Injury. 2026 Apr 10;57(6):113284. doi: 10.1016/j.injury.2026.113284. Online ahead of print.

ABSTRACT

The bifurcation and confluence of the common iliac vessels and their course are critical considerations for safe surgical acetabular fracture repair. Anatomical variations in the expected placement of these vessels have been associated with intraoperative complications, including hemorrhage. The purpose of this study was therefore to define vertebral levels of bifurcation and confluence of the common iliac vessels and trace their passage across the quadrilateral plate, a surgically significant landmark. The findings revealed 57% and 11% of bifurcation and confluence, respectively, were located at vertebral levels higher than the commonly reported level of L4. Variations were also more common than previous reports, with the current study observing cases of absent common iliac veins and aberrant communicating veins. The course trajectories revealed 10.6% of the study sample would have been predisposed to surgical complications involving the common iliac vessels.

PMID:41985388 | DOI:10.1016/j.injury.2026.113284

Injury. 2026 Apr 10;57(6):113272. doi: 10.1016/j.injury.2026.113272. Online ahead of print.

ABSTRACT

BACKGROUND: As per current British Orthopaedic Association Standards for Trauma (BOAST), all patients presenting with pelvic fractures should undergo a contrasted Computer Tomography (CT) scan and post binder removal X-ray (PBXR). According to those guidelines, retrograde cystography is recommended to investigate suspected bladder injury. However, retrograde cystography is an invasive procedure that is not easy to perform in polytrauma patients. We hypothesise that timely PBXR can show contrast accumulation in the bladder which may help detect bladder or urethra injuries.

AIM: This paper evaluates whether patterns of contrast within the bladder or extravasating on the PBXR indicate associated urological injury. It also examines if catheterisation and timing of the PBXR affects diagnostic ability.

METHODS: Patients with pelvic ring and/or acetabulum fractures were retrospectively identified from Electronic Patient Records of two Level 1 Trauma centres (July 2021 to December 2024). PBXRs were analysed to determine the contrast pattern and to look for extravasation. Patterns were correlated with bladder injury findings from urological investigations or intra-operative findings. Catheterisation and CT-PBXR time interval were recorded.

RESULTS: Of the 601 patients with pelvic fracture, 186 underwent a CT scan followed by PBXR. Five (2.69%) patients had confirmed bladder injury. Contrast extravasation was visible on PBXR in 4 (80%) patients with bladder injury (p < 0.001). Of the 181 patients without bladder injury, none of them showed contrast extravasation and 122 (67%) had contrast visible within the bladder. In patients without bladder injury, 47 (25.97%) were catheterised, which was associated with less commonly seeing contrast filling the bladder when compared to those without a catheter (p = 0.005). PBXR performed within 10 h of CT scan was associated with a significantly higher rate of contrast-filled bladder (85.82%) than those performed more than 10 h after CT scan (14.89%) (p < 0.001). There was also significant correlation between those with a catheter and having a bladder injury (p = 0.021).

CONCLUSIONS: Visible contrast extravasation on PBXR correlates strongly with bladder injury associated with pelvic trauma. This is more reliable when patients are not catheterised and PBXR is performed within 10 h of CT scan. Timely PBXR after contrasted CT can identify patients who would benefit from expedited urological referral. Further prospective investigation is warranted.

PMID:41985387 | DOI:10.1016/j.injury.2026.113272

Injury. 2026 Apr 9;57(6):113264. doi: 10.1016/j.injury.2026.113264. Online ahead of print.

ABSTRACT

INTRODUCTION: Heterotopic ossification (HO) is a frequent complication of acetabular fracture fixation; however, the optimal strategy for prophylaxis remains controversial. This study aimed to evaluate the incidence and clinical course of HO after posterior acetabular fixation performed without routine prophylaxis, and to identify independent predictors of its development.

MATERIALS AND METHODS: A cohort of 257 consecutive patients who underwent acetabular fracture fixation via the Kocher-Langenbeck approach between 2001 and 2023 at a Level I trauma center was retrospectively analyzed. No routine postoperative prophylaxis with non-steroidal anti-inflammatory drugs or radiation therapy was administered. The patients were followed up for a minimum of 12 months (mean, 53 months). HO was graded according to the Brooker classification. Potential risk factors for HO development were examined using univariate and multivariate logistic regression analyses.

