J Bone Joint Surg Am. 2026 Mar 24. doi: 10.2106/JBJS.25.01108. Online ahead of print.

ABSTRACT

BACKGROUND: The U.S. Centers for Medicare & Medicaid Services (CMS) requires the collection of patient-reported outcome measures (PROMs) after primary total joint arthroplasty (TJA), with penalties for noncompliance affecting all Medicare reimbursement. The CMS will publish risk-standardized improvement rates based on substantial clinical benefit (SCB) thresholds of 22 points for the HOOS JR (Hip disability and Osteoarthritis Outcome Score for Joint Replacement) and 20 points for the KOOS JR (Knee injury and Osteoarthritis Outcome Score for Joint Replacement). Our aims were to determine if preoperative scores predicted postoperative PROMs, to externally validate the SCB thresholds, and to analyze them with different anchors.

METHODS: We retrospectively identified patients who underwent TJA at our institution between 2015 and 2023. The HOOS JR and KOOS JR were prospectively collected in the Michigan Arthroplasty Registry Collaborative Quality Initiative (MARCQI); all other variables were obtained from electronic medical records. Logistic regression analyses and anchor-based receiver operating characteristic curves were generated to determine threshold values and the efficacy of using preoperative and postoperative scores as predictors of patient improvement, satisfaction, and willingness to repeat surgery.

RESULTS: In total, 3,465 cases (1,498 total knee arthroplasties [TKAs] and 1,967 total hip arthroplasties [THAs]) were included. Preoperative scores failed as predictors (area under the curve [AUC], <0.6) of patient improvement, satisfaction, and willingness to repeat surgery. The change in scores for TKA, particularly at 1 year postoperatively, was predictive of improvement (AUC, 0.79), satisfaction (AUC, 0.77), and willingness to repeat surgery (AUC, 0.71); and the change in scores for THAs was predictive of improvement (AUC, 0.85), satisfaction (AUC, 0.82), and willingness to repeat surgery (AUC, 0.77). The Youden index indicated that change thresholds of 24 points for patient improvement, 24 points for satisfaction, and 26 points for willingness to repeat surgery provided the best predictions at 1 year after THA. Similarly, change thresholds of 21 points for patient improvement, 22 points for satisfaction, and 24 points for willingness to repeat surgery provided the best predictions at 1 year after TKA. Twenty percent of patients did not achieve CMS-proposed SCB thresholds.

CONCLUSIONS: Although preoperative scores were not predictive of patient-reported outcomes, the degree of score improvement postoperatively was strongly associated with patient improvement, satisfaction, and willingness to repeat surgery. CMS-proposed SCB thresholds appear to be validated in our population and compare favorably with the thresholds produced in this study.

LEVEL OF EVIDENCE: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

PMID:41875225 | DOI:10.2106/JBJS.25.01108

J Bone Joint Surg Am. 2026 Mar 24. doi: 10.2106/JBJS.25.01338. Online ahead of print.

ABSTRACT

BACKGROUND: We aimed to develop automated data extraction pipelines with large language models (LLMs) to extract registry data from total hip arthroplasty (THA) operative notes and compare the performance with that of existing natural language processing (NLP) algorithms.

METHODS: We randomly sampled 1,000 primary THA cases from our institutional registry. Two human annotators manually reviewed each operative note for 3 data points: surgical approach, bearing surface, and fixation technique. All labeled THA notes were split into the development set (n = 239) and the testing set (n = 719). We developed a custom data extraction pipeline for each data point by combining an iteratively customized prompt with an LLM. The performance was compared with that of existing rules-based NLP algorithms.

RESULTS: The accuracy of LLMs was superior to that of NLP algorithms for all data points: surgical approach (96% compared with 94%), bearing surface (89% compared with 74%), and fixation technique (96% compared with 95%). Furthermore, the LLM accurately inferred the bearing surface for 80% of the notes that were ambiguous about the bearing surface.

CONCLUSIONS: We developed LLM pipelines for extracting 3 registry-relevant data points from THA operative notes, demonstrating superior performance to existing NLP algorithms.

CLINICAL RELEVANCE: LLMs have the potential to impact clinical care, including the evaluation of electronic medical record free-text data. As registries serve as a cornerstone of orthopaedic evidence, this work demonstrates promise for LLMs to simplify, improve, and democratize the construction of registry databases from operative notes.

