SICOT J. 2025;11:47. doi: 10.1051/sicotj/2025042. Epub 2025 Aug 8.

ABSTRACT

INTRODUCTION: Tourniquet use in total knee arthroplasty (TKA) can cause ischaemia-reperfusion (I-R) injury via oxidative stress. This study evaluated whether combined administration of the antioxidant N-acetylcysteine (NAC) and the iron-chelator Deferiprone can mitigate oxidative damage and improve clinical outcomes.

MATERIALS AND METHODS: Twenty TKA patients were randomized into two groups, one group receiving NAC (600 mg, 6 h pre-op) and Deferiprone (1000 mg, 2 h pre-op) (intervention group) and the other group serving as placebo (control). Lipid hydroperoxides (LOOH) and protein malondialdehyde (PrMDA) were measured from quadriceps muscle tissue samples at 5 min (T1) and 40 min (T2) after tourniquet inflation, and 5 min after deflation (T3). Blood markers including serum ferritin, white blood cell (WBC) count, and polymorphonuclear neutrophils (PMNs) were assessed along with tissue PrMDA and LOOH as primary outcome measurements, while pain scores and knee flexion were recorded postoperatively as secondary outcome measurements.

RESULTS: LOOH levels were significantly lower in the intervention group at T2 and T3. PrMDA levels showed no significant differences. Ferritin levels rose by 69% in controls vs. 18% in the intervention group. WBC and PMNs normalized faster, with reduced pain and improved range of motion in the intervention group.

CONCLUSION: The attenuation of LOOH elevation, the faster PMN deactivation, the inhibition of ferritin release from the cells along with the improved clinical outcomes suggest that combined NAC and Deferiprone administration may reduce tourniquet-related oxidative stress and inflammation, enhancing early recovery in TKA patients.

PMID:40779705 | PMC:PMC12334122 | DOI:10.1051/sicotj/2025042

J Bone Joint Surg Am. 2025 Aug 8. doi: 10.2106/JBJS.24.01180. Online ahead of print.

ABSTRACT

BACKGROUND: Persistent sedentary lifestyles are prevalent after complex lumbar surgery. Inactivity often is due to habit, is not necessary, and results in both adverse general health and adverse spine health. We tested a multicomponent behavioral intervention administered in surgical practices to increase lifestyle walking after recuperation from surgery involving ≥3 lumbar levels or fusion. This analysis reports the main objective of measuring change in physical activity; subsequent analysis will address the additional objective of measuring change in disability due to lumbar pain.

METHODS: At 3 months postoperatively, patients were interviewed in person, completed the self-reported Paffenbarger Physical Activity and Exercise Index measuring energy expenditure in kcal/week from walking and total activity, and were randomized to the control or a behavioral intervention. Patients in the intervention group made a contract to increase walking and received a pedometer and information about activity benefits, followed by telephone contacts over 1 year to reinforce the intervention and assess activity change. Controls received only information about activity benefits and fewer telephone contacts to assess activity change. The primary outcome was the difference in within-patient change in kcal/week from walking (as measured by the Paffenbarger Index) from enrollment to 4 months later. Additional assessments and outcomes included changes in the total Paffenbarger Index from enrollment to 4 and 12 months and changes in the walking domain to 12 months.

RESULTS: Among 250 patients (mean age, 63 years; 53% men; 96% White patients and 6% Latino patients), 123 received the intervention and 127 were controls. The mean energy expenditure from walking increased from enrollment to 4 months for patients in the intervention group (1,437 to 2,582 kcal/week; p < 0.0001) and for controls (1,320 to 1,870 kcal/week; p < 0.0001), with a greater difference for the intervention group (1,165 compared with 600 kcal/week; p = 0.03). At 12 months, the effectiveness of the intervention was sustained (estimated effect, 588 kcal/week [95% confidence interval (CI), 119 to 1,056 kcal/week]; p = 0.01) when accounting for new events that potentially affect activity, such as another lumbar surgery (estimate, -1,396 kcal/week [95% CI, -2,116 to -676 kcal/week]; p = 0.0002) and new arthroplasty or foot or ankle surgery (estimate, -701 kcal/week [95% CI, -1,212 to -189 kcal/week]; p = 0.007). Similar results were obtained for changes in total activity. Retention in this study was 92%; 72% of all patients reported that being in the study did not affect spine symptoms, and 28% reported that being in the study made symptoms better. No adverse events were associated with the trial.

CONCLUSIONS: A behavioral intervention was effective in increasing lifestyle walking after recuperation from complex lumbar surgery. These findings support integrating counseling about physical activity into routine postoperative care in surgical practices.

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

PMID:40779643 | DOI:10.2106/JBJS.24.01180

Int Orthop. 2025 Aug 8. doi: 10.1007/s00264-025-06631-z. Online ahead of print.

