Background Periacetabular resections for pelvic tumors present complex reconstructive challenges. Trabecular metal implants, known for their osteoconductive properties, offer a promising solution for managing segmental acetabular defects. Methods We retrospectively reviewed 29 patients (10 females, 19 males, mean age 58.9 years) who underwent P2 pelvic resections and acetabular reconstructions using trabecular metal between 2014 and 2022 at a tertiary sarcoma center. Fixation survival was assessed radiologically and clinically. Functional outcomes were evaluated using the Toronto Extremity Salvage Score (TESS) and Oxford Hip Score. Results Indications included chondrosarcoma (n = 15), metastasis (n = 9), Ewing sarcoma (n = 3), and others (n = 2). At a mean follow-up of 7.5 years, 25 patients were alive, with 84.0% implant survival. Complications included three infections, one dislocation, one aseptic loosening, and one neuropraxia. Mean postoperative TESS was 63.5/100; Oxford Hip Score was 47.7 (range 41–57). Conclusion Trabecular metal acetabular implants offer a robust, modular solution for reconstructing periacetabular defects post-oncologic resection, with acceptable complication rates and favorable mid-term outcomes.
Background: The microbiology of long bone fracture-related infections (LB-FRIs) in low and middle-income countries remains poorly described. Herein, we determine the microbiological profile, antimicrobial resistance patterns, and host factors associated with LB-FRIs in a South African orthopaedic trauma cohort. Methods: This multi-centre retrospective cohort study included adult patients (>18 years) with confirmed LB-FRIs. We employed STATA 18 statistical software Release 18. College Station, TX: Stata Corp LLC for descriptive statistics, univariate and multivariate analyses, which identified associations between host factors and microbiological profiles. Results: The study cohort comprised 115 patients, yielding 128 microbiological isolates. Gram-negative organisms predominated 57.0% (73/128), led by Pseudomonas aeruginosa 34.3% (44/128), sensitive to ciprofloxacin 75.0% (33/44) and piperacillin-tazobactam 68.2% (30/44). Gram-positive isolates comprised 35.2% (45/128), including Staphylococcus aureus (18.0%, 23/128), and the susceptibility to cloxacillin was 56.0% (13/23). In our univariate analysis, increased age (odds ratio, OR = 1.02; 95% confidence interval, CI 1.01-1.03; p < 0.001), HIV positivity (OR 3.33; CI 1.33–8.30; p = 0.01), and male sex (OR 3.16; CI 1.81–5.58; p < 0.001) were significantly associated with monomicrobial isolation. Conclusion: In this cohort from South Africa, LB-FRIs were predominantly gram-negative, specifically P. aeruginosa, which was sensitive to ciprofloxacin and piperacillin-tazobactam. Age, male sex, and HIV status influenced microbial distribution, but only male sex remained independently associated which likely reflects known epidemiological patterns rather than intrinsic biological susceptibility. Ongoing regional surveillance and larger prospective studies are warranted to guide empirical therapy and optimise outcomes in resource-limited settings. Level of evidence: level 4
Objective Lisfranc (tarsometatarsal) joint injuries are uncommon but potentially disabling and may lead to chronic pain and deformity if misdiagnosed or inadequately treated. Despite advances in imaging and surgical techniques, epidemiologic and radiographic data on unstable Lisfranc injuries remain limited. Methods This retrospective descriptive study included consecutive adult patients with surgically treated unstable Lisfranc injuries at a Level I trauma center and a tertiary orthopedic referral hospital between January 2018 and December 2024. Demographic characteristics, injury mechanisms, associated fractures, and fixation methods were recorded. Injuries were classified according to the Hardcastle–Myerson system. Postoperative malreduction was assessed using predefined radiographic criteria, including diastasis or displacement exceeding 2 mm. Statistical analyses were performed using SPSS (version 26), with a significance threshold of p < 0.05. Results A total of 280 patients were included (mean age 36.6 ± 13.6 years; 77.9% male). High-energy trauma accounted for 75.0% of cases, most commonly motor vehicle accidents (48.2%). Type B2 injuries were the most frequent pattern (68.2%). Associated foot and ankle fractures were identified in 60.4% of patients, most commonly involving the base of the second metatarsal (78.7% of fractures). Early postoperative malreduction was observed in 34.3% of cases, most frequently between the base of the second metatarsal and the intermediate cuneiform. Malreduction occurred more often in cases treated with K-wire fixation than with screw fixation. Conclusion Unstable Lisfranc injuries predominantly affect young men following high-energy trauma and are most commonly characterized by Type B2 patterns and associated second metatarsal base fractures. Early postoperative malreduction remains frequent. These descriptive findings improve understanding of the epidemiologic and radiographic characteristics of unstable Lisfranc injuries and may assist clinicians in diagnostic and surgical decision-making. Level of Evidence Level IV, according to the Oxford Centre for Evidence-Based Medicine 2011 Levels of Evidence.
