Int Orthop. 2026 Apr 27. doi: 10.1007/s00264-026-06814-2. Online ahead of print.

ABSTRACT

BACKGROUND: The Zweymüller femoral stem is a well-established design for cementless total hip arthroplasty (THA). However, long-term data are scarce on modified versions produced by different manufacturers. This study aimed to evaluate the ten year clinical and radiographic outcomes of the Elance stem, a modified Zweymüller-type prosthesis.

METHODS: We retrospectively reviewed 82 primary THAs performed between 2013 and 2015 using the Elance stem. This stem features an alkali- and heat-treated bioactive surface and lacks the traditional trochanteric shoulder. The target roughness of the stem surface was 1.0 to 2.5 µm. The primary endpoint was survivorship with revision for any reason; the secondary endpoint was the rate of the aseptic loosening of the Elance stem.

RESULTS: The 10-year survivorship rate with revision for any reason was 53% (95% CI: 40-63%). Forty-one hips (50%) underwent revision surgery, with 40 of these revisions (98%) due to aseptic stem loosening. Additionally, four stems demonstrated radiographic loosening but had not yet undergone revision, resulting in a total stem loosening rate of 54%.

CONCLUSIONS: The Elance femoral stem demonstrated unacceptably low year survivorship. Design modifications, specifically the omission of the trochanteric shoulder and a lower surface roughness compared to the original Zweymüller design, likely compromised initial stability and long-term osseointegration. These findings emphasize that bioactive surface treatments cannot compensate for suboptimal stem design and that caution is warranted when adopting modified orthopaedic implants without robust long-term evidence.

PMID:42043540 | DOI:10.1007/s00264-026-06814-2

Injury. 2026 Apr 23:113303. doi: 10.1016/j.injury.2026.113303. Online ahead of print.

ABSTRACT

BACKGROUND: Motor vehicle crashes (MVCs) are a leading cause of injury and death in the United States. Community-level factors, such as social vulnerability and urbanicity, have been associated with risk of death; less is known about how these factors impact nonfatal, post-injury outcomes. This study examined the association between social vulnerability and urbanicity with hospital length of stay (LOS) and hospital discharge disposition among MVC patients.

METHODS: Patients aged 18 years and older who were admitted to a Montana regional trauma center with a non-fatal injury following an MVC from 2016 to 2024 were included in the study. The CDC Social Vulnerability Index (SVI) was used to quantify social vulnerability at the census tract level and scores were divided into tertiles representing low, medium, and high vulnerability. Urbanicity was defined using RUCA codes based on patient residence. Generalized estimating equations with a binomial distribution were used to estimate the joint association between SVI and urbanicity with discharge disposition (home vs. facility) and prolonged LOS (≥7 days), controlling for injury severity, patient demographics, and comorbidities.

RESULTS: Of the 668 patients, 529 (79%) were discharged home and 179 (27%) had a prolonged LOS. Among metropolitan patients, higher SVI rankings were associated with increased odds of discharge home; patients with medium and high SVI had respectively 2.6 and over 3 times greater odds of being discharged home than low SVI (medium aOR: 2.64; 95% CI: 1.96, 3.57; high aOR: 3.26; 95% CI: 2.52, 4.23). This association was not observed for non-metropolitan patients; however, patients from non-metropolitan had 2 times the odds of a prolonged LOS than those from metropolitan areas regardless of SVI (aOR: 2.03; 95% CI: 1.38, 2.98).

CONCLUSION: The association between social vulnerability and discharge disposition following a MVC differed by urbanicity, and urbanicity was also associated with prolonged LOS. Further research to better understand how sociodemographic factors impact nonfatal injury outcomes can help reduce disparities in care.

PMID:42034518 | DOI:10.1016/j.injury.2026.113303

Injury. 2026 Apr 15:113292. doi: 10.1016/j.injury.2026.113292. Online ahead of print.

