Journal Of Orthopaedics And Traumatology[JOURNAL]
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200 papers
Partial versus full revision in cementless single-stage exchange for hip periprosthetic joint infection: a multicenter comparative study with 10-year survivorship analysis.
Mu W, Jarusriwanna A, Xu B … +5 more , Brown SA, Zhang X, Dawes A, Parvizi J, Cao L
J Orthop Traumatol · 2026 Jan · PMID 41609922 · Full text
BACKGROUND: Periprosthetic joint infection (PJI) is one of the most challenging complications following total hip arthroplasty (THA). Traditional management typically involves full revision to ensure comprehensive infect...
BACKGROUND: Periprosthetic joint infection (PJI) is one of the most challenging complications following total hip arthroplasty (THA). Traditional management typically involves full revision to ensure comprehensive infection eradication. However, for patients with well-fixed implants, partial revision in a single-stage cementless approach may provide a viable alternative, potentially preserving bone stock and reducing operative time. The relative efficacy of this approach compared with full revision remains to be fully explored. This multicenter study aims to determine whether partial revision in cementless single-stage exchange surgery offers comparable infection control outcomes to full revision for select patients with well-fixed implants. METHODS: We conducted a retrospective, multicenter cohort study involving 226 patients who underwent cementless single-stage exchange hip arthroplasty for PJI between 1 October 2013 and 31 July 2022. Patients were divided into partial revision (n = 61) and full revision (n = 165) groups. The primary outcome was treatment success, defined as the absence of clinical symptoms and signs of infection at a minimum follow-up of 2 years. RESULTS: The success rates were 77.0% for the partial revision group and 80.0% for the full revision group, with no significant difference (p = 0.629). Both groups showed comparable 10-year survival rates for overall success and infection-free status. Patients with partial revision had significantly shorter operative times (137.3 versus 169.1 min, p < 0.001). Age ≥ 65 years (odds ratios (OR): 2.433, p = 0.003), American Society of Anesthesiologists (ASA) score ≥ 3 (OR: 1.778, p = 0.030), and chronic kidney disease (OR: 3.467, p = 0.053) were identified as independent risk factors for reinfection in the partial revision group. CONCLUSIONS: Partial cementless single-stage revision may offer comparable infection control to full revision in selected hip PJI cases with well-fixed implants, while reducing operative time. Given the retrospective design, these findings should be interpreted with caution, and future prospective studies are needed to confirm long-term outcomes, assess implant survival, and evaluate functional recovery.
Iatrogenic femoral neck fractures or separation of the proximal femoral epiphysis during closed reduction of irreducible femoral head fracture-dislocations in children: a review of 12 cases.
Lu Y, Xue C, Canavese F … +6 more , De Salvo S, Yao H, Huang D, Lin R, Zheng J, Chen S
J Orthop Traumatol · 2026 Jan · PMID 41572071 · Full text
OBJECTIVES: This study aimed to analyze the radiologic characteristics of irreducible pediatric femoral head fracture-dislocations to prevent potential iatrogenic femoral neck fractures (FNF) or separation of the proxima...
OBJECTIVES: This study aimed to analyze the radiologic characteristics of irreducible pediatric femoral head fracture-dislocations to prevent potential iatrogenic femoral neck fractures (FNF) or separation of the proximal femoral epiphysis (SPFE). METHODS: This is a retrospective review of patients who were skeletally immature and diagnosed with traumatic hip dislocations combined with femoral head fractures. The collected data included patient demographics, fracture classification, fragment ratio, combined injuries, urgent reductions, treatment strategies, complications, and final outcomes. RESULTS: We treated 12 patients with femoral head fractures and dislocations; 11 out of 12 patients underwent urgent closed reduction (91.7%). Six of the patients failed closed reduction and experienced FNF (n = 2, 33.3%) or SPFE (n = 4, 66.7%). Five patients presented with avascular necrosis of the femoral head after open reduction with internal fixation via a surgical hip dislocation approach, and two patients required further surgical treatment. Analysis of radiographs and computed tomography (CT) scans of irreducible femoral head fracture-dislocations revealed that the fractured femoral head was perched on the sharp angle of the posterior wall of the acetabulum, with a fragment ratio of 18-27%. After recognizing the irreducibility, one case with a fragment ratio of 26% underwent immediate open reduction without further attempts at closed reduction. This procedure preserved the natural hip joint, preventing FNF and SPFE. CONCLUSIONS: For pediatric patients with irreducible femoral head fracture-dislocation injuries and a fragment ratio greater than 10%, repeated or forceful closed reduction may result in iatrogenic FNF or SPFE. Examining plain radiographs and CT images carefully before attempting reduction may help determine the safest treatment strategy.