Background Rotator cuff disorders represent one of the most common causes of shoulder pain and functional disability across all age groups. Owing to the complex anatomy and biomechanics of the shoulder joint, accurate diagnosis of rotator cuff pathology is essential for appropriate management. Magnetic resonance imaging (MRI) has emerged as the imaging modality of choice for comprehensive evaluation of rotator cuff tendons, associated musculature, and secondary changes. Aims To describe the MRI characteristics of rotator cuff pathologies and to evaluate their distribution with respect to age, gender, clinical presentation, and associated secondary changes. Materials and Methods A descriptive cross-sectional study was conducted on 50 adult patients with clinically suspected rotator cuff pathology referred for MRI evaluation. Imaging was performed using a 1.5-Tesla MRI system with a dedicated shoulder surface coil. Standardized imaging protocols were followed. MRI findings were analyzed for tendon degeneration, partial-thickness tears, full-thickness tears, muscle atrophy, fatty infiltration, and associated bony and joint abnormalities. Results Rotator cuff pathology was most commonly observed in the supraspinatus tendon. Partial-thickness tears were more frequent than full-thickness tears. Increasing age, male predominance, and associated acromial and acromioclavicular joint degenerative changes were commonly observed. MRI demonstrated high diagnostic confidence in characterizing the spectrum of rotator cuff disorders. Conclusion MRI is a highly effective, non-invasive modality for evaluating rotator cuff pathology, enabling accurate diagnosis, classification of tears, and assessment of prognostic factors critical for clinical and surgical decision-making.
Background Spinal cord stimulation (SCS) is widely used for post-laminectomy syndrome (PLS), also referred to as failed back surgery syndrome (FBSS). However, comparative safety and utilization outcomes across perioperative and longer-term horizons remain incompletely defined. Methods We performed a retrospective matched cohort analysis using a large multi-institutional network. Adults with PLS were assigned to SCS or non-SCS cohorts. Following 1:1 propensity score matching, 2,853 patients remained in each cohort. Prespecified outcomes were evaluated at two and five years. Effect estimates were reported as odds ratios (ORs) with 95% confidence intervals (CIs). Results At two years, SCS was associated with lower pressure ulcer formation (3.87% vs 7.77%; OR 0.48, 95% CI 0.37–0.61; p < 0.0001), venous thromboembolism (VTE) (2.66% vs 4.03%; OR 0.65, 95% CI 0.49–0.88; p = 0.004), depression or anxiety (10.57% vs 15.41%; OR 0.65, 95% CI 0.53–0.79; p < 0.0001), antidepressant use (16.78% vs 25.66%; OR 0.58, 95% CI 0.50–0.68; p < 0.0001), opioid abuse (4.63% vs 6.13%; OR 0.74, 95% CI 0.59–0.94; p = 0.012), and interventional pain procedures (6.34% vs 8.56%; OR 0.72, 95% CI 0.58–0.90; p = 0.004). Stroke incidence was lower with SCS at two years (1.01% vs 1.72%; OR 0.58, 95% CI 0.36–0.93; p = 0.021), while emergency department (ED) admission rates did not differ (12.50% vs 12.16%; p = 0.73). Device-related reoperation was more frequent in the SCS cohort. Mortality was lower with SCS at two years (2.28% vs 3.40%; OR 0.66, 95% CI 0.48–0.91; p = 0.011).At five years, SCS remained associated with lower pressure ulcers (4.47% vs 10.33%; OR 0.42, 95% CI 0.34–0.80; p < 0.0001), VTE (3.44% vs 4.66%; OR 0.73, 95% CI 0.56–0.95; p = 0.019), depression or anxiety (17.16% vs 22.42%; OR 0.72, 95% CI 0.61–0.85; p < 0.0001), antidepressant use (10.48% vs 14.58%; OR 0.69, 95% CI 0.59–0.80; p < 0.0001), opioid abuse (7.47% vs 12.53%; OR 0.56, 95% CI 0.47–0.68; p < 0.0001), and ED admission rates (24.33% vs 28.92%; OR 0.79, 95% CI 0.70–0.89; p < 0.0001). Stroke rates were not significantly different at five years (2.26% vs 2.72%; OR 0.83, 95% CI 0.59–1.16; p = 0.27). Device-related reoperation remained substantially more common among SCS-treated patients. Mortality remained lower with SCS at five years (4.03% vs 6.03%; OR 0.66, 95% CI 0.51–0.83; p = 0.0006). Conclusions In real-world practice, SCS for post-laminectomy syndrome was associated with lower risks of several systemic and neuropsychiatric complications and reduced longer-term healthcare utilization, but substantially greater procedural utilization due to device-related reoperations. Stroke risk differed by time horizon and was not significantly different at five years. Mortality was lower among SCS-treated patients at both two and five years. These findings support shared decision making that emphasizes benefits, trade-offs, peri-implant infection prevention strategies, psychological screening, and careful vascular risk management.