NO ABSTRACT

PMID:40779171 | DOI:10.1007/s00264-025-06631-z

Int Orthop. 2025 Aug 8. doi: 10.1007/s00264-025-06629-7. Online ahead of print.

NO ABSTRACT

PMID:40779170 | DOI:10.1007/s00264-025-06629-7

SICOT J. 2025;11:46. doi: 10.1051/sicotj/2025045. Epub 2025 Aug 7.

ABSTRACT

PURPOSE: Intraoperative periprosthetic femoral fracture (IPFF) is a known complication during hemiarthroplasty (HA), which may lead to inferior outcomes. Few studies have assessed the outcomes of IPFF in HA for displaced femoral neck fractures (FNF). This study aims to evaluate the incidence of IPFF in cementless HA for displaced FNF and compare long-term outcomes between patients with and without IPFF.

METHODS: We retrospectively reviewed institutional surgical data of patients who underwent cementless HA for displaced FNF from January 2010 to January 2022. The presence, location, and treatment of IPFF, as well as the effect of IPFF on postoperative weight-bearing, status were assessed. Mortality, readmission, and revision rates were compared between the IPFF and non-IPFF group.

RESULTS: A total of 1,586 patients were included in the study. 104 patients (6.6%) in the IPFF group vs. 1,482 patients (93.4%) in the non-IPFF group. The IPFF location was mostly the calcar (59.6%), followed by the greater trochanter (35.5%) and the femoral shaft (8.6%). Most fractures were treated with fixation (92.3%) and full weight-bearing postoperatively (95.1%). Surgery duration was longer in the IPFF group (p < 0.001). However, there were no significant differences between groups regarding 30-day, 90-day, and 1-year mortality rates, 90-day readmission rates, or revision rates at the latest follow-up. A multivariate binary logistic regression found similar long-term results.

CONCLUSIONS: While IPFF remains a recognized complication of cementless HA for displaced FNF, its occurrence does not adversely affect long-term outcomes when appropriately managed.

PMID:40773666 | PMC:PMC12331202 | DOI:10.1051/sicotj/2025045

SICOT J. 2025;11:45. doi: 10.1051/sicotj/2025041. Epub 2025 Aug 7.

ABSTRACT

INTRODUCTION: The learning curve associated with adopting new surgical systems in total knee arthroplasty (TKA) can significantly impact surgical efficiency and patient outcomes. This study aimed to evaluate the evolution of operative time with the KNEO® (Groupe Lépine, Genay, France) posterior stabilized knee system and to analyze the learning curve for postoperative complications to achieve surgical proficiency.

METHOD: This retrospective, multicentric study analyzed 481 patients who underwent primary TKA with the KNEO® implant in a high-volume university center between 2020 and 2024. The evolution of operative time and postoperative complications requiring reoperation surgery were evaluated, with a follow-up period extending until January 2025, during which complications were monitored. The study included 481 patients with a mean age of 71.7 ± 8.0 years and a mean Body Mass Index of 29.0 ± 4.0 kg/m2. The cohort comprised 308 female (64%) and 173 male (36%) patients.

RESULTS: The mean operative time significantly decreased from 83.5 min in the initial case to 63.0 min after 481 cases (p < 0.001). The learning curve showed an initial learning phase with high variability, followed by stabilization around 150 procedures and subsequent optimization. Postoperative complication rates showed a 31.9% reduction per group of 100 patients (β = -0.3848, p = 0.0075), indicating improved surgical proficiency and patient safety over time.

CONCLUSION: The findings suggest that the KNEO® system follows a measurable learning curve, with operative efficiency and complication rates improving as case volume increases. These results emphasize the importance of structured training and experience accumulation in optimizing patient outcomes when implementing new implant technologies.

PMID:40773665 | PMC:PMC12331203 | DOI:10.1051/sicotj/2025041

Injury. 2025 Jul 29;56(10):112634. doi: 10.1016/j.injury.2025.112634. Online ahead of print.

ABSTRACT

PURPOSE: Malrotation of the radius following a shaft fracture can lead to persistent pain, limited motion, and adjacent joint instability. This study aimed to evaluate radial torsion patterns by specific location.

METHODS: We included 50 patients with uninjured radii on computed tomography (CT). The torsion measuring zone (TMZ), defined along the longitudinal axis from just proximal to the watershed line to the distal end of the radial tuberosity, was divided into 3 mm intervals, generating cross-sectional images for torsion evaluation. Distal and proximal 30 mm segments were defined as distal end zone (DEZ) and proximal end zone (PEZ), respectively. The area with the largest 30 mm angular difference in distal half was designated the distal shaft torsion zone (DSTZ). The area between the proximal end of DSTZ and distal end of PEZ was the mid-shaft zone (MSZ). Angle change rate was evaluated in each zone, with the DSTZ compared to DEZ, MSZ, and PEZ.

