Gluteus minimus (GMin) tendon pathology is underreported and probably one of the most frequent causes of lateral hip pain. Today, direct anterior approach (DAA) for total hip arthroplasty (THA) is one of the most used approaches. DAA is the only surgical approach that allows a very good visualization of GMin tendon without the need for any other tendon detachment. This study first aimed to determine the real incidence of intraoperatively detected GMin lesions in a consecutive cohort of patients during their THA through a DAA. Furthermore, factors associated with these lesions have been analyzed as early treatment results. A consecutive cohort of 123 patients who underwent primary THA through the DAA at a single surgeon was intraoperatively screened for GMin tendinopathy. In case of a GMin tendon lesion, tendon to bone sutures and/or a tenodesis GMin-vastus lateralis or, rarely, anchor suture, were performed. The iHOT-12, modified Harris Hip Score (mHHS), Numeric Rating Scale (NRS) for pain, and VISA-G were recorded at baseline (T0), 2 months (T2), and 6 months (T6) postoperatively. Longitudinal changes were analyzed with one-way repeated-measures analysis of variance (ANOVA) and post-hoc pairwise comparisons. Patients were stratified by intraoperative GMin lesion status; group differences up to 6 months were assessed with unpaired t-tests, and multivariable logistic regression was used to identify baseline factors associated with GMin lesions. Intraoperative GMin tendon lesions were identified in 24 (19
The concept of femoroacetabular impingement (FAI) has fundamentally changed our understanding of hip pain and early osteoarthritis in young adults. Although first formally described in 2003, many of the anatomical observations and surgical principles underlying the concept were recognized decades earlier. This narrative review traces the historical evolution of FAI from the earliest anatomical descriptions of femoral and acetabular abnormalities in the late nineteenth century through the development of surgical hip dislocation, which enabled direct visualization of dynamic mechanical conflict within the hip joint and ultimately led to the formulation of the FAI concept. The review highlights early observations of cam-like deformities, acetabular version abnormalities, and pioneering hip-preserving procedures performed long before the pathomechanical significance of these findings was understood. It also discusses the shift from the traditional concept of primary osteoarthritis to a mechanical model of hip degeneration and examines how the original concept has evolved through advances in arthroscopy, three-dimensional imaging, and increasingly individualized assessment of hip morphology and biomechanics. The history of FAI shows that transformative advances in orthopaedic surgery often arise from the integration of previously disconnected anatomical, radiographic, and surgical observations into a unified biomechanical framework. More than 2 decades after its introduction, the FAI concept remains the cornerstone of contemporary hip-preserving surgery and continues to shape research into the prevention and treatment of degenerative disease of the young adult hip.
Restoration of shoulder function after resection for primary bone tumors of the scapula is a challenge, according to the sacrifice of rotator cuff muscles and glenoid. This study aims to define the advantages of a prosthetic design over the others in different clinical situations, comparing the functional outcomes and complication rate of patients treated for a primary tumor of the scapula or surrounding soft tissue with resection and reconstruction with custom-made prostheses. Eight patients were retrospectively reviewed; seven underwent total scapulectomy, while one underwent partial. A humeral prosthesis was placed in five patients (four with constrained and one with anatomical design), and in one patient, a transposition of the latissimus dorsi was performed, in order to replace the deltoid muscle. At a median follow-up of 55 months (24–97), two complications requiring further surgeries (a local recurrence and a wound dehiscence) were assessed in two patients, all managed without scapular prosthesis removal. The median MSTS score was 24 (14–30); in the group of constrained prosthesis, the median MSTS score was 24 (19–26), while in the group of nonconstrained prosthesis it was 19 (14–26). The patient with partial scapular reconstruction scored 30 points. After resection of the scapula, custom-made prostheses represent an effective reconstruction, with good functional results and low complication rate. In patients in whom the rotator cuff and its innervation are preserved, an anatomic design seems to allow for good functional results; after rotator cuff sacrifice, a constrained prosthetic design in our experience seems to allow for a stable and painless shoulder with acceptable functional results. Level of evidence: IV.
Periprosthetic joint infection (PJI) remains one of the most devastating complications in orthopedic surgery, associated with substantial morbidity, high treatment costs, and increased mortality. Although antibiotic therapy remains the cornerstone of prevention and treatment, the emergence of antimicrobial resistance has driven the development of alternative antibacterial strategies targeting implant surfaces and the local biological environment. However, the clinical effectiveness of these nonantibiotic approaches has not yet been fully established. This systematic review and meta-analysis aimed to identify nonantibiotic antibacterial strategies currently applied in clinical practice, to evaluate their effectiveness in preventing or managing PJI and to quantify, through meta-analysis, the comparative infection-prevention effect of silver-coated versus uncoated prostheses. A systematic literature search was conducted in PubMed, Scopus, Web of Science, and Google Scholar following Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. The search was performed on 27 January 2026 and included studies published over the last 10 years (January 2015–December 2025). Eligible studies comprised clinical investigations assessing nonantibiotic antibacterial strategies in patients undergoing primary or revision orthopedic procedures. Interventions included antibacterial implant coatings, physicochemical surface modifications, and biologically based antimicrobial therapies. Primary outcomes were infection prevention/control, and reinfection; secondary outcomes included implant survival, adverse events, and function. Risk-of-bias was assessed with Cochrane Risk-of-Bias in Nonrandomized Studies of Interventions (ROBINS-I). Studies with extractable raw infection counts for silver-coated versus uncoated prostheses were pooled in a random-effects meta-analysis to estimate absolute risk reduction (ARR) and number needed to treat (NNT). Twenty-nine studies, including 2100 patients, met the inclusion criteria. Silver-coated prostheses were the most studied strategy, showing a trend toward reduced infection and improved limb salvage, not always significant. Ten comparative studies (1207 patients: 546 silver-coated, 661 uncoated) were meta-analyzed: pooled infection rates were 12.3
Abstract Background Non-pharmacologic management of chronic low back pain (cLBP) should be considered the first-line treatment. However, consensus guidelines and internationally accepted recommendations on the therapeutic algorithm are missing. The present level I systematic review presents a qualitative analysis of advancements in physiotherapy over the past decades to discuss the role of physical and rehabilitation medicine in the management of cLBP. Methods In August 2025, the following databases were accessed: PubMed, Web of Science and Embase. All randomised controlled trials evaluating the efficacy of physiotherapy programs in patients with cLBP were assessed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) criteria. The data extraction and risk-of-bias evaluation were performed independently by two authors. Results Data from 150 randomised controlled trials (RCTs) (12,773 patients) were collected. The mean symptom duration was 61.2 ± 51.0 months, and the mean follow-up was 4.3 ± 5.9 months. The mean age was 44.5 ± 9.4 years, and the mean body mass index (BMI) was 25.8 ± 2.9 kg/m2. Conclusions Managing cLBP is challenging. While individual investigations highlight the efficacy of a specific intervention, most cLBP management strategies share common elements. Combining key elements from various approaches may prove crucial. Although this result is not decisive for treatment, it paves the way for further research that considers a more holistic and multidisciplinary approach.