Background Both Ewing sarcoma (EWS) and Langerhans cell histiocytosis (LCH) affect children and adolescents. Differentiating between the radiological findings of EWS and LCH can be challenging. However, there has been no reported comparison of the plain radiographic findings of these lesions at the initial presentation. Methods Plain radiographs taken at first presentation at an orthopedic out-patient clinic were analyzed retrospectively upon referral. There were 8 solitary EWS cases (4 trunks, 4 extremities) and 9 LCH cases (6 trunks, 2 extremities and a skull). The magnetic resonance imaging (MRI) findings and the time elapsed from the initial visit to the referral date were also analyzed. Results The mean age of patients with EWS and LCH were 16.8 and 6.8 years, respectively. Seven EWS cases had normal plain radiographs, while one case exhibited an apparent abnormality with a collapsed lumbar vertebra. MRIs showed extraosseous extension in all examined EWS cases. All LCH cases showed varied abnormal osteolytic/sclerotic findings on plain radiographs and edema on MRIs. Referral periods longer than 30 days occurred in 5 out of 8 (63%) EWS cases and 2 out of 7 (29%) LCH cases. Conclusions The plain radiographic findings of EWS at the initial presentation were almost normal, in contrast to those of LCH. First point of care doctors should consider EWS can be overlooked.
Background Anterior cruciate ligament (ACL) injuries are frequent among athletes and active individuals. While hamstring and patellar tendon autografts are standard for ACL reconstruction, the peroneus longus tendon has emerged as a promising alternative due to favorable graft characteristics and lower donor site morbidity. Objective To evaluate the clinical outcomes and donor site morbidity associated with ACL reconstruction using ipsilateral peroneus longus tendon autograft over a 24-month follow-up. Methods A prospective study was conducted involving 42 patients (mean age 27.43 years) with isolated ACL tears. All patients underwent arthroscopic ACL reconstruction using the ipsilateral peroneus longus tendon. Functional outcomes were assessed using the International Knee Documentation Committee (IKDC) and Lysholm scores at 6, 12, and 24 months. Donor site morbidity was evaluated using the American Orthopaedic Foot and Ankle Score (AOFAS) and the Foot and Ankle Disability Index (FADI). Knee stability was measured using Lachmann, anterior drawer, and pivot shift tests. Results IKDC scores significantly improved from a preoperative mean of 63.48 to 96.26 at 24 months (p < 0.0001), and Lysholm scores reached a mean of 95.88. Donor site outcomes were favorable, with AOFAS and FADI scores averaging 98.74 and 95.14, respectively. Postoperative stability tests showed high rates of negative results, indicating restored knee function. Conclusion ACL reconstruction using the peroneus longus tendon autograft provides excellent functional results with minimal donor site morbidity. The tendon is a viable and safe alternative for primary ACL reconstruction and may be especially useful in select patient populations.
