Nonsteroidal anti-inflammatory drugs (NSAIDs) are the principal pharmacological option for inflammatory musculoskeletal pain and are frequently treated as an interchangeable class from which any agent may be selected. This narrative review examines the pharmacological basis of that assumption and organises the evidence around three questions: which molecule, at what dose, and in which formulation. Four observations follow from the available data. COX selectivity is an incomplete predictor of clinical risk, since a non-selective agent may carry a cardiovascular profile comparable to that of the coxibs while a coxib may reduce events across the whole gastrointestinal tract; risk is therefore better assigned to individual molecules at defined doses than to selectivity classes. Comparative efficacy is dose-dependent rather than uniformly equivalent, so equivalence between agents applies only at comparable analgesic doses, and apparent non-response is frequently sub-therapeutic dosing. Organ-specific risk differs in kind as well as in degree across the cardiovascular, gastrointestinal, renal, hepatic and haemostatic axes, and proton pump inhibitors protect the upper gastrointestinal tract only. Modified-release formulations alter onset and peak-to-trough fluctuation, but no evidence indicates that they attenuate class-level organ toxicity. Contraindications lying outside the cardiorenal and gastrointestinal axes are stated, together with the clinically relevant drug interactions and the regulatory restrictions applying to individual agents.
Proximal humerus fractures (PHFs) are common in the elderly and may require surgical fixation, yet controversy persists regarding the optimal technique—open reduction and internal fixation (ORIF) versus intramedullary nailing. This study synthesizes high-quality randomized controlled trials (RCTs) evidence to determine the relative efficacy, safety, and functional outcomes. A systematic review was performed by searching PubMed, the Cochrane Library, and Embase through February 2026. Eligible RCTs compared intramedullary nailing and plate fixation for PHFs, evaluating range of motion (ROM), strength, complications, reoperation rates, and patient-reported outcomes (PROs). Six RCTs comprising 404 PHFs were included (204 nails, 200 plates). Mean patient age was 69.3 years (nail) and 68.5 years (plate), with average follow-up of 30.6 months. There were no significant differences between intramedullary nailing and locking plate fixation in DASH score (MD, −0.66; 95
In imageless robotic-assisted total knee arthroplasty (RA-TKA), intraoperative assessment of ligament balance may be influenced by asymmetric cartilage wear, potentially misrepresenting true soft-tissue behavior. Functional alignment (FA) aims to restore constitutional alignment while respecting the native ligament envelope. Using the unworn compartment as the primary reference for intraoperative balancing may reduce the effect of asymmetric wear and improve mediolateral symmetry. A retrospective analysis was performed on 180 knees (176 patients) undergoing femur-first imageless RA-TKA with a functional alignment strategy at a single-volume center. All procedures were performed using the ROSA Knee System with a medial congruent implant. Intraoperative balancing prioritized the unworn or less affected compartment, targeting a 19-mm implant space with near-symmetric medial–lateral laxity in extension and flexion. Medial and lateral laxities were recorded robotically before implantation and after final component placement and classified using the Robotic Evaluation of Articular Laxity (REAL). Preoperatively, lateral laxity exceeded medial laxity in both extension and flexion. Following implantation, mediolateral symmetry was restored with a significant reduction in medial–lateral laxity differences (p < 0.001). At final assessment, 178 knees (98.9
Depression is common among patients with cubital tunnel syndrome and may adversely influence surgical recovery. This study evaluates the impact of depression and antidepressant use on postoperative complications following ulnar nerve transposition (UNT). A retrospective cohort study was performed using the TriNetX Research Network. Adults undergoing primary UNT between 2005 and 2025 were identified and stratified by depression status. Three 1:1 propensity-matched analyses were performed to evaluate the impact of (1) depression status, (2) antidepressant use among depressed patients, and (3) specific antidepressant subclasses. Matching controlled for demographics and comorbidities. Outcomes included 90-day medical and postoperative complications and 1 year pain-related outcomes and opioid dependence. After matching, 11,821 patients were included in each cohort. Depression was associated with significantly higher 90-day medical morbidity, including infection (RR 1.39, P = 0.0008), acute postoperative pain (RR 1.28, P < 0.0001), emergency department utilization (RR 1.37, P < 0.0001), and increased need for PT evaluation (RR 1.21, P < 0.0001) and orthopedic aftercare (RR 1.11, P = 0.001). At 1 year, depressed patients demonstrated higher rates of persistent elbow pain (RR 1.16, P < 0.0001) and nearly double the risk of opioid dependence or abuse (RR 1.88, P < 0.0001). Among patients with depression, preoperative antidepressant use was associated with higher 1-year opioid dependence (RR 1.66, P = 0.007) and persistent pain (RR 1.21, P = 0.001). SSRI use specifically was linked to increased long-term pain (RR 1.17, P = 0.001) and opioid dependence (RR 1.31, P = 0.023). TCA use was associated with higher 90 day ED visits (RR 1.20, P = 0.022), while atypical antidepressants were associated with increased acute postoperative pain (RR 1.42, P = 0.004). Depression was associated with adverse postoperative outcomes after UNT. Antidepressant use, particularly SSRIs, was associated with higher long-term pain and opioid-related risk; however, these associations may reflect underlying depression severity rather than a direct pharmacologic effect.
Psychiatric comorbidities are increasingly recognized as modifiers of arthroplasty outcomes. However, the effect of generalized anxiety disorder (GAD) on outcomes following total hip arthroplasty (THA) remains underexplored. A retrospective cohort study was conducted using the PearlDiver national database to identify patients who underwent primary, unilateral THA for osteoarthritis between 2010 and 2022. Patients with <90-day follow-up were excluded. Among 278,655 eligible patients, 17,422 (6.2