The presence of a positive blood culture should be regarded a risk factor for DAIR failure in cases of haematogenous total knee arthroplasty infection.
Pedemonte-Parramón G, Reynaga E, Molinos S … +6 more , de Los Ríos JD, Vivero A, García-Oltra E, López-Pérez V, Paredes R, Hernández-Hermoso JA
J Orthop Traumatol · 2026 Jan · PMID 41566067 · Full text
PURPOSE: Late acute haematogenous total knee arthroplasty (LAH TKA) infections represent approximately 20% of all prosthetic infections. Debridement, antibiotics, and implant retention (DAIR) is a widely accepted treatme...
PURPOSE: Late acute haematogenous total knee arthroplasty (LAH TKA) infections represent approximately 20% of all prosthetic infections. Debridement, antibiotics, and implant retention (DAIR) is a widely accepted treatment; however, it carries a significant risk of failure. The study aims to identify risk factors for DAIR failure in LAH TKA infections, focusing on blood cultures (BC) as a potential contributor. METHODS: A retrospective cohort study was conducted on 37 cases of LAH TKA infections from 2015 to 2023. Patients were divided into two groups: 20 in the success group (SG) and 17 in the failure group (FG). The study analyzes various factors, including demographics, comorbidities, serum and joint fluid biomarkers, blood and intraoperative cultures, prior infection or antibiotic use, and surgical and post-surgical variables. RESULTS: Positive BC were more frequent in the FG compared with the SG (P = 0.03), and were also more common in patients with a history of prior infection (P = 0.03). Logistic regression identified positive BC as the only significant predictor of DAIR failure (odds ratio (OR) 12, 95% confidence interval (CI) 1.1-18, P = 0.04), even after adjusting for other variables. Positive intraoperative cultures were more frequent in the FG, particularly in those with a prior infection history (P = 0.08), even if they were receiving antibiotics (P = 0.05). CONCLUSIONS: Positive BC may be an additional risk factor for DAIR failure in LAH TKA. This highlights the importance of routinely performing BC during diagnosis. LEVEL OF EVIDENCE: level III.
Simultaneous versus staged bilateral total hip arthroplasty: a meta-analysis.
Soler F, Hernández J, Lamo-Espinosa JM … +2 more , Benlloch M, Mariscal G
J Orthop Traumatol · 2026 Jan · PMID 41553690 · Full text
BACKGROUND: There is debate regarding the optimal timing of bilateral total hip arthroplasty (THA), with simultaneous or staged approaches considered. Cost-effectiveness is an important factor that influences resource al...
