To assess whether diabetes mellitus (type 1 or type 2) increases the risk of developing adhesive capsulitis (frozen shoulder). A systematic review and meta-analysis were conducted in 2026 using multiple electronic databases. Additional studies were identified through screening reference lists and consulting professional networks. Studies examining the relationship between diabetes mellitus and the incidence of adhesive capsulitis were eligible for inclusion. Study quality and bias risk were assessed, and when enough data were available, a random-effects meta-analysis was performed to estimate the general association between diabetes and the development of frozen shoulder. The combined analysis showed that people with diabetes had 3.69 times higher odds (95

Background and Objectives: Joint-preserving options for bilateral non-traumatic ankle osteoarthritis (OA) are limited. This study evaluated whether intraosseous bone marrow concentrate (IO BMC) was associated with a lower observed occurrence of ankle arthrodesis or total ankle arthroplasty and greater procedure-free survival, and whether delivered colony-forming unit-fibroblast (CFU-F) count was associated with procedure-free survival. Materials and Methods: This retrospective, non-randomized, contralateral-controlled study included 88 patients with bilateral non-traumatic ankle OA treated between 2000 and 2014. The more symptomatic ankle received IO BMC, whereas the contralateral ankle was managed non-operatively. The primary endpoint was subsequent ankle arthrodesis or total ankle arthroplasty. Survival analyses were truncated at 15 years. Results: Arthrodesis or arthroplasty occurred in 16 of 88 IO BMC-treated ankles (18.2%) and 44 of 88 control ankles (50.0%). Thirty patients underwent a procedure only on the control side compared with two only on the IO BMC-treated side (p < 0.001). In the adjusted Cox model, IO BMC treatment was associated with a lower hazard over 15 years (summary HR = 0.24, 95% CI 0.15 to 0.38, p < 0.001), representing a summary association over the analysis interval rather than a constant effect. Restricted mean procedure-free survival was 9.89 versus 8.10 years through ten years (difference 1.78 years, 95% CI 1.28 to 2.32) and 14.23 versus 10.77 years through 15 years (difference 3.46 years, 95% CI 2.58 to 4.40). In an exploratory analysis with only 16 endpoint events, higher delivered CFU-F count remained associated with greater procedure-free survival (HR = 0.70 per 10,000-cell increase, 95% CI 0.55 to 0.90, p = 0.004). Conclusions: IO BMC treatment was associated with a lower observed occurrence of arthrodesis or arthroplasty and greater procedure-free survival in bilateral non-traumatic ankle OA. Higher delivered CFU-F counts were also associated with greater procedure-free survival in an exploratory analysis. These observational findings do not establish a causal treatment effect.

To evaluate whether intraosseous (IO) autologous bone marrow concentrate (BMC), containing mesenchymal stem cells (MSCs) enumerated in vitro as colony forming unit-fibroblasts (CFU‑F), reduces or delays conversion to total hip arthroplasty (THA) compared with matched conservative care, and to assess the influence of disease progression and CFU‑F dose on outcomes. A monocentric matched cohort (n = 434 hips; 217 BMC, 217 control) was followed for up to 15 years. Bone marrow was aspirated from the iliac crest, processed into BMC to concentrate nucleated cells, and injected intraosseously into the femoral head under fluoroscopy. Demographics, BMI, osteoarthritis grade, and CFU‑F were recorded. The primary outcome was THA‑free survival by Kaplan–Meier with log‑rank testing. Cox proportional-hazard models provided adjusted effects and predictions. Progression to THA after 15 years occurred in 16.1

Mobile-bearing stability in Oxford medial unicompartmental knee arthroplasty (UKA) depends on maintaining a consistent femorotibial component relationship throughout knee motion. This study evaluated whether a modified extramedullary femoral referencing technique, designed to account for extension-phase alignment, was associated with reduced motion-related variation in femorotibial component position and more stable mobile-bearing positional behavior than the previously described extramedullary technique. This single-center retrospective cohort study included 60 patients who underwent primary medial mobile-bearing Oxford UKA between January 2023 and January 2024. Thirty consecutive patients treated with the modified technique (modified group, MG) were compared with 30 individually matched controls treated with the previous extramedullary technique (control group, CG). Standardized standing and 90° flexion anteroposterior radiographs were used to assess the normalized horizontal distance between the femoral component and the tibial lateral wall, bearing horizontal translation, and bearing rotation. Clinical outcomes included range of motion (ROM), Hospital for Special Surgery (HSS) knee score, and postoperative complications. Baseline demographic and preoperative clinical characteristics did not differ significantly between groups. Follow-up duration was similar (27.4 ± 3.3 vs. 26.5 ± 2.9 months, p = 0.267). Postoperative ROM and HSS were also comparable, with postoperative HSS scores of 90.6 ± 5.8 in the MG and 89.2 ± 5.2 in the CG (p = 0.319). The MG showed significantly lower motion-related variation in femorotibial component position than the CG (ΔDistance: -0.006 ± 0.040 vs. 0.024 ± 0.054, p = 0.018). Within-group analysis showed no significant extension-versus-flexion change in normalized femorotibial distance in the MG, whereas a significant change was observed in the CG (p = 0.021). Compared with the CG, the MG had lower extension bearing rotation (-0.001 ± 0.054 vs. 0.037 ± 0.077, p = 0.033) and smaller bearing horizontal translation (0.039 ± 0.047 vs. 0.071 ± 0.052, p = 0.018). One bearing dislocation occurred in the CG and none occurred in the MG. The modified extramedullary femoral referencing technique was associated with less motion-related variation in femorotibial component position and more stable radiographically derived mobile-bearing positional behavior. These differences were not accompanied by superior short-term ROM or HSS. Not applicable.