Background Arthritis is a leading cause of chronic pain and physical disability globally, yet its sub-national distribution and drivers in Somalia remain poorly understood. This study utilizes a "precision public health" framework to map the geographic concentration of arthritis and identify individual and community-level determinants. Methods We analyzed a nationally representative sample of 15,804 Somali adults from the 2020 Somalia Health and Demographic Survey (SHDS). Methodological approaches included Exploratory Spatial Data Analysis (ESDA), Small Area Estimation (SAE) via Fay-Herriot models, and four-stage multilevel logistic regression. Spatial inequality was quantified using Gini and Theil indices, and a Spatial Error Model was employed to evaluate geographic dependencies. Results The Global Moran’s I (-0.073, p = .51) indicated a lack of global clustering, suggesting a dispersed distribution of arthritis; however, local clusters were identified via LISA analysis. Spatial inequality was high (Gini = 0.418; Theil = 0.190). Multilevel modelling revealed that 37.5% of the variance in arthritis is attributable to regional differences (ICC = 0.375). Key predictors included being female (AOR = 2.02, 95% CI [1.22–3.35]), advanced age (55–64 years: AOR = 9.42), and being underweight (AOR = 5.50). Spatial econometrics confirmed significant spatial error dependence (Lambda = -1.24, p < .001). Conclusion Arthritis in Somalia is driven by demographic aging and gender disparities, with significant regional variation. Public health strategies should prioritize screening for elderly women and underweight individuals, particularly in regions identified as high-risk through Small Area Estimation.
Background Spinopelvic injuries represent some of the most complex challenges in orthopedic trauma, with profound implications for patient function and quality of life. This study aimed to evaluate the comprehensive one-year clinical, functional, and radiographic outcomes of spinopelvic fixation in a cohort of patients with unstable pelvic trauma. Methods A prospective cohort study was conducted at two university-affiliated trauma centers. Between March 2023 and March 2024, 54 consecutive adult patients with traumatic spinopelvic instability who underwent surgical fixation were enrolled, with 45 completing the one-year follow-up (follow-up rate: 83.3%).Primary outcomes included the Majeed Pelvic Score (MPS). Secondary outcomes encompassed pain severity (Visual Analogue Scale, VAS), functional independence (SF-36 Physical Functioning subscale, Barthel Index), radiographic parameters (vertical pelvic displacement, leg length discrepancy), and surgery-related complications. Assessments were performed preoperatively and at 2 weeks, 1, 3, 6, and 12 months postoperatively. Results The mean patient age was 41.9 ± 13.5 years, with 73.3% male. The most common injury patterns were AO/OTA 61-C type injuries (62.2%) and Denis Zone II sacral fractures (48.9%). A significant and sustained improvement was observed in the MPS, increasing from 35.0 ± 8.2 at two weeks to 84.0 ± 7.1 at one year (p<0.001). Pain scores demonstrated a significant reduction over time (p<0.001). However, at the 12-month follow-up, chronic pain (defined as VAS >4 for ≥2 consecutive months after postoperative month 3) was present in 35.6% (n=16) of patients. Functional scores (SF-36 PF, Barthel Index) showed marked improvement (p<0.001). Radiographically, mean vertical pelvic displacement decreased from 14.2 ± 4.1 mm preoperatively to 3.8 ± 1.9 mm postoperatively (mean difference 10.4 mm; 95% CI 9.2–11.6, p<0.001), and leg length discrepancy was significantly reduced from 31.0 ± 12.0 mm to 9.0 ± 1.0 mm (p<0.001). The overall complication rate was 20%, including surgical site infection (8.9%), implant failure (4.4%), and neurologic injury (4.4%). Conclusion In carefully selected trauma patients with unstable pelvic injuries, spinopelvic fixation facilitates significant improvement in pelvic function, pain reduction, functional independence, and anatomical restoration at one-year follow-up. While the complication rate is notable, most complications were manageable. The high prevalence of chronic pain at one year highlights an area requiring targeted multidisciplinary intervention. Level of Evidence Therapeutic Level IV.
Background Symptomatic flexible flatfoot in children and adolescents can cause pain, functional limitations, and reduced quality of life. Subtalar arthroereisis with the calcaneal stop screw (CSS) is a minimally invasive surgical option; however, prospective data on combined radiographic and clinical outcomes using validated pediatric instruments are limited. This study aimed to evaluate the radiographic and clinical outcomes of CSS in children with symptomatic flexible flatfoot. Methods In this prospective case series, 60 children and adolescents (42 boys, 18 girls; mean age 11.8 ± 1.9 years) with symptomatic flexible flatfoot who underwent CSS arthroereisis were enrolled. Radiographic parameters (calcaneal pitch angle, talar inclination angle, and Costa-Bartani angle) were measured on weight-bearing radiographs. Clinical outcomes were assessed using the Oxford Ankle Foot Questionnaire for Children (OxAFQ-C), a validated pediatric instrument. Assessments were performed preoperatively and at six weeks, three, six, and twelve months postoperatively. Linear mixed models were used for statistical analysis to account for repeated measures. Results All radiographic parameters improved significantly at 12 months postoperatively (p < 0.001 for all). The calcaneal pitch angle increased from 12.7° ± 3.0° to 18.3° ± 3.3°, the talar inclination angle decreased from 27.9° ± 5.8° to 20.3° ± 2.7°, and the Costa-Bartani angle decreased from 135.2° ± 5.4° to 125.9° ± 4.8°. OxAFQ-C scores also improved significantly across all domains (p < 0.001 for all), with all improvements substantially exceeding previously reported minimal clinically important difference thresholds. Concomitant percutaneous Achilles tendon lengthening was performed in 12 patients (20%). No major complications were observed. Conclusions Subtalar arthroereisis with the calcaneal stop screw appears to be a safe and effective minimally invasive procedure for symptomatic flexible flatfoot in children and adolescents, leading to significant improvements in both radiographic alignment and clinical outcomes at one year postoperatively. Longer-term comparative studies are warranted to confirm the durability of these results. Level of Evidence Level IV, therapeutic case series For clinical trials (if applicable) This study was registered as a prospective case series with the Iranian Registry of Clinical Trials (IRCT20250817066885N1).
