Apr 1. doi: 10.1007/s00264-026-06787-2. Online ahead of print.

ABSTRACT

PURPOSE: To evaluate the incidence of surgical complications, particularly periprosthetic fractures, following femoral impaction bone grafting (fIBG) in revision total hip arthroplasty (rTHA).

METHODS: This systematic review followed PRISMA guidelines. Studies reporting on fIBG in rTHA with a minimum follow-up of 12 months were included. Risk of bias was assessed using the Methodological Index for Non-Randomised Studies (MINORS). A random-effects meta-analysis with inverse-variance weighting was performed. Heterogeneity was assessed using Higgins and Thompson's I2 statistic and Cochran's Q test. Subgroup analyses were conducted based on patient characteristics, revision indication, follow-up period, bone loss severity, stem length, and cementation. Complications requiring intervention, as well as nerve lesions with partial or no recovery, were classified as major.

RESULTS: Forty-five studies including 4,686 hips (4,409 patients) were analyzed. The pooled incidence of major complications was 21% (n = 730; 95% CI 16-26%; I2 = 89%, p < 0.01). Of these, 78% required surgical intervention. The most common major complications were intraoperative fractures (22.7%), postoperative fractures (19.3%), and instability (19.2%). Higher complication rates were reported with long stems (44.1%) compared with short stems (18.8%, p = 0.016) and in cases of severe bone loss (Endo-Klinik grades III/IV, 25.3%) compared with I/II (14.2%, p = 0.028).

CONCLUSION: Major complications following fIBG in rTHA are relatively frequent, although interpretation is limited by substantial study heterogeneity. Higher complication rates were observed in cases with severe bone loss and the use of long stems, likely reflecting greater surgical complexity.

PMID:41920370 | DOI:10.1007/s00264-026-06787-2

Int Orthop. 2026 Mar 31. doi: 10.1007/s00264-026-06788-1. Online ahead of print.

ABSTRACT

STUDY DESIGN: Population-based retrospective cohort study.

OBJECTIVES: To assess the longitudinal association between incident gout and risk of incident cervical ossification of the posterior longitudinal ligament (OPLL).

METHODS: Using National Health Insurance Service data linked to health screening records (2002-2013), adults aged 20-79 years with incident gout were identified (≥ 2 primary diagnoses of ICD-10 M10.0/M10.9 within 30 days) after a two year washout. Controls without gout were propensity score-matched 1:20. Incident cervical OPLL was defined as ICD-10 M48.82 with cervical CT or MRI within 30 days. Participants were followed from index date to OPLL, death, or December 31, 2013. Cox proportional hazards models estimated adjusted hazard ratios (HRs); sensitivity analyses used a stricter OPLL definition (≥ 2 diagnoses > 30 days apart).

RESULTS: The matched cohort included 5,977 gout patients and 119,540 controls (478,828 person-years). OPLL developed in 17 (0.28%) gout patients versus 162 (0.14%) controls, yielding incidence rates of 0.75 vs 0.36 per 1,000 person-years (incidence rate ratio 2.11; 95% CI, 1.28-3.47). Gout was associated with increased OPLL risk in the fully adjusted model (HR 2.13; 95% CI, 1.27-3.56). Findings were consistent under the stricter definition (incidence rate ratio 2.29; 95% CI, 1.26-4.17).

CONCLUSIONS: In this nationwide cohort, incident gout was independently associated with more than a twofold higher risk of incident cervical OPLL.

PMID:41915154 | DOI:10.1007/s00264-026-06788-1

Int Orthop. 2026 Mar 28. doi: 10.1007/s00264-026-06795-2. Online ahead of print.

ABSTRACT

The terms Köhler´s teardrop, Köhler disease I and Köhler disease II are known to almost all orthopaedic surgeons and radiologists. However, little is known about this prominent personality of the German and world radiology, who described these structure or diseases. Alban Köhler (1874-1947) was one of the first German speaking pioneers in the emerging discipline - radiology, particularly radiology of bones and joints. He introduced new radiological techniques, such as "Teleröntgenographie", and published a number of outstanding studies focused primarily on the musculoskeletal system, as well as on pulmonary tuberculosis and cardiac radiology. For a long time, Köhler had been actively involved in the study of radiation sickness and proposed measures that are valid to this day. The most famous Köhler´s publication "Lexikon der Grenzen des Normalen und der Anfänge des Pathologischen im Röntgenbilde" (The borderlands of the normal and early pathological in the skiagrams) was published for the first time in 1910. After Köhler´s death, the book was repeatedly published and gained recognition worldwide. Its 9th edition was initiated by Professor Emil Alfred Zimmer in 1953. Under a slightly modified title "Borderlands of normal and early pathological findings in skeletal radiology ", it is still published today, both in German and English.

PMID:41902913 | DOI:10.1007/s00264-026-06795-2