RESULTS: The cohort included 27 men and 23 women, mean age of 54.8 ± 19.6 years. TMZ length was 160.5 ± 16.3 mm, with torsion angle of 49.8 ± 13.3° The angle change rate was 4.6 ± 1.9°/cm in the DEZ and 5.1 ± 3.3°/cm in the PEZ. The centre of the DSTZ was 4.8 ± 1.4 cm from distal end, with an angle change rate of 6.5 ± 1.8°/cm. The MSZ length was 6.7 ± 1.7 cm, with angle change rate of 0.3 ± 1.6°/cm. DSTZ showed significantly higher angle change rates compared to DEZ (P < 0.001) and MSZ (P < 0.001).

CONCLUSION: The DSTZ, located about 5 cm from the distal end, exhibited the most significant torsion, while the MSZ showed minimal torsion. Recognising these torsion patterns will guide proper plate positioning and prevent iatrogenic malrotation during plate osteosynthesis for radius shaft fracture.

PMID:40774028 | DOI:10.1016/j.injury.2025.112634

J Bone Joint Surg Am. 2025 Aug 7. doi: 10.2106/JBJS.24.01098. Online ahead of print.

ABSTRACT

BACKGROUND: Managing soft-tissue balance and selecting an appropriate alignment target are crucial factors in modern total knee arthroplasty (TKA). Medial soft-tissue release has been widely performed in posterior-stabilized (PS) TKA; however, recent approaches to medial structure management have been reconsidered. This retrospective study aimed to assess the effectiveness of minimizing medial structure invasion using personalized alignment (PA) with precise additional bone cutting in PS-TKA compared with conventional mechanically aligned (MA) PS-TKA.

METHODS: Overall, 188 patients who underwent PS-TKA were enrolled; propensity score matching on the basis of preoperative patient characteristics was used to ensure that the groups were similar. Additional medial soft-tissue release was performed if necessary in the MA group for inappropriate ligament balance. Adequate bone recutting, as an alternative to medial release, was performed in the PA group, permitting a maximum of 3° tibial varus alignment.

RESULTS: Additional medial soft-tissue release was performed in 33 knees (35.1%) in the MA group, whereas bone recutting was performed in 37 knees (39.4%) in the PA group. The PA group had a significantly more varus postoperative medial proximal tibial angle than the MA group (mean ± standard deviation, 89.1° ± 1.2° versus 90.3° ± 1.8°; p < 0.0001). The postoperative patient satisfaction score of the 2011 New Knee Society Score (KSS) in the PA group was significantly higher than that in the MA group (mean, 29.4 ± 6.7 versus 27.5 ± 7.3; p = 0.04). Moreover, PA with bone recutting resulted in a significantly greater postoperative extension angle (mean, -1.5° ± 3.7° versus -3.0° ± 3.5°; p = 0.02) and higher KSS patient satisfaction (30.1 ± 7.7 versus 26.7 ± 7.2; p = 0.04) compared with MA with medial release.

CONCLUSIONS: This novel surgical strategy achieved appropriate balance without excessive medial release and resulted in superior clinical outcomes in PS-TKA.

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

PMID:40773529 | DOI:10.2106/JBJS.24.01098

Int Orthop. 2025 Aug 7. doi: 10.1007/s00264-025-06632-y. Online ahead of print.

ABSTRACT

BACKGROUND: Ehlers-Danlos Syndrome (EDS) is a connective tissue disorder characterized by joint hypermobility, ligamentous laxity, and frequent joint injuries. These features could increase the risk of anterior cruciate ligament (ACL) tears, typically managed through ACL reconstruction (ACLR). Surgical intervention in EDS is challenging due to potential complications such as poor wound healing and tissue fragility. Limited evidence exists regarding the outcomes of ACLR in EDS patients; therefore, in this study we aimed to evaluate survival rates of primary and revision ACLR and examine associated demographic and anatomic risk factors for failure after ACLR.

METHODS: A retrospective review of 21 EDS patients (25 knees) who underwent ACLR between 1993 and 2023 was conducted. Patients with vascular EDS were excluded. Demographic and surgical data, including graft type, cause of injury, concomitant procedures such as meniscus repair and anatomical measurements (posterior tibial slope, intercondylar notch width, lateral femoral condyle morphology, tibiofemoral rotation and tibial tubercle- trochlear groove distance), were collected. Survival analysis was performed using Kaplan-Meier curves, with endpoints defined as ACLR failure or conversion to total knee arthroplasty (TKA). A multivariable survival analysis was used to identify predictors of outcomes. In addition, the influence of demographic and anatomical factors on the development of concomitant injuries and concomitant procedures were assessed. Anatomical factors were then compared with non-EDS patients from the existing literature.

