Int Orthop. 2026 Mar 28. doi: 10.1007/s00264-026-06793-4. Online ahead of print.

ABSTRACT

PURPOSE: To assess whether diabetes mellitus (type 1 or type 2) increases the risk of developing adhesive capsulitis (frozen shoulder).

METHODS: A systematic review and meta-analysis were conducted in 2026 using multiple electronic databases. Additional studies were identified through screening reference lists and consulting professional networks. Studies examining the relationship between diabetes mellitus and the incidence of adhesive capsulitis were eligible for inclusion. Study quality and bias risk were assessed, and when enough data were available, a random-effects meta-analysis was performed to estimate the general association between diabetes and the development of frozen shoulder.

RESULTS: The combined analysis showed that people with diabetes had 3.69 times higher odds (95% CI 2.99-4.56) of developing adhesive capsulitis compared to people without diabetes. Several additional risk factors were noted across studies, including poor glycemic control, obesity, hyperlipidaemia, hypertension, thyroid issues, age between 40 and 65, female gender, smoking, and alcohol use.

CONCLUSION: Diabetes mellitus is strongly associated with an increased risk of adhesive capsulitis. However, the observed association may be influenced by unmeasured confounding factors. Further high-quality longitudinal studies are required to clarify the causal relationship and underlying mechanisms.

PMID:41896299 | DOI:10.1007/s00264-026-06793-4

Int Orthop. 2026 Mar 27. doi: 10.1007/s00264-026-06796-1. Online ahead of print.

NO ABSTRACT

PMID:41894011 | DOI:10.1007/s00264-026-06796-1

Int Orthop. 2026 Mar 27. doi: 10.1007/s00264-026-06790-7. Online ahead of print.

NO ABSTRACT

PMID:41894010 | DOI:10.1007/s00264-026-06790-7

Int Orthop. 2026 Mar 27. doi: 10.1007/s00264-026-06794-3. Online ahead of print.

ABSTRACT

PURPOSE: Routine augmentation of pedicle screws in standard clinical practice is performed using polymethylmethacrylate (PMMA) cement. However, owing to its high compressive strength and high Young's modulus, this material acts more as a stiffener in the spine than as a suitable replacement for compressed cancellous bone. Adjacent fractures caused by this represent a common clinical problem. A new experimental magnesium phosphate cement seems more suitable for this purpose, as it shows promising biomechanical properties and has been proven to be injectable via long cannulated systems. However, the application of this material has not yet been explored or quantified.

METHODS: Fenestrated pedicle screws were inserted into polyurethane bone blocks of different densities and augmented with experimental magnesium phosphate cement. This was followed by biomechanical testing in a realistic loading scenario. In addition, the injection force required for augmentation was quantified depending on the syringe type.

RESULTS: Cement augmentation was possible in all bone blocks used and consistently had a positive effect on the biomechanical stability of fenestrated pedicle screws. The size of this effect varied depending on the density of the bone blocks used. No cutoff value could be identified at which augmentation should be performed.

CONCLUSION: The novel experimental ready-to-use formulation of magnesium phosphate cement reliably enabled cement augmentation of fenestrated pedicle screws and consistently resulted in improved biomechanical stability. These findings suggest that a biocompatible and degradable bone cement with suitable biomechanical properties may represent a future alternative for spinal augmentation.

PMID:41894009 | DOI:10.1007/s00264-026-06794-3

Int Orthop. 2026 Mar 25. doi: 10.1007/s00264-026-06792-5. Online ahead of print.

ABSTRACT

PURPOSE: The modified Broström operation is the gold standard surgical approach for chronic lateral ankle instability. The aim of surgical treatment for chronic lateral ankle instability is to shorten and repair the lax lateral ligaments, once the healing process is complete, the sutures will no longer be necessary. While non-absorbable sutures are commonly used, they may cause complications, such as inflammation and foreign body reactions. The purpose of this study was to evaluate the clinical outcomes of the modified Broström operation using absorbable sutures, which we expected to yield favorable results.

METHODS: From 2019 to 2023, 157 cases of mechanical chronic lateral ankle instability treated with the modified Broström operation using absorbable sutures were analyzed retrospectively Functional outcomes were assessed using preoperative and postoperative AOFAS Ankle-Hindfoot scores and Karlsson-Peterson scores.