OBJECTIVE Delays in hip fracture surgery are associated with increased morbidity and mortality. The American Heart Association (AHA) American College of Cardiology (ACC) Clinical Practice Guidelines (CPG) were made to standardize indications for preoperative cardiology consultation and transthoracic echocardiograms (TTE). The purpose of this study is to determine if the AHA/ACC CPG are accurately applied or overused and whether this leads to delay in time to surgery for hip fracture patients at a cardiac specialty hospital. METHODS Design: Retrospective review.Setting: Cardiac specialty hospital.Patients: 207 charts from 2021-2023 were reviewed for indications for preoperative cardiology consultations or TTEs according to AHA and ACC CPG in geriatric hip fracture patients.Outcome Measure: Primary: Time to surgery.Secondary: Major adverse cardiac events (MACE) postoperatively. RESULTS 102 (49.3%) consults were placed despite indications for 41 (40.2%). Of the 38 patients (18.4%) with both a cardiac consult and echocardiogram, 16 (42.1%) of them were indicated. Median time to surgery was not significantly greater for patients receiving cardiology consultation versus those who did not (18.16 vs. 17.12, P-value 0.28, U-statistic 5825). Median time to surgery for patients receiving a TTE was not significantly greater versus those who did not (20.12 vs. 17.11, P-value 0.18, U-statistic 4589). 6 patients experienced a MACE within 30 days postoperatively. Three of 102 patients (2.94%) who received a preoperative cardiac consultation experienced a 30-day MACE compared with three of 105 patients (2.86%) without consultation (Fisher’s exact p ≈ 1.0). CONCLUSION Cardiology consultations and TTEs are often used without AHA/ACC CPG indication, wasting hospital and patient resources. At a cardiac specialty hospital, unindicated preoperative cardiac evaluations and TTEs did not delay times to surgery, likely due to cardiology expertise, efficient evaluations, and ample resources. Nonetheless, hospitals should be mindful of consult indications, and AHA/ACC CPG may need to be elucidated.
Background Residual neuromuscular deficits are common following anterior cruciate ligament reconstruction (ACLR), potentially limiting full functional recovery. While surgical techniques have advanced, long-term outcomes are largely determined by rehabilitation quality. Multimodal rehabilitation programs integrating various training modalities may enhance and sustain neuromuscular adaptations beyond traditional physiotherapy approaches. Objective This study aimed to evaluate the durability of neuromuscular and functional adaptations at 6- and 12-month follow-ups following a structured multimodal rehabilitation program in individuals after ACLR. Methods A randomized controlled trial was performed on 90 participants (Group A: experimental; Group B: control) with comparable baseline characteristics (p > 0.05). The experimental group received a 6-week supervised multimodal intervention with 12-month follow-up incorporating concentric–eccentric strengthening, balance training, endurance exercises, and functional retraining, while the control group underwent standard physiotherapy. Outcome measures included muscle power (concentric and eccentric), endurance, isometric strength, dynamic balance, and patient-reported scores—Knee Injury and Osteoarthritis Outcome Score (KOOS), Cincinnati Knee Rating Scale (CKRS), and Oxford Knee Score (OKS)—assessed at baseline, 6 weeks, 6 months, and 12 months. Results The experimental group demonstrated significant gains in concentric power (+100.3%), eccentric power (+138.3%), endurance (+25.2%), and isometric strength (+20.6%) at 12 months, with improved balance (−41.9%) and functional outcomes (KOOS +70.1%, CKRS +61.8%, OKS +37.6%). Between-group comparisons favored the multimodal protocol (Cohen’s d = 0.25–1.14). The control group showed smaller or inconsistent improvements. Conclusion Long-term, multimodal rehabilitation following ACLR results in superior and sustainable neuromuscular and functional recovery compared to conventional physiotherapy, underscoring the necessity of comprehensive, structured rehabilitation to optimize postoperative outcomes.
