Bone cement implantation syndrome (BCIS) is classically associated with acute intraoperative cardiopulmonary disturbances during cemented arthroplasty. However, accumulating clinical observations suggest that its systemic manifestations may extend beyond the immediate peri-cementation period. Hepatic involvement remains rarely reported and is poorly characterized, particularly in frail elderly patients with limited physiological reserve. We report the case of an 82-year-old woman who developed severe but reversible ischemic acute liver failure with concomitant acute kidney injury following cemented total hip arthroplasty. A brief peri-cementation episode of hypotension and mild hypoxemia was followed, within the early postoperative period, by abrupt elevation of aminotransferases (AST 4980 IU/L; ALT 3120 IU/L), coagulopathy (INR ≥ 1.5), transient neurological alteration compatible with early hepatic encephalopathy, severe acute kidney injury, and new-onset atrial fibrillation. An extensive diagnostic evaluation excluded viral, autoimmune, toxic, biliary, vascular, infectious, and structural causes of liver injury. The clinical and biochemical profile was consistent with ischemic hepatocellular injury occurring in the context of systemic hypoperfusion. Management consisted of supportive intensive care focused on hemodynamic stabilization, respiratory support, rhythm control, metabolic management, and close laboratory monitoring, resulting in complete hepatic, renal, and neurological recovery. This case describes a rare presentation of ischemic acute liver failure with multiorgan involvement following cemented total hip arthroplasty. The temporal association with transient peri-cementation hypotension and hypoxemia suggests a possible delayed systemic manifestation within the spectrum of BCIS, even in the absence of overt intraoperative collapse. Although causality cannot be established, the clinical course underscores the importance of careful postoperative evaluation in vulnerable patients who experience perioperative hemodynamic disturbances.

Background/Objectives: Emergency surgical patients are at increased risk of acute postoperative delirium. Processed EEG monitoring, such as entropy indices and burst suppression ratio (BSR), may optimize anesthetic dosing, yet their role in non-elective surgery remains underexplored. This retrospective cohort study aimed to examine whether entropy monitoring and intraoperative burst suppression are associated with the incidence of early postoperative delirium during the first 72 h after emergency surgery. Methods: Adult patients undergoing emergency surgery between March 2022 and March 2024 were classified into two groups based on anesthesia records: the entropy-monitored group (EG) and the standard care group without processed EEG (SG). Demographic, intraoperative, and cognitive data (NEECHAM scores during the first 72 h) were extracted from institutional perioperative records. The primary outcome was postoperative delirium (NEECHAM ≤ 24), with secondary analyses examining anesthetic exposure, burst suppression, and intraoperative hemodynamics. Results: Entropy-monitored patients received lower sevoflurane and fentanyl doses and exhibited improved hemodynamic stability, including fewer hypotensive episodes and lower norepinephrine requirements. Early postoperative cognitive dysfunction (NEECHAM ≤ 24) was more frequent among patients with intraoperative burst suppression, with BSR > 15% or suppression duration > 6 min strongly associated with cognitive decline within the first 72 h. Conclusions: In this retrospective cohort, entropy-guided anesthesia was associated with more precise anesthetic titration and more stable hemodynamic parameters. Burst suppression characteristics may serve as indicators of neurocognitive vulnerability rather than solely reflecting direct effects of anesthetic dosing. These results support the use of processed EEG monitoring in emergency surgery, though prospective studies are needed to confirm these findings.