RESULTS: The mean AOFAS score improved from 66.84 (range: 36-98) preoperatively to 88.20 (range: 55-100) postoperatively, and the mean Karlsson score improved from 53.67 (range: 25-95) to 82.29 (range: 35-100). Recurrence of instability or sprains occurred in 6.3% of cases, with only two patients (1.2%) requiring reoperation. Complications other than recurrence were rare, limited to a single case of superficial peroneal nerve injury and one deep infection. Multivariate analysis revealed that younger age was associated with a higher risk of recurrence.

CONCLUSION: The modified Broström operation using absorbable sutures demonstrated favorable functional improvement with low recurrence and complication rates, suggesting that it may represent a safe and effective surgical option.

PMID:41879989 | DOI:10.1007/s00264-026-06792-5

Int Orthop. 2026 Mar 24. doi: 10.1007/s00264-026-06778-3. Online ahead of print.

ABSTRACT

BACKGROUND: The COVID-19 pandemic produced a substantial reduction in arthroplasties, which could have affected patient quality of life. This study investigated quality of life in Australians undergoing elective arthroplasty before and during the COVID-19 pandemic.

METHODS: Using data from the Australian Orthopaedic Association National Joint Replacement Registry, quality of life was assessed in patients before and six months after primary total hip arthroplasty (THA), total knee arthroplasty (TKA) and reverse total shoulder arthroplasty (RTSA) using the EQ-5D-5L instrument. Patients with an EQ-5D Utility score less than zero were considered to have a quality of life worse than dead. Secondary outcomes included Oxford Scores, joint-specific pain, patient perceived change, responder status and patient satisfaction. Quality of life was compared before (1 July 2018-10 March 2020) and during the pandemic (11 March 2020-10 March 2023) using linear or logistic regression models.

RESULTS: The analysis included preoperative data for more than 24,000 THA patients, 20,000 TKA patients and 1,100 RTSA patients. Compared to the pre-pandemic period, preoperative and postoperative quality of life significantly reduced during the pandemic for THA and TKA, but not by a meaningful amount (adjusted mean difference ≤ 0.03 points, p < 0.001). The likelihood of having quality of life worse than dead increased during the pandemic but was only significant for preoperative THA (ORs 1.24 to 1.40, p < 0.02). For secondary outcomes, joint-specific scores deteriorated, and joint pain increased to a small degree during the pandemic for THA and TKA (p < 0.05), but not for RTSA. The proportion of THA and TKA patients satisfied with their surgery outcome increased modestly during the pandemic by approximately five percentage points, compared to pre-pandemic.

CONCLUSION: The COVID-19 pandemic was not associated with a clinically meaningful deterioration in pre- or post-operative quality of life, on average, for patients undergoing THA, TKA or RTSA in Australia.

PMID:41872348 | DOI:10.1007/s00264-026-06778-3

Int Orthop. 2026 Mar 21. doi: 10.1007/s00264-026-06782-7. Online ahead of print.

ABSTRACT

PURPOSE: To compare platelet-rich plasma (PRP) with hyaluronic acid (HA), corticosteroid (CS), or saline placebo (NS) for symptomatic knee osteoarthritis (OA) and to assess whether total blood-draw volume, a proxy for platelet dose, is associated with treatment effect.

METHODS: Following PRISMA, randomized controlled trials comparing intra-articular PRP with HA, CS, or NS were identified. Random-effects meta-analyses estimated mean differences (MDs) in pain (VAS) and function (WOMAC) at six and twelve months. Risk of bias was assessed with RoB 2.0 and certainty of evidence with GRADE. Subgroup analyses stratified PRP vs HA trials by total blood draw volume (< 40 mL vs ≥ 40 mL).

RESULTS: Sixty-two trials (n = 4,969) were included. PRP improved VAS and WOMAC versus HA, CS, and NS at six months and remained superior versus HA and CS at twelve months (insufficient studies for twelve-month PRP vs NS). In PRP vs HA trials, blood draw volume ≥ 40 mL was associated with larger improvements in six-month WOMAC (P = 0.004) and twelve-month VAS (P = 0.029). Heterogeneity was substantial (I2 > 90% for most analyses), and evidence certainty ranged from moderate to very low.

CONCLUSION: PRP provides superior patient-reported pain and function outcomes compared with HA, CS, and NS through six months, with benefits maintained to twelve months versus HA and CS in longer-term trials. Blood-draw volume may be a useful alternate when platelet dose is unreported.

PMID:41863556 | DOI:10.1007/s00264-026-06782-7

Int Orthop. 2026 Mar 19. doi: 10.1007/s00264-026-06768-5. Online ahead of print.