BACKGROUND: There is debate regarding the optimal timing of bilateral total hip arthroplasty (THA), with simultaneous or staged approaches considered. Cost-effectiveness is an important factor that influences resource allocation. The main aim of this study was to assess the cost implications of bilateral simultaneous (sim-THA) versus staged (st-THA) total hip arthroplasty. The secondary objective was to evaluate the efficacy and safety of sim-THA compared those with of st-THA. METHODS: A systematic review and meta-analysis were conducted according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. Studies comparing simultaneous and staged bilateral THA in terms of cost, complications, length of hospital stay, and patient outcomes were eligible. Odds ratios (ORs), mean differences (MD), and standard mean differences (SMD) with 95% confidence intervals (CIs) were calculated. The risk of bias was assessed using the Methodological Index for Non-randomised Studies (MINORS). Meta-analyses were performed using Review Manager version 5.4 (Cochrane, Oxford, United Kingdom). RESULTS: A total of 20 observational studies including 13,984 patients were included. Sim-THA was associated with significantly lower total costs (SMD -0.54, 95% CI -0.92 to -0.16; p = 0.005) and shorter hospital stay (MD -2.90, 95% CI -4.38 to -1.42; p = 0.0001) than those in the st-THA group. Revisions were less frequent in the sim-THA group (OR 0.44, 95% CI 0.36-0.53; p < 0.00001). No differences were observed in mortality (OR 1.01, 95% CI 0.31-3.28; p = 0.98) or readmission rates (OR 0.58, 95% CI 0.23-1.44; p = 0.24). The number of transfusions (OR 4.42, 95% CI 2.18-8.99; p < 0.0001) was lower in st-THA. Functionality (SMD 0.37, 95% CI 0.20-0.53; p < 0.0001) and pain scores (SMD 0.19, 95% CI 0.04-0.33; p = 0.01) favored sim-THA. CONCLUSIONS: A meta-analysis of 20 studies demonstrated that sim-THA offers economical and clinical advantages, including reduced hospital expenses and improved patient quality of life, despite a higher number of transfusions, with comparable surgical blood loss to standard THA.
Clinical relevance of patient-reported outcome measures in the surgical management of focal chondral defects of the knee: a systematic review.
Migliorini F, Maffulli N, Memminger MK … +1 more , Hofmann UK
J Orthop Traumatol · 2026 Jan · PMID 41543615 · Full text
INTRODUCTION: To evaluate clinical outcome following surgical management of focal chondral defects in the knee, patient-reported outcome measures (PROMs) are used. To give these measures meaning, parameters such as the m...
INTRODUCTION: To evaluate clinical outcome following surgical management of focal chondral defects in the knee, patient-reported outcome measures (PROMs) are used. To give these measures meaning, parameters such as the minimal clinically important difference (MCID), patient-acceptable symptom state (PASS), minimally detectable change (MDC), clinically important difference (CID) and substantial clinical benefit (SCB) have been introduced. This systematic review investigated the MCID, SCB, CID, PASS and MDC of the most commonly used PROMs for assessing patients following surgical repair of focal chondral defects of the knee. METHODS: This systematic review was conducted in accordance with the 2020 Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and the recommendations of the Cochrane Handbook for Systematic Reviews of Interventions. All clinical studies investigating tools to assess the clinical relevance of PROMs in the surgical repair of focal chondral defects of the knee were reviewed. In April 2025, the following databases were accessed: PubMed, Web of Science and Embase. The PROMs of interest included: the International Knee Documentation Committee (IKDC) questionnaire, the Knee Injury and Osteoarthritis Outcome Score (KOOS) and its related subscales activities of daily living (ADL), pain, quality of life (QoL), sports and recreational activities, and symptoms, the Western Ontario and McMaster Universities Osteoarthritis (WOMAC) score, the Tegner Lysholm knee scoring scale, the Short Form-12 (SF-12) and its related mental and physical component subscales, the Short Form-36 (SF-36) and the Cincinnati Knee Rating System (CKRS). The Risk of Bias in Nonrandomised Studies of Interventions (ROBINS-I) indicated a low to moderate risk of bias. RESULTS: The systematic literature search yielded 524 articles. Only data from four studies (involving 421 patients) were included. All of these were non-randomised controlled trials (RCTs) employing a retrospective study design. Most reported thresholds for a significant change across the questionnaires ranged from 20 to 30 points on a 100-point scale, whereas PASS values ranged from 62 points in the IKDC to 87 points in the KOOS ADL. CONCLUSIONS: Despite a comprehensive search strategy, only four studies met the inclusion criteria, underscoring that the parameters analysed remain overlooked in the scientific literature. Reported results for MCID, CID and MDC following cartilage repair are relatively consistent in magnitude, ranging from 10 to 20. Differences reported in the literature that fall below this range should be regarded as no improvement. For SCB and PASS, values were even higher, spanning from 20 to 30 and from 62 to 87 points in IKDC and KOOS ADL, respectively. Given the high standard of modern medical care, further development and validation of condition-specific PROMs should be considered to facilitate future clinical evaluations using PROMs. LEVEL OF EVIDENCE: Level III, systematic review.