ABSTRACT

Concomitant ipsilateral fractures of the clavicle, scapula, and ribs, termed forequarter lateral implosion injury, represent a severe but underrecognized injury pattern resulting from high-energy lateral shoulder trauma. While the surgical indications for isolated chest wall and shoulder girdle injuries are well described, guidance on the integrated management of this combined injury complex remains limited. We describe a reproducible multidisciplinary approach for the concurrent surgical fixation of clavicle, scapula, and rib fractures, illustrated through two cases of forequarter lateral implosion injury resulting from high-energy road traffic accidents. Preoperative planning incorporated CT three-dimensional (3D) reconstructions and patient-specific 3D printed models to facilitate pre-operative planning, with a multidisciplinary team involved for incision planning and fixation sequencing. Surgery was performed in a single setting with the patient in the lateral position, utilizing muscle-sparing approaches and a staged fixation strategy to address the clavicle, scapula, and ribs through coordinated exposures. Simultaneous osseous stabilization allowed restoration of the superior shoulder suspensory complex integrity and chest wall mechanics, enabling immediate postoperative shoulder mobilization and aggressive pulmonary rehabilitation. Both patients demonstrated early pain resolution, functional shoulder range of motion, radiographic union, and return to work within months and without major complications. In the setting of combined chest wall and shoulder girdle disruption, the cumulative biomechanical instability may justify a judicious relaxation of traditional surgical thresholds to permit concurrent surgical stabilization to facilitate earlier rehabilitation and recovery. This study characterizes the underrecognized entity of a forequarter lateral implosion injury, highlights practical management considerations, and supports an integrated surgical strategy to optimize functional recovery.

PMID:42034517 | DOI:10.1016/j.injury.2026.113292

Injury. 2026 Apr 22;57(6):113297. doi: 10.1016/j.injury.2026.113297. Online ahead of print.

ABSTRACT

BACKGROUND: Septic tibial nonunion regarding proximal metaphysis is a rare complication with devastating results.

METHODS: Due to scarce literature about this condition, a prospective interventional study using Ilizarov External Frame was conducting with participants recruitment from December 2020 till January 2022. Primary outcomes were bone healing and infection eradication while side-effects were reported. Secondary outcomes were the final leg length discrepancy (LLD) more than 2.5 cm, external fixation time, the Association for the Advancement of Methods of Ilizarov (ASAMI) bone and functional classification scores, the Knee Outcome Survey-Activity of Daily Living Scale (KOS-ADSL) score, the American Academy of Orthopedic Surgeons (AAOS) Lower Limb Scale, the quality-adjusted life year (QALY) Time Trade-Off and the Short-Form 12 (SF-12) physical and mental score.

RESULTS: 17 patients (16 males) with infected proximal tibial nonunions were treated with an Ilizarov external fixator at the Orthopedic Department of Serres General Hospital in Serres, Greece. Fracture healing and infection eradication were achieved in all patients with minimum follow-up of 30 months. Tibia deformity was present in four cases (23.5%), and length discrepancies were observed in one patient (3 cm). Limping was recorded in three patients. Stiffness of the knee or ankle was reported in six patients but all patients except one were pain-free. Everyone resumed their work or daily activities. According to ASAMI, the bone results were excellent in 13 patients, good in three patients, and fair in one. Analogously, the functional results were excellent in 11 patients, good in two and fair in 4 patients. Patient Reported Outcome Measures (PROMs) display an impressive improvement over the observation period.

CONCLUSION: The Ilizarov method is a reliable technique for managing septic proximal tibial metaphyseal nonunions, particularly in cases involving extensive bone loss and existing deformities. Of vital importance is the assembling of an experienced multidisciplinary team to manage these rare and complex clinical conditions.

TRIAL REGISTRATION: ISRCTN30905788 (SePseT Ilizarov).

PMID:42034023 | DOI:10.1016/j.injury.2026.113297

Injury. 2026 Apr 20;57(6):113298. doi: 10.1016/j.injury.2026.113298. Online ahead of print.

ABSTRACT

AIM: To investigate the appropriateness of lower doses of loxoprofen in patients with type two diabetes (T2D) with bone fractures/surgeries in comparison to common NSAIDs.

METHODS: The current study is a prospective cross-sectional study. A total of 174 patients treated for bone fractures/orthopedic surgeries were recruited from orthopedic outpatient clinics in Amman, Madaba, and University of Jordan Hospital. Risk stratifications were performed for cardiovascular (CV), gastrointestinal (GI), renal, and hepatic complications. We created in-depth comparisons of safety and effectiveness of common NSAIDs in alleviating postoperative/ fracture pain.