ABSTRACT

BACKGROUND: Favourable long-term clinical and radiological outcomes with low revision and reoperation rates have been reported for unicondylar knee arthroplasty (UKA) in the treatment of end-stage unicompartmental knee osteoarthritis. However, no information on these data is available for the Turkish population. Our aim was to analyze the demographics, indications, outcomes, and revision rates of UKA in Türkiye using a nationwide database.

METHODS: The electronic medical records of 8,590 patients undergoing UKA for unicompartmental osteoarthritis between 2016 and 2022 were retrospectively analyzed. Demographic data of the study population including sex, age, body mass index (BMI), and institution were assessed. The primary outcome measures were complication and revision rates.

RESULTS: Of the 8,590 analyzed patients, 85.2% were women with an average age of 59 ± eight years. The primary indication was osteoarthritis in 7,205 (94.1%) cases. Most patients received cemented implants (78% vs. 22%) and the use of fixed insert designs increased from 18 to 74% between 2018 and 2022. The overall complication rate for the study population was 5.5% (475/8,590). The rate of complications did not differ according to fixation type. However, it was statistically significantly higher in patients who received mobile UKA than the fixed design (3.8% vs. 1.8% for mechanical complications and 1.7% vs. 0.6% for other complications, respectively; P < 0.001). The overall revision rate was 4.4% (234/5,377), with rates being similar for cemented and cementless designs (P = 0.832). However, the revision rate of mobile UKA was significantly higher than that of fixed designs (P < 0.001).

CONCLUSION: The majority of UKAs in Türkiye were cemented implants with an increased usage of fixed bearings over time. Mobile-bearing designs had significantly greater complication and revision rates compared to fixed-bearing implants.

PMID:41854873 | DOI:10.1007/s00264-026-06768-5

Int Orthop. 2026 Mar 19. doi: 10.1007/s00264-026-06750-1. Online ahead of print.

ABSTRACT

PURPOSE: To evaluate the Fast Anterior Medium Approach (FAMA) as an alternative to traditional anterior cervico-thoracic approaches, enhancing access to the C7-T1-T2 and T2-T4 junctions while minimizing postoperative morbidity. The cervico-thoracic junction is one of the most challenging regions to access surgically due to its deep location and proximity to critical neurovascular structures. Conventional approaches, including postero-lateral thoracotomy and transmanubrial techniques, are associated with high morbidity. The FAMA technique was designed to provide enhanced exposure while reducing surgical trauma.

METHODS: A cadaveric study was performed to understand how FAMA approach could find application in spine surgery in order to obtain wider access to the cervico-thoracic spine with lower post-operative morbidity compared to the surgical procedure with sternotomy. This approach involves controlled dislocation of the sterno-clavicular joint to extend anterior access without requiring sternotomy.

RESULTS: The approach allowed excellent exposure of the thoracic apex, enabling safe spinal stabilization procedures with minimal disruption to surrounding structures. No major neurovascular injuries occurred.

CONCLUSION: The FAMA approach represents a viable alternative to conventional cervico-thoracic surgical techniques, offering improved visualization and accessibility while preserving anatomical integrity. This technique has the potential to reduce morbidity and improve patient recovery. Larger-scale studies are required to validate these findings.

PMID:41854872 | DOI:10.1007/s00264-026-06750-1

Int Orthop. 2026 Mar 18. doi: 10.1007/s00264-026-06786-3. Online ahead of print.

ABSTRACT

BACKGROUND: Morton's neuroma is a painful forefoot condition commonly treated with corticosteroid injections. Although ultrasound guidance improves injection accuracy, various single-operator approaches exist with differing reproducibility and technical challenges. This study describes and evaluates a novel " three-handed " ultrasound-guided technique involving coordinated manipulation by both a radiologist and an injecting physician, hypothesized to enhance the therapeutic response while maintaining a low complication rate.

METHODS: We retrospectively reviewed the data of 56 evaluable patients (selected from a total of 110 treated patients) with symptomatic Morton's neuroma. The technique involved a radiologist applying dorsal compression to stabilize the neuroma while an orthopaedic surgeon performed a plantar, ultrasound-guided injection of 1 cc betamethasone. The primary outcome was patient-reported pain relief at ≥ one month follow-up, categorized as significant (> 50% relief), partial (30-50%), or minimal (< 30%).

