Int Orthop. 2026 Jan 7. doi: 10.1007/s00264-025-06732-9. Online ahead of print.

ABSTRACT

BACKGROUND: Giant cell tumour of the distal radius (GCTDR) is a locally aggressive benign tumour that often results in local recurrence and functional impairment. While curettage preserves joint function, it has high recurrence rates, particularly for grade III lesions. Wide resection reduces recurrence but compromises wrist function. This study evaluates the outcomes of non-vascularized fibular head-shaft autografting combined with distal radioulnar ligament (DRUL) reconstruction for GCTDR management.

METHODS: A retrospective study was conducted from 2010 to 2020, involving 50 patients with histologically confirmed GCTDR (Campanacci grade III). Surgical treatment included wide tumour excision, non-vascularized ipsilateral fibular head-shaft autograft reconstruction, and DRUL reconstruction using the palmaris longus tendon.

RESULTS: The recurrence rate was 4%, with no malignant transformation or metastasis. The average time to graft union was 7.2 ± 1.2 months, and functional outcomes were favourable, with an MSTS score of 26.2 ± 3.7 and a DASH score of 9.7 ± 13.1. No DRUJ instability was observed, and graft fractures occurred in 14% of patients, all of which healed.

CONCLUSION: Non-vascularized fibular head-shaft autografting, combined with DRUL reconstruction, is an effective approach for GCTDR, reducing recurrence, preserving wrist function, and maintaining long-term stability.

PMID:41498921 | DOI:10.1007/s00264-025-06732-9

Int Orthop. 2026 Jan 5. doi: 10.1007/s00264-025-06731-w. Online ahead of print.

ABSTRACT

BACKGROUND: Modular dual mobility (MDM) cups are widely used in primary total hip arthroplasty (THA) to reduce dislocation, but their impact on range of motion (ROM) to impingement versus single-mobility (SM) cups remains uncertain.

METHODS: In this paired robotic-simulation study, 108 primary robotic-assisted THAs were virtually planned twice with CT-based software, once with an SM cup and once with an MDM cup. Cup and stem orientation were optimised to restore intra-articular length and global offset within 5 mm of the contralateral hip and to avoid impingement. ROM to first impingement was measured in extension/external rotation (ER), flexion/internal rotation (IR) with physiological pelvic tilt, and flexion/IR with 20° adduction. The mode of first impingement (intra-articular, extra-articular, or mixed) was recorded.

RESULTS: Compared with SM, MDM cups increased ROM to impingement in extension and ER but slightly reduced ROM in flexion and IR at several test positions. Maximal extension to impingement and ER in extension were higher with MDM, whereas flexion with pelvic anteversion and IR at 100° flexion were lower. ROM to impingement was not uniformly greater with MDM, and first contact often shifted from intra-articular implant-on-implant impingement toward extra-articular impingement.

CONCLUSION: In robotic THA, MDM cups provide selective gains in ROM to impingement and shift the impingement towards extra-articular structures rather than providing a global increase in safe ROM. Clinically, MDM may suit patients needing extension/ER reserve or with anterior instability risk, and planning should consider osteophytes and bony constraints. Further prospective clinical validation is warranted.

PMID:41491305 | DOI:10.1007/s00264-025-06731-w

Int Orthop. 2026 Jan 5. doi: 10.1007/s00264-025-06722-x. Online ahead of print.

ABSTRACT

INTRODUCTION: Nonoperative treatment is the preferred initial intervention for plantar fasciitis. However, some patients fail to respond and present with continued pain. This study investigated the effectiveness of concentrated bone marrow aspirate concentrate (BMAC) injections in the treatment of recalcitrant plantar fasciitis.

METHODS: Retrospective chart review was performed to identify patients diagnosed with chronic plantar fasciitis that underwent treatment with BMAC injection. Bone marrow aspirate was harvested from the iliac crest, concentrated, and injected into the site of maximal tenderness in the plantar fascia. Visual analogue scale (VAS) pain scores were collected before and after the BMAC injection at six, ten, 24, and 48 weeks. Postoperative complications were recorded.

