Musculoskeletal Surgery[JOURNAL]
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200 papers
Knee arthroplasty for spontaneous osteonecrosis of the knee: a matched analysis comparing total and unicompartmental.
Daher M, Tarchichi J, Nassar JE … +3 more , Liu J, Daniels AH, El-Othmani MM
Musculoskelet Surg · 2026 Jan · PMID 41520086 · Publisher ↗
The surgical management of spontaneous osteonecrosis of the knee (SONK) in its advanced stages typically involves joint replacement procedures such as unicompartmental knee arthroplasty (UKA) and total knee arthroplasty...
The surgical management of spontaneous osteonecrosis of the knee (SONK) in its advanced stages typically involves joint replacement procedures such as unicompartmental knee arthroplasty (UKA) and total knee arthroplasty (TKA). This study aims to compare the risk of complications, revisions, and costs between patients undergoing TKA and UKA for SONK. This study is a retrospective review of the PearlDiver Mariner Database. The patients with a diagnosis of SONK undergoing surgical management were divided into 2 groups: patients with TKA, and patients with UKA. The two groups were matched based on age, gender, the Charlson comorbidity index (CCI), and obesity. There was a higher rate of transfusions at 30 days (< 10 vs. 0%, p = 0.04) and 90 days (< 10 vs. 0%, p = 0.02) in the TKA group. In addition, there was a higher rate of stiffness and manipulation under anesthesia (MUA) in the TKA group at 1 year (3.2% vs. < 10, p = 0.01; and 4.1% vs. < 10, p < .001 respectively), 2 years (3.6% vs. < 10, p = 0.01; and 4.5% vs. < 10, p < .001 respectively), and 3 years (3.8% vs. < 10, p = 0.003; and 4.7% vs. < 10, p < .001 respectively). Furthermore, the TKA group had higher costs at 3 years compared to the UKA group (35,269 ± 61,459 vs. 25,141 ± 25,185, p = 0.001). This study highlights the increased risks of transfusion, stiffness, MUA, and higher costs after TKA compared to patients with UKA for SONK. Our study shows that UKA seems to be a safer and less expensive option for patients with SONK.
Accuracy in predicting 135° neck-shaft angle short-stem and glenoid components size in reverse shoulder arthroplasty with 3D preoperative planning.
Donà A, Bonfatti R, Micheloni GM … +4 more , Giorgini A, Basile D, Pirozzi A, Porcellini G
Musculoskelet Surg · 2026 Jan · PMID 41483076 · Publisher ↗
BACKGROUND: Reverse shoulder arthroplasty (RSA) is a widely used procedure for glenohumeral joint degeneration. Despite advancements in 3D preoperative planning, the concordance between planned and intraoperatively impla...
BACKGROUND: Reverse shoulder arthroplasty (RSA) is a widely used procedure for glenohumeral joint degeneration. Despite advancements in 3D preoperative planning, the concordance between planned and intraoperatively implanted components remains unclear. This study evaluates the accuracy of 3D preoperative planning in predicting humeral and glenoid components size in RSA with a 135° neck-shaft angle (NSA) short-stem. MATERIALS AND METHODS: A retrospective study was conducted on 84 RSA cases performed between October 2023 and September 2024 at a specialized shoulder surgery center. All cases underwent standardized preoperative imaging, including anteroposterior and axillary radiographs and a 3D CT scan-based planning protocol using BluePrint software. The planned and intraoperatively implanted humeral stems, glenoid baseplates, and glenospheres were compared. Statistical analyses were performed to assess concordance in term of size and identify factors influencing deviations from the preoperative plan. RESULTS: The preoperative plan was fully respected in 23.1% of cases for both the humeral and glenoid components. The humeral stem size matched the preoperative plan in 28.6% of cases, with a deviation within one adjacent size in 67.9%. The glenoid baseplate size was concordant in 92.6%, while the glenosphere size matched in 60.7%. Kappa values indicated slight agreement for stem size (κ = 0.12) and moderate agreement for glenosphere size (κ = 0.54). A statistically significant correlation was observed between changes in humeral stem and glenosphere size (p < 0.05). No significant correlation was found with patient age, while sex significantly influenced stem and glenosphere size variation (p < 0.05). CONCLUSION: 3D preoperative planning demonstrated moderate to high accuracy for glenoid component selection but lower concordance for humeral stem size. Intraoperative adjustments were mainly related to metaphyseal bone quality and soft tissue tension. Future improvements in planning software should incorporate bone mineral density and humeral osteotomy variability to enhance predictive accuracy.
Are outcomes of proximal row carpectomy and four-corner fusion dependent on the diagnosis of scapholunate advanced collapse or scaphoid non-union advanced collapse? a systematic review.
Cadoux-Hudson D, Muir D, Brewster M
Musculoskelet Surg · 2025 Dec · PMID 41455026 · Publisher ↗
Scapholunate advanced collapse (SLAC) and scaphoid non-union advanced collapse (SNAC) are well-recognised degenerative wrist conditions. Debate persists over optimal treatment, particularly since 4 corner fusion (4CF) em...