RESULTS: All NSAIDs showed variable reductions in the numerical pain score (NPS) after four weeks. Loxoprofen was the only NSAID prescribed at lower daily doses of 60-120 mg. Loxoprofen resulted in the most reduction in NPS; the fastest onset of action; the least time to reach peak analgesia; decrease in nocturia and the strongest overall pain relief in bone fractures and postoperative pain, p < 0.05. Celecoxib had the highest variability in pain relief among the agents.

CONCLUSION: Lower doses of loxoprofen provide an effective strategy to alleviate postoperative and bone fracture pain and increase patient satisfactions among T2D at lower systemic risks compared to other NSAIDs. Such low dosing approach provides a plausible balanced triad of safety, effectiveness and maximum bone healing which lead to maximum patient satisfaction.

PMID:42034022 | DOI:10.1016/j.injury.2026.113298

Injury. 2026 Apr 21;57(6):113289. doi: 10.1016/j.injury.2026.113289. Online ahead of print.

ABSTRACT

INTRODUCTION: Antibiotic-laden beads provide high, local concentrations of antibiotics and are used to prevent infections in open fractures. This study aimed to determine if wound management with antibiotic beads was associated with fewer surgical site infections (SSI) and unplanned fracture-related operations in patients with severe lower extremity open fractures.

MATERIALS AND METHODS: This cohort study included patients enrolled in the Aqueous-PREP and PREPARE Open trials with a single Gustilo-Anderson (GA) type III open fracture of the lower extremity. Our primary outcome was SSI within 90 days of initial surgery. The secondary outcomes included both SSI and unplanned reoperation for infection within one year of injury and adverse renal events. We used propensity score matching to reduce bias related to several factors, including wound contamination and number of surgeries that may influence the use of antibiotic beads. We used conditional logistic regression to estimate odds ratios (ORs) for the association between antibiotic bead use and the study outcomes.

RESULTS: Of 1039 included patients, 106 (10%) received antibiotic beads comprised primarily of vancomycin (95%) and tobramycin (77%). After propensity score matching, the association of antibiotic beads and SSI within 90 days of initial surgery did not reach statistical significance (OR = 1.9, 95% CI 1.0 - 3.8, p = 0.06). Bead use was associated with an increased odds of SSI within the year following injury (OR = 2.0, 95% CI 1.1 - 3.6, p = 0.02) and an increased odds of unplanned reoperation for infection (OR = 2.0, 95% CI 1.1 - 3.8, p = 0.03). Bead use was not associated with renal serious adverse events.

DISCUSSION: Patients with severe lower extremity open fractures treated with antibiotic beads had greater odds of SSI and unplanned reoperation for infection in the year following injury; however, antibiotic bead formulation was not standardized and could potentially influence the results of this study. These findings challenge the previously reported effectiveness of antibiotic-laden beads from retrospective studies. A randomized trial examining this treatment strategy is warranted.

PMID:42034021 | DOI:10.1016/j.injury.2026.113289

Injury. 2026 Apr 15:113199. doi: 10.1016/j.injury.2026.113199. Online ahead of print.

ABSTRACT

INTRODUCTION: Traumatic injury in older people is a significant health burden with higher mortality rates than younger cohorts. Survival following older trauma may be complicated by the patients pre-injury state and clinical uncertainty. Timely identification of palliative and end-of-life care needs may be challenging for acute clinical teams, and treatment escalation planning is not routinely embedded in trauma care. This point prevalence snap-shot aimed to evaluate treatment escalation discussions and palliative/end of life care (EoLC) practice in older major trauma patients at a national level.

METHODS: A one-day point prevalence "flash-mob" audit was conducted across Major Trauma Centres (MTCs) and Trauma Units (TUs) in England, Wales and Scotland. All trauma patients aged ≥ 65 years in hospital were eligible for inclusion. Patients with and without treatment escalation plans (TEPs) and those on care pathways were analysed.