Internal fixation versus revision arthroplasty for Vancouver B2-B3 fractures: mortality and functional outcomes in frail patients. Insights from the PIPPAS study of 485 patients.
Moreta J, Aguado HJ, Castillón-Bernal P … +149 more , Muñoz-Vives JM, Camacho P, Jornet-Gibert M, Teixidor J, Pereda-Manso A, García-Sánchez Y, Ojeda-Thies C, García-Portabella P, Álvarez EM, Noriega-González D, Muñoz-Moreno MF, Arroyo-Hernantes I, Álvarez-Ramos BA, García-Medrano B, Martínez-Sellés C, Marín-Jiménez S, García-Virto V, País-Ortega S, Acha A, Tomás-Hernández J, Selga-Marsà J, Andrés-Peiró JV, Piedra-Calle C, Blasco-Casado F, Guerra-Farfán E, Querolt-Coll J, de Santamaría GT, Hernández JM, Renau-Cerrillo M, Gil-Aliberas C, Carreras-Castañer A, Vives-Barquiel M, Fernández EA, Manzano EF, De Cortázar UG, Arrieta M, Escobar D, Castrillo E, Balvis Balvis P, Denisiuk M, Menéndez MC, Pastor S, Larrazábal A, Olías-López B, Amaya-Espinosa P, Boluda-Mengod J, González-Martín D, López-Dorado D, Borrás-Cebrián JC, Martínez-Pérez C, Pazmiño PAF, Calavia-Calé P, Suárez-Suárez MÁ, Lanuza-Lagunilla L, Arias AG, Cabria-Fernández J, García-Coiradas J, Valle-Cruz J, Del Saz JS, Mora-Fernández J, Lalueza-Andreu P, Bonome-Roel C, Cano-Leira MÁ, Carrasco AB, Pariza AL, Fernández-Juan A, la Puente CS, Juldain-Mondragón M, Arsuaga JG, Saura-Sánchez E, Giménez-Ibáñez S, Sánchez-Gómez P, Ricón-Recarey FJ, García García EM, Cuadrado-Abajo F, Pérez-Núñez MI, Del Pozo-Manrique P, Navas-García FMG, García-Paredero E, Guijarro-Valtueña A, Robles TB, Navas-Pernía I, De Villasante-Jirón I, Porta TS, Becerra CC, Otero-Naveiro V, Paz SP, Castrillo IF, Fernández-Dorado F, Martínez-Menduiña A, Vaquerizo-García V, Murcia-Asensio A, Galián-Muñoz E, Marín-Martínez C, Muñoz-Vicente A, Plaza-Salazar N, Gámez-Asunción C, Benito-Santamaría J, Salgado-Tarrida P, Prats-Puente O, Cuenca-Copete A, González-Montero B, Giraldo-Vegas LA, Mingo-Robinet J, Briso-Montiano R, Barbería-Biurrun A, Escudero-Martínez E, Chouza-Montero L, Naharro-Tobío M, Gasset-Teixidor A, Domínguez-Ibarrola A, Peñalver JM, Serrano-Sanz J, Roche-Albero A, Martín-Hernández C, Macho-Mier M, Saló-Cuenca JC, Roselló JE, Criado-Albillos G, Cabello-Benavides HG, Nestar DA, González-Bernal J, González-Santos J, Cunchillos-Pascual J, Blasco JM, Bogallo-Dorado JM, Ramírez-Roldán A, Cano-Porras JR, Marqués-López F, Martínez-Díaz S, Slullitel PI, Carabelli GS, Astore I, Boietti BR, Córdova-Peralta JC, Hernández-Pascual C, Rodríguez-Gangoso A, Dot-Pascuet I, Piñeiro-Borrero A, Pérez-Sánchez JM, Mandía-Martínez A, De Caso-Rodríguez J, Martín-Marcuello J, Benito-Mateo M, Alda-Gastiain O, Corcuera-Elosegui I, González-Panisello MR, Pérez-Salazar NE, De Sande-Díaz M
J Orthop Traumatol · 2025 Dec · PMID 41428314 · Full text
BACKGROUND: Periprosthetic femoral fractures following hip arthroplasty (FH-PPF) represent a severe complication, especially in elderly patients with compromised health. Traditionally, revision arthroplasty is recommende...