Scapholunate advanced collapse (SLAC) and scaphoid non-union advanced collapse (SNAC) are well-recognised degenerative wrist conditions. Debate persists over optimal treatment, particularly since 4 corner fusion (4CF) emerged in the 1980s. Reviews have compared the outcomes of 4CF and PRC; however, none of these have looked at whether the initial diagnosis determines the final outcome. This systematic review hypothesises that the outcome of PRC and 4CF for the treatment of stage 2 and 3 SNAC and SLAC varies depending on the initial diagnosis. Searches of PubMed, Google Scholar and Cochrane database using the terms 'SNAC' and 'SLAC' were performed. Studies were excluded based on results recorded, study nature and whether results were separated according to the initial diagnosis. Studies were assimilated using weighted averages and further analysed using Microsoft Excel and GraphPad Prism software. A total of 3320 studies were identified; however, only 6 studies (8 study arms) were included. Of these, 7 study arms recorded pre- and post-operative range of movement data, 4 with pre- and post-operative disabilities of the arm, shoulder and hand (DASH) scores and 5 with pre- and post-operative Visual Analogue Score (VAS) pain scores. There was no statistical difference in these outcome measures with a mean follow-up of 62 months (38-120). This review found no significant difference in the outcomes of these procedures; however, there is a high level of uncertainty. Further studies should focus on reporting data by procedure as well as initial diagnosis with appropriate power calculations and should be designed as prospective randomised control trials.
Retrospective analysis of ultrasound-guided hydrodistension in patients with post-traumatic adhesive capsulitis of the shoulder.
Vita F, Donati D, Langone L … +6 more , Origlio F, Tedeschi R, Miceli M, Stella SM, Galletti S, Faldini C
Musculoskelet Surg · 2025 Dec · PMID 41444457 · Publisher ↗
BACKGROUND: Adhesive capsulitis (AC) is a painful shoulder condition characterized by limited motion due to fibrosis and contracture of the joint capsule. Secondary AC frequently occurs after upper limb fractures and imm...
BACKGROUND: Adhesive capsulitis (AC) is a painful shoulder condition characterized by limited motion due to fibrosis and contracture of the joint capsule. Secondary AC frequently occurs after upper limb fractures and immobilization, delaying recovery. METHODS: This retrospective study analyzed 11 patients with post-traumatic AC (< 3 months) following non-displaced humeral fractures treated conservatively with a median immobilization period of 25 days. The cohort included seven men and four women (mean age 52.6 years), five of whom also had rotator cuff injuries. Treatments involved hydrodistension, with glenohumeral drainage in seven cases and subacromial bursa drainage in four cases. Range of motion (ROM), pain (VAS), and functionality (DASH) were assessed at baseline, 1-, 2-, and 3-month post-treatment. RESULTS: Significant improvements in ROM were seen across all planes: flexion increased from 80° to 150°, extension from 15° to 60°, abduction from 55° to 160°, internal rotation from 10° to 85°, and external rotation from 10° to 80° (all p < 0.001). Pain levels (VAS) decreased from a mean score of 8 at baseline to 3 at 3 months (p < 0.001), and functional capacity (DASH) improved from a score of 45-10 (p < 0.001). Among the five patients with rotator cuff injuries, despite improved ROM and pain, strength deficits persisted, leading to subsequent arthroscopic repairs. CONCLUSION: Hydrodistension resulted in significant improvements in ROM, pain relief, and functionality, suggesting it is a promising treatment for post-traumatic AC. Early intervention may aid faster recovery after shoulder immobilization.
Correction: Ultrasonography allows for a safe and early diagnosis of patellofemoral dysplasia in newborns: a prospective study.
Moya-Angeler J, De la Torre-Conde C, Maestre-Cano D … +5 more , Sanchez-Jimenez R, Jimenez-Soto C, Serrano-García C, Forriol F, León-Muñoz V
Musculoskelet Surg · 2025 Dec · PMID 41432884 · Publisher ↗
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Long-term functional and radiologic outcomes following MPFL reconstruction: a 10-year retrospective study.
Almeida J, Senra AR, Correia MC … +4 more , Leite MJ, Oliveira P, Serdoura F, Torres J
Musculoskelet Surg · 2025 Nov · PMID 41222880 · Publisher ↗
INTRODUCTION: Medial patellofemoral ligament (MPFL) reconstruction has become a popular treatment option for recurrent patellofemoral instability. At the fifth-year follow-up, patients reported a high satisfaction rate a...