Background/Objectives: Delayed bone healing remains a relevant complication after polytrauma, where fracture repair occurs in the setting of systemic inflammation and repeated physiologic stress. This study evaluated whether serial changes in interleukin-6 (IL-6), C-reactive protein (CRP), and fibrinogen are associated with delayed union in polytrauma patients with long-bone fractures. Methods: We performed an exploratory retrospective cohort study including 115 adult polytrauma patients with long-bone fractures treated at a single tertiary trauma center between 2 January 2022 and 14 December 2024. Serum IL-6, CRP, and fibrinogen were recorded at 24 h, 72 h, 1 week, 2 weeks, and 4 weeks after injury. IL-6 was measured in the institutional clinical laboratory using routine immunoassay methods, whereas CRP and fibrinogen were measured using standard hospital analytical methods, including an immunoturbidimetric assay for CRP and the Clauss clotting method for fibrinogen. Radiographic healing was assessed at 6, 12, and 24 weeks using an mRUST-based healing score. The primary endpoint was clinician-assigned delayed union at 24 weeks; nonunion at 9 months was assessed secondarily. Complete-case multivariable logistic regression was performed in 86 patients, and exploratory longitudinal biomarker analyses used generalized estimating equations. Results: Delayed union at 24 weeks occurred in 39/115 patients (33.9%), while nonunion at 9 months occurred in 7/115 patients (6.1%). Patients with delayed union had longer time to definitive fixation (35.3 ± 10.2 h vs. 29.0 ± 14.0 h; p = 0.003) and more frequent shock on admission (43.6% vs. 23.7%; p = 0.047). IL-6 was higher in the delayed-union group at 1 week (57.3 ± 30.3 vs. 46.5 ± 29.2 pg/mL; p = 0.043) and 4 weeks (21.2 ± 11.6 vs. 17.1 ± 10.3 pg/mL; p = 0.022), whereas CRP was markedly higher at 4 weeks (29.4 ± 14.2 vs. 16.3 ± 10.6 mg/L; p < 0.001). After false-discovery-rate correction, only CRP at 4 weeks remained significant among serial biomarker comparisons. In multivariable analysis of 86 complete cases, CRP at 4 weeks remained independently associated with delayed union (adjusted OR 2.16 per 10 mg/L, 95% CI 1.36-3.43; p = 0.001). The model showed apparent discrimination with an AUC of 0.80 and acceptable calibration (Hosmer-Lemeshow p = 0.41). In sensitivity analysis excluding deep surgical-site infection cases, the association between CRP and delayed union persisted (adjusted OR 2.02 per 10 mg/L, 95% CI 1.26-3.26; p = 0.004). Conclusions: In this exploratory retrospective cohort of polytrauma patients with long-bone fractures, persistent post-traumatic CRP elevation at 4 weeks was associated with clinician-assigned delayed union, whereas IL-6 findings were weaker and exploratory. Because CRP is a nonspecific inflammatory marker, the observed association may reflect delayed healing, infection, reoperation, and/or persistent postoperative inflammatory burden. These data support association rather than validated prediction and require prospective validation with standardized outcome adjudication.

Background:Musculoskeletal disorders represent a substantial global health burden, often leading to pain, functional impairment, and reduced quality of life. Total hip arthroplasty (THA) remains a key intervention for advanced hip pathology, yet postoperative recovery depends heavily on targeted rehabilitation. This study examined muscle strength progression and quality-of-life outcomes following a structured rehabilitation program after THA. Methods:Patients who underwent primary THA were enrolled in a structured postoperative physiotherapy protocol. Muscle strength (abduction, extension, and flexion peak force) was quantified using a validated digital dynamometer (ActivForce 2). Quality of life was evaluated using the Hip Disability and Osteoarthritis Outcome Score (HOOS), including the Quality-of-Life subscale (HOOS_QL). Assessments occurred at discharge (T1), six weeks post-discharge (T2), and twelve weeks postoperatively (T3). Results:Statistically significant longitudinal improvements in muscle strength were observed across all movement planes between T1-T2 and T2-T3 (p < 0.001). HOOS_QL scores showed a parallel increase over the same intervals. In regression analysis, hip extension peak force at T3 emerged as the only significant individual predictor of quality-of-life outcomes (p = 0.025). Conclusion:Participation in a structured postoperative rehabilitation program was associated with measurable improvements in muscle strength and patient-reported quality of life following THA. Hip extension strength was identified as an individual predictor of quality-of-life outcomes; however, the overall regression model demonstrated modest explanatory capacity, suggesting that this association warrants confirmation in larger controlled studies.