RESULTS: Data from 957 patients in 49 hospitals were included and median time from injury was 11 days (interquartile range 4-24). A TEP or equivalent was documented in 393 patients (41.0%). Among patients with a TEP, there were more aged > 85 years (165/393 (41.9%), than in those without a TEP (167/564 (29.6%), p < 0.001). Clinical frailty scoring was performed in 657 patients (68.6%), and where recorded, TEPs were associated with increased frailty (CFS ≥5 TEP: 68% [207/304] vs. No TEP: 46.4% [164/353], p < 0.001). Polytrauma predominated over any single site injury (TEP: 140/393, 35.6% vs. No TEP: 197/564, 34.9%). Admitting specialty teams differed between groups and those with a TEP were more likely to be under the care of a medical consultant (92/393, 23.4%) compared to only 60/564, 10.6% of the no-TEP patients (p < 0.001). A fifth of those with a TEP were on a documented palliative, time-limited or end-of-life care pathway (20.3%). Care pathways were more likely in those with older age (p < 0.001) and severe frailty (CFS≥7) (p = 0.03) rather than injury type, clinical specialty or advance care plans.

CONCLUSION: This national snapshot demonstrates limited and variable use of treatment escalation planning with low rates of recorded palliative and EoLC need discussions in older major trauma patients. Greater integration of frailty assessment and early goals-of-care discussions are required to improve care for this growing population.

PMID:42031637 | DOI:10.1016/j.injury.2026.113199

Injury. 2026 Apr 19;57(6):113184. doi: 10.1016/j.injury.2026.113184. Online ahead of print.

ABSTRACT

Femoral neck fractures (FNFs) represent a critical challenge in orthopedic trauma, characterized by high incidences of postoperative osteonecrosis of the femoral head (ONFH) and nonunion. For young patients and active elderly individuals, anatomic reduction and stable internal fixation remain the primary therapeutic goals. However, conventional assessment of reduction quality relies on two-dimensional (2D) fluoroscopic indices, which often lack the sensitivity to detect complex rotational or translational malalignment. Emerging three-dimensional (3D) digital techniques and robotic assistance offer superior spatial visualization and objective measurement frameworks. This review evaluates the evolution from classic 2D radiographic criteria to contemporary 3D digital assessment tools, discussing their clinical efficacy and potential for enhancing robotic-assisted surgical precision.

PMID:42030599 | DOI:10.1016/j.injury.2026.113184

Injury. 2026 Apr 9;57(6):113263. doi: 10.1016/j.injury.2026.113263. Online ahead of print.

ABSTRACT

OBJECTIVES: To determine the frequency, laterality, diameter, and arterial origin of the corona mortis (CM) using computed tomography angiography (CTA) in a large consecutive cohort from two affiliated academic hospitals. A secondary objective was to assess demographic associations with CM, including age, sex, body mass index (BMI), and race or ethnicity.

METHODS: This retrospective study evaluated 988 consecutive abdominal and pelvic CTAs performed between 2020 and 2022 at Parkland Hospital and Clements University Hospital, representing 1976 hemipelvises. All patients aged be ≥ 18 years with diagnostic-quality CTA were included. Studies were not excluded for trauma indications or prior pelvic surgery, ensuring an inclusive, real-world imaging population. CM presence, laterality, vessel diameter, and arterial origin were recorded. Demographic variables were collected, and analyses were performed using the Wilcoxon rank-sum test, paired t-test, and sign test.

RESULTS: Arterial CM was identified in 318 of 988 patients (32.2%). Among CM-positive cases, 53% were unilateral and 47% bilateral, with laterality distributed as 25% right-sided, 27% left-sided, and 47% bilateral. The median vessel diameter measured 2.40 mm (IQR, 2.00-2.50 mm). Most CMs originated from the inferior epigastric artery (98%), while 2.3% arose directly from the external iliac artery. CM was more common in females and in non-Hispanic Black individuals. Patients with CM were significantly older than those without (p = 0.035). Vessel diameter differed significantly between sexes (paired t-test, p = 0.004; sign test, p = 0.006).

CONCLUSIONS: Across two major academic hospitals, this large consecutive CTA cohort-the largest reported to date-identified arterial CM in nearly one-third of patients and demonstrated meaningful demographic variability. Given its potential for clinically significant bleeding, systematic evaluation of CM on preoperative or preprocedural CTA may help reduce iatrogenic vascular injury during pelvic and acetabular surgery.

