The presence of an osteoid osteoma (OO) in the calcaneus and patella remains an uncommon condition. These lesions can often lead to diagnostic and therapeutic difficulties. Initial assessment and cautious management contribute to excellent results and limited complications. We report a 20-year-old male with OO of the calcaneus and a 35-year-old male with OO of the patella. The clinical suspicion, in combination with thorough imaging control, can lead to the final diagnosis. Imaging examinations usually reveal a nidus; however, computed tomography remains the gold-standard tool for the detection and diagnosis of lesions. The state-of-the-art therapeutic methods emphasize minimally invasive techniques. The unusual location of these tumors emphasizes the specific need for careful management and minimally invasive treatment, which ultimately contributes to excellent outcomes with minimal adverse effects.

Proximal fibular osteotomy (PFO) is an emerging joint-preserving procedure for medial compartment knee osteoarthritis (OA), with most evidence derived from East Asian populations. Its safety and efficacy in Western patients remain underexplored. This prospective single-centre study, conducted at a tertiary university hospital in Greece (Southern Europe), evaluated 27 patients (30 knees) with medial compartment OA or knee OA with predominantly medial symptoms who underwent PFO. Primary outcomes were changes in VAS pain, Knee Society Score (KSS), Oxford Knee Score (OKS), KOOS-Jr, and EQ-5D-5 L at 12 months. Secondary outcomes included postoperative complications and conversion to total knee arthroplasty (TKA). At 12 months, all outcomes improved significantly from baseline ( p < 0.001), exceeding established minimal clinically important differences: VAS −4.4, KSS +27.9, OKS +14.8, KOOS-Jr +20.6, EQ-5D-5 L + 0.27. One knee (3.3%) converted to TKA due to persistent pain. Peroneal nerve–related symptoms occurred in 36.7% of knees but resolved by 6 months. In this European (Greek) cohort, PFO provided substantial pain relief, functional improvement, and quality-of-life gains at 12 months with a favorable safety profile. These findings align with prior reports from East Asian populations and suggest that PFO may be a viable minimally invasive option for carefully selected Western patients with mild-to-moderate varus OA and medial compartment symptoms. Further high-quality research is needed to confirm these results and define PFO’s role in knee OA management.

Patellar management in primary total knee arthroplasty (TKA) remains one of the most debated and variable aspects of contemporary arthroplasty practice. Patellar resurfacing, non-resurfacing, and selective resurfacing each offer distinct advantages, but no universally superior strategy has emerged. Although global functional outcomes are generally comparable across techniques, differences persist in anterior knee pain, survivorship, patellofemoral degeneration, and the likelihood of secondary patellar procedures. This narrative review synthesizes current clinical, radiographic, biomechanical, and registry-based evidence to provide a comprehensive understanding of these differences. Patellar resurfacing tends to offer clearer benefits in patients with advanced patellofemoral osteoarthritis, significant preoperative symptoms, unfavorable patellar morphology, or implant designs that increase patellofemoral loading. Conversely, non-resurfacing remains a safe and effective option in patients with minimal patellofemoral disease and favorable anatomical characteristics. Selective resurfacing represents a patient-tailored compromise, though its effectiveness is currently limited by the absence of standardized selection criteria. The integration of evidence across multiple studies reinforces that patellar resurfacing should follow an individualized, indication-guided approach instead of routine application. It also proposes a structured framework that incorporates anatomical, radiographic, and implant-related factors to guide patellar management during primary TKA.