BACKGROUND: Periprosthetic femoral fractures following hip arthroplasty (FH-PPF) represent a severe complication, especially in elderly patients with compromised health. Traditionally, revision arthroplasty is recommended for B2-B3 FH-PPF, yet internal fixation has emerged as a debated alternative in select patients. The hypothesis was that fixation, in selected patients with B2-B3 FH-PPF, decreases mortality and surgical complication rates with the same functional outcomes as revision arthroplasty. MATERIALS AND METHODS: PIPPAS is a multicenter prospective observational study. This cohort substudy includes 485 patients across 57 hospitals with B2-B3 FH-PPF between January 2021 and May 2023. Management strategy, revision or fixation, was at the attending surgeon's discretion. Propensity score matching, controlled for age, age-adjusted Charlson Comorbidity Index (a-CCI), prefracture mobility, Pfeiffer scale, and ASA score, was done. Mortality risk factors were assessed using univariate and multivariate analysis. RESULTS: Out of 485 patients, 164 received fixation, and 321 underwent revision. Fixation patients were older (88 versus 82 years, p < 0.001) and frailer. Fixation was associated with shorter hospital stay (13 versus 15 days, p = 0.003) but higher 1-year mortality (25% versus 14.3%, p = 0.04). There were no differences in medical or surgical complications (p = 0.83 and p = 0.36) at any time, but dislocation rate was higher in the revision group (p = 0.001). The 1-year mortality rate in patients with no weight-bearing restrictions was higher for the revision group (p = 0.01). The propensity score matching showed higher 1-year mortality rate in the fixation group but no differences in functional outcomes, complications, or up to 6-months mortality. In the multivariate analysis a-CCI, cognitive impairment, B3 fractures, and prefracture independent walking impairment were independent mortality risk factors. CONCLUSIONS: Revision arthroplasty showed less 1-year mortality rate and weight-bearing restrictions than fixation. However, frail patients with B2-B3 FH-PPF managed with fixation allowing full weight-bearing showed a lower 1-year mortality rate. Fixation in B2-B3 FH-PPF is a treatment option in frail patients, while aiming for stable constructions allowing full weight-bearing. LEVEL OF EVIDENCE II: prospective cohort study. TRIAL REGISTRATION: ClinicalTrials.gov (NCT04663893).
Robotic versus conventional single-level lumbar fusion in frail older adults: analysis of the National Readmission Database, 2016-2020.
Chen PW, Yang TH, Yang TC … +1 more , Chen SY
J Orthop Traumatol · 2025 Dec · PMID 41417167 · Full text
BACKGROUND: Lumbar fusion is a common intervention for degenerative spinal conditions, with robotic-assisted techniques offering improved precision. However, evidence comparing robotic and conventional fusion in frail ol...
BACKGROUND: Lumbar fusion is a common intervention for degenerative spinal conditions, with robotic-assisted techniques offering improved precision. However, evidence comparing robotic and conventional fusion in frail older adults is limited. This study evaluated short-term postoperative outcomes in this high-risk population. MATERIALS AND METHODS: This retrospective study analyzed data from frail adults aged ≥ 60 years who underwent single-level lumbar fusion between 2016 and 2020 using the National Readmission Database. Frailty was assessed with the Hospital Frailty Risk Score (HFRS). Outcomes-including in-hospital mortality, complications, hospital charges, and length of stay (LOS)-were compared between robotic and conventional fusion groups using propensity score matching (PSM). Key covariates used in the matching process included age and severe liver disease. Logistic regression provided adjusted odds ratios (aOR) with 95% confidence intervals (CI). RESULTS: Among 29,938 patients identified, 20,227 met inclusion criteria, and 3135 patients remained after PSM. Robotic surgery was associated with significantly higher hospital charges compared with the conventional approach (mean 203,700 USD versus 151,200 USD; β = 52.51, 95% CI 26.41, 78.60; p < 0.001). No significant differences were observed in in-hospital mortality (0.4% for both; OR 1.03, 95% CI 0.14, 7.79, p = 0.978), LOS (5.3 versus 5.6 days; β = -0.36, p = 0.263), or complication rates between groups. CONCLUSIONS: Robotic-assisted lumbar fusion in frail older adults leads to higher total hospital charges without short-term clinical benefit compared with conventional techniques. Further research is needed to assess long-term outcomes and justify the use of robotic surgery in this population.