INTRODUCTION: Medial patellofemoral ligament (MPFL) reconstruction has become a popular treatment option for recurrent patellofemoral instability. At the fifth-year follow-up, patients reported a high satisfaction rate and experienced few episodes of instability. The literature is scarce regarding the long-term outcomes after MPFL reconstruction. Therefore, a retrospective study was conducted, covering the period between 2008 and 2013. MATERIAL AND METHODS: Demographic and clinical data, including age, gender, number of dislocations, and revision surgery, were collected. Radiologic measurements included patellar height, tilt, maltracking, and trochlear dysplasia. Radiologic assessment was made with computed tomography (CT) preoperatively and magnetic resonance imaging (MRI) postoperatively, contributing to the further identification of chondral lesions. Functional evaluation was based on the Kujala and Lysholm scores. RESULTS: In this study, 32 patients (62.5% female and 37.5% male, mean age 18 ± 5 years) underwent MPFL reconstruction. There was an increase in the tibial tubercle-trochlear groove (TT-TG) distance in the postoperative (16.2 [IQR 13.8-18.3] vs. 20 [IQR 18-21] mm). Patellar tilt improved both in 0º extension (24 [IQR 15-29.5]° vs. 15 [IQR 6.5-26.8]°; p > 0.05) and with quadriceps contraction (32 [IQR 26-41]° vs. 22.5 [IQR 9.25-37.5]°; p > 0.05). Among patients with lateral release (40%), postoperative tilt reduction was significant (p < 0.005). Two patients experienced re-dislocation, with one requiring revision surgery. More than half showed grade III/IV chondral lesions, mainly on the lateral patellar facet, with an association between a higher patellar tilt and chondral damage (p < 0.05). Median Kujala and Lysholm scores were 89 (IQR 81.25-96.75) and 86 (IQR 76.75-94.75), respectively. CONCLUSION: This study suggests that MPFL reconstruction yields good long-term clinical outcomes, though it is insufficient to fully correct a TT-TG offset. Increased preoperative patellar tilt was significantly linked to patellofemoral chondropathy; adjunct lateral release might be a preventive procedure since it helps by reducing lateral facet contact pressures. LEVEL OF EVIDENCE: III.
The outcomes of acetabular impaction bone grafting using allografts in uncemented cups for acetabular bone loss: a systematic review and meta-analysis.
Patel R, Saadeh K, Bates O … +7 more , Bhatti A, Jou E, Ho JSY, Jou S, Arshad Z, Jeevaratnam K, Selvaratnam V
Musculoskelet Surg · 2025 Nov · PMID 41217730 · Publisher ↗
PURPOSE: Acetabular bone loss poses a significant challenge in total hip arthroplasty (THA), especially during revision procedures. Impaction bone grafting (IBG) using allografts with uncemented cups is established as a...
PURPOSE: Acetabular bone loss poses a significant challenge in total hip arthroplasty (THA), especially during revision procedures. Impaction bone grafting (IBG) using allografts with uncemented cups is established as a biological reconstruction technique which aims to restore bone stock and achieve a stable fixation. However, there are inconsistent reports regarding its outcomes. This systematic review and meta-analysis aimed to evaluate the clinical and functional outcomes of IBG with uncemented cups in acetabular bone loss. METHODS: A comprehensive literature search of five databases: PubMed, Embase, CINAHL, Cochrane, and Web of Science was completed. Studies reporting functional outcomes and/or complications of IBG in uncemented THA were included. 20 studies, all observational, involving 1166 THAs in 1122 patients met prespecified inclusion criteria. A meta-analysis was conducted for these outcomes, and heterogeneity was assessed. RESULTS: Meta-analysis revealed significant improvement in mean Harris Hip Score (HHS) of 41.51 (95% CI: 35.71-47.30). Pooled complication rates were low: aseptic loosening (7%; 95% CI: 4%-13%), infection (4%; 95% CI: 3%-5%), need for revision (9%; 95% CI: 6%-14%), and mortality (4%; 95% CI: 2%-11%). There was considerable heterogeneity in the results, reflecting methodological variation across studies. CONCLUSIONS: IBG with uncemented cups suggests meaningful functional improvement and generally acceptable complication rates in managing acetabular bone loss, particularly in revision THA. However, the current evidence base is limited by risk of bias, high heterogeneity, observational study designs, and lack of defect stratification. Future studies should focus on randomised controlled trials to better optimise surgical decision-making.
Mechanical failure of modular hip stems due to titanium alloy neck breakage: a single-center case series.
Papapietro N, Zampogna B, Caria C … +5 more , Giusti S, Marinozzi A, Di Martino A, Papalia R, Denaro V
Musculoskelet Surg · 2025 Nov · PMID 41206831 · Publisher ↗
BACKROUND: Modular neck implants in total hip arthroplasty (THA) allow control of length, offset, and version. However, these implants showed problems such as implant fracture and adverse reactions due to metal debris. T...
BACKROUND: Modular neck implants in total hip arthroplasty (THA) allow control of length, offset, and version. However, these implants showed problems such as implant fracture and adverse reactions due to metal debris. This study aims to analyze our modular titanium-titanium neck THA stems, focus on mechanical complications related to its breakage, conduct a metallurgical analysis on these broken implants, and report revision surgery outcomes. METHODS: We performed a retrospective review to identify patients who had undergone THA with a specific modular (H2M-C2F Implants) implant at our institute (Fondazione Policlinico Universitario Campus Bio-Medico, Rome). Patient demographics, implant characteristics, clinical follow-up, and revision outcomes were obtained. A metallurgical examination was conducted on the broken implants. RESULTS: Out of thirty-eight patients eligible patients, seventeen had a titanium alloy neck, whereas the remaining twenty-one had CrCo necks. Thirteen of seventeen patients with titanium necks reported spontaneous ruptures of the neck due to fretting corrosion phenomena. Revision surgery was offered to all patients, including the ones who did not experience spontaneous rupture (four patients). Neither intraoperative nor long-term complications were reported, except for one patient who showed gluteal insufficiency. No clinical differences were reported between the patients who underwent revision surgery and those who were revised preventively. CONCLUSION: Using modular implants should be limited to strict indications. Patients' characteristics are vital in selecting the ideal candidate for a modular THA. Modular implants should answer all the questions regarding durability and fracture risk to become a valid alternative to fixed-neck stems.