Background: Dual mobility (DM) total hip arthroplasty (THA) was introduced to reduce postoperative instability, one of the most frequent causes of revision after hip replacement. Its use has progressively expanded beyond revision surgery to selected high-risk primary cases; however, comparative data integrating both clinical and radiographic outcomes from real-world tertiary centers remain limited. Methods: A retrospective comparative study was conducted including 78 patients who underwent THA with a DM acetabular component between January 2019 and December 2024, and 78 matched controls who received conventional fixed-bearing THA during the same period. Matching criteria were age, sex, and procedure type (primary versus revision). Clinical outcomes were assessed using the Harris Hip Score (HHS) and visual analogue scale (VAS) for pain. Radiographic evaluation focused on component positioning, radiolucent lines, and signs of loosening. Complications and revision rates were compared between groups. Results: The mean age was 71 ± 9 years, and 62% of patients were female. Mean follow-up was 38 months. HHS improved from 54 ± 10 preoperatively to 89 ± 8 postoperatively in the DM group (p < 0.001), with similar final functional outcomes in the conventional THA group (90 ± 9, p = 0.48), and comparable improvement between groups (p = 0.62). Radiographic parameters demonstrated stable fixation and appropriate component positioning in both groups, with no significant intergroup differences. The dislocation rate was numerically lower in the DM group (1.3% vs. 5.1%), although this difference did not reach statistical significance (p = 0.37). No cases of intraprosthetic dislocation occurred. Overall implant survival free from revision at five years was 96.5% for DM and 94.7% for conventional THA (p = 0.47). Conclusions: DM THA achieved excellent clinical and radiographic outcomes, with a numerically lower dislocation rate than conventional THA. Mid-term implant survivorship was comparable between groups, supporting DM as a reliable option for improving stability in appropriately selected patients.

The optimal surgical approach for total hip arthroplasty (THA) remains a subject of ongoing debate. Posterior, direct lateral, and direct anterior techniques differ in their soft-tissue handling, complication patterns, and applicability in complex reconstruction. This systematic review synthesizes contemporary evidence comparing functional outcomes, perioperative complications, and revision suitability across major THA approaches. A systematic search of PubMed, Scopus, and Web of Science was conducted according to PRISMA guidelines. Eligible studies directly compared at least two THA approaches, reported clinical or functional outcomes with ≥ 12 months of follow-up, and were published between 2015 and 2025. Data were extracted on functional scores, early recovery parameters, dislocation rates, nerve injury profiles, intraoperative complications, and revision-specific considerations. Due to heterogeneity in outcome definitions, follow-up intervals, and incomplete reporting of numerical outcome data, a formal quantitative meta-analysis was not feasible. Therefore, the review provides a structured narrative synthesis rather than pooled effect estimates. Across comparative studies, the direct anterior approach (DAA) consistently demonstrated faster early functional recovery and reduced short-term pain compared with the posterior approach, although long-term functional outcomes were similar between approaches. Anterior-based approaches generally showed lower dislocation rates, while the direct lateral approach (DLA) provided intrinsic stability but was associated with a higher incidence of transient abductor weakness. Complication patterns were approach-specific: lateral femoral cutaneous nerve symptoms occurred predominantly with DAA, superior gluteal nerve irritation with DLA, and sciatic nerve palsy was rare and primarily associated with posterior THA. In revision and complex cases, the posterior approach remained favored due to its extensile exposure and ease of acetabular and femoral access. All major surgical approaches for THA can achieve excellent long-term outcomes when performed by experienced surgeons. The DAA offers advantages in early recovery, whereas the posterior approach remains the most versatile for complex or revision arthroplasty. Selection of surgical approach should be individualized based on patient anatomy, surgeon expertise, and reconstructive requirements. Not applicable. This study is a retrospective systematic review. The protocol was not registered in PROSPERO because data extraction had begun before submission, and retrospective registration is not permitted by the registry.