RESULTS: A total of 19 patients (19 feet) with chronic plantar fasciitis were treated with BMAC injection. Average age was 52.6 (SD, ± 7.5) years with an average BMI of 26.4 (SD, ± 4.6) kg/m2. The average duration of pain prior to the BMAC injection was 2.5 (SD, ± 1.3) years. Preoperatively, average VAS was 7.5 (SD, ± 2.3), with significant improvement at six weeks (mean, 2.3; SD, ± 1.2), ten weeks (mean, 2.2; SD, ± 1.2), 24 weeks (mean 1.7; SD, ± 1.1), and at 48 weeks (mean, 1.1; SD, ± 0.7) postoperatively (all p < 0.05). No complications were observed at the surgical or donor site.

CONCLUSION: Patients with recalcitrant plantar fasciitis treated with BMAC injection demonstrated and maintained a statistically significant decrease in VAS pain score upon assessment at each postoperative follow-up up to 48 weeks, with no adverse effects at the donor or injection site. These findings suggest that BMAC injection may be a safe treatment option offering early pain relief.

PMID:41489648 | DOI:10.1007/s00264-025-06722-x

Int Orthop. 2026 Jan 2. doi: 10.1007/s00264-025-06724-9. Online ahead of print.

ABSTRACT

PURPOSE: The cumulative probability of a first-time dislocation (CPD) after total hip arthroplasties (THAs) with a 22-mm head was reported in 2004 to rise steadily to 7% at 25 years. Later reports employing larger heads indicated that dislocations were concentrated in shorter periods after THA. Therefore, dislocations may occur differently over time depending on head sizes, which has not been clearly demonstrated. The purpose was to examine this hypothesis.

METHODS: With first-time dislocation as the endpoint, the Cox proportional-hazards regression model and the Kaplan-Meier analyses were applied to 6,339 THAs performed for nontraumatic osteonecrosis of the femoral head, considering all possible influencing variables. Follow-up was 6.5 years on average (range, 0 to 27).

RESULTS: First-time dislocations occurred in 289 THAs (4.6%) at a mean of 2.9 years (range, 0 to 19) following THA, with head sizes of 22, 26, 28, 32, and ≧ 36 mm in 33, 76, 86, 58, and 36 THAs, respectively (dislocation rate: 13.5, 8.2, 5.7, 2.5, and 2.7%, respectively; p < 0.001 in χ2 test). CPD increased linearly after THA in the 22-mm group, while larger-head groups showed a steep early rise followed by a decline.

CONCLUSION: First-time dislocations occurred differently over time with different head sizes.

PMID:41483131 | DOI:10.1007/s00264-025-06724-9

Int Orthop. 2026 Jan 2. doi: 10.1007/s00264-025-06729-4. Online ahead of print.

ABSTRACT

PURPOSE: Hip arthroscopy is widely used for treating femoroacetabular impingement (FAI), yet long-term data evaluating PASS, MCID thresholds, functional recovery, and revision rates remain limited. This study aimed to assess minimum five year outcomes following hip arthroscopy for FAI and to identify predictors of postoperative success.

METHODS: In this retrospective cohort study, 133 patients with a minimum of five years of follow-up were evaluated. Preoperative and postoperative outcomes included mHHS and VAS scores. Postoperative PROMs included iHOT-12, HOS-ADL, and HOS-Sport. PASS, MCID achievement, return to sport (RTS), return to work (RTW), revision arthroscopy, and conversion to total hip arthroplasty (THA) were recorded. MCID for ΔmHHS was determined using ROC analysis with PASS as the external anchor. Logistic regression identified predictors of PASS.

RESULTS: The mean mHHS improved from 62.0 ± 12.9 preoperatively to 83.6 ± 12.8 at final follow-up (p < 0.001). VAS scores improved from 7.7 ± 1.9 to 3.1 ± 2.3 (p < 0.001). PASS was achieved by 72.2% of patients, and 83.1% met the MCID threshold of a 10-point increase in mHHS. Return-to-sport and return-to-work rates were 96.2% and 96.9%, respectively.