RESULTS: The overall survival rate was 85.7% at mean follow-up of 50 months. Primary ACLR showed significantly higher survival rates 93.8% compared to revision ACLR 62.5% at 50 months (p = 0.03). Sports injuries, particularly skiing, were the leading cause of ACL tears (62%). Anatomical differences, such as increased lateral femoral condyle ratio (LFCR) and tibiofemoral rotation (TFR), were observed compared to non-EDS, ACL-intact patients from the literature (p < 0.01). However, these factors did not predict failure or influence concomitant injuries.

CONCLUSION: This study demonstrates that ACLR in EDS patients achieves good survival rates. Anatomical risk factors differed significantly from non-EDS, ACL-intact patients, but were not predictive of failure, highlighting ligamentous laxity as the primary challenge.

PMID:40775375 | DOI:10.1007/s00264-025-06632-y

Int Orthop. 2025 Aug 7. doi: 10.1007/s00264-025-06630-0. Online ahead of print.

ABSTRACT

PURPOSE: Shoulder deformities and impaired function in individuals with birth brachial plexus injury (BBPI) are often caused by internal rotator (IR) contractures and abductor weakness, which may progress to glenohumeral dysplasia. Although subscapularis-complex release and tendon transfer is a time-tested procedure, there are controversies regarding the appropriate management of shoulder contractures, especially in preschool children. Therefore, this study examines the efficiency of arthroscopically done progressive controlled release of IR contracture combined with tendon transfer.

METHODS: This study included 12 children who presented with shoulder soft tissue contractures and functional impairments, specifically, loss of shoulder abduction and external rotation, but with good deltoid function. They underwent a surgical intervention involving arthroscopy-assisted subscapularis-complex release and conjoint muscle transfer onto the infraspinatus footprint on the humeral head. The evaluation of shoulder function was conducted using the Mallet score system, and the range of motion was measured at preoperative and six month postoperative intervals. Statistical analyses were performed to determine the significance of the outcomes.

RESULTS: The average age of participants was 4.83 ± 2.1 years. Preoperatively, the mean Mallet score was 14.08 ± 1.4, which improved to 23.83 ± 1.2 postoperatively. The average gain in shoulder abduction was 66.4 ± 5.6°, and external rotation improved by 85.4 ± 16.6° at 18 months final follow-up. All patients exhibited improvements in shoulder function, with a significant correlation (p value = 0.037) between Naraka grading, and clinical outcomes.

CONCLUSION: The combined surgical approach of arthroscopic subscapularis-complex release with conjoint tendon transfer effectively enhances the shoulder function in the studied cohort. Further research and extended follow-up are needed to evaluate the long-term benefits.

LEVEL OF EVIDENCE: Level IV (Therapeutic case series).

PMID:40772960 | DOI:10.1007/s00264-025-06630-0

Injury. 2025 Jul 28;56(10):112624. doi: 10.1016/j.injury.2025.112624. Online ahead of print.

ABSTRACT

INTRODUCTION: The purpose of this study was to utilize a large national database to evaluate short- and long-term outcomes of acute management of proximal humerus fractures (PHF) with reverse total shoulder arthroplasty (RSA) compared to open reduction internal fixation (ORIF).

METHODS: The TriNetX platform was utilized to perform a retrospective review of patients who sustained PHFs treated within three weeks of injury. Patients were identified using Current Procedural Terminology codes and the International Classification of Disease diagnosis codes. The cohorts were 1:1 propensity matched. Patients who received RSA were propensity matched to patients who underwent ORIF. Short-term and long-term outcomes were compared across the cohorts across various post operative periods. Kaplan Meier survival analysis was used to analyze implant survival rate and Cox hazard ratio was used to identify risk factors of re-operation.

RESULTS: Following propensity matching, each cohort included 2733 patients with an average age of 71±9.5. Patients treated with ORIF were more likely to have a re-operation or hospital admission than patients who underwent RSA at both 1 and 2 year follow up (5.5 % vs 2.1 %; p < 0.001; 6.9 % vs 2.6 %, p < 0.001 and 13.7 % vs 11.3 %, p = 0.01; 19.6 % vs 16.4 %, p = 0.003). At two year follow up, 173 patients treated with ORIF had a re-operation of which 60 (35 %) were converted to arthroplasty. On Kaplan Meier survival analysis for re-operation, both implants had satisfactory survival rates at both one and two year time point with survival rates over 90 %. However, there was a difference between survival rates at both one and two years between the ORIF and RSA groups (94 % vs 98 %, p < 0.0001; 91 % vs 97 %, p < 0.0001). For ORIF, patients with four part PHF and osteoporosis had a 39 % and 19 % increased risk of re-operation (p < 0.001; p = 0.03).