PMID:41875224 | DOI:10.2106/JBJS.25.01338

J Bone Joint Surg Am. 2026 Mar 24. doi: 10.2106/JBJS.25.00787. Online ahead of print.

ABSTRACT

BACKGROUND: Carpal tunnel syndrome (CTS) diagnosis has traditionally relied on electrodiagnosis (EDX) to confirm the diagnosis and to assess severity. Ultrasound has shown potential in measuring median nerve cross-sectional area (CSA) for CTS diagnosis, and magnetic resonance imaging (MRI) can be used for wrist soft-tissue evaluation. This study explored the correlation between CTS diagnosis and median nerve CSA measured on MRI at different wrist levels.

METHODS: A retrospective review of an electronic medical record database identified patients who underwent both wrist MRI and EDX within a 90-day interval between January 2000 and December 2022. Median nerve CSA was measured on axial T2-weighted images at 3 levels: proximal to the carpal tunnel inlet (the distal radioulnar joint [DRUJ]), the inlet, and the outlet. Continuous variables are presented as means ± standard deviations. A logistic regression model was constructed to evaluate the diagnostic accuracy of median nerve CSA, at the 3 anatomical levels, in identifying CTS. Empirical cut point estimation determined optimal cutoffs and corresponding areas under the receiver operating characteristic curve (AUCs).

RESULTS: Sixty-eight patients (76 wrists; mean age, 51.4 ± 14.2 years; male-to-female ratio, 26 to 50; 59 White patients, 8 Hispanic patients, and 1 Asian patient) were included. The mean median nerve CSA in the EDX-negative group compared with the EDX-positive group was 10.6 ± 3.4 versus 11.7 ± 4.0 mm2 (p = 0.248) at the DRUJ level, 11.1 ± 3.1 versus 14.4 ± 5.1 mm2 (p = 0.007) at the inlet level, and 9.8 ± 2.4 versus 11.0 ± 5.2 mm2 (p = 0.833) at the outlet level. The inlet CSA cutoff for CTS was 11.3 mm2 (AUC = 0.67), with a sensitivity of 74% and a specificity of 60%.

CONCLUSIONS: MRI-based measurements of median nerve CSA, particularly at the inlet level, suggest that relying solely on CSA measurements may not be an optimal diagnostic strategy for CTS in patients with equivocal clinical symptoms. Even with MRI and highly standardized measurement protocols, only poor-to-fair diagnostic accuracy was achieved. This study raises questions about the diagnosis of CTS based on CSA measurements.

LEVEL OF EVIDENCE: Diagnostic Level III. See Instructions for Authors for a complete description of levels of evidence.

PMID:41875223 | DOI:10.2106/JBJS.25.00787

J Bone Joint Surg Am. 2026 Mar 24. doi: 10.2106/JBJS.25.00880. Online ahead of print.

ABSTRACT

BACKGROUND: Recent evidence suggests that variations in overall scapular morphology may predispose individuals to specific shoulder pathologies. The purposes of this study were to provide a comprehensive 3D analysis of scapular anatomy in a healthy population and to investigate potential age-related differences and associations with pathological thresholds described in the literature.

METHODS: This study included computed tomography scan data from 369 healthy scapulae of subjects ≥18 years of age without shoulder pathology. The scapulae were analyzed to measure key morphological parameters, including glenoid version, acromial coverage, posterior acromial height, coracoid angles, and scapular spine angle. Scapulae of individuals <60 years old were compared with those of individuals ≥60 years old. Morphological thresholds described in previous studies were used to identify the percentage of healthy scapulae that demonstrated values exceeding pathological thresholds.

RESULTS: Significant differences were observed between the scapulae of patients <60 years old and those ≥60 years old, with younger patients generally exhibiting scapular morphologies more closely resembling those reported in pathological cases. Key differences included posterior acromial height, posterior acromial coverage, scapular spine angle, and coracoacromial coverage (p < 0.05 for each). Across the cohort, a small percentage of healthy scapulae exceeded pathological thresholds published in the literature for posterior instability (posterior acromial height: 12.2%; posterior acromial coverage: 12.7%), anterior instability (coracoid pillar angle 2: 9.5%; scapular spine angle 2: 13.3%; glenoid rotation: 0.5%), and primary osteoarthritis (anterior coracoid plane coverage: 6.5%; coracoacromial plane coverage: 10.8%; posterior acromial coverage: 10.3%; critical shoulder angle: 6.0%).