Uncemented hip resurfacing in patients over 65: 16-year outcomes from a large, single-surgeon series.
Gaillard-Campbell D, Gross T
Musculoskelet Surg · 2025 Nov · PMID 41199106 · Publisher ↗
BACKGROUND: Hip resurfacing is often reserved for younger, active patients due to concerns over implant durability and fracture risk in older patients. However, there is a lack of long-term data evaluating outcomes in pa...
BACKGROUND: Hip resurfacing is often reserved for younger, active patients due to concerns over implant durability and fracture risk in older patients. However, there is a lack of long-term data evaluating outcomes in patients over 65 years old at time of surgery. This study addresses this gap by directly comparing implant survivorship, failure and complication rates, and clinical outcomes in a younger control cohort from the same large single-surgeon series (> 6000 cases). METHODS: We queried a large, prospective institutional clinical database comprising over 7000 hip resurfacing cases performed by a single, high-volume surgeon; findings may not be generalizable to lower-volume or less-experienced centers. From this cohort, we identified 395 cases in patients ≥ 65 years (mean age 68.8) and 5,106 cases in patients < 65 years of age at time of surgery. All included patients had a minimum of 2-year follow-up, and 88.4% of the study cohort had up-to-date follow-up. RESULTS: There was no difference in the 98.6% 10- and 98.2% 16-year Kaplan-Meier implant survivorship of our over-65 study group when compared to a younger under-65 control group. These results exceed the NICE (National Institute for Clinical Excellence) criteria and registry benchmarks for total hip replacement from three major registries. The early femoral failure rate (femoral failure occurring < 1 year postoperative) was only 0.3%, which compares favorably with total hip arthroplasty perioperative fracture data. The long-term femoral fracture rate over the duration of this study was 1.3% for this older cohort, lower than what was reported for total hip arthroplasty. CONCLUSIONS: This is the first known long-term study to demonstrate that hip resurfacing patients over 65 can achieve implant survivorship rates equivalent to younger resurfacing patients and superior to national total hip arthroplasty registry benchmarks. These findings challenge age-based restrictions and support expanded candidacy for hip resurfacing in select older adults when managed by experienced surgeons.
Delivering orthopaedics in Burundi: a model for humanitarian surgery in resource-limited settings.
Cenci G, Fidanza A, Grasso M … +4 more , Migliorini F, Contini A, Falez F, Mazzoleni MG
Musculoskelet Surg · 2025 Nov · PMID 41191252 · Publisher ↗
Burundi remains one of the most socioeconomically challenged countries globally, facing profound limitations in healthcare infrastructure, workforce, and access. In this context, the Italian Medical Foundation for Centra...
Burundi remains one of the most socioeconomically challenged countries globally, facing profound limitations in healthcare infrastructure, workforce, and access. In this context, the Italian Medical Foundation for Central Africa (FIMAC) has conducted humanitarian orthopaedic missions for over two decades in Bubanza, addressing critical musculoskeletal conditions in both paediatric and adult populations. This essay provides a comprehensive overview of the operational, clinical, and ethical dimensions of these missions. Commonly treated pathologies include chronic osteomyelitis, neglected fractures, open injuries, and congenital or acquired limb deformities-conditions frequently encountered in advanced stages due to delayed access to care. Resource-sensitive protocols guide interventions and rely heavily on collaboration with local healthcare workers, who receive targeted training in trauma management, postoperative care, and basic surgical techniques. The aim is not just to deliver urgent care but to foster sustainable improvements through capacity building and knowledge exchange. Major challenges include a lack of surgical infrastructure, limited availability of diagnostics and sterile equipment, as well as sociocultural barriers to care, such as language and traditional beliefs. Despite these constraints, the missions yield significant functional and psychosocial outcomes, particularly among paediatric patients. Ethical considerations, including informed consent, scope of practice, and cultural humility, are central to responsible practice in this setting. The personal and professional impact on participating surgeons is profound, often reshaping clinical priorities and reinforcing the humanistic foundations of the medical profession. The paper concludes by advocating for the establishment of permanent surgical facilities, structured deployments, and scalable innovations to enhance the continuity of care and address surgical inequities in low-resource settings.
A case series of robotic TKA in stiff knees using the imageless CORI system: technical strategies and early functional results.
Bagaria V, Nadange S, Tiwari A
Musculoskelet Surg · 2026 Jun · PMID 41171591 · Publisher ↗
Preoperative stiffness in the knee joint significantly compromises outcomes after total knee arthroplasty (TKA). Robotic-assisted TKA (raTKA) using the imageless CORI system may offer precision in alignment and gap balan...