Periprosthetic Joint Infection (PJI) remains one of the most challenging complications in arthroplasty, often leading to diagnostic uncertainty and suboptimal treatment decisions. Synovial calprotectin has emerged as a promising biomarker, with the lateral flow test (LFT) offering real-time results for intraoperative decision-making. This meta-analysis aimed to evaluate the diagnostic accuracy of intraoperative synovial calprotectin LFT in detecting PJI. A systematic review and meta-analysis were conducted according to PRISMA guidelines. Thirteen studies comprising 990 patients were included. Pooled sensitivity, specificity, positive and negative predictive values (PPV, NPV), likelihood ratios (LR+, LR−), diagnostic odds ratio (DOR), and area under the curve (AUC) were calculated using a random-effects model. Subgroup analyses were performed based on test kit type and calprotectin cutoff values. The pooled sensitivity and specificity of synovial calprotectin LFT were 88

Recent research underscores the significance of meniscal extrusion in knee osteoarthritis progression. Centralization of the meniscus has emerged as a potential intervention, yet comprehensive literature on this is limited. This systematic review aims to synthesize evidence on meniscus centralization's impact on extrusion and knee biomechanics. A search of PubMed Central and Scopus yielded 14 relevant articles until June 1, 2023. Included were 3 case series, 9 cadaveric studies, and 2 involving animals or patients. Biomechanical effects on both medial and lateral menisci were explored, alongside implications for anterior cruciate ligament reconstruction. Findings suggest centralization may mitigate extrusion and improve knee biomechanics, potentially benefiting clinical outcomes. However, further high-quality studies are warranted to validate these observations and ascertain optimal centralization techniques.

Objectives: Ankle joint injuries are among the most common orthopedic injuries and are associated with significant healthcare costs. To reduce unnecessary radiographic screening, diagnostic tools such as the widely accepted Ottawa Ankle Rules (OARs) have been developed. However, the accuracy of OARs in excluding fractures remains uncertain. Recently, a new diagnostic test, the Shetty Test (ST), has been introduced. This prospective comparative study aimed to evaluate the diagnostic accuracy of the “ST” in comparison to the “OARs” for detecting ankle and foot fractures.Methods: A total of 112 consecutive adult patients (>18 years old) were included in the study. They were presented to the Emergency Department of a University Hospital in Alexandroupolis due to an ankle or foot injury. Data were collected over 6 months, from November 2022 to May 2023.Results: The sensitivity of the ST was 68.4%, specificity was 76.3%, positive predictive value (PPV) was 37.1%, and negative predictive value (NPV) was 92.2%. For the OARs, sensitivity was 94.7%, specificity was 15%, PPV was 18.5%, and NPV was 93.3%. When at least one of the tests was positive, the sensitivity and NPV increased to 100%.Conclusion: The ST was found to be reliable; however, it did not outperform the OARs in this study. Nevertheless, when used in conjunction, the two tests significantly improved sensitivity and the NPV. Due to its simplicity and reproducibility, the ST could be a valuable tool in daily clinical practice, particularly for non-orthopedic emergency department personnel.

Introduction: Enhanced recovery strategies have resulted in significant reductions in length of hospitalization and postoperative morbidity in total hip (THA) and total knee (TKA) arthroplasties. The success and safety of the arthroplasties are characterized by the establishment of evidence-based criteria, which offer safe hospitalization and postoperative care. Aim: The objective of the present survey was to investigate components related to fast-track recovery, discharge criteria, delayed discharge, complications, and readmissions. Materials and methods: The following methods were employed: the ASA grade, the Charlson index, the neuropathic pain (DN4) questionnaire, and the patient health (PHQ-9) questionnaire. Additionally, the study included an examination of comorbidities, hospitalization, era deliver discharge standards, and 90-day readmission. The visual analogue pain scale, complications, and demographics were also examined in the retrospective study for the research. The study was conducted f om November 2017 to January 2020. Results: Two hundred and thirty-five patients underwent TKA (n=134) and THA (n=101), the mean age was 68±8.7 years and BMI was 32.4±5.4 kg/m2. On average, the patients had 1.6±1.1 comorbidities, the Charlson index was 2.4±1.3 and the ASA grade was 2.1±0.5. The exit rules were attained at 1.9±0.75 days postoperatively. However, the actual infirmary care was 3.06±1.01 days, with a waiting span of 62.5% or 1.2 days. THA succeeded in departure principles more quickly (1.8 days vs. 2 days for TKA). Sex (p=0.04), age (p=0.009), and the Charlson index (p=0.046) were strongly related to the instant to fulfil the release norm in the TKA. While in THA, the length of ward stay was statistically significant and correlated with both age (p=0.05) and the Charlson index (p=0.05). In addition, the superPATH approach had a strong effect on the consummation of the delivery measures (1.48 days vs. 1.89 days for the Hardinge approach) (p=0.002) and shorter treatment (p=0.04). Conclusion: Achieving safe release goals and reducing hospitalization were associated with modifiable (superPATH approach) and unmodifiable (age, sex, and Charlson index) foretold agents. These indexes could offer reproducible results with limitation of postoperative complications, morbidity, and readmissions.

