Cortical hypertrophy (CH) is a common radiological finding associated with short-stem total hip arthroplasty (THA), but its clinical significance remains unclear. This study evaluates differences in outcomes between young patients under 60 years of age and elderly patients over 75 years of age who underwent cementless short stem THA. The aim was to evaluate if there are differences in these patients depending on the presence of CH. A retrospective analysis of 208 short-stem THAs performed between 2014 and 2017 was conducted. Patients were divided into younger (< 60 years, n = 119) and older (> 75 years, n = 89) groups. Clinical outcomes, including Harris Hip Scores (HHS) and Oxford Hip Scores (OHS), were compared between patients with and without CH. Multivariate regression analysis was performed to identify risk factors for CH, focusing on delta hip offset, canal fill index, and stem alignment. Younger patients with CH demonstrated significantly better HHS (96.1 ± 7 vs. 90.8 ± 14.3, p = 0.010) and OHS (45.8 ± 5.2 vs. 42.9 ± 8.8, p = 0.028) compared to those without CH. In older patients, the presence of CH did not significantly impact outcomes. Regression analysis identified younger age (p = 0.012), higher Canal Fill Index III (p = 0.047), and stem alignment (p = 0.049) as significant predictors of CH. Cortical hypertrophy is associated with non-inferior functional outcomes in younger patients but shows limited clinical relevance in older patients. Implant positioning and patients demographics significantly influence the development of CH. These findings support the interpretation of CH as an adaptive response in younger, active patients rather than a pathological condition.
To estimate the comparative effectiveness of single-stage versus two-stage revision for hip prosthetic joint infection (PJI) in Chinese tertiary hospitals by emulating the INFORM randomized trial using the target trial emulation framework. Retrospective cohort study emulating a target trial, reported per the TARGET guideline. The protocol and analysis plan were written before analysis but were not prospectively registered. Three tertiary hospitals in China. Index revision surgeries were performed between 1 January 2018 and 30 June 2022, with follow-up data locked on 31 December 2023, ensuring a minimum potential follow-up of 18 months for every patient. 754 adults with confirmed hip PJI undergoing revision surgery (280 single-stage; 474 two-stage), identified from electronic health records and confirmed by manual chart review. Treatment groups reflected the intended surgical strategy documented before or at the index operation. Primary outcome: Harris Hip Score (HHS) at 18 months. Secondary outcomes: surgically treated reinfection, reoperation, mortality, and complications. The primary analysis used inverse probability of treatment weighting (IPTW) on the full cohort with multiple imputation of missing covariate and outcome data; 1:1 propensity score (PS) matching (280 pairs) was confirmatory. Patients who died before an assessment were excluded from the functional analysis at that assessment rather than having a score imputed, so the functional estimand is restricted to survivors (727 of 754 at 18 months). No a priori sample size calculation was performed because all eligible patients were included; precision is reported in place of retrospective power. Mean age was 60.6 (SD 14.4) years; 511 of 754 patients (67.8
The management of severe acetabular bone defects remains challengin due to extensive bone loss and poor soft tissue quality during revision total hip arthroplasty (rTHA). The aim of this study was to assess clinical and radiological outcomes of the use of dual mobility components (DMC) cemented into a newly implanted porous tantalum (PT) acetabular shell during acetabular rTHA. Patients who underwent cementation of a DMC into a newly implanted PT cup between 2014 and 2020 were included. Bone defects were classified according to the Paprosky classification. The primary outcome was to determine the reintervention-free survival rate. The secondary outcome was clinical and radiographic assessment at last follow-up. Thirty-six patients (36 hips), with an average age of 67.9 years (range, 46–90) were included. Paprosky type III defects (61.1
It remains unclear whether early surgical fixation of trochanteric femoral fractures in patients with direct oral anticoagulation (DOAC) therapy has an impact on the long-term outcome. A retrospective cohort study on patients with trochanteric femoral fractures and DOAC therapy between 2016 and 2024 was conducted. Patients were divided into two groups according to their time to surgery and matched with age and ASA score as covariates. The primary outcome of interest was the impact of early surgery on the long-term outcome. Of 233 included patients, 102 patients were assigned in each group after propensity score matching. Patients with early surgery had lower in-hospital complication rates (16.0