CONCLUSION: Hip arthroscopy for FAI provides durable clinical improvement at long-term follow-up, with high PASS and MCID achievement rates. RTS and RTW rates were excellent, and revision and THA conversion rates were comparable with contemporary long-term reports. Preoperative pain severity was the only independent predictor of PASS.

PMID:41483130 | DOI:10.1007/s00264-025-06729-4

Int Orthop. 2025 Dec 29. doi: 10.1007/s00264-025-06730-x. Online ahead of print.

NO ABSTRACT

PMID:41460257 | DOI:10.1007/s00264-025-06730-x

Int Orthop. 2025 Dec 23. doi: 10.1007/s00264-025-06728-5. Online ahead of print.

NO ABSTRACT

PMID:41430401 | DOI:10.1007/s00264-025-06728-5

Int Orthop. 2025 Dec 19. doi: 10.1007/s00264-025-06721-y. Online ahead of print.

ABSTRACT

PURPOSE: Orthopaedic surgery patients are at an elevated risk of venous thromboembolic events thus necessitating effective prophylaxis strategies.

METHODS: This IRB-approved, single-center retrospective study evaluated patients who underwent orthopaedic surgery and were protected with Inferior Vena Cava (IVC) filters from January 2007 to December 2021. Study outcomes include incidence of venous thromboembolism (VTE) in the form of deep vein thrombosis (DVT) and pulmonary embolism (PE), and filter-related complications.

RESULTS: A total of 104 patients (median age 57 years, range: 18 - 78; 53% women) who underwent orthopaedic surgery were protected against PE with IVC filters. This cohort was surgically diverse with 50 patients (48%) having underwent arthroplasty, 17 (16%) underwent amputations, disarticulations, and hemipelvectomies, 16 (15%) had resections and 16 (15%) had open reduction and internal fixations (ORIF), three patients (3%) underwent incision and drainages (I&D), and two patients (2%) had complex multi-operational surgeries. Patients were high-risk given the large burden of comorbidities, including low functional status (88%), VTE history (62%), malignancy (57%), and history of tobacco use (47%). All filters were placed without complication. A majority of filters were retrieved (58%; n = 60), with an average dwell time of 6.7 months (1-31 months). In the post-placement period, 16 patients (15%) experienced DVTs with four patients (4%) experiencing PEs. There were three removal attempts that encountered difficulty, leading to aborted attempts of which two were later successful.

CONCLUSION: IVC filters were placed and retrieved in orthopaedic patients with a low complication rate while achieving a low incidence of VTE in this high-risk cohort.

PMID:41417049 | DOI:10.1007/s00264-025-06721-y

Int Orthop. 2025 Dec 18. doi: 10.1007/s00264-025-06726-7. Online ahead of print.

ABSTRACT

OBJECTIVE: In the context of the widespread implementation of enhanced recovery after surgery (ERAS) in orthopaedics, postoperative supportive interventions for patients with lower limb fractures remain limited. This study aimed to introduce a vibration-stimulation device designed in accordance with ERAS principles and to evaluate its clinical effectiveness.

METHODS: This prospective randomized controlled trial consecutively screened 1,241 patients aged 18-75 years with lower limb fractures admitted to a tertiary university-affiliated orthopaedic hospital between January and December 2024, of whom 707 met the inclusion criteria. Patients were randomly assigned in a 1:1 ratio by a random number table to a vibration group or a blank control group. The primary outcomes were the seven day postoperative pain visual analogue scale (VAS) score and the incidence of lower limb deep vein thrombosis (DVT). Secondary outcomes were radiographic fracture-healing time and postoperative functional scores. The primary analysis followed the intention-to-treat (ITT) principle, comparing all randomized patients with available outcome data according to their original allocation, and a per-protocol (PP) sensitivity analysis was additionally performed.