RESULTS: The cohort (n = 56; 75.0% female; mean age 54.3 ± 11.4 years) had a mean follow-up of 9.5 months. Significant improvement (> 50% pain reduction) was reported by 75.0% (42/56) of the patients. The overall clinical response rate (pain reduction > 30%) was 80.4% (of 45/56). The outcomes were not significantly different (p = 0.746) between the one-site (n = 33) and two-site (n = 23) injection groups. No major complications occurred, and 8.9% (5/56) of the patients reported transient pain.

CONCLUSIONS: Ultrasound-guided three-handed technique is a safe and feasible method for Morton's neuroma injection. This cooperative approach enhances neuroma stabilization and needle visualization, yielding high rates of preliminary clinical improvement. These retrospective findings are limited by selection bias and lack of control. Prospective randomized trials are warranted to validate its efficacy against standard single-operator techniques.

PMID:41851449 | DOI:10.1007/s00264-026-06786-3

Int Orthop. 2026 Mar 18. doi: 10.1007/s00264-026-06780-9. Online ahead of print.

NO ABSTRACT

PMID:41848887 | DOI:10.1007/s00264-026-06780-9

Int Orthop. 2026 Mar 17. doi: 10.1007/s00264-026-06784-5. Online ahead of print.

ABSTRACT

PURPOSE: To identify thresholds of acetabular chondral burden (number of Ilizaliturri zones involved) associated with failure to achieve minimal clinically important difference (MCID) following hip arthroscopy for femoroacetabular impingement, and to determine whether cartilage extent provides prognostic information independent of lesion severity (Outerbridge grade).

METHODS: We analyzed 168 consecutive patients who underwent hip arthroscopy with two year follow-up. Acetabular cartilage was assessed intraoperatively for extent (Ilizaliturri 6-zone classification) and severity (Outerbridge grading). Patients were categorized by chondral burden: 0 zones (N = 70), 1-2 zones (N = 62), or ≥ 3 zones (N = 36). Primary outcome was MCID achievement (≥ 9-point improvement) in Hip Outcome Score-Activities of Daily Living. Multivariable regression adjusted for age, sex, BMI, baseline function, and Outerbridge grade (Table 3).

RESULTS: MCID achievement differed significantly by chondral burden: 70% (0 zones), 79% (1-2 zones), and 50% (≥ 3 zones) (p = 0.011), representing a 29 percentage-point difference between groups. In multivariable analysis adjusting for Outerbridge grade and other confounders, the ≥ 3 zone group showed a trend toward reduced odds of achieving MCID (OR = 0.43, 95% CI: 0.18-1.02, p = 0.056). Extent and severity showed low correlation (ρ = 0.20), suggesting they represent distinct aspects of cartilage pathology.

CONCLUSION: Acetabular chondral involvement of ≥ 3 Ilizaliturri zones was associated with a lower probability of achieving clinically meaningful improvement after hip arthroscopy. Cartilage extent may provide prognostic information beyond lesion severity and should be considered during preoperative counseling and surgical decision-making.

PMID:41843111 | DOI:10.1007/s00264-026-06784-5

Int Orthop. 2026 Mar 17. doi: 10.1007/s00264-026-06773-8. Online ahead of print.

ABSTRACT

AIMS: This study evaluated the accuracy of resection of bone tumours and the fit between host bone and massive bone allograft (MBA) in children with malignant bone tumours of lower limb who underwent surgery using in-house 3-dimensional (3D)-printed patient-specific instruments (PSIs) for tumour resection and graft-specific instruments (GSIs) for shaping the MBA.

METHODS: This retrospective study included seven children (3 males, 4 females; median age 13) with malignant bone tumours of the lower limb who underwent intercalary resection and reconstruction with MBA between September 2023 and March 2025 using in-house designed 3D-printed PSIs and GSIs. Tumours were located in the femur (5 children) and tibia (2 children). We analysed the accuracy of bone resection, complications of reconstruction, and function of patients.

RESULTS: All resections achieved R0 margins. The median planned resection length was 16.5 cm versus 16.8 cm actually resected (median difference 0.2 cm). Bone union was achieved in 13 of 14 (92.9%) osteotomy sites. Bone union was faster at metaphyseal junctions (median 5.9 months) than diaphyseal junctions (median 8.4 months) (p = 0.01). One of the osteotomy sites (7.1%) had a delayed union requiring secondary bone grafting. The median Musculoskeletal Tumour Society score was 30 at the last follow-up.

CONCLUSION: 3D-printed PSIs and GSIs appear to enhance the accuracy of bone tumour resection and host bone-MBA fit, thereby reducing the risks of inadequate margins and non-union, respectively.