This study aimed to systematically evaluate factors associated with periprosthetic joint infection (PJI) following total knee arthroplasty (TKA), and thereby to provide evidence-based references for clinical prevention and perioperative risk stratification. Computerized searches were conducted in the following databases from their inception until May 26, 2025: PubMed, Web of Science, Embase, the Cochrane Library, CINAHL, China National Knowledge Infrastructure, Wanfang Database, Chinese Scientific Journal Database, and Chinese Biomedical Literature Database. Two researchers independently screened the literature, extracted data, and assessed study quality. The methodological quality was assessed using the Newcastle–Ottawa Scale. Quantitative synthesis was performed when at least two studies reported comparable exposure definitions and sufficient comparator information; otherwise, narrative synthesis was used. Review Manager 5.4 software was used for the primary analysis. This study is registered on PROSPERO (CRD420251079339). A total of 25 observational studies were included in the qualitative synthesis, of which 24 contributed to the primary quantitative synthesis. Quantitatively pooled factors associated with PJI included male sex (OR = 1.39, 95
Locked plate osteosynthesis functions as an internal fixator, yet load-induced plate–bone and fragment–fragment contacts – key transitions from load-bearing to load-sharing – remain poorly characterized. This study quantified their effects on construct stiffness, plate strain, and interfragmentary motion under axial loading. Twenty-seven configurations were tested using epoxy-glass surrogate bone fixed with titanium LCP plates, varying fracture gap (3–9 mm), working length (49–121 mm), and plate–bone distance (0–3 mm). Digital image correlation measured strain and motion. Contact events were identified manually from characteristic transitions in the force–displacement response, supported by corresponding changes in plate-surface strain progression. Geometric parameters dominated initial stiffness (125–442 N/mm), decreasing with plate elevation and working length in elevated setups. Within the investigated load range up to 600 N, 16/27 configurations showed non-linear transitions associated with contact events: fragment–fragment contact caused pronounced stiffness increases and strain stagnation at the fracture gap, whereas plate–bone contact was associated with local plate-surface strain stagnation at the location overlying the contact while strain at the fracture gap continued to increase. Interfragmentary motion stagnated after contact, confirming contact-dependent shifts in load transfer. Response surface regression explained 81.9
Intramedullary screw fixation is an emerging technique for operative metatarsal fractures, yet the extent and location of articular cartilage disruption from retrograde screw insertion remain undefined. This study quantifies cartilage surface disruption and maps injury locations in the metatarsal head following screw placement. Fourteen fresh-frozen cadaveric feet (56 lesser metatarsals) underwent standardized retrograde intramedullary screw fixation using 3.6 mm screws. Following dissection, the total articular surface area and cartilage defect were measured to calculate the percentage of disruption. The cartilage surface was divided into quadrants (dorsal-to-plantar) and thirds (medial-to-lateral) to determine screw trajectory. Mean cartilage disruption increased progressively from the 2nd to 5th metatarsals: 10.17
To evaluate the platform-specific learning curve and early tibial radiographic agreement of imageless ROSA®-assisted medial unicompartmental knee arthroplasty (UKA), with short-term clinical findings assessed exploratorily. This retrospective consecutive case series included 30 patients who underwent ROSA®-assisted medial UKA with the Persona® Partial Knee implant between January and April 2026 at a high-volume arthroplasty referral centre. A continuous learning-curve cumulative summation (LC-CUSUM) analysis of total surgical duration was performed against an independently defined surgeon-specific historical benchmark derived from institutional operative-register skin-to-skin times for manual UKA performed by the same surgeon (20 ± 4 min). Adequate performance was defined as a mean duration of 25 min, inadequate performance as 30 min, and the reference standard deviation as 4 min. Type I and type II error targets were 0.05 and 0.10, respectively; the decision boundary was calibrated by Monte Carlo simulation over a 30-case monitoring horizon. Robotic time and a supportive comparison of cases 1–5 versus 6–30 were secondary efficiency analyses. Postoperative radiographic measurements were performed by an observer blinded to the planned and robot-validated ROSA® values. Agreement was quantified using Bland–Altman bias and 95
Proximal humerus fractures are common injuries, and achieving stable fixation is essential to prevent complications such as varus collapse and screw perforation. While optimal screw positioning has been emphasized biomechanically, clinical evidence regarding the required number of screws in the humeral head, particularly when minimally invasive aiming devices limit placement to four screws, remains limited. This study evaluated whether fixation with four cranial screws provides adequate clinical and radiological stability. A retrospective cohort study was conducted including 105 patients with displaced proximal humerus fractures treated with plate osteosynthesis. Patients were grouped according to the number of proximal screws used: four screws (n = 58) or more than four screws (n = 47). The primary outcome was the Constant–Murley Score. Secondary outcomes included secondary screw perforation, head–shaft angle maintenance, restoration of medial cortical support, and avascular necrosis. Mean follow-up was 18 ± 6 months. Functional outcomes were comparable between groups, with Constant–Murley Scores of 78 ± 7 in the four-screw group and 73 ± 13 in the multi-screw group (p = 0.23). Rates of screw perforation (8.6
