The optimal surgical approach for total hip arthroplasty (THA) remains a subject of ongoing debate. Posterior, direct lateral, and direct anterior techniques differ in their soft-tissue handling, complication patterns, and applicability in complex reconstruction. This systematic review synthesizes contemporary evidence comparing functional outcomes, perioperative complications, and revision suitability across major THA approaches. A systematic search of PubMed, Scopus, and Web of Science was conducted according to PRISMA guidelines. Eligible studies directly compared at least two THA approaches, reported clinical or functional outcomes with ≥ 12 months of follow-up, and were published between 2015 and 2025. Data were extracted on functional scores, early recovery parameters, dislocation rates, nerve injury profiles, intraoperative complications, and revision-specific considerations. Due to heterogeneity in outcome definitions, follow-up intervals, and incomplete reporting of numerical outcome data, a formal quantitative meta-analysis was not feasible. Therefore, the review provides a structured narrative synthesis rather than pooled effect estimates. Across comparative studies, the direct anterior approach (DAA) consistently demonstrated faster early functional recovery and reduced short-term pain compared with the posterior approach, although long-term functional outcomes were similar between approaches. Anterior-based approaches generally showed lower dislocation rates, while the direct lateral approach (DLA) provided intrinsic stability but was associated with a higher incidence of transient abductor weakness. Complication patterns were approach-specific: lateral femoral cutaneous nerve symptoms occurred predominantly with DAA, superior gluteal nerve irritation with DLA, and sciatic nerve palsy was rare and primarily associated with posterior THA. In revision and complex cases, the posterior approach remained favored due to its extensile exposure and ease of acetabular and femoral access. All major surgical approaches for THA can achieve excellent long-term outcomes when performed by experienced surgeons. The DAA offers advantages in early recovery, whereas the posterior approach remains the most versatile for complex or revision arthroplasty. Selection of surgical approach should be individualized based on patient anatomy, surgeon expertise, and reconstructive requirements. Not applicable. This study is a retrospective systematic review. The protocol was not registered in PROSPERO because data extraction had begun before submission, and retrospective registration is not permitted by the registry.
Quadriceps muscle and tendon injuries are a significant cause of impairment of the knee extensor mechanism, ranging from minor muscle strains to complete tendon ruptures and extensive defects following oncologic resections. This narrative review provides a comprehensive analysis of contemporary concepts in anatomy, biomechanics, diagnosis, surgical management, and rehabilitation, with a particular focus on reconstructive techniques and functional outcomes. While most muscle injuries respond well to conservative management, complete quadriceps tendon ruptures typically require surgical repair to restore extensor continuity. Both transosseous suture techniques and suture anchor fixation demonstrate reliable outcomes, with no clear superiority in clinical results. Chronic ruptures present additional challenges due to tendon retraction and poor tissue quality, often necessitating advanced reconstruction methods such as V–Y tendon lengthening and augmentation with autografts, allografts, or synthetic materials. In cases of large defects, especially following soft-tissue sarcoma resection, free functional muscle transfer (FFMT) has emerged as a key reconstructive strategy. Common donor muscles include the latissimus dorsi, gracilis, rectus abdominis, and vastus lateralis, each offering specific biomechanical advantages. Functional recovery is strongly influenced by the extent of quadriceps preservation, with better outcomes observed when at least two muscle heads remain functional. Rehabilitation protocols vary depending on the surgical approach. Early controlled mobilisation is generally recommended after tendon repair, whereas FFMT requires a more cautious and prolonged rehabilitation process to allow for flap integration and reinnervation. Overall, optimal outcomes depend on a multidisciplinary approach combining appropriate surgical technique, individualized rehabilitation, and careful patient selection.
Cardiomyopathies comprise a heterogeneous group of myocardial disorders characterized by intrinsic structural and functional abnormalities that are not explained by secondary cardiovascular or systemic conditions. Although genetically determined cardiomyopathies have traditionally been interpreted within a Mendelian framework, this paradigm does not fully account for the marked variability in penetrance, expressivity, and clinical outcomes observed in affected individuals. Increasing evidence indicates that disease manifestation arises from a complex interplay between rare pathogenic variants, common genetic variation, epigenetic regulation, environmental factors, and stochastic molecular processes. This review focuses on hypertrophic and dilated cardiomyopathies, the most prevalent and extensively studied forms, and critically examines how epigenetic mechanisms, genetic modifiers, and molecular noise challenge classical pathophysiology concepts. We discuss how these factors contribute to phenotypic heterogeneity and influence disease severity, progression, and therapeutic response. Recognition of this multilayered genetic architecture has important clinical implications, supporting more refined risk stratification, improved genetic counseling, and the development of personalized and potentially variant-agnostic therapeutic strategies.