PMID:41843110 | DOI:10.1007/s00264-026-06773-8

Int Orthop. 2026 Mar 16. doi: 10.1007/s00264-026-06766-7. Online ahead of print.

ABSTRACT

INTRODUCTION: Validated patient-reported outcome measures (PROMs) play a crucial role in assessing the outcome of any intervention, including hip preservation surgery. This study aims to evaluate floor and ceiling effects, which indicate data capture limitations, of the International Hip Outcome Tool-12 (iHOT-12) in patients undergoing hip preservation surgery.

METHODS: Data from the UK's Non-Arthroplasty Hip Registry (NAHR) were analyzed. Patient demographics, surgical details, and iHOT-12 scores were collected. Floor and ceiling effects were assessed using three definitions: absolute minimum or maximum scores, scores within 10% of the minimum or maximum, and scores within one minimal clinically important difference (MCID) of the minimum or maximum. Analyses were performed for patients undergoing hip arthroscopy and periacetabular osteotomy (PAO), as well as for male and female subgroups and by iHOT-12 domain.

RESULTS: 8,408 patients (7,081 hip arthroscopy, 1,327 PAO) were included. At 26 to 52 weeks, a ceiling effect was observed in 15-22% of patients, indicating limited data capture. A floor effect was present in 9-15% of patients at baseline indicating possible limited data capture in pre-operative patients. Male and female patients had similar ceiling effects at 52 weeks, but females exhibited a higher risk of a floor effect at baseline. The sport and recreational domain was most susceptible to floor effects at baseline, and the job-related concerns domain was most susceptible to ceiling effects at follow-up.

CONCLUSIONS: The study demonstrates the presence of floor and ceiling effects in the iHOT-12 for patients undergoing hip preservation surgery. The floor and ceiling effects were similar between patients undergoing hip arthroscopy or PAO. The study also suggests that some patients may experience greater improvement than reflected in post-operative iHOT-12 scores. Future research should focus on identifying patients at risk of floor and ceiling effects and explore modifications to PROMs to enhance their accuracy and utility.

PMID:41840038 | DOI:10.1007/s00264-026-06766-7

Int Orthop. 2026 Mar 16. doi: 10.1007/s00264-025-06720-z. Online ahead of print.

ABSTRACT

PURPOSE: To systematically review the efficacy, safety, and outcomes of limb lengthening procedures in patients with achondroplasia, including effects on quality of life.

METHODS: Following PRISMA guidelines, a systematic review and meta-analysis was performed. Eligible studies included patients with achondroplasia who underwent limb lengthening of the upper and/or lower extremities. Data were extracted on length gain, external fixator index, fixation duration, complications, and quality of life. Pooled means and 95% confidence intervals (CIs) were calculated using single-arm meta-analysis.

RESULTS: Fourteen studies including 1149 patients were analyzed. The mean femoral gain was 8.85 cm (95% CI: 7.42-10.28), tibial gain 7.36 cm (95% CI: 6.21-8.52), and humeral gain 8.38 cm (95% CI: 7.01-9.74). The mean fixator index was 37.1 days/cm (95% CI: 32.37-41.82), with a mean fixation duration of 7.71 months (95% CI: 5.98-9.63). The overall complication rate was 56.1% (95% CI: 26.9-85.2). Importantly, the pooled quality of life score measured by the Paediatric Quality of Life Inventory was 75.69 (95% CI: 65.14-86.23), indicating moderate improvement despite high treatment burden.

CONCLUSION: Limb lengthening in achondroplasia achieves significant stature and proportional gains but requires prolonged treatment and carries a high complication risk. Nevertheless, improvements in functional ability and quality of life are evident, particularly when multi-limb lengthening is performed. Future studies should standardize outcome reporting, assess long-term QoL trajectories, and evaluate newer technologies such as intramedullary nails combined with multidisciplinary support.

PMID:41838116 | DOI:10.1007/s00264-025-06720-z

Int Orthop. 2026 Mar 15. doi: 10.1007/s00264-026-06772-9. Online ahead of print.

ABSTRACT

INTRODUCTION: Osteonecrosis of the femoral head (ONFH) is a progressive condition that often requires surgical intervention. Although treatment strategies have traditionally emphasized joint-preserving procedures in younger patients, advances in implant technology and perioperative management may have altered contemporary surgical decision-making. However, large-scale evidence describing temporal changes in surgical treatment patterns for ONFH is limited.