CONCLUSION: While both ORIF and RSA have been shown to be acceptable techniques for managing PHFs in the elderly, ORIF had a significantly higher re-operation and hospital readmission rate at mid- and long-term follow up. Additionally, a large portion of patients undergoing re-operation following ORIF were converted to shoulder arthroplasty although acute RSA has superior outcomes compared to delayed RSA. Therefore, for operative elderly candidates we advocate for the use of RSA in three- and four-part PHFs.

PMID:40763431 | DOI:10.1016/j.injury.2025.112624

J Bone Joint Surg Am. 2025 Aug 5. doi: 10.2106/JBJS.24.01511. Online ahead of print.

ABSTRACT

BACKGROUND: Tranexamic acid (TXA) has been shown to reduce blood loss during total knee arthroplasty (TKA) and total hip arthroplasty (THA), but the most effective administration method has yet to be determined. This systematic review and meta-analysis aimed to compare topical and systemic TXA administration to reduce operative blood loss.

METHODS: MEDLINE, Embase, and Cochrane CENTRAL were screened for randomized controlled trials comparing topical and systemic TXA for patients who underwent elective TKA and THA. The primary outcome was the total volume of operative blood loss, and the secondary outcomes were postoperative transfusion requirements, hemoglobin drop, hospital length of stay, and the frequencies of the main adverse events (infections and thromboembolic events). Data pooling was performed using RStudio. Subgroup analyses compared outcomes between TKA and THA.

RESULTS: Fifty-nine randomized controlled trials with a total of 6,791 patients were included in this review. Data analysis showed no significant difference between topical and systemic TXA application in terms of total blood loss (Hedges g = 0.11; 95% confidence interval [CI], -0.04 to 0.26; I2 = 82.4%). There was also no significant difference between the 2 groups in hemoglobin drop, hospital length of stay, and transfusion requirements. Subgroup analysis showed that patients undergoing TKA who received topical TXA had a significant reduction in total blood loss (g = 0.19; 95% CI, 0.00 to 0.38; I2 = 85%; p = 0.046) compared with those who received systemic TXA.

CONCLUSIONS: Topical and systemic TXA were equally effective in reducing blood loss in the analysis in which THA and TKA were combined. However, in TKA, topical application significantly reduced blood loss compared with systemic administration, while the reverse was true in THA. Further research is still necessary to find the optimal TXA dosage and administration route.

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

PMID:40763214 | DOI:10.2106/JBJS.24.01511

J Bone Joint Surg Am. 2025 Aug 5. doi: 10.2106/JBJS.24.01436. Online ahead of print.

ABSTRACT

BACKGROUND: Accurate debridement of poorly perfused bone and soft tissue is critical to reduce the risk of infection in open fracture or of recurrent fracture-related infection (FRI). However, accurate delineation of viable and nonviable tissue is difficult with current technology. The aim of this pilot study was to develop and evaluate an indocyanine green (ICG)-based dynamic contrast-enhanced fluorescence imaging (DCE-FI) strategy to provide intraoperative, objective, real-time information on bone perfusion using an osteotomy model in patients undergoing lower-extremity amputation.

METHODS: Fifteen patients who were ≥18 years of age and were undergoing lower-extremity amputation were included in this study. Perfusion-related kinetic parameters derived from DCE-FI, including maximum fluorescence intensity, ingress slope, and blood flow, were compared among 3 conditions reflecting sequentially increasing osseous damage: baseline, osteotomy (disruption of endosteal blood flow), and osteotomy plus periosteal stripping (disruption of endosteal and periosteal blood flow).

RESULTS: There were significant decreases in median values from baseline to after osteotomy alone for maximum intensity (96.2 to 58.9 relative fluorescence units [RFUs]), ingress slope (3.2 to 2.0 RFU/second), and blood flow (6.7 to 4.9 mL/min/100 g). Following osteotomy plus periosteal stripping, there were also significant decreases in median values for maximum intensity (12.0 RFU), ingress slope (0.2 RFU/s), and blood flow (0.8 mL/min/100 g). The Mann-Whitney U test confirmed a significant perfusion reduction (p < 0.001) in the tibial diaphysis due to these injuries. The areas under the curve (AUC) in the receiver operating characteristic (ROC) analysis for identifying periosteal stripping (compared with only osteotomy or no osseous damage) were 0.89 to 0.90, which were higher than the AUCs for identifying any osseous damage (osteotomy with or without periosteal stripping) compared with no damage, 0.75 to 0.82.