RESULTS: HO developed in 34 (13.2%) patients, with 23 (9.0%) demonstrating clinically significant HO (Brooker grade III or IV). Radiographic HO was first detected at a mean of 6.7 weeks postoperatively. Among the patients with HO, seven (20.6%) developed painful ankylosis requiring surgical excision at a mean of 11.5 months after diagnosis: one had Brooker grade III HO and six had grade IV HO. Univariate analysis demonstrated significant associations between HO and traumatic brain injury, mechanical ventilation, traumatic hip dislocation, femoral head fracture, and retained intra-articular debris (all p < 0.05). After adjustment for confounding factors, traumatic brain injury (odds ratio [OR], 6.98; 95% confidence interval [CI] 3.03-16.08), mechanical ventilation (OR, 9.49; 95% CI, 3.70-24.32), and retained intra-articular debris (OR, 7.42; 95% CI, 3.01-18.29) remained independent predictors, whereas hip dislocation and femoral head fracture were no longer significant.

DISCUSSION: In this cohort, posterior acetabular fixation without routine prophylaxis was associated with a relatively low incidence of clinically significant HO, comparable to the rates reported in a contemporary series. HO development is primarily associated with markers of systemic injury severity and the presence of retained intra-articular debris. These findings suggest that risk stratification based on injury severity and meticulous intra-articular management may be appropriate for determining the need for HO prophylaxis.

PMID:41985386 | DOI:10.1016/j.injury.2026.113264

Injury. 2026 Apr 6:113251. doi: 10.1016/j.injury.2026.113251. Online ahead of print.

NO ABSTRACT

PMID:41982036 | DOI:10.1016/j.injury.2026.113251

Injury. 2026 Apr 3:113219. doi: 10.1016/j.injury.2026.113219. Online ahead of print.

NO ABSTRACT

PMID:41982035 | DOI:10.1016/j.injury.2026.113219

J Bone Joint Surg Am. 2026 Feb 19. doi: 10.2106/JBJS.25.01203. Online ahead of print.

ABSTRACT

BACKGROUND: Periprosthetic femoral fractures (PFFs) are an increasingly common indication for revision total hip arthroplasty (THA). While patient-related risk factors are well documented, the influence of femoral stem design on PFF risk remains poorly characterized. In this study using nationwide data, we assessed the association between stem design and PFF risk.

METHODS: We analyzed 182,118 primary THAs (performed from 2015 to 2023) from the Swiss National Joint Registry (SIRIS). Cementless stems were categorized according to the Kheir classification, and cemented stems were categorized as double-tapered polished, triple-tapered polished, composite-beam, or custom. A multivariable Cox regression model, including variables such as age, sex, American Society of Anesthesiologists (ASA) class, body mass index (BMI), surgical indication, prior ipsilateral hip surgery, stem design, collar, dual-mobility cup, bearing, and head size, was analyzed. Hazard ratios (HRs) with 95% confidence intervals (CIs) are reported.

RESULTS: Among 182,118 THAs (mean patient age, 68.9 ± 11.5 years; female sex in 53.1% of cases), 1,226 (0.7%) were complicated by PFF. The cumulative incidence of PFF reached 0.7% at 5 years and 1.3% at 10 years. Higher PFF risk was associated with an age of 75 to 84 years (HR = 1.68 [95% CI = 1.44 to 1.96]) and ≥85 years (HR = 1.86 [95% CI = 1.47 to 2.35]), ASA class of 3 to 5 (females, HR = 1.70; males, HR = 1.73), BMI of <18.5 kg/m2 (HR = 1.61) or ≥40 kg/m2 (HR = 1.64), prior ipsilateral hip surgery (HR = 1.32), and use of a dual-mobility cup (HR = 1.56). Elective procedures (HR = 0.36) and collared stems (HR = 0.26) were associated with a lower risk. Compared with cementless type-3 stems, cementless type-7 (anatomic) stems showed a higher risk of PFF (HR = 1.88), whereas cementless type-1B (HR = 0.62) and composite-beam cemented stems (HR = 0.45) were protective.

CONCLUSIONS: In this large nationwide registry study, femoral stem design independently influenced PFF risk after primary THA. Cementless anatomic stems increased the risk, whereas composite-beam cemented stems and the presence of a collar conferred a protective effect. These findings support personalized implant selection, particularly for older patients or those with frailty.

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

PMID:41985069 | DOI:10.2106/JBJS.25.01203

J Bone Joint Surg Am. 2026 Apr 15. doi: 10.2106/JBJS.26.00134. Online ahead of print.