Long-term outcome (28-40 years) after correction of leg length discrepancy through permanent epiphysiodesis.
Laufer A, Swoboda P, Gosheger G … +6 more , Rölfing JD, Frommer A, Toporowski G, Masthoff M, Roedl R, Vogt B
J Orthop Traumatol · 2025 Dec · PMID 41400744 · Full text
BACKGROUND: Permanent epiphysiodesis (pED) according to Phemister is an established treatment for leg length discrepancies (LLD) but has largely been replaced by less invasive techniques. Nevertheless, modern pED procedu...
BACKGROUND: Permanent epiphysiodesis (pED) according to Phemister is an established treatment for leg length discrepancies (LLD) but has largely been replaced by less invasive techniques. Nevertheless, modern pED procedures based on the Phemister principle are still widely used in paediatric orthopaedics for LLD correction and treatment of tall stature. However, the long-term effects of pED on the knee joint remain unclear. This study aimed to evaluate the long-term outcomes of Phemister pED, specifically assessing secondary alterations in knee joint morphology and the incidence of pre-mature osteoarthritis. A clearer understanding of these sequelae may help guide treatment decisions in paediatric orthopaedic care. MATERIALS AND METHODS: A retrospective review of our institution's longitudinal database identified 75 patients who underwent Phemister pED for LLD between 1980 and 2006. Of these, 20 patients met inclusion criteria and were available for long-term evaluation. Their clinical and radiographic outcomes were compared with those of an age- and sex-matched control cohort of ten untreated individuals. Clinical and radiographic assessments included LLD, mechanical axis deviation, joint orientation angles, central knee anatomy and osteoarthritis grading. Patient-reported outcomes were evaluated using the Oxford Knee Score (OKS), EQ-5D-3L and Knee Injury and Osteoarthritis Outcome Score (KOOS). RESULTS: The median follow-up was 37 years (interquartile range 33-39). The mean pre-operative LLD of 2.8 cm (standard deviation (SD) 0.7) was reduced to 1.1 cm (SD 0.6) at last follow-up, although 55% of patients had residual LLD > 1 cm. No relevant differences in joint alignment or central knee anatomy were found between patients and controls. Mild knee osteoarthritis (Kellgren-Lawrence grade 1) was observed in two patients and none in controls. Patient-reported outcomes showed lower OKS and EQ-5D-3L scores in the pED group, although KOOS scores were similar. CONCLUSIONS: Phemister pED showed satisfactory long-term results for LLD correction, without secondary angular or intra-articular deformities or relevant knee osteoarthritis. Despite slightly lower function and more discomfort, findings support the use of modern pED techniques based on the Phemister principle. This is especially relevant for elective indications such as tall stature. Further comparative studies with percutaneous methods remain necessary to confirm these observations. Level of evidence Level IV, therapeutic study.
Negative pressure wound therapy for the prevention of surgical site infections in orthopedic and trauma surgery: a systematic review and meta-analysis of RCTs.
Ebeid I, Ebeid A, Shalaby A … +3 more , Mohamed Noureldeen I, Essa A, A Elmenawi K
J Orthop Traumatol · 2025 Dec · PMID 41400731 · Full text
BACKGROUND: Surgical site infections (SSIs) are an important postoperative complication in orthopedic surgery, resulting in increased morbidity, prolonged hospital stay, and higher healthcare costs. Negative pressure wou...