Whether nighttime orthopedic trauma surgery adversely affects outcomes remains controversial. Evidence specifically addressing intramedullary fixation across femoral fracture locations remains limited. This study evaluated whether nighttime surgery was associated with a higher rate of recorded postoperative complications than daytime surgery. This retrospective observational cohort included adult patients with nonperiprosthetic femoral fractures treated with intramedullary fixation between January 2010 and January 2023 at a single Level I trauma center. Of 311 screened records, 23 were excluded because the patient was younger than 18 years (n = 17) or the fracture was periprosthetic (n = 6), leaving 288 procedures (242 daytime and 46 nighttime). The primary outcome was any recorded postoperative complication during available follow-up. Secondary outcomes included radiographic abnormality, delayed union (> 24 weeks), nonunion, revision surgery, and mortality. Surgeon experience was categorized as senior surgeon or resident. Exploratory fracture-location subgroup analyses and multivariable logistic regression were performed. Nighttime patients were younger (35.1 ± 19.1 vs. 46.6 ± 24.6 years, p < 0.001), more frequently male (82.6
Comparative evidence on patient-reported outcomes (PROs) after lateral unicompartmental knee arthroplasty (UKA) and total knee arthroplasty (TKA) remains limited. We compared PROs between cohorts matched for demographic characteristics and baseline knee function. Prospectively collected single-center data were retrospectively analyzed. Lateral UKA was performed for isolated lateral-compartment osteoarthritis and TKA predominantly for multicompartmental disease. One-to-one propensity score matching incorporated age and body mass index, exact matching on sex, and restrictions on age and preoperative Oxford Knee Score (OKS), yielding 31 pairs. Postoperative OKS was the primary outcome. Secondary outcomes included OKS improvement, Forgotten Joint Score (FJS), University of California, Los Angeles (UCLA) activity score, OKS minimal clinically important difference (MCID) achievement, and FJS patient acceptable symptom state (PASS) attainment. All matching covariates achieved acceptable balance (absolute standardized mean differences < 0.20). Postoperative OKS did not differ significantly (UKA, 38.9 ± 7.0; TKA, 39.8 ± 7.5; mean paired difference [TKA minus UKA], 0.94; 95
Scaphoid fractures (SF) in adolescents differ from adult fractures in fracture pattern, healing capacity, and skeletal maturity. Limited data exist on factors affecting union and healing time in this population. This study evaluated clinical, radiological, and treatment-related factors associated with union and healing time in adolescent SF. This study included 77 adolescents (aged 10–18 years) treated for SF. Chronological age, bone age, fracture characteristics, treatment modality, union status, and healing time were recorded. Fractures were classified by anatomical location, displacement, and time to diagnosis (< 6 weeks or ≥ 6 weeks). CT-based morphometric measurements, including scaphoid height, lateral intrascaphoid angle, and dorsal cortical angle, were obtained from initial computed tomography images. Functional outcomes were assessed using the QuickDASH and patient-rated wrist evaluation (PRWE) scores. Union was achieved in 63 patients (81.8
To synthesize, critically appraise and systematically review studies comparing outcomes after primary total hip arthroplasty (THA) performed by low- vs. high-volume surgeons, and to propose evidence-based threshold definitions for these categories. This review followed the PRISMA guidelines and was registered in PROSPERO. Medline and Embase were searched on March 24, 2025. Prospective and retrospective clinical studies were included if they reported THA thresholds for low- and high-volume surgeons. Articles not written in English or German were excluded. Outcomes were pooled and presented in forest plots. Methodological quality was assessed. Of 872 identified articles, 18 were included, reporting on 796,061 patients undergoing THA. Methodological quality was high in all studies (>6 of 7 points). Thresholds used to define high- vs. low-volume were determined using arbitrary values (n = 11), tertiles (n = 1), quartiles (n = 3), percentiles (n = 2), or receiver operating characteristic curves (n = 1). High-volume surgeons had significantly lower 1-month readmission rates [odds ratio (OR) = 1.6; p = 0.033] and 3-month mortality rates (OR = 1.8; p = 0.008). In contrast, there were no significant differences between high- and low-volume surgeons for 3-month revision rates (OR = 2.0; p = 0.228), 12-month revision rates (OR = 1.8; p = 0.228), and 3-month readmission rates (OR = 1.3; p = 0.337). The included studies demonstrated considerable variability in the definitions of surgeon volume. However, there remains a trend suggesting that higher-volume surgeons experience fewer revisions, complications, readmissions, and mortality; although these differences were largely not statistically significant. Nonetheless, surgeon volume may not be the only factor influencing outcomes, as hospital and patient characteristics may influence short- to long-term outcomes following primary THA.