Introduction The implementation of patients’ blood management (PBM) is being leaded in a considerable decline of both blood loss and allogenic blood transfusion in primary Total Hip (THR) and Knee Replacement (TKR). The aim was to outline the results after a stepwise implementation of PBM protocol in THR and TKR. Material and Methods We conducted a retrospective study. A PBM protocol regarding the entire blood bleeding, the use of tranexamic acid (TXA) (0gr or 1gr or 2gr), the preoperative anaemia and a transfusion trigger (from 10 to 8 Hb gr/dl) was applied. Patients and surgery related data were prospectively recorded and analyzed. Results 427 patients underwent either TKR (n:260) or THR (n:167). In both TKR and THR presented gradual reduction (a) blood loss from 1.430 to 1.129 and from 1.277 to 1.101 respectively, (b) transfusion rate from 30.4–0.2% and from 35.7–0.1% respectively and (c) mean hospitalization from 5 to 2.97 days and from 4.8 to 2.87 days respectively. In TKR, pre-operative anaemia was an independent determinant of bleeding, as were BMI > 30, ASA > II and no-TXA use. Independent determinants of transfusion rate were pre-operative anemia and no-TXA use. In THR, independent determinants of hemorrhage were male, BMI > 30, operation > 90 minutes, transfusion rate, pre-operative anaemia and no-TXA use. Conclusion The implementation of a restrictive PBM protocol addressing the “modifiable” factors of increased blood loss and transfusion rate such as pre-operative anemia, TXA use, short surgical time and low transfusion trigger can substantially reduce the transfusion of allogenic blood. Level of Evidence II

The management of complex and severe lower-extremity injuries is challenging for the orthopedic surgeon. When the primary or secondary closure of the defect is not feasible, complex procedures with graft (split-thickness or full-thickness) or flap (pedicled or free) are required. These procedures are performed by specialized plastic surgeons and are at high risk for adverse effects, even high morbidity among both the donor and acceptor sites. Furthermore, split-thickness skin grafts (STSGs) often lead to unsatisfactory results in terms of mechanical stability, flexibility, and aesthetics due to the lack of underlying dermal tissue. Consequently, dermal substitutes, such as MatriDerm (MedSkin Solutions Dr Suwelack AG, Billerbeck, Germany), have been proposed and further developed as a treatment option addressing the management of full-thickness wound defects in conjunction with STSGs. We aimed to present a case of post-traumatic full-thickness wound defect of the left foot after traumatic amputation of the digits that was treated with MatriDerm combined with autologous STSG. In addition, we performed a systematic review of the literature to delineate the efficacy of the use of MatriDerm combined with STSGs in orthopedic cases exclusively.

Increased use of arthroscopically assisted techniques for the treatment of ankle fractures has been reported. Despite their rapid development, there is only one systematic review regarding arthroscopically assisted treatment of ankle fractures, in which, however, only malleolar fracture studies are included. Various other types of ankle fractures have also been treated with arthroscopically assisted procedures. The purpose of this review was to identify and evaluate the existing literature about arthroscopically assisted surgical management of other types of foot and ankle fractures, such as Tillaux, pilon, Bosworth, talar, and calcaneal fractures. A systematic review was conducted until December 2022 using the Arksey and O'Malley framework and reported according to the PRISMA-ScR (Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews). Three databases—PubMed, Elsevier Scopus, and Cochrane Library—were searched for relevant studies. The chosen studies were divided into groups according to the fracture type. Of the 424 initially identified studies, 36 were finally included in the review: 22 case reports or case series and 14 original retrospective cohort studies. Participant demographic characteristics; methods of arthroscopically assisted reduction and fixation; and clinical, radiologic, and patient-reported outcomes were extracted. Arthroscopically assisted techniques for the treatment of Tillaux, pilon, Bosworth, talar, and calcaneal fractures are effective procedures and have already shown satisfactory and promising clinical and radiologic outcomes. There are some limitations in their use though, especially in some specific fracture patterns. Long-term effects and possible superiority of arthroscopically assisted techniques over classic reduction and fixation must be further studied.