BACKGROUND:Revision total hip arthroplasty (THA) in the presence of significant acetabular bone loss remains challenging, particularly in Paprosky IIC-III defects, where biomechanical stability and biological fixation are often compromised. Trabecular metal (TM) revision cups were developed to enhance osseointegration through high porosity and an elastic modulus closer to native bone, yet comparative real-world evidence against conventional revision cups remains limited in early follow-up. METHODS:We conducted a retrospective comparative cohort analysis of patients undergoing acetabular revision THA for Paprosky IIC-III defects between 2022 and 2024. Ten patients were included, with six receiving TM cups (TM group) and four receiving conventional revision cups (control group). Radiographic osseointegration was assessed through secondary signs of ingrowth (absence of radiolucent lines, bone apposition, and absence of migration), while clinical fixation and early stability were evaluated using postoperative Harris Hip Score (HHS) and complication rates. Minimum follow-up was 12 months. RESULTS:Early radiographic osseointegration was observed in 100% of the TM group versus 50% of the conventional group at 12 months. No cup migration or radiographic loosening occurred in the TM group, while two cases in the control group demonstrated early signs of mechanical instability. Mean postoperative HHS improved more robustly in the TM group (from 41.8 to 78.6) compared to controls (from 40.9 to 68.3). There were no infections or dislocations in either cohort. One patient who received a conventional cup required prolonged protected weight bearing due to suspected partial loss of early fixation. CONCLUSION:In revision THA for Paprosky IIC-III acetabular defects, TM cups demonstrated markedly higher rates of early osseointegration and lower radiographic loosening at 12 months compared with conventional revision cups. These findings support the preferential use of TM technology in cases of advanced acetabular bone loss, where biological fixation is critical for long-term stability.

Pain management in multiple trauma patients presents a complex clinical challenge due to competing priorities such as hemodynamic instability, polypharmacy, coagulopathy, and the urgency of life-saving interventions. In this context, peripheral nerve blocks (PNBs) are increasingly recognized as a valuable asset for their role in managing pain in patients with multiple traumatic injuries. By reducing reliance on systemic opioids, PNBs support effective pain control and facilitate early mobilization, aligning with enhanced recovery principles. This narrative review summarizes current evidence on the use of PNBs in the context of polytrauma, focusing on their analgesic efficacy, integration within multimodal analgesia protocols, and contribution to improved functional outcomes. Despite these advantages, clinical application is limited by specific concerns, including the potential to mask compartment syndrome, the risk of nerve injury or local anesthetic systemic toxicity (LAST), and logistical barriers in acute trauma settings. Emerging directions in the field include the refinement of ultrasound-guided PNB techniques, the expanded use of continuous catheter systems, and the incorporation of fascial plane blocks for anatomically complex or multisite trauma. Parallel efforts are focusing on the development of decision-making algorithms, improved risk stratification tools, and integration into multimodal analgesic pathways. There is also growing emphasis on standardized clinical protocols, simulation-based training, and patient education to enhance safety and consistency in practice. As evidence continues to evolve, the long-term impact of PNBs on functional recovery, quality of life, and healthcare utilization must be further explored. With thoughtful implementation, structured training, and institutional support, PNBs may evolve into a cornerstone of modern trauma analgesia.