CONCLUSIONS: This clinical study utilizing DCE-FI for intraoperative bone perfusion assessment in orthopaedic surgery demonstrated that kinetic variables derived from DCE-FI can effectively characterize and classify degradation of bone perfusion due to osteotomy and osteotomy plus periosteal stripping.

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

PMID:40763212 | DOI:10.2106/JBJS.24.01436

J Bone Joint Surg Am. 2025 Aug 5. doi: 10.2106/JBJS.24.00920. Online ahead of print.

ABSTRACT

BACKGROUND: Vancouver Type-B1 and C periprosthetic hip fractures have traditionally been treated using single- or double-plate fixation constructs. Concern exists regarding screws within the cement mantle due to the theoretical risk of cement fracture and eventual prosthetic loosening. The aim of this study was to assess femoral stem survivorship in patients with Vancouver Type-B1 or C fractures around a well-fixed cemented femoral component who were treated with a plate construct and screws into the cement mantle. The hypothesis was that screw fixation into the cement mantle would not compromise stem fixation.

METHODS: A retrospective review was performed of patients who were consecutively, surgically treated for a periprosthetic fracture around a femoral stem by 3 surgeons, as identified through a search of records from January 1, 2007, to January 1, 2023. A total of 112 consecutive patients with Vancouver Type-B1 or C periprosthetic femoral fractures treated at our institutions were reviewed. Patients who underwent fixation using plate constructs with ≥1 screw within the cement mantle around the stem were included. Patients were followed until union, revision due to plate construct failure, or stem revision. Other complications, including alignment loss, cemented stem subsidence, radiographic stem loosening, and new cement-mantle fractures, were assessed.

RESULTS: Twenty-eight patients (19 female; 27 White or Caucasian; 3 Hispanic or Latino; mean age, 81.4 ± 8.7 years) met the inclusion criteria. Radiographic union was achieved in 26 patients (92.9%). The study included 8 (28.6%) interprosthetic fractures between a total hip arthroplasty prosthesis and a total knee arthroplasty prosthesis. The mean union time was 8.0 ± 4.6 months (range, 2.2 to 25.6 weeks). The mean follow-up duration following the index procedure was 33.3 ± 24.0 months (range, 6.1 to 86.2 months). Two nonunions occurred (7.1%), both involving plate failure. Both patients required revision of the femoral prosthesis, which was not loose at the time of reoperation. No stem subsidence or cement mantle fractures occurred during follow-up, and no revisions were performed for stem loosening.

CONCLUSIONS: Screw fixation into cement around a well-fixed stem did not contribute to stem loosening at short-term follow-up. There were no isolated femoral component revisions for cement mantle issues.

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

PMID:40763211 | DOI:10.2106/JBJS.24.00920

J Bone Joint Surg Am. 2025 Aug 5. doi: 10.2106/JBJS.25.00031. Online ahead of print.

ABSTRACT

➢ The growing prevalence and complexity of spinal pathologies have prompted hospital systems to establish dedicated spine centers to provide personalized, high-quality patient care.➢ The Joint Commission offers Advanced Certification in Spine Surgery to recognize programs that meet rigorous, evidence-based standards of care to their patient population.➢ Designing and implementing a spine center of excellence require the identification of key stakeholders, the development of a strategic plan, the generation of evidence-based clinical protocols, and routine evaluation of program metrics.➢ Spine centers of excellence offer standardized clinical pathways involving comprehensive preoperative optimization and coordinated postoperative care, thus leading to reduced complications and improved patient satisfaction with outcomes.➢ With recent advancements in minimally invasive techniques, robotic surgery, and value-based care models, a dedicated spine program should routinely evaluate the current best clinical practices to ensure compliance with the latest evidence-based care.

PMID:40763208 | DOI:10.2106/JBJS.25.00031

J Bone Joint Surg Am. 2025 Aug 5. doi: 10.2106/JBJS.24.01269. Online ahead of print.

ABSTRACT

BACKGROUND: The smallest worthwhile effect (SWE) enables patients to evaluate the expected value of a treatment by weighing its benefits, risks, and costs. It has emerged as an alternative to the minimal clinically important difference (MCID) for interpreting patient-reported outcome measures (PROMs). The purposes of this study were to determine the SWE estimates and MCID thresholds in patients undergoing surgery for adult idiopathic scoliosis (AdIS) and to verify whether meeting or exceeding the SWE estimates correlates with satisfaction at a minimum of 2 years postoperatively.

METHODS: Patients with postoperative satisfaction measured at a minimum of 2 years were prospectively recruited between July 2017 and August 2022. The Scoliosis Research Society-22 revised (SRS-22r) questionnaire was preoperatively administered to estimate the SWE thresholds using the benefit-harm trade-off method. The baseline SRS-22r and the SRS-30 at a minimum of 2 years postoperatively were recorded to determine the MCID estimates using the anchor-based approach, with questions 24 to 30 of the SRS-30 used as anchors. A construct validity assessment was performed to evaluate the association between meeting or exceeding the 50th percentile of the SWE (SWE50) threshold and postoperative satisfaction (defined as a score of ≥4 on both SRS-22r satisfaction questions). Race and ethnicity data were collected from the medical records.