Aims/Objectives Plasma-rich Platelets (PRP) injections are becoming popular, but their uses remain controversial. This study aims to determine whether PRP injections within six months prior to TKA increase the incidence of postoperative prosthetic joint infection (PJI), superficial surgical site infection (SSI), and other implant-related complications. Material & Methods This retrospective study used PearlDiver Mariner165 database, covering patient records from January 2010 to March 2021. Patients who underwent TKA for osteoarthritis with a history of PRP injections were identified and stratified by timing of injection: <6 months, 6–12 months, and >12 months before TKA. Propensity matching was performed. Postoperative complications, including SSIs, were compared, and multivariate regression was used to calculate odds ratios, with P<0.01 considered significant to minimize Type I error. Results There was no statistically significant difference in rates of PJI following TKA groups at 90 days or two years postoperatively. The <6-month group demonstrated higher odds of 2-year SSI compared with the >12-month group (OR 7.74, 95% CI 1.4–57.8); however, this did not meet the predefined significance threshold (p = 0.022). Absolute event counts were low across all cohorts. Conclusion For patients who received PRP prior to TKA, injection timing was not associated with an increased risk of PJI. A numerically higher rate of 2-year SSI was observed among patients receiving PRP within 6 months of surgery. However, statistical significance did not reach the predefined threshold, and event counts were limited. These findings should be interpreted cautiously and considered hypothesis-generating. Further studies with greater clinical granularity and adequate power are warranted.
Introduction Robotic-assisted total knee arthroplasty (RA-TKA) aims to improve alignment accuracy and surgical precision compared with conventional manual total knee arthroplasty (C-TKA). This systematic review and meta-analysis evaluated differences in validated patient-reported outcome measures (PROMs) between RA-TKA and C-TKA. Materials and Methods This review was conducted in accordance with PRISMA 2020 guidelines and prospectively registered in PROSPERO (CRD420261303242). PubMed, Cochrane Library, and Google Scholar were searched from inception to the final search date. Comparative studies reporting validated PROMs following RA-TKA versus C-TKA were included. Randomized controlled trials were assessed using RoB 2 and non-randomized studies using ROBINS-I. Continuous outcomes were pooled as mean differences (MD) with 95% confidence intervals (CI) using a random-effects model. Heterogeneity was assessed using the I2 statistic. Results Twenty studies comprising approximately 5,800 patients (13 randomized controlled trials and 7 comparative cohort studies) were included. For Knee Society Score (10 RCTs; 2,724 knees), the pooled MD was 0.62 (95% CI −1.51 to 2.76; I2 = 89%). Oxford Knee Score (6 studies; 438 patients) showed an MD of 0.79 (95% CI −0.12 to 1.71; I2 = 32%). KOOS (4 studies; 1,111 patients) demonstrated an MD of 3.00 (95% CI −0.24 to 6.24; I2 = 78%), while WOMAC (8 studies; 3,217 knees) showed an MD of −0.21 (95% CI −2.46 to 2.04; I2 = 80%). Forgotten Joint Score, HSS score, VAS pain (I2 = 0%), and range of motion (14 RCTs; 3,798 knees; MD −0.44, 95% CI −2.55 to 1.67; I2 = 89%) were also comparable. Reported infection, revision, and reoperation rates were similar between groups. Conclusion RA-TKA has not demonstrated superiority over C-TKA in PROMs at final follow-up. Despite improved technical precision, robotic assistance was not associated with clinically meaningful advantages in pain, function, or satisfaction based on current evidence.