Preoperative stiffness in the knee joint significantly compromises outcomes after total knee arthroplasty (TKA). Robotic-assisted TKA (raTKA) using the imageless CORI system may offer precision in alignment and gap balancing, especially in difficult cases with limited range of motion (ROM). We present a case series of 25 knees in 22 patients with preoperative ROM < 50°, all treated using the imageless CORI robotic system (Smith & Nephew). All patients had advanced osteoarthritis or inflammatory arthritis and underwent primary TKA through a standard medial parapatellar approach with posterior cruciate-sacrificing implants. Postoperative follow-ups were conducted at 15 days, 3 months, 6 months, 1 year, and 2 years, with evaluation of ROM, Knee Society Score (KSS), and Visual Analog Score (VAS). Mean preoperative ROM was 38.7° ± 5.4 (range: 28°-45°). At final follow-up, all patients showed significant improvement in ROM, with a mean of 110.2° ± 6.2. KSS improved from a mean of 32 to 84, and VAS decreased from a mean of 8.2 to 1.6. Varus deformity was corrected in all patients. No cases of postoperative neurovascular complications, patellar tendon injuries, or manipulations under anesthesia were noted. The CORI robotic system offers a promising strategy for managing preoperatively stiff knees. It allows precise bone cuts and real-time soft tissue balancing with minimal releases, reducing complications, and improving functional outcomes. Further controlled studies are needed to establish its long-term advantages.
Surgical management of spinal ochronosis: A case series of surgical interventions and outcomes.
Chehrassan M
Musculoskelet Surg · 2026 Jun · PMID 41162815 · Publisher ↗
STUDY DESIGN: A retrospective case series of 4 patients with spinal ochronosis. OBJECTIVE: To evaluate the clinical, radiological, and surgical outcomes in patients with spinal ochronosis undergoing surgical intervention...
STUDY DESIGN: A retrospective case series of 4 patients with spinal ochronosis. OBJECTIVE: To evaluate the clinical, radiological, and surgical outcomes in patients with spinal ochronosis undergoing surgical intervention. Ochronosis, resulting from alkaptonuria, leads to homogentisic acid deposition in connective tissues, affecting the spine early. Due to its rarity, limited literature addresses the clinical, radiological, and surgical aspects of spinal ochronosis. METHODS: We reviewed four cases of spinal ochronosis where patients underwent surgery for symptoms such as pain, paresthesia, and myelopathy. Radiological findings, intraoperative observations, and postoperative outcomes were analysed. The iOS 'Measure' app was used to quantify angles intraoperatively. RESULTS: Patients, aged 45-56, presented with leg pain, paresthesia, and gait disturbances. Radiographs revealed disc degeneration, spinal stenosis, and sagittal imbalance. Surgical interventions included decompression, fusion, and en bloc resection of calcified ligamentum flavum. Dural tears occurred in 2 cases but were successfully repaired. All patients experienced significant symptom relief, though residual sagittal imbalance persisted in some. CONCLUSIONS: Spinal ochronosis presents significant surgical challenges due to tissue fragility, adhesions. Surgical intervention can provide symptom relief, however, complete correction of deformities may not always be feasible. Further research is required to optimize treatment strategies for this rare condition.
Does non-anatomic reduction and fixation of acetabular fractures affect the post-operative quality of life?-a single center, five years, retrospective analytical study.
Kundu Choudhury A, Gupta K, Das S … +6 more , P V C, Goyal T, S Raja B, Singh V, Sarkar B, Bhushan Kalia R
Musculoskelet Surg · 2026 Jun · PMID 41094225 · Publisher ↗
BACKGROUND: Displaced acetabulum fracture is one of the most difficult traumatic injuries to be managed. It has a bearing on the patients' life in the long-term. The ability to return to pre-injury quality of life (QoL)...
BACKGROUND: Displaced acetabulum fracture is one of the most difficult traumatic injuries to be managed. It has a bearing on the patients' life in the long-term. The ability to return to pre-injury quality of life (QoL) is of major importance after acetabular fracture fixation, which in turn depends on quality of fracture reduction. The purpose of this study is to ascertain the effect of the quality of reduction on patients' QoL. HYPOTHESIS: The patients with non-anatomic reduction of acetabular fracture will have a poorer QoL and higher complication rate as compared to anatomic reduction group. METHOD: A retrospective review of all the patients with acetabular fracture who were managed surgically was conducted. The patients were divided into two groups-anatomic reduction (n = 79) and non-anatomic reduction (n = 47) after reviewing the post-operative Computed Tomography (CT) scans. QoL parameters using various patient-reported outcomes measures (PROMs) like, VAS score for hip pain, Modified Harris Hip Score, Short-form 12 questionnaire, UCLA activity score and Patient satisfaction score were compared between the two groups at a minimum follow-up of 2 years. Complications like conversion to Total hip arthroplasties (THA) due to development of arthritis or AVN of femoral head, were also evaluated. RESULTS: Modified Harris Hip score (mHHS) for the affected hip [61.5 ± 7.5 (59.9-63 .2) vs 57.1 ± 7.8 (54.8-59.3)], SF-12 (both PCS [50.5 ± 9.9 (48.4-52.7) vs 44.3 ± 8 (42-46.5)] and MCS [53.3 ± 7.8 (51.6-55.1) vs 48.3 ± 9.7 (45.6-51.1)]), UCLA activity score [4.6 ± 1.1 (4.4-4.8) vs 4.1 ± 0.9 (3.8-4.3)], and patient satisfaction scores [47.2 ± 4.5 (46.2-48.2) vs 45.1 ± 5.8 (43.4-46.8)] were significantly (p < 0.05) better in those with anatomic reduction. However, post-operative VAS was comparable in both groups. The conversion rate to THA was not found to be different between the two groups. Multivariate analysis found reduction quality to be an independent factor affecting patients' QoL. CONCLUSION: Quality of fracture reduction is one of the most important factors for determining the clinical outcome of the patient. An anatomic reduction not only provides better functionality to the hip; it also results in a better quality of life for the patient. LEVEL OF EVIDENCE: III, Retrospective cohort study.