PMID:42030598 | DOI:10.1016/j.injury.2026.113263

J Bone Joint Surg Am. 2026 Apr 23. doi: 10.2106/JBJS.26.00126. Online ahead of print.

NO ABSTRACT

PMID:42024769 | DOI:10.2106/JBJS.26.00126

J Bone Joint Surg Am. 2026 Apr 23. doi: 10.2106/JBJS.26.00355. Online ahead of print.

NO ABSTRACT

PMID:42024718 | DOI:10.2106/JBJS.26.00355

J Bone Joint Surg Am. 2026 Apr 23. doi: 10.2106/JBJS.25.00667. Online ahead of print.

ABSTRACT

BACKGROUND: Understanding drivers of supply and labor cost variation in orthopaedic surgery is crucial to provide value-based care. Time-driven activity-based costing (TDABC) is a more accurate methodology for capturing costs of care than traditional methods. Anterior cruciate ligament reconstruction (ACLR) is one of the most performed outpatient procedures within orthopaedic surgery. The purpose of this study was to characterize the cost composition of ACLR and identify factors that drive cost variation.

METHODS: Cost data for supplies and time-based personnel usage were extracted from electronic health records and were used to calculate costs using TDABC. TDABC methodology was applied to calculate the cost of personnel usage by multiplying the duration and associated cost per minute. Descriptive statistics and mixed-effects modeling were used to determine cost drivers.

RESULTS: This study included 861 patients who underwent ACLR at 8 hospitals. The mean patient age (and standard deviation) was 31.1 ± 11.6 years. Of the 861 patients, 350 were male and 511 were female; 85.6% of patients were White, 8.1% were Asian, and 3.4% were Black. There was 3.2-fold variation in supply costs ($2,950) and 1.6-fold variation in labor costs ($940) between the 10th and 90th percentiles. Overall, supply costs accounted for 58.2% of total costs, whereas labor costs comprised the remaining 41.8%. The intraoperative phase was the greatest generator of total cost (89.7%). After adjusting for surgeon and hospital variability, variation in total cost was most effectively explained by graft type, primary surgery status, and meniscal repair (conditional R2 = 0.84; marginal R2 = 0.27). On subanalysis, patients undergoing allograft ACLR had significantly higher total costs, implant costs, and age compared with those undergoing ACLR with any autograft type (all p < 0.01).

CONCLUSIONS: The most notable drivers of labor and supply cost variation were graft type, surgeon, surgery center, primary surgery status, and concomitant meniscal repair. Understanding modifiable cost drivers may aid health systems in designing value-based pathways, implant formularies, and surgeon education programs. Future studies may integrate cost with outcome measures for a more holistic view of value.

LEVEL OF EVIDENCE: Economic and Decision Analysis Level III. See Instructions for Authors for a complete description of levels of evidence.

PMID:42024715 | DOI:10.2106/JBJS.25.00667

Injury. 2026 Apr 17:113295. doi: 10.1016/j.injury.2026.113295. Online ahead of print.

ABSTRACT

BACKGROUND: Trauma team activation protocols are critical for mobilizing resources in the care of severely injured patients. In the US, the American College of Surgeons (ACS) specifies minimum criteria for the highest-level (full) trauma activation (fTA), but hospitals retain discretion to add criteria, potentially leading to variability in activation practices and resource utilization. The extent of this variation and its impact on patient outcomes is unknown. The aim of this study was to quantify inter-hospital variability in fTA use and its relationship to mortality.

METHODS: We conducted a multicenter, retrospective cohort study of adult trauma patients treated at 37 Level I and II trauma centers across the United States from 2017 to 2019; transfers were excluded. Mixed-effects logistic regression models were used to quantify inter-hospital variability in fTA utilization and total mortality (death+hospice), adjusting for 12 patient and hospital-level characteristics. Correlation analyses assessed the relationship between adjusted hospital-specific fTA rates and adjusted total mortality.