CONCLUSIONS: This study provides a comprehensive reference for the 3D morphology of the healthy scapula. The results reveal relatively low variability in shape among healthy scapulae; however, specific morphological variations appear to predispose individuals to certain pathologies. As degenerative conditions develop over time, younger subjects with such predispositions may gradually transition out of the healthy cohort. Conversely, individuals who remain healthy beyond 60 years of age likely possess a "healthy" anatomy that does not favor pathology, representing the true cohort of healthy subjects.

CLINICAL RELEVANCE: Understanding the 3D morphology of the healthy scapula could enhance our knowledge of the etiology of conditions such as posterior and anterior instability and primary osteoarthritis, potentially improving their surgical management.

PMID:41875222 | DOI:10.2106/JBJS.25.00880

J Bone Joint Surg Am. 2026 Mar 24. doi: 10.2106/JBJS.25.01084. Online ahead of print.

ABSTRACT

➢ The Medicare Transforming Episode Accountability Model (TEAM) is a 5-year payment model that started on January 1, 2026, with mandatory participation from >700 U.S. hospitals in 5 surgery categories, 3 of which are orthopaedic.➢ The TEAM encompasses a specified operation from the day of the admission or outpatient procedure to 30 days after discharge, with payment based on a hospital-specific target price that is adjusted for hospital demographic characteristics and a Composite Quality Score multiplier.➢ Although hospitals hold the financial risk and benefit, orthopaedic surgeons will drive the TEAM's success, making their strategic engagement with leadership essential.➢ Robust data infrastructure, along with timely collection and analysis, forms the foundation for the TEAM implementation and compliance.➢ Many hospitals are unprepared for the TEAM, and the inclusion of high-variability procedures, such as the surgical treatment of hip and femoral fractures and spinal fusion, heightens financial risk, underscoring the need for a clear strategic framework and orthopaedic surgeon leadership.

PMID:41875221 | DOI:10.2106/JBJS.25.01084

J Bone Joint Surg Am. 2026 Mar 23. doi: 10.2106/JBJS.25.01652. Online ahead of print.

NO ABSTRACT

PMID:41871183 | DOI:10.2106/JBJS.25.01652

J Bone Joint Surg Am. 2026 Mar 20. doi: 10.2106/JBJS.26.00068. Online ahead of print.

NO ABSTRACT

PMID:41861031 | DOI:10.2106/JBJS.26.00068

J Bone Joint Surg Am. 2026 Mar 18. doi: 10.2106/JBJS.25.00964. Online ahead of print.

ABSTRACT

BACKGROUND: It is unclear whether postoperative pain differs by treatment type for patients with severe open tibial fractures.

METHODS: We performed a secondary analysis of data from the FIXIT study. Adults with severe open tibial fractures were randomized to undergo definitive modern external ring fixation (n = 122) or internal fixation (n = 132). Primary outcomes were pain intensity and interference at 6 and 12 months, measured by the Brief Pain Inventory. Secondary outcomes were Numeric Pain Rating Scale (NPRS) scores and the incidence of moderate to severe pain. Post hoc subanalysis compared pain in patients with and without pin-site infections and with and without external fixation removal.

RESULTS: At 6 months, median pain intensity did not differ significantly between the external fixation group (4.1 [interquartile range (IQR), 2.2 to 5.5]) and the internal fixation group (3.0 [IQR, 1.8 to 5.8]) (p = 0.11); however, patients who underwent external fixation had greater median pain interference (6.0 [IQR, 3.3 to 8.0]) than patients who underwent internal fixation (4.0 [IQR, 1.9 to 7.4]) (p = 0.01). At 12 months, pain intensity, pain interference, and NPRS scores did not differ by treatment type. The overall incidence of moderate to severe pain was 33% at 6 months and 35% at 12 months. At 6 months, pin-site infections were associated with greater pain intensity (p = 0.01) but not greater interference (p = 0.10). At 12 months, the presence of external fixation was associated with greater pain intensity (p = 0.01) and interference (p < 0.01).

CONCLUSIONS: At 6 months after a severe open tibial fracture, patients treated with modern external ring fixation had greater pain interference than patients treated with internal fixation, partly because of pin-site infections. No differences in pain interference or intensity were seen at 12 months. At 12 months, patients with external fixation in place had greater pain intensity and interference than those whose external fixation had been removed, but this was not the case at 6 months. Approximately one-third of all patients had moderate to severe pain at both time points, highlighting that persistent pain is common, regardless of treatment type. These findings can guide surgeons in choosing ring external fixation or internal fixation for these fractures.