The Ponseti method is the gold standard treatment for idiopathic congenital talipes equinovarus (CTEV). Clinical monitoring during correction primarily relies on the Modified Pirani score, which evaluates deformity severity based on clinical findings. However, objective quantitative assessment of morphological foot changes during treatment remains limited. This study aimed to evaluate the relationship between serial foot anthropometric measurements and Modified Pirani scores during Ponseti correction of idiopathic clubfoot. A prospective observational cohort study was conducted in 30 children with idiopathic unilateral CTEV undergoing Ponseti correction at a tertiary care center between June 2024 and February 2026. Five anthropometric parameters were measured weekly for eight weeks: great toe to midheel distance (GT-MH), little toe to midheel distance (LT-MH), second toe to midheel distance (ST-MH), medial malleolus to midheel distance (MM-MH), and lateral malleolus to midheel distance (LM-MH). Modified Pirani scores were assessed simultaneously by two independent observers. Pearson correlation analysis and inter-observer reliability testing were performed. Significant improvement was observed in all anthropometric parameters and Pirani scores over the study period (p < 0.001). Mean GT-MH increased from 80.73 ± 3.36 mm to 87.56 ± 3.41 mm, LT-MH from 65.36 ± 2.04 mm to 70.22 ± 2.05 mm, and MM-MH from 26.19 ± 0.79 mm to 30.85 ± 0.78 mm. LM-MH decreased from 28.40 ± 0.56 mm to 25.25 ± 0.51 mm, reflecting correction of hindfoot varus. Pirani score improved from 5.33 ± 0.24 to 0.03 ± 0.18. Strong inverse correlations were observed between Pirani score and GT-MH (r = -0.56), LT-MH (r = -0.61), ST-MH (r = -0.71), and MM-MH (r = -0.88), while LM-MH demonstrated a positive correlation (r = 0.71). Inter-observer reliability was excellent, with ICC values ranging from 0.9956 to 1.000. Percutaneous Achilles tenotomy was required in 80
Hip and knee replacements are increasingly performed as same-day surgery (SDS). However, the feasibility of SDS pathways in departments without prior experience is unknown. We report on the implementation process, feasibility and early results of implementing a SDS protocol in a department without prior experience with same-day hip and knee replacement. The study design was based on Bowens feasibility study framework on implementation processes. Data were collected prospectively through patient reported questionnaires and medical records during, and from the local Department of Digitalisation and Analytics after implementation. Outcome data included discharge on day of surgery, 30-days primary-care contacts, 90-days readmissions and patient satisfaction. Implementation was initiated as a dedicated fellowship from September 2023 to October 2024. Patients were admitted and discharged through a dedicated day-surgical department with transfer to the regular ward in case of admission. The first SDS patient underwent surgery the 4th of September 2023. By October 2024, 150 of 713 operated patients (21.0
Severe talar destruction due to infection, trauma, avascular necrosis, or neuroarthropathy represents a major reconstructive challenge. Talectomy followed by tibiocalcaneal arthrodesis (TCA) is a limb-salvage option in selected high-risk patients, although optimal fixation remains controversial. Modern hexapod external fixators offer computer-assisted multiplanar control that may improve alignment and fusion after talectomy. The aim of this study was to evaluate the clinical and radiographic outcomes of talectomy followed by TCA using the TL-HEX system in a series of high-risk patients. A retrospective observational study was conducted between January 2020 and January 2024 including all patients who underwent total talectomy followed by TCA using a TL-HEX circular external fixator. Indications included talar destruction secondary to infection, avascular necrosis, post-traumatic collapse, Charcot neuroarthropathy, and aseptic loosening of total ankle arthroplasty. Primary outcomes were radiographic fusion and hindfoot alignment. Secondary outcomes included time to union, functional scores (AOFAS, EFAS), pain (VAS), complications, and patient satisfaction. Preoperative and final follow-up outcomes were compared using paired statistical tests, with significance set at p < 0.05. Thirteen patients (mean age 57 years) were included with a mean follow-up of 24 months. Radiographic fusion was achieved in 11 of 13 patients (84.6