RESULTS: A total of 119 Asian participants (19 male and 100 female) with a mean age of 26.5 ± 7.2 years were included. The absolute SWE50 estimates for the SRS-22r were 0.8 (interquartile range [IQR], 0.6 to 1.2) for self-image, 0.0 (IQR, 0.0 to 0.2) for function, 0.0 (IQR, 0.0 to 0.6) for pain, 0.4 (IQR, 0.0 to 0.6) for mental health, and 0.4 (IQR, 0.2 to 0.6) for the total score. The MCID thresholds for the corresponding domains or total score were 0.7, 0.1, 0.1, 0.3, and 0.3, respectively. Achieving or exceeding the absolute SWE50 threshold for the total score (p < 0.001) or the self-image (chi-square, 11.3; p < 0.001), function (chi-square, 6.3; p = 0.012), or pain (chi-square, 5.7; p = 0.017) domain was significantly correlated with postoperative satisfaction at a minimum of 2 years.

CONCLUSIONS: The SWE could serve as an effective alternative to the MCID for interpreting PROMs at a minimum of 2 years postoperatively in patients with AdIS.

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

PMID:40763206 | DOI:10.2106/JBJS.24.01269

Int Orthop. 2025 Aug 5. doi: 10.1007/s00264-025-06617-x. Online ahead of print.

ABSTRACT

INTRODUCTION: Debridement, antibiotics, and implant retention (DAIR) is a commonly employed strategy for managing acute postoperative prosthetic joint infections (PJI) while preserving the prosthesis. However, the clinical value of an unplanned second DAIR - performed due to inadequate infection control - remains controversial and is often considered a potential treatment failure. This study aimed to compare the two year clinical outcomes of patients undergoing a single DAIR versus those requiring an unplanned second DAIR for acute postoperative PJI of the hip or knee.

METHODS: We retrospectively reviewed electronic medical records of patients treated with DAIR for acute postoperative PJI between January 1999 and December 2020. Patients were categorized into two groups: those managed with a single DAIR (DAIR-1 group) and those requiring an unplanned second DAIR within 12 weeks (DAIR-2 group). Treatment failure was defined as any of the following: further debridement beyond 12 weeks, revision surgery with prosthesis removal, initiation of long-term suppressive antibiotic therapy, or PJI-related mortality. Patients lost to follow-up before two years were excluded.

RESULTS: A total of 318 patients were included, with 292 in the DAIR-1 group and 26 in the DAIR-2 group. Mean follow-up was 89.4 months. At two years, revision surgery was required in 19.2% (56/292) of DAIR-1 patients and 42.3% (11/26) of DAIR-2 patients (p = 0.005). Overall failure-free survival at two years was observed in 75.3% (220/292) of DAIR-1 patients compared to 46.2% (12/26) of those in the DAIR-2 group (p = 0.001).

CONCLUSION: Unplanned second DAIR procedures are associated with significantly lower success rates at two years. Nonetheless, given that nearly half of these patients remained free of failure, a second DAIR may still be a reasonable therapeutic option in selected cases, provided that the increased risk of a poorer prognosis is taken into account.

PMID:40762855 | DOI:10.1007/s00264-025-06617-x

SICOT J. 2025;11:44. doi: 10.1051/sicotj/2025044. Epub 2025 Aug 4.

ABSTRACT

BACKGROUND: To evaluate whether the use of patient-specific instrumentation (PSI) or conventional instrumentation (CI) is associated with superior implant positioning and knee alignment in total knee arthroplasty (TKA).

METHODS: Clinical data, pre- and post-operative knee X-rays of 95 patients, who underwent TKA with use of either patient-specific instrumentation (group PSI) or conventional intra-/extramedullary cutting guides (group CI) were retrospectively collected. Preoperative measurements of knee alignment were done by assessing the femorotibial axis, the lateral femoral distal angle, and the medial tibial proximal angle. Postoperative measurements of the mechanical TKA alignment were performed by assessing the relative position of components to the femur and tibia and the femorotibial axis angle. Only when all three parameters were within generally accepted limits was the postoperative radiological outcome considered optimal.