Study Design Retrospective Study Purpose Our study aims to assess the impact of metabolic and bariatric surgery on spinal sagittal alignment and spinopelvic parameters, as well as patients’ nutritional status.Overview of the literature: Metabolic and Bariatric Surgery (MBS) is currently the most effective for substantial weight loss in morbid obesity. It has been shown to reduce lower back pain; however, results are not always consistent, and some patients continue to experience significant back pain after the procedure. Methods Following IRB approval, data were retrospectively collected from patients' medical records and operative notes. Variables collected included age, gender, BMI, type of MBS, pre- and postoperative spinopelvic parameters (pelvic tilt, sacral slope, pelvic incidence, lumbar lordosis), and the degree of multifidus muscle fatty infiltration on MRI. Micronutrient and macronutrient levels were assessed preoperatively and 2-3 years post-MBS. Results Twenty-three patients, with a mean age of 44.95 ± 10.77 years and mostly female (78%), were included. After MBS, a significant drop in body mass index (BMI) was observed (p < 0.001). Hemoglobin levels increased significantly after surgery (p = 0.047). Similarly, levels of Total proteins (p = 0.001) and Albumins (p = 0.047) were elevated postoperatively. Vitamin D levels decreased further after MBS, from 25 to 16.5 (p = 0.046). No statistically significant changes were observed in all spinopelvic parameters at 12 months post-surgery. The cross-sectional area of the back muscles shifted from a predominantly mild reduction pre-operatively (77%) to a higher proportion with moderate (26%) and severe (22%) reductions post-operatively; however, this trend did not reach statistical significance (p = 0.25). Conclusion Higher hemoglobin and protein levels can be achieved through proper postoperative nutrient supplementation and adherence to intake. Spinopelvic parameters and changes in back muscle volume are unlikely to be the cause of persistent back pain following bariatric surgery.
Background Non-displaced closed fracture of the fifth metatarsal is commonly managed conservatively. However, efficacy in promoting early mobilization and improve patient quality of life remains variable. Pneumatic walking boot have been proposed to facilitate pain control and earlier functional load bearing. Case Presentation A 12-year-old boy who sustained a non-displaced closed fracture of the right fifth metatarsal following an accidental impact at his daycare centre on 29th January 2026. Initial management included backslab immobilization with non-weight bearing (NWB), resulting in pain score of 3-4/10when ambulating with crutches or walking frame. After consultation with an orthopaedic specialist, a pneumatic walking boot was recommended and fitted on day one of injury. With this orthotic aid, the patient reported a pain score of 0 – 1/10 and was able to ambulate independently without any other support, while still adhering to fracture care principles. On top of that, the boy able to return to school on day 4 of injury due to the aid of pneumatic walking boot. Discussion Conservative management of fifth metatarsal fracture traditionally involved casting and prolonged NWB, which may impede early ambulation and affecting all other daily activities. Studies comparing walking boots against traditional casting shows that walking boot can lead to earlier functional improvement and reduced pain. A comparative cohort study showed improved functional outcome and earlier return to pre-injury function in patient treated with walking boot versus short leg casts. Early functional treatment with walking boots has also demonstrated reliable outcomes and patient satisfaction in previous cohorts. Recent reviews suggest that less rigid immobilization and weight bearing as tolerated can yield improved early functional scores. Conclusion This case highlights the potential benefit of pneumatic walking boot in facilitation pain free early mobilization and enhancing quality of life in amateur paediatric patients with non-displaced fifth metatarsal fractures. Further prospective studies are warranted to refine guidelines on early functional management using pneumatic walking boots.
Background Same-day discharge (SDD) after elective primary total hip arthroplasty (THA) is expanding, yet contemporary national determinants and simple adjusted eligibility tools remain unclear. We examined factors associated with SDD in a short-stay cohort and evaluated a parsimonious postoperative day-0 (POD0) score. Methods We conducted a retrospective cohort study using the Nationwide Readmissions Database (2020-2022). Elective primary THA cases were identified using ICD-10-PCS codes and linked within calendar year. We excluded COVID-19 diagnoses, age <18 years, traumatic indications, and non-elective admissions; analyses were restricted to procedures performed on hospital day 0 with length of stay (LOS) 0-1 days. The primary outcome was SDD (LOS 0) versus overnight stay (LOS 1). A 5-point POD0 score assigned one point each for age <65 years and absence of obesity, chronic anemia, major organ disease, and major cardio-neurovascular disease. Multivariable logistic regression adjusted for demographics, socioeconomic status, payer, hospital location, year, and robotic assistance. Results Among 211,794 patients, SDD occurred in 18,330 (8.7%). SDD was more frequent in higher-income ZIP codes and metropolitan hospitals (p<0.001). Ninety-day readmission was lower after SDD (3.6% vs 4.9%, p<0.001). SDD increased stepwise across POD0 scores (4.8% at 0 to 12.3% at 5; p<0.001). The score independently predicted SDD (aOR 1.36 per point, 95% CI 1.32-1.39); robotic-assisted THA was associated with lower odds (aOR 0.63, 95% CI 0.58-0.69). Conclusions In a contemporary national short-stay THA cohort, SDD was uncommon and influenced by clinical and socioeconomic factors. A simple POD0 score showed graded, independent association with SDD. Levels of Evidence Level III