BACKGROUND: Surgical site infections (SSIs) are an important postoperative complication in orthopedic surgery, resulting in increased morbidity, prolonged hospital stay, and higher healthcare costs. Negative pressure wound therapy (NPWT) has been proposed to reduce SSIs by facilitating wound healing by increased perfusion, edema reduction, and bacterial control. This systematic review and meta-analysis evaluate the effectiveness of NPWT compared with conventional dressings for prevention of surgical site infections in orthopedic and trauma surgery. METHODS: A comprehensive literature search was performed across PubMed, Web of Science, Scopus, and the Cochrane Library in December 2024. Only randomized controlled trials (RCTs) comparing NPWT with CD in patients undergoing joint replacement, trauma surgery, or spine surgery were included. Two independent reviewers conducted data extraction and assessed study quality using the Cochrane Risk of Bias 2 tool. Pooled outcomes were evaluated with odds ratios (ORs) computed for dichotomous variables and mean differences (MDs) for continuous outcomes. Heterogeneity was assessed via the I statistic and publication bias through Egger's test. RESULTS: Overall, 18 RCTs, comprising a total of 4585 patients, were included. Meta-analysis demonstrated that NPWT significantly reduced SSIs (pooled OR 0.64, 95% CI 0.50-0.82; p = 0.0005) and wound dehiscence (pooled OR 0.39, 95% CI 0.23-0.65; p = 0.0003). Additionally, NPWT was associated with a reduction in length of hospital stay by 0.87 days (MD -0.87, 95% CI -1.36 to -0.38; p = 0.0005) and fewer dressing changes compared with conventional methods. The quality of evidence for the primary outcome was rated as moderate based on the GRADE approach. CONCLUSIONS: NPWT appears to offer a significant clinical benefit in reducing the incidence of SSIs in orthopedic and trauma surgery. Secondary analyses also demonstrated benefits for surgical wound dehiscence, length of hospital stay, and number of dressing changes. However, the certainty of evidence is moderate, and these findings should be interpreted with caution. Further well-designed, multicenter RCTs are warranted to confirm these benefits, assess long-term outcomes, and evaluate cost-effectiveness. Level of evidence Level I. REGISTRATION: CRD42024624188.
Total hip arthroplasty in Italy: an observational, population-based study on surgical volume growth from 2001 to 2023 and forecasts until 2050 with six different statistical models.
Ciminello E, Cuccu A, Romanini E … +9 more , Venosa M, Cazzato G, Tucci G, Boniforti F, Carpanese L, Falcone T, Ceccarelli S, Ciccarelli P, Torre M
J Orthop Traumatol · 2025 Dec · PMID 41342988 · Full text
BACKGROUND: The number of total hip arthroplasty (THA) procedures has been steadily increasing worldwide, driven by aging population, improvements in surgical techniques and implant design. This study aimed to analyze th...
BACKGROUND: The number of total hip arthroplasty (THA) procedures has been steadily increasing worldwide, driven by aging population, improvements in surgical techniques and implant design. This study aimed to analyze the temporal trends of elective THA in Italy since 2001-2023 and forecast THA volumes up to 2050 to provide insights for healthcare planning. MATERIALS AND METHODS: International Classification of Diseases, 9th Revision, Clinical Modification (ICD9-CM) coding system was used to extract records of interest (elective THA) from the Italian National Hospital Discharge Record database. Six statistical models were applied to forecast future THA volumes: logistic regression; Poisson regression; logarithmic regression; inverse/power regression; Poisson log-normal regression; and hierarchical Poisson regression with temporal effects (HPTE). Model performances were assessed by using error metrics and internal validation on the basis of a rolling-origin approach. An out-of-sample validation was conducted to ensure a robust assessment of forecasting reliability. THA volume forecasts were provided with 95% prediction intervals. RESULTS: A total of 1,318,400 records for primary elective THAs performed in Italy since 2001-2023 were analyzed. The number of THAs increased by approximately 80%, rising from 68.270 in 2001 to 122.777 in 2023. Among the tested models, HPTE generally showed the best fitting and forecasting performances. By using the HPTE model, the forecasts showed an increase in THA volumes up to a maximum rate ratio (RR) of 1.3 (PI: 1.1-1.4) in terms of RR in 2036, then decreasing to a RR equal to 1.2 (PI: 1.1-1.4) by 2050 with respect to 2019. CONCLUSIONS: Our findings forecast a steady increase between 10% and 40% in THA, driven by demographic and epidemiological trends. These projections are essential for anticipating future surgical demand and guiding healthcare system planning. Without adequate investment and strategic planning, rising volumes may strain service capacity and sustainability. LEVEL OF EVIDENCE: population based study, level 1 evidence.