LEVEL OF EVIDENCE: Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.

PMID:41849563 | DOI:10.2106/JBJS.25.00964

J Bone Joint Surg Am. 2026 Mar 18;108(6):416. doi: 10.2106/JBJS.25.00902. Epub 2025 Nov 20.

NO ABSTRACT

PMID:41848566 | DOI:10.2106/JBJS.25.00902

J Bone Joint Surg Am. 2026 Mar 18;108(6):399-400. doi: 10.2106/JBJS.25.01392. Epub 2026 Mar 18.

NO ABSTRACT

PMID:41848565 | DOI:10.2106/JBJS.25.01392

J Bone Joint Surg Am. 2026 Mar 18;108(6):397-398. doi: 10.2106/JBJS.25.01287. Epub 2026 Mar 18.

NO ABSTRACT

PMID:41848564 | DOI:10.2106/JBJS.25.01287

J Bone Joint Surg Am. 2026 Mar 18;108(6):395-396. doi: 10.2106/JBJS.25.01291. Epub 2026 Mar 18.

NO ABSTRACT

PMID:41848563 | DOI:10.2106/JBJS.25.01291

J Bone Joint Surg Am. 2026 Mar 18;108(6):393-394. doi: 10.2106/JBJS.26.00094. Epub 2026 Mar 18.

NO ABSTRACT

PMID:41848562 | DOI:10.2106/JBJS.26.00094

J Bone Joint Surg Am. 2026 Mar 13. doi: 10.2106/JBJS.25.00177. Online ahead of print.

ABSTRACT

BACKGROUND: Periprosthetic joint infection (PJI) is the most common reason for revision total knee arthroplasty (TKA). Recent evidence has demonstrated that patients who develop PJI within 1 year following total hip arthroplasty have a significantly elevated risk of mortality within 10 years. Thus, the aim of this study was to compare long-term mortality rates between patients who did and did not develop PJI within 1 year following the index TKA.

METHODS: This was a retrospective population-level database study. All eligible participants interacted with a single-payer public health-care system. The primary outcome measure was mortality at 10 years following index TKA; 1- and 5-year mortality were also compared. Mortality was compared for propensity-score-matched groups.

RESULTS: Of the total of 263,204 patients who underwent primary TKA in the study period (mean age and standard deviation, 67.9 ± 9.3 years), 1,228 (0.5%) subsequently developed PJI within 1 year. Across the entire sample, patients who developed PJI within 1 year following the index TKA were more likely to be male, have frailty, and have a Charlson-Deyo score of >0; they also had significantly higher rates of congestive heart failure and chronic obstructive pulmonary disease compared with those who did not develop PJI within 1 year. A total of 1,202 patients who developed PJI within 1 year of the index TKA were matched to 1,202 patients who did not develop PJI within 1 year of the index TKA, with standardized differences of <0.10 for all covariates, indicating a robust match. After matching, TKA recipients who developed PJI in the first year had a significantly higher 10-year mortality rate (7.2% [86] versus 1.6% [19]; absolute risk difference = 5.45% [95% confidence interval (CI) = 3.41% to 7.74%]; hazard ratio = 4.66 [95% CI = 2.84 to 7.66]).

CONCLUSIONS: Patients who developed PJI within 1 year following TKA were at significantly higher risk for mortality at 10 years post-TKA compared with those who did not develop PJI within 1 year following TKA. The etiological factors leading to this increased risk remain unclear and warrant further investigation alongside efforts to further the prevention, diagnosis, and management of PJI.

LEVEL OF EVIDENCE: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

PMID:41824557 | DOI:10.2106/JBJS.25.00177

J Bone Joint Surg Am. 2026 Mar 12. doi: 10.2106/JBJS.25.01315. Online ahead of print.

ABSTRACT

BACKGROUND: The literature regarding optimal autograft choice for anterior cruciate ligament (ACL) reconstruction (ACLR) remains inconclusive. This network meta-analysis (NMA) compares common autografts for primary ACLR.