Background: Degenerative, metabolic and oncologic diseases are scarcely amenable to the complete reconstruction of tissue structure and functionalities using common therapeutic modalities. On the nanoscale, extracellular vesicles (EVs) and nanoparticles (NPs) have emerged as attractive candidates in regenerative and personalised medicine. However, EV transfection is hindered by its heterogeneity and low yield, while NPs suffer from cytotoxicity, immunogenicity, and long-term safety issues. Scope of Review: This review synthesises data from over 180 studies as part of a narrative synthesis, critically evaluating the disease-specific utility, mechanistic insights, and translational obstacles. The focus is laid on comparative cytotoxicity profiles, the capacities of hybrid EV–NP systems to circumvent mutual shortcomings, and the increasing impact of artificial intelligence (AI) on predictive modelling, as well as toxicity appraisal and manufacturing. Key Insights: EVs have inherent biocompatibility, immune evasive and organotropic signalling functions; NPs present structural flexibility, adjustable physicochemical properties, and industrial scalability. Common molecular pathways for NP toxicity, such as ROS production, MAPK and JAK/STAT activation, autophagy, and apoptosis, are significant biomarkers for regulatory platforms. Nanotechnological and biomimetic nanocarriers incorporate biological tropism with engineering control to enhance therapeutic efficacy, as well as their translational potential. AI approaches can support rational drug design, promote reproducibility across laboratories, and meet safe-by-design requirements. Conclusions: The intersection of EVs, NPs and AI signifies a turning point in regenerative nanomedicine. To advance this field, there is a need for convergence on experimental protocols, the adoption of mechanistic biomarkers, and regulatory alignment to ensure reproducibility and clinical competence. If realised, these endeavours will not only transition nanoscale medicament design from experimental constructs into reliable and patient-specific tools for clinical trials, but we also have the strong expectation that they could revolutionise future treatments of challenging human disorders.

Nutritional support in critically ill patients has been acknowledged as a pillar of ICU care, playing a pivotal role in preserving muscle mass, supporting immune function, and promoting recovery during and after critical illness. Providing effective nutritional support requires adapting it to the patient’s diagnosis, unique characteristics, and metabolic state to minimize the risks of overfeeding or underfeeding while mitigating muscle loss. This level of care requires a comprehensive nutritional assessment and the establishment of a nutrition-focused protocol. Regular, consistent and detailed nutritional evaluation can influence both therapeutic decisions and clinical interventions, thus ensuring that the specific needs of critically ill patients are met from the acute phase through their entire recovery process. Bioelectrical impedance analysis (BIA) is increasingly recognized as a valuable tool for enhancing nutritional care in critically ill patients. By delivering precise, real-time insights into key aspects of body composition, BIA is thought to provide clinicians with a more comprehensive understanding of the complex physiological changes that occur during critical illness. This narrative review highlights the potential of BIA in offering these precise assessments, facilitating the development of more accurate and personalized nutritional strategies for critically ill patients. If BIA can reliably assess dynamic shifts in hydration and tissue integrity, it holds the promise of further advancing individualized care and optimizing clinical outcomes in this vulnerable population.

Background/Objectives: This study examines the relationship between visceral fat (VF), metabolic health, and dietary patterns in patients with obstructive bronchial diseases (OBDs) using bioelectrical impedance analysis (BIA). Methods: A total of 75 patients diagnosed with OBD, including chronic obstructive pulmonary disease (COPD) and/or asthma, were assessed for VF levels via BIA. Dietary habits were evaluated using a structured questionnaire to explore their correlation with VF accumulation. Results: The study cohort comprised predominantly male participants (66.7%), with the majority aged between 61 and 70 years (46.7%). Significant gender differences in VF distribution were observed, with 60% of females maintaining normal VF levels (1–9) compared to only 28% of males, while 38% of males exhibited very high VF levels (15–30; p = 0.003). Body mass index (BMI) showed a strong correlation with VF (p < 0.0001), as overweight and obese individuals predominantly displayed elevated VF levels (≥10). Moreover, metabolic syndrome (MS) was present in 66.7% of participants, with these individuals exhibiting significantly higher VF levels compared to those without MS (p = 0.001). Dietary analysis revealed that frequent consumption of fast food (r = 0.717, p < 0.001), carbonated drinks (r = 0.366, p = 0.001), and refined carbohydrates (r = 0.438, p < 0.001) was significantly associated with increased VF accumulation. Conversely, higher intake of water (r = −0.551, p < 0.001), fruits (r = −0.581, p < 0.001), and vegetables (r = −0.482, p < 0.001) correlated with lower VF levels. Lack of physical activity was also strongly linked to VF accumulation (r = 0.481, p < 0.001), further reinforcing the role of lifestyle factors in metabolic health. Conclusions: The findings underscore the significant impact of dietary habits and physical activity on VF accumulation in OBD patients. BMI and MS emerged as critical predictors of VF, while unhealthy dietary patterns and sedentary lifestyles further exacerbated VF deposition. Elevated VF levels were linked to adverse lipid profiles, reinforcing the need for dietary and lifestyle modifications in managing metabolic health among OBD patients. Although no direct association was identified between VF and forced expiratory volume in one second (FEV1), the results highlight the necessity of integrated nutritional and metabolic interventions in the management of chronic respiratory diseases.