ABSTRACT

➢ Multiligament knee injuries (MLKIs) encompass a heterogeneous spectrum of severe knee trauma, presenting ongoing challenges in their diagnosis, classification, management, and postoperative rehabilitation. This review synthesizes the current evidence with expert clinical perspectives to summarize key principles in evaluation and management.➢ Thorough clinical examination, stress radiography, and magnetic resonance imaging can improve injury characterization and objective quantification of pathologic laxity to guide surgical planning.➢ Contemporary reconstruction strategies emphasize the detection of posteromedial corner, posterolateral corner, and meniscal pathologies, while recognizing that appropriate management of these associated injuries protects cruciate reconstruction grafts.➢ Treatment timing remains controversial, with increasing evidence and consensus for early, comprehensive single-stage surgery when feasible in selected patients.➢ Modern approaches to MLKI management should prioritize restoration of anatomy, biomechanical stability, meticulous planning to avoid tunnel convergence, and rehabilitation strategies.

PMID:41984925 | DOI:10.2106/JBJS.26.00134

J Bone Joint Surg Am. 2026 Apr 15;108(8):535-540. doi: 10.2106/JBJS.26.00162. Epub 2026 Apr 15.

NO ABSTRACT

PMID:41984066 | DOI:10.2106/JBJS.26.00162

J Bone Joint Surg Am. 2026 Apr 15;108(8):533-534. doi: 10.2106/JBJS.25.01299. Epub 2026 Apr 15.

NO ABSTRACT

PMID:41984065 | DOI:10.2106/JBJS.25.01299

J Bone Joint Surg Am. 2026 Apr 15;108(8):531-532. doi: 10.2106/JBJS.25.01418. Epub 2026 Apr 15.

NO ABSTRACT

PMID:41984064 | DOI:10.2106/JBJS.25.01418

J Bone Joint Surg Am. 2026 Apr 15;108(8):529-530. doi: 10.2106/JBJS.25.01142. Epub 2026 Apr 15.

NO ABSTRACT

PMID:41984063 | DOI:10.2106/JBJS.25.01142

J Bone Joint Surg Am. 2026 Apr 15;108(8):527-528. doi: 10.2106/JBJS.26.00115. Epub 2026 Apr 15.

NO ABSTRACT

PMID:41984062 | DOI:10.2106/JBJS.26.00115

Int Orthop. 2026 Apr 15. doi: 10.1007/s00264-026-06799-y. Online ahead of print.

ABSTRACT

PURPOSE: To investigate anterior cruciate ligament (ACL) injury associated meniscal and cartilage lesions and to evaluate the independent effects of sports activity level and surgical timing on their distribution.

METHODS: A retrospective cohort analysis was conducted on all primary ACL reconstructions performed at a specialized sports medicine hospital between 2018 and 2022. The primary outcome was the prevalence of ACL-associated injuries. Secondary outcomes included classification of associated injuries, differences according to sports activity level, and injury-to-surgery time. Multivariate logistic regression was used as the main analysis.

RESULTS: A total of 582 patients were included, with a median age of 26.0 years. Of these, 321 (55%) had at least one meniscal tear. Cartilage lesions were identified in 93 patients (16%), most commonly affecting the medial femoral condyle (MFC). Registration in a professional sports club was associated with increased odds of lateral meniscus posterior horn tears. Surgical delay showed increasing odds of chondral lesions, particularly involving the MFC, as well as medial meniscal tears. Surgeries performed more than 30 days after injury were associated with significantly lower odds of identifying ramp lesions.

CONCLUSION: ACL injuries are frequently associated with a range of concomitant intra-articular lesions. Medial compartment lesions are primarily associated with surgical timing, independent of sports activity level. In contrast, lateral meniscus posterior horn tears were more common among professional athletes. Surgeries performed within 30 days of injury were associated with higher odds of detecting ramp lesions, regardless of sports activity level.

PMID:41986481 | DOI:10.1007/s00264-026-06799-y

Int Orthop. 2026 Apr 15. doi: 10.1007/s00264-026-06806-2. Online ahead of print.

ABSTRACT

BACKGROUND: Large language model based chatbots are increasingly used by patients seeking information about periprosthetic joint infection (PJI) and revision strategies, yet the quality of patient-facing answers for one-stage revision remains uncertain.