METHODS: PubMed, Scopus, Web of Science, and Embase were searched up to May 3, 2025, for randomized clinical trials (RCTs) on primary ACLR in adults that compared ≥2 of the following tendon autografts: 4-strand semitendinosus (4SST), 4-strand semitendinosus-gracilis (4SSTG), its 5-strand variant (5SSTG), bone-patellar tendon-bone (BPTB), quadriceps tendon with bone (QTB), and free quadriceps tendon (FQT). Outcomes analyzed in the NMA were the International Knee Documentation Committee (IKDC) subjective score, Lysholm score, Tegner Activity Scale, anteroposterior (instrumented) and rotational (pivot-shift) stability, and rerupture or revision ACLR rate. Autografts were ranked using surface under the cumulative ranking (SUCRA) values.

RESULTS: A total of 44 RCTs with 3,491 patients were included in the NMA. With respect to the IKDC, QTB was statistically superior to BPTB (mean difference = 3.46, 95% credible interval [CrI]: 0.29 to 6.77), although the difference was likely not clinically meaningful. QTB ranked highest for the IKDC (SUCRA = 90.1%) and Tegner (SUCRA = 85.3%), while BPTB ranked lowest for the IKDC and Lysholm. With respect to knee laxity, QTB ranked second in anteroposterior and first in rotational stability, and it carried a significantly lower risk of a 2+ or higher pivot-shift than 4SST (risk ratio = 0.26, 95% CrI: 0.07 to 0.85). QTB was associated with a decreased risk of rerupture/revision compared with other autografts (SUCRA = 83.3%).

CONCLUSIONS: Based on the autograft rankings, QTB was found to lead to improved functional, activity-related, and stability outcomes overall, while also reducing the risk of graft failure.

LEVEL OF EVIDENCE: Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.

PMID:41818333 | DOI:10.2106/JBJS.25.01315

J Bone Joint Surg Am. 2026 Mar 12. doi: 10.2106/JBJS.25.01211. Online ahead of print.

ABSTRACT

BACKGROUND: Acute Achilles tendon rupture is a common and serious injury in sports medicine. Clinical studies demonstrate that both surgical and nonsurgical interventions can achieve satisfactory outcomes; however, considerable debate exists regarding the optimal treatment modality for this injury. Currently, most animal experimental studies on acute Achilles tendon rupture lack clinical relevance due to inadequate fixation of the ankle joint.

METHODS: This study involved 162 male C57BL/6 mice and 30 Scx-CreERT2; Rosa26-tdTomato transgenic mice. The injury+repair groups underwent Achilles tenotomy followed by Kessler suture repair, while the injury+no repair groups underwent tenotomy alone. Ankle joints were immobilized at 160° (plantar flexion) or 90° (neutral alignment). Samples were collected at 2 and 4 weeks post-injury for biomechanical, histological, and quantitative real-time PCR (qPCR) analyses, including tracing of Scx+ tendon progenitor stem cells.

RESULTS: Biomechanical analysis was performed 2 and 4 weeks post-injury. At 2 weeks, the injury+repair group immobilized at a maximum plantar flexion angle of 160° showed significantly higher failure force and stiffness compared with the injury+no repair+160° group. However, there was no significant difference between the groups at 4 weeks (p > 0.05). The failure force in each 160° group was significantly higher than in the corresponding 90° group (p < 0.0001). Histological analysis indicated better collagen fiber alignment and higher expression of collagen type I alpha 1 (COL1A1) in the injury+repair groups. qPCR revealed generally higher expression of tendon repair-related genes (Scx, Tnmd, Tgfb1) in the injury+repair groups, while inflammatory factors (Il1b, Il6) were higher in the injury+no repair+90° group. Scx+ tendon progenitor stem cell tracing showed the greatest percentage in the injury+repair+160° group.

CONCLUSIONS: Both surgical and nonsurgical treatments for acute Achilles tendon rupture achieved satisfactory tendon healing results when the ankle joint was maintained in maximum plantar flexion. However, surgical treatment yielded superior histological tendon repair.

CLINICAL RELEVANCE: The results suggest that clinical trials may show immobilization in maximum plantar flexion following surgery to be optimal for tendon healing.

PMID:41818331 | DOI:10.2106/JBJS.25.01211

J Bone Joint Surg Am. 2026 Mar 12. doi: 10.2106/JBJS.25.01375. Online ahead of print.

ABSTRACT

BACKGROUND: Limited vascularization at the tendon-bone interface (TBI) hinders rotator cuff (RC) healing. Although cell sheet technology has shown promise for interfacial repair, prevascularization strategies remain underexplored.