RESULTS: Overall, 158,696 patients were included, with 34,374 (21.7%) receiving a fTA. The median age was 53 yrs, with 59% male, 71% White, 88% blunt, and a median Injury Severity Score of 9. Use of fTA varied widely (3.3% to 54.1%, median [IQR]=19.3% [13.6-27.3%]) and the adjusted odds of fTA varied significantly across hospitals (SD=0.88; coefficient of variation [CV]=0.53), with 83.7% of hospitals differing significantly from the average hospital. In contrast, adjusted odds of total mortality showed lower inter-hospital variation (SD=0.31; CV=0.22), with 35% of hospitals differing significantly from the average hospital. Overall, no statistically significant correlation was found between adjusted hospital-level fTA rates and total mortality (r = 0.07, b=0.01, p = 0.69). Age-stratified sensitivity analyses also confirmed substantially greater inter-hospital variability in fTA rates compared to mortality rates.

CONCLUSIONS: Substantial variation in fTA utilization exists across this sample of U.S. trauma centers. Importantly, higher fTA rates were not associated with improved mortality outcomes. These findings suggest that discretionary activation practices may lead to inconsistent resource utilization without measurable benefit on total mortality. Standardized evidence-based criteria for fTA may improve resource stewardship and trauma system efficiency.

PMID:42025512 | DOI:10.1016/j.injury.2026.113295

Injury. 2026 Apr 10;57(6):113274. doi: 10.1016/j.injury.2026.113274. Online ahead of print.

ABSTRACT

BACKGROUND: Hip fractures and vertebral fractures are significant public health concerns, causing substantial morbidity, mortality, and economic costs. Hip fractures often lead to mobility loss, while vertebral fractures, frequently underdiagnosed, can result in spinal deformities and recurrent fractures or subsequent injuries.

METHODS: This study identified hip and vertebral fractures using ICD-9 and ICD-10 codes in Taiwan's National Health Insurance Research Database (NHIRD). It applied Kaplan-Meier and Monte Carlo methods to estimate survival functions, comparing outcomes with a reference population. Extrapolation beyond the follow-up period was done to calculate lifetime life expectancy.

RESULTS: The study included 214,077 hip fracture patients and 101,731 vertebral fracture patients. The average age was 77.1 for hip fractures and 73.4 for vertebral fractures, with women comprising the majority. For hip fractures, the estimated life expectancy (LE) was 7.9 years, while for vertebral fractures, it was 11.9 years. Patients with a history of stroke exhibited the greatest loss of life expectancy in both fracture cohorts.

CONCLUSION: This study highlights the significant loss of life expectancy in stroke patients with hip fractures. It urges policymakers to prioritize prevention strategies and resource allocation to improve outcomes for high-risk populations.

PMID:42025401 | DOI:10.1016/j.injury.2026.113274

Injury. 2026 Apr 16;57(6):113296. doi: 10.1016/j.injury.2026.113296. Online ahead of print.

ABSTRACT

INTRODUCTION: Periprosthetic distal femur fractures are deleterious injuries, found commonly in the elderly osteoporotic population, typically addressed with open reduction internal fixation (ORIF). Fractures that are very distal (Su type III) require special considerations due to limited distal bone stock for fixation. The utilization of the nail-plate combination (NPC) technique for these patients aims for an early return to ambulation by maximizing distal fixation and stability while allowing for immediate postoperative weight-bearing.

METHODS: The technical steps for NPC in very distal periprosthetic femur fractures are outlined in addition to a comparative case series of these injuries treated with NPC, retrograde intramedullary nail (rIMN), lateral locking plate (LLP), and dual plate contruct (DPC). Primary outcomes included postoperative weight-bearing status, ambulatory recovery using Koval scores, radiographic union (mRUST and documented union), reoperation, and mortality.

RESULTS AND CONCLUSIONS: All NPC patients were permitted immediate weight-bearing as tolerated (WBAT) on postoperative day 1, significantly more frequently than other constructs (p < 0.001), with maintained significance versus rIMN after correction (p = 0.012). There were no significant differences in Koval mobility scores at any postoperative time point. One-year mortality was 15.9%, and reoperation occurred in 20%, with no significant differences between constructs. Union outcomes were limited due to sparse data. Therefore, the NPC is a useful method that allows immediate and consistent functional recovery and stability for very distal periprosthetic femur fractures.

PMID:42025400 | DOI:10.1016/j.injury.2026.113296

Int Orthop. 2026 Apr 23. doi: 10.1007/s00264-026-06819-x. Online ahead of print.