METHODS: This expert based, cross sectional exploratory study evaluated ChatGPT generated answers to 12 patient-oriented questions on one-stage revision arthroplasty for PJI. Questions were purposively selected from a pool of 30 commonly asked items to maximize topic coverage while minimizing redundancy. All questions were entered ad verbatim into ChatGPT on January 3, 2026 (freely accessible web interface; GPT-5.2), using a new session per question; only the first response was recorded without follow-up prompts or browsing. Four raters (two senior orthopaedic surgeons, one junior orthopaedic surgeon, one infectious diseases specialist) independently graded each response using a predefined ordinal rubric and recorded brief comments when limitations were identified. Inter-rater reliability was assessed using Krippendorff's alpha (ordinal).

RESULTS: Responses were rated positively overall. Answers addressing procedural steps, postoperative antibiotic management, and recovery expectations received the most consistently high ratings. Clarification was most frequently requested in domains where decision making is conditional or evolving, including indications/contraindications and patient selection, culture-negative PJI framing, protocol dependent weight bearing recommendations, and management options after failure. Inter-rater agreement was modest (α = 0.375; 95% CI - 0.012 to 0.651).

CONCLUSION: In this exploratory study, ChatGPT provided generally clear patient-facing explanations for one-stage revision PJI topics, with stronger performance in standardized and procedural domains and more limited performance in areas requiring individualized clinical judgment. These findings suggest that it may have a supportive role in patient education, although clinician oversight remains important to ensure appropriate contextualization and to avoid overgeneralization.

PMID:41986480 | DOI:10.1007/s00264-026-06806-2

Int Orthop. 2026 Apr 15. doi: 10.1007/s00264-026-06801-7. Online ahead of print.

ABSTRACT

PURPOSE: In PJI revision surgery, prolonged wound drainage (PWD) is a common concern associated with increased periprosthetic joint infection (PJI), yet no clinical guidelines exist, guiding when intervention should occur. This study aimed to quantify the association between PWD and treatment failure following hip PJI surgery, and which factors were associated with those results.

METHODS: A retrospective cohort study of hip PJI patients was conducted from March 2019 to January 2023. Univariate and multivariate logistic regression was performed to identify risk factors associated with PWD and failure of treatment (per modified Delphi criteria) Statistical significance was considered for p<0.05.

RESULTS: 164 patients were identified: 98 women (59.8%) and 66 men (40.2%), with a mean age of 69.3±13.9 years, Univariate analysis demonstrated that wound leakage duration was associated with treatment failure (OR:1.1, 95% CI 1.0-1.1, p=0.0024). Multivariate analysis demonstrated that leakage >14 days was the strongest predictor of treatment failure (OR 2.8, 95% CI 1.3-6.0, p=0.0064) Factors associated with leakage >14 days included malnutrition (p=0.0042), number of previous PJI surgeries (p=0.0214), and McPherson host grade 2 (p=0.0230). Gram-negative (p= 0.0266) and polymicrobial hip cultures (p=0.0128) were also associated with prolonged leakage. Univariate associations remained significant with multivariate analysis.

CONCLUSION: Wound drainage >14 days is associated with an elevated risk of failure after PJI surgery. Surgeons should consider early repeat surgery on patients with PWD by two weeks following PJI revision surgery. Previous PJI surgery and malnutrition are risk factors for PWD and should prompt early consultation with nutritional services.

PMID:41984159 | DOI:10.1007/s00264-026-06801-7

Int Orthop. 2026 Apr 14. doi: 10.1007/s00264-026-06805-3. Online ahead of print.

ABSTRACT

PURPOSE: Acute Achilles tendon rupture with delayed treatment more than four weeks is referred to as chronic, which can lead to severe functional impairment. The literature advocates surgical reconstruction to restore ankle joint push-off strength. This study aims to introduce the technique and clinical outcomes of endoscopic autologous tendon suspension fixation for chronic insertional Achilles tendon rupture.

METHODS: Twenty-two patients (16 males, 6 females) with a mean age (range) of 49.2 ± 10.3 (30-67) years underwent Achilles tendon reconstruction surgery using all-endoscopic autologous tendon suspension fixation. Patients were evaluated at the last follow-up, with assessment indicators including Visual analogue scale (VAS), American Orthopaedic Foot & Ankle Society Ankle Hindfoot Scale (AOFAS-AH), Achilles tendon total rupture score (ATRS), Foot and Ankle Ability Measure (FAAM), Range of motion (ROM) and maximum calf circumference.