METHODS: Twenty female New Zealand rabbits underwent bilateral infraspinatus tendon repair and were randomized to receive either bone marrow-derived mesenchymal stem cell (BMSC) sheets or prevascularized BMSC sheets generated by coculture with endothelial cells, implanted at the TBI. An age- and weight-matched uninjured group served as a control. Healing at 6 weeks was assessed by gross observation, histology, immunohistochemistry, gene expression, and biomechanical testing.

RESULTS: Prevascularization of the BMSC sheets enhanced TBI vascularization, indicated by greater density of α-smooth muscle actin-positive vessels (16.16 ± 2.81 versus 10.63 ± 2.79/mm2, p = 0.0079). Immunohistochemistry demonstrated greater areas positive for collagen type II alpha 1 (86.96 ± 29.95 versus 40.25 ± 11.96 μm2, p = 0.0079) and interleukin 10 (14.93 ± 4.79 versus 7.43 ± 2.48 μm2, p = 0.0159). Biomechanically, prevascularization of the sheets yielded greater ultimate failure load (156.89 ± 51.92 versus 111.67 ± 27.51 N, p = 0.0364) and stiffness (37.27 ± 12.16 versus 27.16 ± 7.33 N/mm, p = 0.0486).

CONCLUSIONS: Prevascularization of BMSC sheets was able to promote angiogenesis and improve structural and mechanical aspects of tendon-bone healing.

CLINICAL RELEVANCE: Prevascularized BMSC sheets may represent a biologic adjunct to enhance tendon-bone healing in RC repair.

PMID:41818324 | DOI:10.2106/JBJS.25.01375

J Bone Joint Surg Am. 2026 Mar 4. doi: 10.2106/JBJS.25.01537. Online ahead of print.

ABSTRACT

Robotic-assisted reverse shoulder arthroplasty has recently entered early limited clinical use, with the goal of improving the execution of preoperative plans and reducing malposition outliers that increase complication rates and health-care costs. This Innovation article reviews the rationale for this technology, explores its potential impact, examines key implementation challenges, and highlights the future directions needed to determine its ultimate value.

PMID:41779866 | DOI:10.2106/JBJS.25.01537

J Bone Joint Surg Am. 2026 Mar 4;108(5):363-369. doi: 10.2106/JBJS.25.00600. Epub 2025 Nov 26.

ABSTRACT

BACKGROUND: Revision total hip arthroplasty (THA) presents several unique challenges, one of which is the removal of osseointegrated uncemented femoral stems. Traditional techniques, such as extended trochanteric osteotomy, are associated with complications and patient morbidity. Recently, the advent of osteotome systems designed to facilitate femoral stem extraction has improved the capacity for complete fixation disruption without the need for osteotomy. This study describes our experience with one such novel system in a large series of revision THAs.

METHODS: Patients undergoing femoral component revision during revision THA from December 2017 to July 2024 were identified from our institutional database. We included and analyzed patients undergoing revision for any indication so long as the revised femoral component was cementless and confirmed to be osseointegrated at the time of revision surgery. Extraction was attempted with the femoral-extraction osteotome system of interest in all cases.

RESULTS: Of the 92 included cases, 65% involved single-taper wedge stems; 16%, fit-and-fill style designs; and 9%, fully hydroxyapatite (HA)-coated stems. Using the osteotome system, femoral extraction was successful (no intraoperative fracture or requirement for osteotomy) in 73% of the cases. Osteotomy was required in 10% of the cases but was not required for extraction of any single-taper wedge stem. Of those with fit-and-fill or fully HA-coated stems, 57% required osteotomy or sustained an extraction-related fracture. Extraction-related intraoperative fractures occurred in 13% of the cases.

CONCLUSIONS: In this large series of revision THAs, the use of a novel osteotome system designed for femoral component extraction led to successful extraction in 73% of the cases. The relatively low rate of osteotomy (10%) suggests that this technique is useful, but it also highlights limitations and the need for further innovation given the contemporary shift toward the use of collared, fully coated triple-tapered stems.

LEVEL OF EVIDENCE: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

PMID:41778989 | DOI:10.2106/JBJS.25.00600

J Bone Joint Surg Am. 2026 Mar 4;108(5):339. doi: 10.2106/JBJS.25.00555. Epub 2025 Nov 13.

NO ABSTRACT

PMID:41778988 | DOI:10.2106/JBJS.25.00555