Diaphyseal fractures of the humerus with radial nerve injury: how to manage both fracture and the nerve injury.
Maresca A, Sirio C, Vitale P … +3 more , Cerbasi S, Calderazzi F, Pascarella R
Musculoskelet Surg · 2026 Jun · PMID 41055829 · Publisher ↗
In this article, data of nerve and bone recovery were reported in a series of patients treated with open reduction and internal fixation (ORIF) with plate in humeral shaft fractures (HSF) associated with radial nerve pal...
In this article, data of nerve and bone recovery were reported in a series of patients treated with open reduction and internal fixation (ORIF) with plate in humeral shaft fractures (HSF) associated with radial nerve palsy (RNP). The authors highlight the role of early surgical intervention for optimal nerve repair and patient's recovery, and to avoid subsequent and more complex surgery to patients. This is a retrospective study of 24 of 31 patients with HSF with RNP (10,1%) out of 308 patients with HSF, treated surgically between 2012 and 2023 in a level I Trauma Center. The mean age was 57 years. The mean follow-up time was 42 months (range 12-60). Twenty-seven were closed fractures and 4 were open. All patients were treated within 24 hours with ORIF with plate and exploration and decompression of radial nerve. The medical records of all patients and their X-ray were reviewed to evaluate fracture's type, location, energy of trauma, status of RN injury and, beyond the time of recovery from RNP, the time of bone healing and functionally recovery. We reviewed 24 patients, and 7 were lost to follow-up. All patients (100%) had good nerve palsy recovery in a mean time of 6.2 months. The mean X-ray bone consolidation occurred after 4 months. The mean time of Rom recovery was 4.46 months. None of our patients needed further surgery for the failure of the radial nerve recovery. In conclusion, our study, even of mall size, demonstrated that early surgical exploration of radial nerve during ORIF with plate of RHSF facilitates nerve repair and enhancing patient recovery. Furthermore, the low incidence of radial nerve palsy should not preclude surgical exploration, conversely, as many patients may have undiagnosed nerve injuries that can be addressed through timely intervention.Level of Evidence: Level IV, retrospective study.
Robotic-assisted total knee arthroplasty: Promise or parity in long-term outcomes?
Bulzacki-Bogucki BD, Digennaro V, Ferri R … +5 more , Panciera A, Cecchin D, Colangelo A, Benvenuti L, Faldini C
Musculoskelet Surg · 2025 Oct · PMID 41037235 · Publisher ↗
INTRODUCTION: The purpose of this systematic review of the literature was to evaluate long-term clinical and radiological outcomes, postoperative complications, and implant survivorship of robotic-assisted total knee art...
INTRODUCTION: The purpose of this systematic review of the literature was to evaluate long-term clinical and radiological outcomes, postoperative complications, and implant survivorship of robotic-assisted total knee arthroplasty (RA-TKA) compared to conventional manual total knee arthroplasty (Co-TKA). METHODS: A systematic review of the literature was performed with a primary search on Medline through PubMed. The PRISMA 2009 flowchart and checklist were used to edit the review. Exclusively human studies comparing RA-TKA with Co-TKA, with at least 12-month follow-up, were included. Outcomes assessed included clinical and radiographic results, postoperative complications, and implant survivorship. RESULTS: Twenty-three articles met the inclusion criteria, mostly rated as level II or III evidence. RA-TKA was associated with improved component alignment, better knee balance, reduced blood loss, and soft tissue preservation. These findings were linked to lower postoperative pain and reduced opioid consumption. Regarding long-term outcomes, RA-TKA showed similar rates in post-operative complications compared to Co-TKA, though results varied across studies. Data on implant survivorship were limited, with most studies reporting comparable medium- and long-term survival rates between RA-TKA and Co-TKA. CONCLUSION: Current evidence suggests RA-TKA offers superior short-term outcomes over conventional techniques, but long-term benefits, especially regarding complications and survivorship, are still uncertain. Additional long-term studies are essential to clarify the potential of RA-TKA in improving durability and patient outcomes in knee arthroplasty surgery.