Coronal shear fractures (CSF) of the capitulum and trochlea humeri are rare injuries during growth age. No systematic, prospective analysis of the classification, procedure, and outcome has yet been found in the literature. Based on the results of a multicentre study of CSF in growing patients, we propose a redesign of the AO Paediatric Comprehensive Classification of Long-Bone Fractures (PCCF) for children and adolescents. We also assessed inter-rater agreement consistency with the modified classification and calculated the intra-class correlation coefficient (ICC) and its 95
Second tarsometatarsal (TMT) joint osteoarthritis occurs in a subset of patients with hallux valgus (HV). While second TMT arthrodesis is performed to address symptomatic arthritis, its association with midfoot alignment changes during HV correction remains unclear. This study aimed to compare changes in radiographic arch parameters between patients undergoing HV correction with and without concomitant second TMT arthrodesis. This retrospective comparative study included 73 feet with HV and medial column malalignment (lateral Meary’s angle > 10°). The TMT group (n = 37) underwent HV correction combined with second TMT arthrodesis for symptomatic osteoarthritis, while the control group (n = 36) underwent isolated HV correction. These patients were matched to achieve comparable baseline characteristics. Radiographic parameters of the transverse arch (M2–M5 angle, C1–M2 distance) and medial column alignment (lateral Meary’s angle) were evaluated preoperatively and at a minimum 1-year follow-up. Functional outcomes were assessed as a secondary measure. The TMT group demonstrated greater changes in transverse arch parameters compared with the control group. The M2–M5 angle decreased by 2.1° (95
As populations age, the number of older patients undergoing knee arthroplasty continues to increase. Cognitive impairment is prevalent among older adults and has been associated with adverse perioperative outcomes; however, its impact on postoperative delirium and discharge disposition following knee arthroplasty remains insufficiently defined, particularly in large Asian populations. We conducted a nationwide retrospective cohort study using Japan’s Diagnosis Procedure Combination database from April 2016 to March 2023. Older patients who underwent primary total knee arthroplasty (TKA) or unicompartmental knee arthroplasty (UKA) were identified. Cognitive impairment was defined using ICD-10 diagnostic codes at admission. The primary outcome was postoperative delirium, and secondary outcomes included discharge to home, length of hospital stay, and perioperative blood transfusion. Propensity score matching (1:1) was performed to adjust for demographic factors, comorbidities, and surgical characteristics. Multivariable logistic regression and sensitivity analyses were conducted. Among 259,319 eligible patients, 3,934 matched pairs were identified after propensity score matching. Patients with cognitive impairment had a significantly higher risk of postoperative delirium compared with those without cognitive impairment (absolute risk difference, 3.2
Reverse shoulder arthroplasty (RSA) has rapidly supplanted hemiarthroplasty for acute proximal humerus fracture, driven by superior functional outcomes and lower revision rates. Whether this shift has altered perioperative morbidity at the population level remains poorly characterized. This study compared in-hospital outcomes between RSA and hemiarthroplasty in a national trauma cohort. This retrospective cohort study used the National Trauma Data Bank (2017–2022). Adults ( > = 18 years) admitted with proximal humerus fracture who underwent RSA (n = 2657) or hemiarthroplasty (n = 428) during the index hospitalization were included. The primary outcome was non-home discharge; secondary outcomes were any in-hospital complication, extended length of stay exceeding 7 days, and intensive care unit (ICU) admission. Multivariable logistic regression and inverse probability of treatment weighting (IPTW) were used to address confounding by indication. Among 3085 patients (median age, 73 years; 2304 [74.7