Total knee arthroplasty (TKA) is currently one of the most common orthopedic surgeries due to the ever-increasing average life expectancy. The constant need for effective and accurate techniques was contributed to the development of three-dimensional (3D) printing in that field, especially for patient-specific instrumentation (PSI) and custom-made implants fabrication. PSI may offer numerous benefits, such as resection accuracy, mechanical axis alignment, cost-effectiveness, and time economy. Nonetheless, the results of existing studies are controversial. For this purpose, a review article of the published articles was conducted to summarize the role of 3D-printed PSI in TKA.

Abstract Introduction Fragility fractures around the proximal end of the femur have increased in recent years due to an aging population, adding to the pressure on national health care systems and to hospital expenses. Peri-trochanteric fractures have historically been treated successfully with anatomic intramedullary nails, giving stable fixation in order to allow early for mobilisation of these frail patients. Some of these nails allow a second (anti-rotational) screw through the nail into the femoral head. We assessed the use of this additional screw in terms of quality of reduction, post-operative mobilization and complications. Materials & methods All patients who were treated in the same hospital for peri-trochanteric fracture between January 2017 and December 2019 were included in the study. The patients were randomly assigned into group A, where the treatment included intramedullary nailing using one femoral hip screw, and group B, where the treatment additionally included a second anti-rotational screw. The patients were followed up clinically and radiologically, for at least 3 months post-operatively. Demographic and operative data were collected alongside radiographic and clinical data. Results A total of 118 patients with an average age of 82.7 years were included in the study after exclusion criteria was applied. There were no statistically significant differences between the two groups regarding the ASA grade, Nottingham Hip fracture score, Koval score, Mental score, operation time, transfusion requirements, and operative radiation dose and time (p > 0.05). In group A, more complications were observed (p < 0.05). The radiographic measurements were statistically significantly different. CART analysis revealed that the use of a single screw in the femoral head for the subgroup of the unstable peri-trochanteric fractures (Jensen Type 4–5 – AO31A2.2 and above), has a tendency toward developing more post-operative complications, though this was not statistically significant. Conclusion The use of an additional anti-rotational screw for unstable peri-trochanteric fractures (Jensen Type 4–5 and AO 31A2.2 and above) could prevent complications such as varus collapse and cut-out.

Background: ChatGPT (OpenAI Incorporated, Mission District, San Francisco, United States) is an artificial intelligence (AI)-based language model that generates human-resembling texts. This AI-generated literary work is comprehensible and contextually relevant and it is really difficult to differentiate from human written content. ChatGPT has risen in popularity lately and is widely utilized in scholarly manuscript drafting. The aim of this study is to identify if 1) human reviewers can differentiate between AI-generated and human-written abstracts and 2) AI detectors are currently reliable in detecting AI-generated abstracts. Methods: Seven blinded reviewers were asked to read 21 abstracts and differentiate which were AI generated and which were human-written. The first group consisted of three orthopaedic residents with limited research experience (OR). The second group included three orthopaedic professors with extensive research experience (OP). The seventh reviewer was a non-orthopaedic doctor and acted as a control in terms of expertise. All abstracts were scanned by a plagiarism detector program. The performance of detecting AI-generated abstracts of two different AI detectors was also analyzed. A structured interview was conducted at the end of the survey in order to evaluate the decision-making process utilized by each reviewer. Results: The OR group managed to identify correctly 34.9% of the abstracts' authorship and the OP group 31.7%. The non-orthopaedic control identified correctly 76.2%. All AI-generated abstracts were 100% unique (0% plagiarism). The first AI detector managed to identify correctly only 9/21 (42.9%) of the abstracts' authors, whereas the second AI detector identified 14/21 (66.6%). Conclusion: Inability to correctly identify AI-generated context poses a significant scientific risk as "false" abstracts can end up in scientific conferences or publications. Neither expertise nor research background was shown to have any meaningful impact on the predictive outcome. Focus on statistical data presentation may help the differentiation process. Further research is warranted in order to highlight which elements could help reveal an AI-generated abstract.