To compare platelet-rich plasma (PRP) with hyaluronic acid (HA), corticosteroid (CS), or saline placebo (NS) for symptomatic knee osteoarthritis (OA) and to assess whether total blood-draw volume, a proxy for platelet dose, is associated with treatment effect. Following PRISMA, randomized controlled trials comparing intra-articular PRP with HA, CS, or NS were identified. Random-effects meta-analyses estimated mean differences (MDs) in pain (VAS) and function (WOMAC) at six and twelve months. Risk of bias was assessed with RoB 2.0 and certainty of evidence with GRADE. Subgroup analyses stratified PRP vs HA trials by total blood draw volume (< 40 mL vs ≥ 40 mL). Sixty-two trials (n = 4,969) were included. PRP improved VAS and WOMAC versus HA, CS, and NS at six months and remained superior versus HA and CS at twelve months (insufficient studies for twelve-month PRP vs NS). In PRP vs HA trials, blood draw volume ≥ 40 mL was associated with larger improvements in six-month WOMAC (P = 0.004) and twelve-month VAS (P = 0.029). Heterogeneity was substantial (I2 > 90

Background Nontraumatic osteonecrosis has historically been attributed to vascular insufficiency, leading to oxygen and nutrient deprivation and subsequent bone death. However, terminology used to describe this condition remains inconsistent and often fails to capture its complex pathogenesis. Terms such as “avascular necrosis” and “ischemic necrosis” may inappropriately emphasize vascular mechanisms, potentially limiting diagnostic and therapeutic approaches. Methods We performed a comprehensive review of the literature to examine the evolution of terminology for nontraumatic osteonecrosis and to evaluate the breadth of underlying pathophysiologic mechanisms. Particular attention was given to the clinical and conceptual implications of commonly used terms. Results Evidence indicates that disrupted bone homeostasis represents the final common pathway in the development of nontraumatic osteonecrosis, which may result from vascular or vascular-independent mechanisms. Continued use of terms that focus solely on vascular insufficiency may bias clinical management toward revascularization strategies, overlooking other contributory factors. Conclusions The term “osteonecrosis” more accurately reflects the multifactorial nature of this condition. Broader adoption of this terminology may foster a more comprehensive understanding of disease mechanisms and stimulate the development of innovative, multimodal treatment strategies.

PURPOSE:Recurrent hip dislocation after total hip arthroplasty is among the most distressing complications for patients, often reshaping their everyday lives. Beyond the immediate physical consequences, repeated instability generates fear of movement, social withdrawal, and emotional strain. Yet, the extent of this burden has rarely been quantified using patient-centered methods. METHODS:We evaluated 170 patients who had experienced at least three dislocations and were scheduled for revision surgery. To capture the impact on health-related quality of life (HRQoL), patients completed a Time Trade-Off (TTO) assessment, estimating how many years of life they would exchange for a dislocation-free state. A parallel measure, the Survival Implant TTO, explored whether patients would sacrifice implant longevity in favor of greater stability. Their preferences were compared with surgeons' attitudes toward balancing implant durability and stability. RESULTS:Patients consistently described instability as a devastating experience, with many reporting restrictions in daily activities and a loss of independence. On average, patients were prepared to exchange nearly one quarter of their remaining life expectancy for stability and were also willing to shorten projected implant survival if this reduced the likelihood of further dislocations. In contrast, surgeons-particularly when treating younger patients-often emphasized implant durability over stability. CONCLUSIONS:Recurrent hip dislocation has a far-reaching impact on quality of life, comparable to or exceeding that of chronic systemic diseases. Importantly, patient priorities differ from those of surgeons: stability is consistently valued over implant longevity. Incorporating these perspectives into revision planning is essential for truly patient-centered care.

Calcium pyrophosphate dihydrate (CPPD) deposition, often visible radiographically as chondrocalcinosis, frequently accompanies knee osteoarthritis and is usually encountered at the time of arthroplasty. Whether its presence influences the outcome of patellofemoral arthroplasty (PFA) remains uncertain. We reviewed 100 PFAs performed in 82 patients between 1997 and 2005, and followed them for an average of 22 years (range, 20–25 years). At surgery, 35 knees showed radiographic chondrocalcinosis, and an additional 33 developed calcification during follow-up. Fifteen knees (15