RESULTS: A total of 707 patients completed six to 12 months of follow-up and were included in the ITT analysis (350 in the vibration group and 357 in the control group). In the overall population, the seven day postoperative incidence of lower limb DVT was significantly lower in the vibration group than in the control group [10.9% (38/350) vs 22.6% (81/357); absolute risk difference (ARD) = 11.7%]. The seven day postoperative pain scores were lower in the vibration group (weighted mean approximately 5.1 vs 5.7), radiographic fracture-healing time was shorter (approximately 5.2 vs 5.5 months), and functional scores at final follow-up were higher (approximately 127.8 vs 123.2). PP sensitivity analyses yielded results consistent in direction with the ITT analyses, further supporting the robustness of the study conclusions.

CONCLUSION: Vibration-stimulation therapy facilitates rapid postoperative recovery in patients with lower limb fractures and has a favourable safety profile, and may represent a promising component of postoperative ERAS strategies in the future.

PMID:41413326 | DOI:10.1007/s00264-025-06726-7

Int Orthop. 2025 Dec 18. doi: 10.1007/s00264-025-06713-y. Online ahead of print.

ABSTRACT

PURPOSE: Longus colli acute calcific tendinitis (LCCT) is a painful disease characterized by a triad of neck pain, neck stiffness and odynophagia. It is a relatively rare cause of neck pain, often unknown or underdiagnosed, but it is important to be aware of its existence as it can mimic other potentially more dangerous illnesses.

METHODS: We present a short series of five cases in which we gathered demographic and clinical data including imaging studies and compared our findings to previous reports by other authors. The diagnosis of LCCT was made by the combination of a compatible clinical presentation and blood workup plus the identification of a calcific deposit in the proximal oblique fibers of the longus colli muscle and retropharyngeal edema via computed tomography.

RESULTS: Five patients were analyzed. Mean age was 44 years, three female and two male. All patients initially presented neck pain and painful mobilization, while only 60% presented with odynophagia. There were no patients with radiculopathy nor fever. The mean values for ESR, CRP and White Blood Cell (WBC) were 23.2 mm/h, 2.97 mg/dl and 10.21 * 10^9/L respectively. On CT and/or MRI exploration all the patients presented a visible calcific deposit on the anteroinferior border of the anterior C1 arch and visible signs of retropharyngeal oedema.

CONCLUSIONS: LCCT is a self-limited pathology that is caused by a foreign-body type reaction in the retropharyngeal space secondary to the degradation and resorption of calcium hydroxyapatite deposits usually found at the anteroinferior border of the anterior C1 arch. It is necessary to create awareness of this pathology amongst physicians because it can mimic more serious illness like retropharyngeal abscess, meningitis and spondylodiscitis and this may lead to unnecessary expenditures and antibiotic usage.

PMID:41410695 | DOI:10.1007/s00264-025-06713-y

Int Orthop. 2025 Dec 16. doi: 10.1007/s00264-025-06727-6. Online ahead of print.

ABSTRACT

PURPOSE: This study aims to describe and analyse pediatric cervical spine (C-spine) trauma over 32 years at a level 1 trauma centre.

METHODS: A retrospective observational study was conducted, including patients younger than 16 years hospitalised after C-spine trauma from 1991 to 2022. Data on demographics, injury mechanisms, affected levels, associated injuries, neurological deficits (Frankel scale), treatments, and outcomes were analysed. Patients were divided into two age groups: < eight years (Group A) and nine to 16 years (Group B). Injuries were categorised as SCIWORA or skeletal, and by level-upper (C0 to C2) or lower (C3 to C7). Statistical analysis was performed using SPSS v29.0 (p < 0.05).

RESULTS: A total of 102 patients were identified (67% male; 65% > 8 years). Younger children had more upper C-spine injuries (55.6%), lower injuries were more common in Group B (53%) (p = 0.006). mechanisms included motor vehicle accidents, pedestrian accidents, falls, and sports injuries. Associated injuries were present in 59% of cases, mainly head trauma. SCIWORA occurred in 14.7% of patients, with MRI-confirmed cord contusions in 60% of these. Most patients (74.7%) underwent conservative treatment. Neurological deficits were present in 38% of patients, and 51.2% showed improvement. The mortality rate was 16.5%, significantly higher among those with neurological impairment (p = 0.004).