RESULTS: Preoperative measurements and demographics were similar among the two groups. No statistically significant differences were found between postoperative radiographic findings in patients operated on with PSI or CI. A restoration of the femorotibial axis was achieved in 87.8% and 87.0% of patients treated with PSI and CI, respectively (p = 0.583). Coronal alignment of the femoral component was within acceptable limits in 97.6% and 94.4% (p = 0.631) of patients of the PSI and CI groups, respectively. The respective percentages for the tibial component were 85.3% and 83.3% (p = 0.510) of patients. An accurate coronal plane radiological outcome was achieved in 82.9% and 77.8% of patients treated with PSI and CI, respectively (p = 0.611) Conclusions: The use of PSI does not increase the accuracy of component positioning and leg axis restoration compared to CI in TKA in patients with mild deformity.

PMID:40758900 | PMC:PMC12321163 | DOI:10.1051/sicotj/2025044

SICOT J. 2025;11:43. doi: 10.1051/sicotj/2025046. Epub 2025 Aug 4.

ABSTRACT

INTRODUCTION: Knee dislocations, particularly high-grade injuries such as Schenck class KDIV, are complex injuries often resulting from high-energy trauma. While magnetic resonance imaging (MRI) is widely used preoperatively to assess ligamentous damage, its diagnostic accuracy remains uncertain.

METHODS: A retrospective review was conducted on 92 patients who underwent surgery for a knee dislocation at a Level I trauma center over 10 years. Patients who had a preoperative MRI report and intraoperative confirmation of a KDIV injury without a tibial plateau fracture were included, which left 31 patients. MRI sensitivity was determined by comparing radiology reports to operative findings with fluoroscopic examination under anesthesia (EUA) for injuries to the anterior cruciate ligament (ACL), posterior cruciate ligament (PCL), medial collateral ligament (MCL), lateral collateral ligament (LCL), and posterolateral corner (PLC). Postoperative follow-up documents were reviewed for functional outcomes. A one-way analysis of variance (ANOVA) was performed to evaluate differences in sensitivity across ligament types, followed by a Tukey post hoc test for pairwise comparisons. Mean flexion ROM at final follow-up (≥6 months) was compared between the accurate and inaccurate MRI cohorts using an independent t-test.

RESULTS: Only 35.5% of MRI reports fully matched operative findings. MRI sensitivity was 71.0% for the ACL (22/31), 61.3% for the PCL (19/31), 93.5% for the MCL (29/31), 64.5% for the LCL (20/31), and 51.6% for the PLC (16/31). ANOVA revealed that MCL sensitivity was significantly higher than that of the PLC, PCL, and LCL. The difference in mean flexion ROM at final follow-up between accurate and inaccurate MRI cohorts was not statistically significant (p = 0.56).

DISCUSSION: Preoperative MRI radiology reports demonstrated substantial limitations in accurately identifying ligamentous injuries in KDIV knee dislocations, particularly involving the PLC, PCL, and LCL. These findings highlight a gap between radiologic interpretation and surgical findings. Surgeons should interpret MRI reports with caution and incorporate fluoroscopic EUA at the time of surgery to ensure a comprehensive assessment of ligamentous damage.

PMID:40758899 | PMC:PMC12321162 | DOI:10.1051/sicotj/2025046

EFORT Open Rev. 2025 Aug 4;10(8):589-599. doi: 10.1530/EOR-2024-0105.

ABSTRACT

PURPOSE: The objective of this study was to assess the benefits of the PENG block on pain control and functional recovery.

METHODS: Randomized controlled trials in PubMed, Web of Science, Embase, and the Cochrane Library were selected, and data were meta-analyzed using a random-effects model to estimate mean difference (MD) or standardized mean differences (SMD).

RESULTS: Eleven trials involving 1,135 patients were included. The PENG block was associated with significantly lower total opioid consumption than sham/no block (MD: -25.23, 95% CI: -27.01 to -23.45, I 2 = 0%), as well as better functional recovery. The PENG block was noninferior to the suprainguinal fascia iliaca block regarding postoperative pain scores and functional recovery and had a significant reduction in total opioid consumption (MD: -8.25, 95% CI: -16.48 to -0.02, I 2 = 68%). The PENG block was associated with similar total opioid consumption and functional recovery as the periarticular anesthetic infiltration (PAI), but worse static pain scores at 12 h (SMD: 0.41, 95% CI: 0.08-0.75, I 2 = 51%) and dynamic pain scores at 48 h after surgery (SMD: 0.36, 95% CI: 0.08-0.64, I 2 = 0%).

CONCLUSIONS: While current evidence supports the PENG block as a viable alternative to other types of peripheral analgesia in THA, existing data remain insufficient to conclude that the PENG block outperforms other peripheral analgesia when it comes to pain control or functional recovery. More well-designed randomized controlled trials are needed in the future to thoroughly explore whether the PENG block has superiority over other analgesic techniques.

PMID:40757814 | PMC:PMC12326972 | DOI:10.1530/EOR-2024-0105