RESULTS: All patients successfully completed the surgery, with an operation time of 62.91 ± 8.82 (45-80) min, intraoperative blood loss of 15 (5-35) mL, and all surgical approaches healed in one stage, with no damage to important structures such as blood vessels, nerves, and tendons during the operation. Twenty-two patients were followed up for 16.23 ± 2.94 (12-23) months. Two patients reported weakness in single-leg heel raises, which subsequently improved with heel raise exercises. At the last follow-up, the AOFAS-AH score improved from 60.64 ± 8.83 (45-77) preoperatively to 94.18 ± 3.91 (88-100), while the ATRS score increased from 45.59 ± 5.85 (35-57) preoperatively to 93.18 ± 4.68 (83-100), and the VAS score decreased from 6 (1) to 1 (0), with all differences being statistically significant. Similarly, the FAAM- Activity of Daily Living (FAAM-ADL) score increased from 44.73 ± 8.79 (30-59) to 90.95 ± 4.62 (83-99), and the FAAM- -Sports (FAAM-S) score increased from 43.55 ± 7.14 (31-55) to 88.27 ± 8.18 (74-99). All differences were statistically significant. (all P < 0.001). The dorsiflexion angle of the affected side ankle joint (13.2 ± 1.9°), plantar flexion angle of the ankle joint (44.3 ± 1.6°), and maximum calf circumference (35.6 ± 1.5 cm) were compared with the healthy side (13.3 ± 1.9°, 44.5 ± 1.7°, 35.6 ± 1.6 cm), and there was no statistically significant difference (all P > 0.05). According to the Arner-Lindholm scoring assessment: excellent in 19 cases, good in three cases, with an excellent and good rate of 100% (22/22).

CONCLUSION: This study demonstrates that all-endoscopic autologous suspension fixation achieves satisfactory outcomes in patients with chronic Achilles tendon ruptures. This technique effectively restores distal ruptures, making it a viable option for Achilles tendon reconstruction.

PMID:41979664 | DOI:10.1007/s00264-026-06805-3

J Bone Joint Surg Am. 2026 Apr 13. doi: 10.2106/JBJS.26.00129. Online ahead of print.

ABSTRACT

➢ Open fractures are a critical global health challenge that disproportionately affect individuals in low- and middle-income countries (LMICs), primarily due to road traffic collisions. Surgical management of open fractures is 1 of the 3 essential bellwether procedures identified by The Lancet Commission on Global Surgery.➢ We developed and evaluated a novel hybrid course on open fracture management for surgical trainees and practicing surgeons in Rwanda, combining a self-directed, virtual, pre-course curriculum with a live, in-person workshop in Kigali in June 2025 that was simultaneously live-streamed for virtual attendees. Prerecorded multilingual lectures (English and French) and curated peer-reviewed articles provided foundational knowledge in advance and prepared learners for in-person didactics, case discussions, and skills training.➢ The in-person workshop included didactic sessions and discussions of local clinical cases from Rwanda related to open fracture management and other orthopaedic emergencies, along with hands-on practice in fracture external fixation and negative pressure wound therapy using affordable devices designed for resource-constrained practice.➢ The workshop engaged 160 active learners (37 in-person, 123 virtual) and demonstrated high overall satisfaction among 84 survey respondents, with an average rating of 4.6 out of 5.➢ Self-reported confidence in managing open fractures increased substantially following the course, from a mean rating of 3.83 to 4.69 on a 5-point scale (p < 0.001). Most survey respondents reported that the course moderately or significantly improved their knowledge (96.4%) and would change their clinical practice (96.5%).➢ Participant feedback highlighted opportunities for improvement, including extending the workshop duration to increase hands-on time, expanding the content on complex soft-tissue management, and improving the engagement of remote learners through mechanisms such as the provision of low-cost external fixation models for at-home practice.➢ Future directions include integrating the course into medical student and general practitioner education in Rwanda, adapting it for major surgical conferences regionally and internationally, and continuing to prioritize hands-on training modules. Iterative refinement of the course is planned on the basis of participant feedback.

PMID:41973832 | DOI:10.2106/JBJS.26.00129

J Bone Joint Surg Am. 2026 Apr 13. doi: 10.2106/JBJS.26.00279. Online ahead of print.