Background: Bupropion, an atypical antidepressant and smoking cessation aid, is known for its potential to cause seizures, cardiotoxicity and neurotoxicity in overdose scenarios. However, overdoses may present variably, and muscular and renal complications, such as rhabdomyolysis and acute kidney injury (AKI), can emerge in unexpected ways. Previous reports have shown that severe overdoses can lead to a spectrum of complications, but the precise mechanisms linking bupropion overdose with rhabdomyolysis remain poorly understood. Clinical presentation: This paper presents the management of a severe rhabdomyolysis case following deliberate ingestion of 4 g of immediate-release bupropion. The report highlights the unexpected presentation of bupropion overdose, including a lack of typical neurotoxic or muscular symptoms, and the subsequent involvement of multiple factors in the decision to initiate early renal replacement therapy, despite the absence of overt acute kidney injury (AKI). Conclusions: This case underscores the importance of individualized patient assessment and the challenges of managing rare and complex drug overdoses. Early intervention with renal replacement therapy, despite the absence of acute kidney injury, may be justified in cases of significant rhabdomyolysis and potential renal complications. Clinicians should maintain a high degree of suspicion for complications like rhabdomyolysis in overdose scenarios and consider early renal support in patients at risk of renal failure, even in the absence of overt kidney injury. The findings also point to the need for a more nuanced approach to diagnosing and treating bupropion overdose in critically ill patients.

Trace elements are essential for several physiological processes. To date, various data have suggested that inadequate levels of trace elements may be involved in the pathogenesis of different chronic diseases, including immune-mediated ones, or may develop during their course. Systemic sclerosis (SSc) is a complex autoimmune multisystemic disease, primarily characterized by microvascular dysregulation, the widespread activation of the immune system and tissue fibrosis. According to the latest reports regarding the pathogenesis of SSc, the main pathophysiological processes—inflammation, vasculopathy and fibrosis—may include various trace element derangements. The present literature review aims to update the available data regarding iron, zinc, copper and selenium status in SSc as well as to underline the possible implications of these trace elements in the complexity of the pathogenic process of the disease. We observe that the status of trace elements in SSc plays a crucial role in numerous pathogenic processes, emphasizing the necessity for proper monitoring and supplementation. The reported data are heterogenous and scarce, and future studies are needed in order to draw clearer conclusions about their complete spectrum.