Plantar fasciitis is a common cause of heel pain. The aim of this study was to review the current literature and attempt to clarify whether endoscopic plantar fasciotomy (EPF) is an effective and reliable treatment for plantar fasciitis in comparison with other invasive or noninvasive treatments. We performed an electronic search of the medical literature in PubMed database using combinations of the following keywords: plantar fasciitis, endoscopic treatment, and plantar aponeurosis. Overall, we had shown that patients had better scores following EPF/endoscopic plantar fascia release. The clinical scores were improved postoperatively and most of the patients were satisfied. Furthermore, the clinical trials showed that time to return to work or to previous activities was shorter compared with other treatments. These studies suggest that EPF/endoscopic plantar fascia release is probably an effective treatment of chronic plantar fasciitis. EPF is an efficient, safe treatment with good early postoperative results in patients with recalcitrant plantar fasciitis. There is evidence that other methods are equivalently effective for EPF, and some authors support that they should be considered as a second-line treatment because of their minimal invasive character and very low risk of complications; thus, more research is required.

The management of septic non-unions with associated bone necrosis is challenging, especially when the resulting bone defect after the debridement is extensile. Different techniques have been described in the literature for the treatment of these demanding cases, with the most prominent being free vascularized Fibular graft and bone transport with distraction osteogenesis principles. Recently, 3D printing technology has been increasingly utilized in many complex orthopaedic pathologies. However, the application of those advancements regarding septic non-unions with residual bone defect has not been previously studied. This study presents a novel 3D printing technique for the management of an infected critical bone deficit of the tibia. Queries, challenges and future perspectives concerning the recruiting of 3D printing technology in limb reconstruction are also being discussed.Clinical Evidence Level: IV.

The number of total knee arthroplasties (TKA) is rising in many countries along with the numbers of the revision TKA. Rotating hinge knee (RHK) implants have a fundamental role in the revision TKA and their design has evolved during the last years becoming appealing to many surgeons worldwide. They are mainly used in cases where large bone defects and severe soft tissue imbalance exist. However, despite their recent advancements, they are still associated with high complication rates such as infection, periprosthetic fractures and insufficiency of the extensor apparatus. An uncommon complication of the latest rotating hinge implants is their mechanical component failure. Here we present a rare case of such a devastating complication where a modern RHK prosthesis dislocated without a preceding traumatic event, a review of the corresponding literature and a potential cause for the failure of the mechanism. Moreover, insight on key aspects that need to be addressed is provided, like intrinsic and extrinsic factors which play a crucial role and shouldn't be overlooked for a successful outcome.

The menisci are crescent-shaped, fibrocartilaginous structures that play a crucial role in the load transition and distribution of the contact forces along the tibiofemoral articulation. Meniscal extrusion (ME) is a radiological finding, especially in magnetic resonance imaging (MRI) scans, for which there has been growing interest in recent years. ME, in the coronary plane, is defined as the maximum distance of the most distal end of the meniscus from the border of the tibial plateau, where the tibial eminences are the most prominent, without taking into account the osteophytes. Although there is still controversy in the literature in respect of the optimal cutoff value, a threshold of 3 mm is considered significant. ME has no specific clinical finding or sign and it is encountered in many knee pathologies. It is associated with either rapidly progressive knee osteoarthritis or early onset of knee osteoarthritis and increased morbidity. In this review, we delineate the clinical significance of ME in various knee pathologies, as well as when, why and how it should be managed. To the best of our knowledge, this is the first study to elaborate on these topics.