CONCLUSION: Pediatric C-spine trauma is uncommon. MRI is essential for detecting spinal cord injury in SCIWORA. The high prevalence and impact of associated injuries on mortality highlight the need for thorough primary evaluation. Multicenter studies are necessary to improve management strategies and outcomes.

PMID:41402532 | DOI:10.1007/s00264-025-06727-6

Int Orthop. 2025 Dec 12. doi: 10.1007/s00264-025-06717-8. Online ahead of print.

NO ABSTRACT

PMID:41385094 | DOI:10.1007/s00264-025-06717-8

Int Orthop. 2025 Dec 10. doi: 10.1007/s00264-025-06725-8. Online ahead of print.

NO ABSTRACT

PMID:41369903 | DOI:10.1007/s00264-025-06725-8

Int Orthop. 2025 Dec 10. doi: 10.1007/s00264-025-06723-w. Online ahead of print.

ABSTRACT

PURPOSE: This study evaluated the accuracy of intraoperative leg length and femoral anteversion measurements obtained during total hip arthroplasty (THA) using the Mako robotic system with enhanced mode.

METHODS: A total of 55 hips in four men and 51 women who underwent primary THA with the Mako system via an anterolateral approach were retrospectively evaluated. Intraoperative measurements of leg length and femoral anteversion displayed by the Mako enhanced mode were compared with postoperative CT-based measurements. Absolute errors and their distributions were calculated to assess the accuracy of intraoperative assessments.

RESULTS: The mean absolute error was 2.3 ± 1.8 mm for postoperative leg length discrepancy and 2.9 ± 2.2° for stem anteversion. Of the 55 hips, 46 (83.6%) showed leg length errors within 3 mm and 51 (92.7%) within 5 mm. For stem anteversion, 48 hips (87.3%) were within 3° and all 55 hips (100%) were within 5°. Mako enhanced mode could not be completed in 10.7% of cases because of femoral array loosening or screw penetration into the medullary canal.

CONCLUSION: Mako enhanced mode demonstrated clinically acceptable accuracy for intraoperative measurement of leg length and femoral anteversion, contributing to precise femoral stem implantation in robotic-assisted THA.

PMID:41369902 | DOI:10.1007/s00264-025-06723-w

Int Orthop. 2025 Dec 9. doi: 10.1007/s00264-025-06702-1. Online ahead of print.

ABSTRACT

PURPOSE: Lenke type 3 and 6 scoliosis present a significant challenge due to the presence of two structural curves. Traditional surgical approaches provide adequate correction for one curve but often leave the secondary curve undercorrected, leading to residual deformity. This study evaluates the efficacy of the novel Simultaneous Independent Rod Derotation (SIRD) technique in treating adolescent idiopathic scoliosis (AIS) with Lenke type 3 and 6 curves.

MATERIALS AND METHODS: A retrospective analysis was conducted on 24 AIS patients (Lenke type 3 and 6) treated between January 2020 and September 2022. Patients were divided into two groups: SIRD group (n = 9) and Standard Single Rod Derotation (SRD) group (n = 15). Preoperative and postoperative radiographs were analyzed to assess the correction of major and minor curves. Intraoperative parameters, including surgical time, blood loss, and postoperative recovery, were evaluated as well.

RESULTS: The SIRD technique demonstrated significantly greater correction in both major and minor curves compared to SRD. The mean percentage reduction in major curves was 78.95% ± 7.09% in the SIRD group versus 68.79% ± 10.05% in the SRD group (p = 0.014). For minor curves, the reduction was 82.71% ± 8.87% in the SIRD group compared to 68.02% ± 13.44% in the SRD group (p = 0.0082). No significant differences were observed in surgical time, intraoperative blood loss, or hospital stay between groups.

CONCLUSION: The SIRD technique overcomes the limitations of conventional methods by effectively correcting both curves in Lenke type 3 and 6, offering a more balanced and comprehensive solution for scoliosis cases. Further studies are needed to confirm these findings.

PMID:41364341 | DOI:10.1007/s00264-025-06702-1