Revisiting the role of bone grafting in scaphoid fixation with volar plates: a multivariable analysis.
Gomez Bermudez SJ, Londoño Restrepo JA, Gómez Trillos MA … +6 more , Ramírez Carmona LX, Galindo Zuluaga RF, Arias Perez RD, Carmona Cano D, Calle Diaz S, Tobon Orrego S
Musculoskelet Surg · 2026 Jun · PMID 41015638 · Full text
PURPOSE: To evaluate the radiographic and functional outcomes of scaphoid fractures and nonunions treated with volar locked plate fixation, with or without autologous bone grafting, and to explore whether graft use was a...
PURPOSE: To evaluate the radiographic and functional outcomes of scaphoid fractures and nonunions treated with volar locked plate fixation, with or without autologous bone grafting, and to explore whether graft use was associated with improved consolidation or function. METHODS: This retrospective cohort study included 19 adult patients who underwent surgical treatment with volar anatomical plates for scaphoid fractures or nonunions. Radiographic union was assessed at 3, 6, and 12 months. Functional outcomes were measured using the QuickDASH score preoperatively and at 12 months postoperatively. Graft use was determined intraoperatively based on defect characteristics. Statistical analyses included non-parametric tests and multivariable models. RESULTS: The mean patient age was 24.5 ± 5.4 years, and 94.7% were male. Scaphoid nonunion was present in 11 patients (57.9%), and autologous bone grafting was performed in 15 (78.9%). Radiographic consolidation was achieved in 94.7% of cases at 12 months. QuickDASH scores improved significantly (mean change: 20.6 points; p < 0.001). There were no significant differences in union or functional outcomes between grafted and non-grafted patients (p = 1.000 and p = 0.115, respectively). Interestingly, patients with nonunions demonstrated significantly better postoperative function than those with acute fractures (p = 0.034), although this did not exceed the minimal clinically important difference. Multivariable analysis failed to identify predictors of union or function, explaining only 37% of the variance. CONCLUSION: Volar locked plate fixation provides high union rates and significant functional improvement in scaphoid fractures and nonunions. Bone grafting did not confer additional benefit, supporting selective rather than routine use. Further studies are warranted to clarify prognostic factors and optimize treatment strategies.
Ultrasonography allows for a safe and early diagnosis of patellofemoral dysplasia in newborns: a prospective study.
Moya-Angeler J, De la Torre-Conde C, Maestre-Cano D … +5 more , Sanchez-Jimenez R, Jimenez-Soto C, Serrano-García C, Forriol F, León-Muñoz V
Musculoskelet Surg · 2026 Jun · PMID 40986271 · Publisher ↗
BACKGROUND: Patellofemoral joint instability is the most common knee pathology observed in childhood and adolescence. One significant contributing factor to this condition is trochlear dysplasia (TD) of the femoral troch...
BACKGROUND: Patellofemoral joint instability is the most common knee pathology observed in childhood and adolescence. One significant contributing factor to this condition is trochlear dysplasia (TD) of the femoral trochlea, which can lead to chronic pain, recurrent instability, and premature wear of the patellofemoral joint. Amongst the identified risk factors, breech presentation (BP) at birth has been highlighted as a potential contributor to the development of trochlear dysplasia. This study explores the association between breech presentation and the femoral trochlea's increased sulcus angle (SA), further emphasising its role in patellofemoral joint pathology. METHODS: A prospective cohort study was conducted with 85 newborns (170 knees), including healthy infants born in breech presentation (BP) between weeks 31 and 42 and those born in cephalic presentation (CP) between weeks 35 and 41. Sulcus angle (SA) values were measured using ultrasound, and a physical examination was performed for each group. RESULTS: We observed significant differences in the SA measurements between the two groups (p < 0.05): 149.92º (95% CI 148.81-151.04; SD = 5.56), compared to the CP group, which had a mean SA of 142.52º (95% CI 141.83-143.21; SD = 2.94). The BP group also had shorter gestation periods (267 days, SD = 11 vs 274 days, SD = 8) and lower birth weights (3091.71 g, SD = 500.94 vs. 3380.74 g, SD = 424.72, p < 0.05). Additionally, the rate of caesarean-section deliveries was higher in the BP group (44.8%) compared to the CP group (17.14%) (p < 0.05). CONCLUSION: Newborns with breech presentation exhibit significantly higher SA values, suggesting a flatter trochlear groove and a potential predisposition to patellofemoral joint instability.
A narrative review on greater trochanteric pain syndrome: diagnostic imaging and non-surgical treatments.
Donati D, Tedeschi R, Garnum PE … +4 more , Vita F, Tarallo L, Faldini C, Catani F
Musculoskelet Surg · 2026 Jun · PMID 40973929 · Full text
BACKGROUND: Greater trochanteric pain syndrome (GTPS) is a common cause of lateral hip pain, primarily affecting middle-aged women. It involves tendinopathy or tears of the gluteus medius and minimus tendons, often misdi...