ABSTRACT

Short-term surgical missions have expanded access to total joint arthroplasty (TJA) in regions where degenerative joint disease remains undertreated. Reports from these initiatives frequently highlight procedural volume and low early complication rates, reinforcing the perception of success. However, these metrics capture only the earliest phase of outcome assessment following TJA. Durable arthroplasty quality is defined by implant survivorship, complication surveillance, revision capacity, and longitudinal follow-up. In many short-term mission models, long-term tracking, implant traceability, and local capacity for complication management are described incompletely. Without standardized benchmarks, the orthopaedic community risks equating surgical throughput with sustained impact. This article examines the limitations of the current reporting practices in mission-based arthroplasty and proposes an accountability framework that is centered on safety surveillance, follow-up infrastructure, implant traceability, revision capability, capacity development, and financial transparency. As global TJA efforts expand, defining meaningful quality metrics is essential to ensure that episodic interventions translate into durable patient benefit and resilient local systems.

PMID:41973830 | DOI:10.2106/JBJS.26.00279

J Bone Joint Surg Am. 2026 Apr 13. doi: 10.2106/JBJS.25.01341. Online ahead of print.

ABSTRACT

BACKGROUND: Long-term outcomes of femoroacetabular impingement (FAI) surgery, particularly survivorship, are critical to guide treatment decision-making and patient counseling, yet only a limited number of studies have reported mid- to long-term survivorship. The purpose of this study was to report survivorship rates at a mean 10-year follow-up in a large, multicenter FAI surgery cohort and to identify clinical predictors of survivorship.

METHODS: A prospective, multicenter cohort study assessed patients treated for FAI with hip arthroscopy or surgical dislocation from 2008 to 2012. At a minimum of 8 years, 362 hips (80.1%) had follow-up that permitted assessment of total hip arthroplasty (THA)-free survivorship. A Cox proportional-hazards model was developed to identify risk factors for THA.

RESULTS: The cohort included 362 hips with a mean patient age of 32.1 years; 53% were in females, and 95.6% were in Caucasian patients. The THA-free survivorship of the cohort was 90.6% at a mean of 10.4 ± 1.6 years postoperatively. Risk factors for THA were older age at surgery (p = 0.01), male sex (p = 0.02), body mass index of ≥30 kg/m2 (p = 0.009), and femoral head chondromalacia (p < 0.001).

CONCLUSIONS: This study demonstrates that FAI surgery yielded durable 10-year THA-free survivorship of 90.6%. Older age at surgery, obesity, male sex, and femoral head chondromalacia were key predictors of conversion to THA.

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

PMID:41973826 | DOI:10.2106/JBJS.25.01341

Int Orthop. 2026 Apr 14. doi: 10.1007/s00264-026-06800-8. Online ahead of print.

ABSTRACT

INTRODUCTION: Precise component positioning in total knee arthroplasty (TKA) influences tibiofemoral mechanics, patellofemoral tracking, and soft-tissue balance. Although robotic-assisted TKA improves alignment accuracy, most comparative studies emphasize mean alignment rather than surgical reproducibility. Variability and outlier rates may better reflect precision. This study compared alignment variability and the proportion of coronal and rotational outliers between robotic-assisted and conventional TKA performed under identical mechanical alignment targets.

METHODS: A retrospective comparative cohort included 300 primary TKAs (150 robotic-assisted, 150 conventional) performed by the same surgical team between 2022 and 2025. Postoperative hip-knee-ankle (HKA) alignment was measured on standardized long-leg radiographs. Rotational alignment was evaluated by computed tomography in a predefined subgroup. Variability was quantified using standard deviation and equality of variance tested with the Brown-Forsythe method. Outliers were defined as deviation > 3° from target alignment. Multivariable logistic regression identified predictors of outlier status.

RESULTS: Mean postoperative HKA did not differ between groups (0.4° ± 1.6° robotic vs. 0.6° ± 2.8° conventional; p = 0.41). Robotic-assisted TKA showed lower dispersion (SD 1.6° vs. 2.8°; p < 0.001). Coronal outliers occurred in 6.7% of robotic cases versus 21.3% of conventional cases (p < 0.001). Rotational mismatch > 3° was less frequent with robotic assistance (8.7% vs. 24.0%; p = 0.006).

CONCLUSIONS: Robotic-assisted TKA reduced alignment variability and outliers without altering mean alignment, suggesting improved surgical reproducibility.

PMID:41975083 | DOI:10.1007/s00264-026-06800-8