MATERIALS AND METHODS: Using the Japanese Diagnosis Procedure Combination (DPC) database, we conducted a nationwide retrospective cohort study of patients who underwent surgical treatment for ONFH between December 2012 and March 2023. Surgical procedures were categorized as total hip arthroplasty (THA), bipolar hemiarthroplasty (BHA), proximal femoral osteotomy, pelvic osteotomy, or hip arthroscopy. Temporal trends in procedure selection were evaluated overall and by age group. Postoperative complications, including infection, deep vein thrombosis (DVT), pulmonary embolism, periprosthetic fracture, and in-hospital mortality, were compared between THA and BHA using univariate and multivariable logistic regression analyses.

RESULTS: A total of 36,109 patients were included. THA was the most frequently performed procedure throughout the study period, with its proportion increasing from 72.6% in 2012 to 90.6% in 2022, while the use of BHA and joint-preserving osteotomy steadily declined. Among patients aged ≤ 20 years, proximal femoral osteotomy predominated until 2020; thereafter, arthroplasty procedures accounted for more than half of all surgeries in this age group. Similar shifts toward THA were observed in patients aged 21-40 years. In adjusted analyses, BHA was associated with a higher risk of postoperative infection and DVT, whereas THA was associated with a higher risk of periprosthetic fracture and in-hospital mortality. No significant differences were observed in dislocation or pulmonary embolism rates.

CONCLUSIONS: Nationwide data demonstrate a substantial shift in surgical management of ONFH in Japan, with increasing use of THA and declining reliance on joint-preserving procedures, even among younger patients. While arthroplasty has become the dominant treatment modality, careful consideration of long-term outcomes, complication profiles, and patient age remains essential. Integration of large-scale administrative data with detailed clinical and imaging information may further refine optimal treatment strategies for ONFH.

PMID:41832264 | DOI:10.1007/s00264-026-06772-9

Int Orthop. 2026 Mar 14. doi: 10.1007/s00264-026-06785-4. Online ahead of print.

NO ABSTRACT

PMID:41830987 | DOI:10.1007/s00264-026-06785-4

Int Orthop. 2026 Mar 14. doi: 10.1007/s00264-026-06783-6. Online ahead of print.

NO ABSTRACT

PMID:41830986 | DOI:10.1007/s00264-026-06783-6

Int Orthop. 2026 Mar 13. doi: 10.1007/s00264-026-06781-8. Online ahead of print.

ABSTRACT

PURPOSE: To investigate the effect of surgical timing and surgical technique on reoperation rates and early clinical outcomes in acute native knee septic arthritis.

METHODS: This retrospective cohort study included adult patients who underwent surgical treatment for acute native knee septic arthritis between 2018 and 2025. Patients were treated with either arthroscopic or open debridement according to the treating surgeon's assessment. Time from symptom onset to surgery was recorded in hours, and an a priori defined 48-h threshold was used to classify early versus delayed lavage. All cases received standardized joint irrigation with nine L of normal saline. The primary outcome was the need for reoperation due to persistent or recurrent infection. Secondary outcomes included knee range of motion at discharge and length of hospital stay. Culture-positive cases were analyzed separately. Multivariable logistic regression analysis was performed to identify independent predictors of reoperation.

RESULTS: A total of 129 patients were included (mean age 58.3 ± 12.3 years; 62.8% male). Baseline demographic and comorbidity characteristics were similar between surgical technique groups; however, early lavage was more frequent in the arthroscopy group (p < 0.001). In early lavage cases, reoperation rates did not differ between arthroscopy and arthrotomy (p = 0.432). In delayed lavage cases, arthroscopy was associated with a significantly higher reoperation rate compared to arthrotomy (p < 0.001). Arthroscopy resulted in greater postoperative range of motion across all subgroups (p < 0.001). Length of hospital stay was shorter with arthroscopy in early lavage but longer in delayed lavage. Early lavage was independently associated with a reduced risk of reoperation (OR 0.02; 95% CI 0.00-0.10; p < 0.001).

CONCLUSION: In acute native knee septic arthritis, our findings suggest that surgical timing may influence the relative outcomes of arthroscopic and open treatment. Early arthroscopic lavage may provide functional advantages without increasing the risk of reoperation, whereas delayed arthroscopy may be associated with higher reoperation rates. Prospective studies are warranted to confirm these observations.

PMID:41824053 | DOI:10.1007/s00264-026-06781-8

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