Background Retained debris found in reusable surgical instruments during total joint arthroplasty raises concern for sterility. Like reusable surgical instruments, such debris undergoes autoclave sterilization, implying it may also be sterile. However, prior literature has failed to reach a consensus. Methods This prospective cohort study included 25 patients with aspirate-confirmed hip or knee prosthetic joint infection (PJI) and 25 patients without infection. Intraoperative bone and tissue specimens were obtained from both cohorts, and seven random cement cultures were obtained. All specimens underwent standard autoclave sterilization followed by aerobic, anaerobic, fungal and acid-fast bacilli (AFB) culture. Results Among patients with PJI (N = 18 knee, 7 hip), preoperative aspiration cultures identified Staphylococcus in 23 cases (18 methicillin-sensitive, 5 methicillin-resistant), Escherichia coli in one, and Pasteurella multocida in one. Intraoperative cultures matched preoperative aspirates in all cases. After sterilization, all bone and tissue specimens obtained from patients with known PJI were negative for aerobic, anaerobic, fungal and AFB. Of the seven cement specimens (three from patients with PJI and four from control group), all were negative after sterilization. All control cultures were negative. Conclusion Autoclave sterilization appears effective in eliminating bacteria, fungi and mycobacteria from previously infected specimens, suggesting the potential safety of using surgical instruments with retained debris for total joint arthroplasty. Level of Evidence III
Background/Purpose : Distal radius fractures (DRFs) are common and often require post-surgery analgesics, overprescription is a major concern. This study investigated postoperative opioid dispensation before and after the introduction of a pre-packed take-home analgesia kit. Methods A retrospective cohort study, comparing opioid dispensation, measured in oral morphine equivalents (OME), before and after the introduction of pre-packed analgesia kits. In 2022, our hospital introduced analgesia kits for patients undergoing volar plate fixation for intra-articular DRF. Thirty-six patients who underwent surgery January–June 2019 met the inclusion criteria (control), and 44 who underwent surgery January–June 2022 (intervention). Results Patients receiving the analgesia kit had lower opioid dispensation (median 105 OME) compared to the control group (315 OME) (p <0.001). There was no statistically significant difference in additional opioid prescriptions or sick leave duration. Conclusion Our findings suggest that introduction of pre-packed take-home analgesia kit significantly reduces opioid dispensation for intra-articular DRF surgeries.
Background This systematic review synthesized perioperative and functional outcomes following simultaneous bilateral total knee arthroplasty (SBTKA) in obese patients. Methods Following PRISMA guidelines, literature searches of Medline, PubMed, Embase, Scopus, and Cochrane Library were conducted from inception to November 2024. Study selection, data extraction, and ROBINS-I risk-of-bias assessment were performed in duplicate. Perioperative data, complications, and functional outcomes were included. Continuous variables were summarized as means and standard deviations; dichotomous outcomes were reported as pooled proportions. Results Eleven studies comprising 61,636 obese patients were included. Mean age was 61.6 years, and mean body mass index (BMI) 36.7 kg/m2. Mean operative time was 105.8 minutes, blood loss was 739 mL, transfusion incidence was 21.7%, and hospital stay was 3.8 days. Pooled surgical complication rates were 0.95% overall (4.99% excluding the large Remily et al. cohort), and medical complication rates were 7.16% (7.82% excluding Remily et al.). Common complications included deep vein thrombosis (1.1-4.8%), pulmonary embolism (0.6-2.6%), and superficial wound issues (0.5-7.4%). Higher BMI was associated with increased operative time and complications, with rates up to 18.8% in morbidly obese institutional cohorts. Functional outcomes improved postoperatively, with mean Knee Society Score (KSS) rising from 51.6 to 81.5 and KSS function from 45.7 to 77.6. Conclusions Obese patients undergoing SBTKA experience improved functional gains, and perioperative risks may be similar to those reported for unilateral TKA in obese patients, although this comparison is indirect and should be interpreted with caution. Morbid obesity was associated with higher complication rates and requires cautious patient selection. Comparative studies with staged BTKA in obese patients are needed to elucidate the optimal surgical strategy. Level of Evidence III PROSPERO Registration Number CRD42024622089