Myxofibrosarcoma (MFS), an aggressive soft tissue sarcoma, is one of the undifferentiated pleomorphic sarcomas; it has a low incidence, affecting people in the sixth to eighth decades of life. It usually involves the extremities and is painless with a slow-growing pattern. Based on the case of a 52-year-old female patient who presented with a painful, massive, rapid-growing, ulcerated tumor of the anterior surface of the left thigh, we performed a literature review regarding the current standard of care for patients with MFS. Computed tomography examination, followed by magnetic resonance imaging and surgical biopsy with histopathological examination, confirmed the diagnosis and the presence of lung and inguinal lymph node metastases. Due to the rapid-growing pattern and the local aggressiveness, our tumor board team recommended emergency excisional surgery, with subsequent reconstructive procedures followed by referral to an oncological center. This review emphasizes the importance of proper and rapid diagnosis, followed by multidisciplinary management, for MFS cases with atypical presentation and distal metastases to improve overall outcomes.

Periprosthetic fractures (PFs) associated with total hip arthroplasty are significant postoperative complications after hip prosthesis implantation surgery. The aim of this study was to evaluate the fragility, performance and functional independence of patients with PFs associated with total hip arthroplasty. A cross-sectional study was conducted between January and October 2024. The 101 patients evaluated were divided into 3 groups: the group consisting of hip arthroplasty patients - named ATS group (n=36), the group consisting of periprosthetic fractures patients - named PF group (n=11), the group consisting of stage III and IV coxarthrosis patients - named OAH group (n=42). Mean scores fall in the range of pre-fragility - mild frailty for ATS and OAH groups (7.098 ± 2.289 vs. 6.939 ± 1.405), with no significant differences between them, while the mean score of PF group falls in the range of moderate-severe frailty (11.727 ± 3.289). Our data analysis suggests a marked impairment of functional independence in more than 90% of PF patients versus 32% of patients in the ATS group and about 20% of patients in the OAH group; about 75% of patients in the PF group have a significant impairment of functional perfomance. Periprosthetic hip fractures are associated with advancing age and increased fragility. Functional performance and independence of patients with periprosthetic fractures, more than 3 months after fracture, is significantly impaired and is associated with frailty status and advanced age.

This study’s goal was to evaluate the biocompatibility of two composite cements over a 90-day period by analyzing the individuals’ behavior as well as conducting macroscopic and histological examinations and Computed Tomography (CT) scans. We conducted the cytotoxicity test by placing the materials subcutaneously and peri/intramuscularly. Days 30 and 90 were crucial for our research. On those days, we harvested the implants, kidneys and liver to search for any toxic deposits. The biomaterial’s uniformity, color and texture remained unaltered despite being in intimate contact with the tissue. Although a slight inflammatory response was observed in the placement location, we observed an improved outcome of the interaction between the material and its insertion area. There were no notable discoveries in the liver and kidneys. According to the obtained results, the biomaterials did not produce any clinical changes nor specific irritation during the research, demonstrating that they are biocompatible with biological tissues.

Controlling pain after major orthopedic surgery may be challenging, and it is related to delayed recovery, the development of chronic pain, and analgesic dependence. It is well known that effective postoperative pain control can reduce hospital stays by ensuring a more rapid rehabilitation,thereby decreasing the overall costs. Despite the development of analgesics, the use of opioids and their derivates remains the cornerstone of treatment for patients with acute moderate-to-severe pain in association with general or regional anesthesia. To reduce the risk of side effects and opioid addiction, considering the alarming epidemiological reports in relation to opioid abuse, combined analgesic methods are used, in addition to lower dosages or different forms of administration, such as transdermal administration. Fentanyl transdermal patches appear to be effective in controlling postoperative pain as part of multimodal analgesic regimens in knee and hip surgery, shoulder arthroplasty, traumatic fractures, and one-day surgery; this treatment has fewer associated side effects and can be safely used even in patients with renal impairment. It is also recommended for postoperative pain management in combination with a femoral–sciatic nerve block during foot and ankle surgery.

Improving preoperative care for elderly patients with hip fractures is crucial for achieving the best outcomes. A multidisciplinary team that can improve overall care quality by addressing patient’s medical conditions, analgesia, timely surgery, and early postoperative mobilization is required. This narrative review provides insights regarding the extent of preoperative optimization needed for hip fracture surgery.