BACKGROUND: Greater trochanteric pain syndrome (GTPS) is a common cause of lateral hip pain, primarily affecting middle-aged women. It involves tendinopathy or tears of the gluteus medius and minimus tendons, often misdiagnosed as trochanteric bursitis. Accurate diagnosis and management require thorough clinical assessment and diagnostic imaging. METHODS: This review examines the pathogenesis, clinical examination, and diagnostic tools like ultrasound (US) and magnetic resonance imaging (MRI) for GTPS. A narrative literature was conducted from May 2002 to February 2024 using PubMed. A total of 85 articles were reviewed, with 56 included, focusing on conservative and interventional treatments such as physical therapy, extracorporeal shock wave therapy (ESWT), corticosteroid injections, and platelet-rich plasma (PRP). RESULTS: Non-surgical interventions showed variable efficacy. ESWT provided significant long-term pain relief, while corticosteroid injections offered short-term benefits that diminished over time. PRP injections demonstrated sustained improvement. US-guided procedures were found superior in precisely targeting anatomical structures. CONCLUSIONS: GTPS remains a challenging, often chronic condition. Non-surgical approaches can effectively manage early stages, but persistent cases may require advanced interventional strategies. Further research is needed to standardize treatment protocols, particularly for severe tendinopathy cases.
Anterior femoral notching during total knee arthroplasty: a predictor of periprosthetic femoral fractures?
Benkovich V, Abialevich A, Schebenkov B … +4 more , Tzaytlin I, Fiterman M, Aronskind A, Benshtein A
Musculoskelet Surg · 2026 Jun · PMID 40946265 · Publisher ↗
INTRODUCTION: Anterior femoral notching during TKA is thought to weaken the distal femur, potentially increasing periprosthetic fracture risk, but its clinical impact remains debated. This study examines whether notching...
INTRODUCTION: Anterior femoral notching during TKA is thought to weaken the distal femur, potentially increasing periprosthetic fracture risk, but its clinical impact remains debated. This study examines whether notching independently predicts such fractures and assesses related clinical outcomes using the Tayside classification system for cortical violations. METHODS: A retrospective cohort study was conducted on 715 patients who underwent primary TKA. Patients were divided into Group 1 without notching (control group) and Group 2 with any presence of notching according to Tayside classification system, which assesses cortical violations based on the extent of involvement. Fracture incidence and additional multivariate analysis were used to control for confounding factors, including bone quality (presence of osteoporosis) and demographics. RESULTS: PPFs were significantly more frequent in the notching group (2.67%) than in the control group (0.24%) (p < 0.01). Despite 6.68% of patients having osteoporosis, no correlation with PPFs was found. All fractures occurred in female patients due to falls. A cortical defect > 2.5 mm was a potential predictor of femoral weakness, with larger defects in the notching group (2.20 ± 0.54 mm) vs. control (0.02 ± 0.16 mm), p < 0.01. PPF incidence was 1.33% for Grade 1 and 2 defects and 0.33% for Grade 3 defects. CONCLUSION: Preventive strategies, including meticulous surgical technique and tailored postoperative rehabilitation, are essential to minimize PPF risk. Anterior femoral notching compromises femoral integrity, with defects > 2.5 mm significantly increasing fracture risk. Careful surgical planning, especially in patients with poor bone quality or advanced age, is crucial to optimize outcomes and reduce complications.
Sarcopenia: current state of knowledge and its implications in orthopaedics and traumatology for enhanced clinical strategies and patient outcomes.
Stefanini N, Di Martino A, Brunello M … +5 more , Morandi Guaitoli M, Di Censo C, Geraci G, Pilla F, Faldini C
Musculoskelet Surg · 2026 Jun · PMID 40921986 · Publisher ↗
INTRODUCTION: Sarcopenia is a pathologic condition frequent in aged population, leading to functional and cognitive impairment. Given the ageing of the population worldwide, the topic has generated interest in the last d...
INTRODUCTION: Sarcopenia is a pathologic condition frequent in aged population, leading to functional and cognitive impairment. Given the ageing of the population worldwide, the topic has generated interest in the last decades and is expected to be more relevant in the near future. This paper aims to present the mechanism of sarcopenia, the current state of knowledge regarding diagnosis and treatment and the role of sarcopenia in orthopaedic and traumatological settings. Sarcopenia is an age-related condition which overlaps with other features of frailty syndrome by similar biochemical pathways. It is characterized by a loss of muscle mass and function, mainly due to reduced anabolism. The importance of prompt diagnosis is highlighted; however, there is a lack of standardized cut-offs, thus affecting also non-pharmacological and pharmacological therapeutic options, which are not well defined. The increased risk of falls, disability, cognitive impairment and association with osteoporosis exacerbates fracture risk. Post-surgery inactivity contributes to sarcopenia, which also leads to prolonged hospital stays, increased complications and worse clinical outcomes. CONCLUSION: Ageing of population will increase chronic-related conditions. Sarcopenia is a growing and still largely unexplored clinical challenge. Research should focus on diagnostic thresholds and therapeutic protocols to promote interdisciplinary assessment and targeted interventions. In the orthopaedic field, attention ranges from the prevention of fragility fractures to proper perioperative management.
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