➢ Cervical disc arthroplasty (CDA) provides clinical outcomes comparable with those of anterior cervical discectomy and fusion (ACDF) for 1-level and 2-level cervical degenerative disc disease (DDD), with durable long-term motion preservation. ➢ Although CDA is associated with lower rates of adjacent-segment pathology compared with ACDF, the absolute risk reduction at longer follow-up is modest and methodological heterogeneity across trials limits definitive conclusions. ➢ Expanded indications including multilevel (≥3-level) CDA, hybrid constructs, and other situations that were previously considered contraindicated during U.S. Food and Drug Administration (FDA) Investigational Device Exemption (IDE) trials have shown promising short-term to intermediate-term results in more recent studies. ➢ As CDA utilization increases, standardized failure reporting and the development of evidence-based revision algorithms are critical to optimize long-term outcomes.
➢ Cervical sagittal alignment is associated with patient-reported outcomes, with higher T1 slope-cervical lordosis mismatch and greater C2-C7 sagittal vertical axis correlating with greater disability and worse health-related quality of life. ➢ Cervical alignment must be interpreted alongside global sagittal balance, as cervical posture interacts with thoracic and spinopelvic alignment and compensatory mechanisms. ➢ Both anterior and posterior cervical fusion can influence sagittal alignment, but optimal outcomes depend on alignment-conscious planning tailored to deformity morphology and spinal flexibility. ➢ Preserving or restoring physiologic cervical alignment reduces the risk of postoperative imbalance and adjacent-segment disease, supporting alignment-guided surgical decision-making.
Background: Iliopsoas impingement (IPI) is a known cause of persistent anterior hip pain following total hip arthroplasty (THA). Management of IPI has often relied on an 8-mm anterior acetabular overhang threshold to guide operative treatment, favoring acetabular revision for greater overhang and iliopsoas tenotomy for lesser overhang. These thresholds were initially established on the basis of the outcomes of open tenotomy, and now, with an improved understanding of IPI and the advent of arthroscopic iliopsoas fractional lengthening (IPFL), a review of the 8-mm threshold is warranted. Methods: A retrospective review was performed to identify patients who underwent arthroscopic IPFL following primary THA between 2017 and 2024, with a minimum follow-up of 1 year. Acetabular overhang was measured for all patients using cross-table lateral radiographs, and patients were stratified into <8-mm and ≥8-mm cohorts. Patient-reported outcome measures, reoperations, revisions, and complications were collected and analyzed on the basis of both the classic 8-mm threshold and continuous statistical methods. Results: We evaluated 86 hips undergoing IPFL. There were 83 patients (30 men and 53 women), with a mean age of 63.0 ± 11.2 years; with regard to race, 80 patients were White, 1 patient was Black or African American, and 2 patients listed other race or chose not to disclose. The acetabular overhang was <8 mm for 67 hips and ≥8 mm for 19 hips. The mean follow-up was 2.5 ± 1.6 years (range, 1 to 7.5 years). When comparing patients with <8-mm and ≥8-mm acetabular overhang, we observed no significant differences (p > 0.06) in the preoperative and postoperative visual analog scale (VAS) pain scores, modified Harris hip score, Single Assessment Numeric Evaluation (SANE) score, Tegner activity level, subjective groin pain improvement, subjective hip flexion strength improvement, and overall satisfaction. Reoperation (2.9% compared with 10.5%; p = 0.210) and acetabular revision rates (1.5% compared with 5%; p = 0.387) were not significantly different between the <8-mm and ≥8-mm overhang groups. Conclusions: Arthroscopic IPFL provided satisfactory outcomes for patients with IPI, independent of the magnitude of acetabular overhang. IPFL should be considered for first-line surgical management of IPI refractory to nonoperative management, even in the setting of substantial acetabular overhang, given positive outcomes and low rates of subsequent acetabular revision. Level of Evidence: Therapeutic Level IV . See Instructions for Authors for a complete description of levels of evidence.
Background: Long-term success after anatomic total shoulder arthroplasty (aTSA) is frequently defined by implant survivorship, but revision-free survival may not reflect durable clinical benefit. Methods: A retrospective cohort study of 791 consecutive aTSAs performed between 2003 and 2015 was conducted. Implant survivorship was assessed using Kaplan-Meier analysis. Clinical outcomes were evaluated at a 10-year landmark, and clinically important thresholds for the American Shoulder and Elbow Surgeons (ASES) score were derived using patient satisfaction as the anchor. Multivariable regression identified predictors of revision and substantial clinical benefit (SCB). Results: Kaplan-Meier survivorship was 96.1% at 10 years and 93.7% at 15 years. Walch B glenoid morphology and younger age were independently associated with revision. Clinical outcomes remained improved at long-term follow-up despite gradual attenuation over time. At 10 years, the patient acceptable symptom state (PASS) threshold for the ASES score was 68.1, and 69.5% of shoulders achieved it. The minimal clinically important difference (MCID) and SCB thresholds for the change in ASES score were 14.0 and 39.2, achieved by 79.9% and 55.8% of shoulders, respectively. Younger age, primary glenohumeral osteoarthritis, and lower preoperative ASES score were independently associated with achievement of SCB. Conclusions: aTSA demonstrated excellent long-term implant survivorship and modest patient-reported outcomes, although shoulder function gradually attenuated over extended follow-up. Despite the gradual functional decline, most patients maintained clinically meaningful benefit at 10 years. Younger age and Walch B morphology increased revision risk. Long-term clinically important thresholds provide patient-centered benchmarks for defining durable success. Level of Evidence: Prognostic Level III . See Instructions for Authors for a complete description of levels of evidence.
➢ Osteochondral lesions of the talus (OLT) are common injuries that remain difficult to treat because of the challenge of restoring durable hyaline cartilage. Surgical outcomes are influenced by lesion size and morphology, cartilage integrity, subchondral bone involvement, and ankle stability, all of which should be considered when evaluating operative strategies. ➢ Fragment fixation preserves the native osteochondral unit in lesions with a viable fragment and is primarily indicated in acute OLT. Lift-drill-fill-fix is utilized in selected chronic lesions with a salvageable fragment and compromised subchondral bone, allowing restoration of the lesion bed and stable fixation. ➢ Bone marrow stimulation techniques, including microfracture, antegrade drilling, and retrograde drilling, have demonstrated improvements in pain and functional outcomes in small and contained lesions, although the long-term durability of fibrocartilaginous repair tissue remains variable. ➢ Replacement procedures such as autologous osteochondral transplantation and osteochondral allograft transplantation restore the osteochondral unit and have demonstrated favorable outcomes in larger or structurally complex lesions. Cell-based and matrix-assisted cartilage restoration strategies, such as autologous chondrocyte implantation, matrix-induced autologous chondrocyte implantation, and autologous matrix-induced chondrogenesis, have demonstrated improvements in clinical outcomes and cartilage repair in selected patients with OLT. ➢ Emerging restorative approaches such as scaffold-based cartilage repair, osteoperiostic autografting techniques, and biologic adjuncts including concentrated bone marrow aspirate, platelet-rich plasma, and hyaluronic acid have demonstrated promising early clinical results, although current evidence remains limited. ➢ Salvage procedures, including bulk allograft transplantation, metallic resurfacing, hemiarthroplasty, and arthrodesis, may be considered for extensive lesions or after failure of prior surgical management, although outcomes remain variable, with high complication and failure rates.