ABSTRACT

PURPOSE: Allograft-prosthetic composites (APC) are used to reconstruct large periarticular defects following tumour resection, with potential advantages especially restoration of bone stock and ligamentous reattachment. While short- and mid-term outcomes have been reported on extensively, long-term clinical results remain limited. This study evaluated the incidence of mechanical and non-mechanical complications, risk factors for complications, and the cumulative incidence of reconstruction failure following APC reconstruction for extremity tumours with a minimum follow-up of ten years.

METHODS: We retrospectively reviewed 64 APC with at least ten years follow-up in our centre. Predominant diagnoses were osteosarcoma (40%) and chondrosarcoma (28%). Reconstructions involved the proximal femur (39%), distal femur (22%), proximal tibia (23%) and proximal humerus (16%). Median follow-up was 24.5 years (95%CI 23.6-25.4).

RESULTS: Instability occurred in nine reconstructions (14%). Non-union was observed in nine reconstructions (14%). Implant loosening occurred in seven reconstructions (11%) after a median of 14 years (range 2-18 years). Allograft collapse occurred in 13 reconstructions (20%) after a median of three years (range 1-15). Infection developed in five reconstructions (8%). Cumulative incidence of mechanical failure at five, ten and 25 years was 15.6% (95%CI 6.6-24.6), 21.9% (95%CI 11.6-32.1) and 28.6% (95%CI 17.2-39.9), respectively.

CONCLUSIONS: APC are associated with a considerable risk of both early and late complications. Non-union and infection predominate in the early postoperative period, whereas aseptic loosening and fractures are the main causes of late failure, occurring up to 18 years after surgery. These findings suggest that the routine use of APC for periarticular reconstruction after tumour resection should be reconsidered.

PMID:42026181 | DOI:10.1007/s00264-026-06819-x

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

ABSTRACT

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

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

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

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

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

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

ABSTRACT

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

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

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

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

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

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

ABSTRACT

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

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

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

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

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

J Bone Joint Surg Am. 2026 Apr 22. doi: 10.2106/JBJS.25.01219. Online ahead of print.

ABSTRACT

BACKGROUND: For patients with periacetabular metastases, protrusio acetabuli is a severely painful and mobility-impairing complication that requires subsequent open joint surgery. We aimed to identify specific structural changes that are associated with progression to protrusio acetabuli and to create a scoring system to guide risk stratification.

METHODS: In this single-institution cohort study, we identified all patients who underwent primary surgical stabilization for periacetabular metastases with osteolytic or mixed osteolytic-osteoblastic characteristics from October 2017 through January 2025. Cases of protrusio acetabuli prior to surgical intervention were identified. Pain and ambulatory functional scores and treatment history were recorded. Locations of bone destruction were evaluated using coronal-cut computed tomography (CT) scans obtained within 3 months before clinical presentation (and earlier, as available). Trabecular and subchondral cortical bone mass of the periacetabular weight-bearing portions were indirectly assessed via Hounsfield unit ratio comparisons across scans. Univariable analysis of each feature was performed. The highest-scoring features were used to create a scoring system and analyzed using a receiver operating characteristic (ROC) curve. Finite element analysis was performed for biomechanical validation.

RESULTS: Eighty-seven patients (67 non-protrusio [mean age of 65.5 ± 13.0 years; 37 female]; 20 protrusio [mean age of 72.9 ± 10.1 years; 11 female]) were included. Locationally, bone defects, thinning, or linear fractures in the middle-third (apex) alongside contiguous involvement of either the medial- or lateral-third of the weight-bearing dome were highly predictive of protrusio. A >50% cortical bone-mass decrease of the acetabular weight-bearing dome was associated with protrusio (p < 0.05). A radiographic risk scoring system was then constructed using a grading system from low- to high-risk features. ROC analysis showed a score of ≥3.0 as 95.0% sensitive and 91.0% specific for progression to protrusio. Finite element analysis further showed that cortical bone loss of the middle-third (apex) of the weight-bearing dome was critical.

CONCLUSIONS: We propose the use of clinical and radiographic risk predictors to stratify patients with periacetabular metastases on the basis of the risk of protrusio. Anatomically, surgical stabilization of the middle-third (apex) of the weight-bearing dome is critical to preventing or delaying progression to protrusio.

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

PMID:42018647 | DOI:10.2106/JBJS.25.01219