Background: The objective of our study was to compare a novel squared section, tapered design - with four conicity - short stem, the MINIMA (R) short stem with the cementless Profemur (R) TL standard femoral stem in primary total hip arthroplasty (THA) in terms of functional outcomes, radiologic evaluation and other perioperative and post-operative data. Material and methods: This is a comparative study including 46 patients undergoing primary THA. In 23 patients, the MINIMA (R) short stem was used. These patients were matched with another 23 patients in whom a cementless Profemur (R) TL standard femoral stem was used. The levels of the pain were evaluated according to the Visual Analog Scale/Numerical Rating Scale (VAS/NRS). The functional and clinical evaluation of the patients was performed with Harris Hip Score (HHS), Charnley's Hip score, EuroQol (EQ-5D)-(EQ-100), Patient Health Questionnaire (PHQ-9), and neuropathic pain questionnaire (DN-4). The rest of the comparison data included demographic data, the American Society of Anesthesiologists score (ASA), Charlson Index score, the pre-operative diagnosis, radiographic evaluation, the days of hospitalization, the operating time, incision length, blood loss, and blood transfusion requirements and complication rates. Results: The two cohorts had comparable results regarding all patients' peri-operative data. The radiographic assessment revealed considerable higher levels of femoral offset and femoral subsidence for the MINIMA group, but within acceptable limits for both cohorts. The majority of the functional and other scores did not give strong prominence to one specific femoral stem. Conclusion: Our comparative study underlined the efficacy of the MINIMA (R) short stem, due to the fact that it revealed comparable and, in some cases, relatively better short-term outcomes compared with the TL standard femoral stem. Yet, more well-designed long-term research is required in order to further establish its effectiveness.

Transient osteoporosis (TO) or bone marrow edema syndrome (BMES) is a self-limited clinical condition, which affects middle-aged men and women. It can be treated with miscellaneous conservative and surgical measures, which are analyzed in this systematic review. BMES/TO is a transient clinical entity, which can be treated with various therapeutic modalities. The aim of our study was to assess the efficacy of different therapeutic options for the alleviation of pain and reduction of bone marrow edema (BME) in patients with BMES/TO, as well as to propose a therapeutic algorithm. PubMed, Scopus, Cochrane, and Google Scholar were searched. Eligibility and extraction of studies were conducted by two authors. Methodological quality assessment was carried out with the modified Delphi technique, Methodological Index for Non-Randomized Studies (MINORS) criteria, and Cochrane Collaboration’s risk of bias tool. Outcomes that were compared were time of pain resolution, VAS pain scores, and BME regression on magnetic resonance imaging (MRI). A total of 36 articles (880 patients) were included. Bisphosphonates had higher efficiency in less than 1-month outcomes on pain resolution compared with core decompression (CD), while iloprost was more efficient at 1–3 months compared with bisphosphonates and CD. At 3–6 months, all three of the aforementioned showed equal results on pain resolution, and at a period of 6–12 months, CD and extracorporeal shockwave therapy (ESWT) showed excellent results followed by bisphosphonates and the conservative group (CG) consisting of non-steroidal anti-inflammatory drugs (NSAIDs) and/or analgesics and/or restricted weight bearing. On MRI at 1–3 months, bisphosphonates, iloprost, and CD had relatively the same outcomes on BME resolution, with the least promising being the CG. At 3–6 months, CD seemed to have achieved the best results on the resolution of BME, followed by ESWT, CG, and bisphosphonates group. At 6–12 months, ESWT had the best outcomes compared with the conservative, bisphosphonates, and iloprost groups. BMES/TO has been treated with many non-standardized measures due to the low number of highly reliable studies. Current literature shows promising results with regard to the reduction of the clinical course of BMES/TO, but further large multicenter randomized controlled trials, as well as standardized radiological and clinical scores, are warranted to acquire evidence-based recommendations on the therapeutic algorithm.