Short-term outcomes of robotic versus conventional unicompartmental knee arthroplasty: evidence from a national database.
Shih CM, Chen KH, Jiang FC … +3 more , Hsu CE, Wang CC, Wang SP
J Orthop Traumatol · 2025 Dec · PMID 41329432 · Full text
BACKGROUND: Robotic-assisted unicompartmental knee arthroplasty (UKA) has gained popularity for its potential to improve implant precision and reduce surgical errors. However, comparative evidence on short-term outcomes...
BACKGROUND: Robotic-assisted unicompartmental knee arthroplasty (UKA) has gained popularity for its potential to improve implant precision and reduce surgical errors. However, comparative evidence on short-term outcomes versus conventional UKA is lacking. Thus, the purpose of this study was to compare the short-term outcomes of robotic-assisted versus conventional UKA using a nationally representative database. METHODS: The Nationwide Readmissions Database 2016-2020 was retrospectively examined to identify adult patients who received an elective UKA. After applying exclusion criteria and 1:2 propensity score matching (PSM), 8310 patients were included in the analysis. Outcomes included in-hospital complications, implant malposition or failure, perioperative fracture, length of hospital stay (LOS), hospital costs, and 30- and 90-day readmission rates. Multivariable regression analyses were performed to adjust for residual confounding factors. RESULTS: Robotic-assisted UKA was associated with significantly lower complication rates compared with conventional UKA (3.7% versus 13.2%, p < 0.001). Specifically, robotic-assisted procedures had reduced risks of implant malposition or failure (odds ratio [OR] = 0.08; 95% confidence interval [CI]: 0.05-0.13; p < 0.001) and perioperative fracture (OR = 0.18; 95% CI 0.04-0.76; p = 0.020). No significant differences were observed in LOS, total hospital costs, or readmission rates at 30 and 90 days. CONCLUSIONS: Robotic-assisted UKA is associated with improved short-term surgical safety, including fewer complications, particularly, reduced implant malposition and perioperative fractures. However, broader hospital metrics such as LOS, cost, and readmissions were comparable between the two approaches. Further prospective studies are needed to validate these findings and assess long-term outcomes and cost-effectiveness. LEVEL OF EVIDENCE: Level III. CLINICAL TRIAL REGISTRATION NUMBER: Not applicable.
Fractures of the coronoid process: state of the art.
Marinelli A, Riva M, Coliva F … +3 more , Minerba M, Carbone G, Guerra E
J Orthop Traumatol · 2025 Dec · PMID 41329416 · Full text
Coronoid fractures are rarely isolated and are much more frequently associated with other osseous or ligamentous structures injuries. On the basis of the coronoid fracture patterns, described by the O'Driscoll classifica...
Coronoid fractures are rarely isolated and are much more frequently associated with other osseous or ligamentous structures injuries. On the basis of the coronoid fracture patterns, described by the O'Driscoll classification, it is possible to recognize three main patterns of injury that differ on traumatic mechanism and on associated lesions: posterolateral rotatory instability, posteromedial rotatory instability, and axial load injuries. The management of coronoid fractures is challenging and varies according to characteristics of the fracture, associated lesions, and amount of elbow instability. In general, operative treatment is indicated in every case the fracture is at least 50% of the whole coronoid, whether the sublime tubercle is involved, and whether the ulno-humeral joint is not perfectly reduced. In conclusion, the correct management of the coronoid, especially in the setting of complex elbow instability, represents a predictive factor for patient outcomes and functional results. The stability of the elbow, rather than the size of the coronoid fragment, is the main parameter for surgical indication, aimed to fix the coronoid and/or repair the associated lesions.
Development and validation of a nomogram for predicting fasciotomy requirement in lower extremity arterial injuries: a retrospective case-control study.
Zhang H, Jia H, Wang H … +3 more , Dong Q, Zhang Y, Hou Z
J Orthop Traumatol · 2025 Nov · PMID 41284192 · Full text
BACKGROUND: Acute compartment syndrome (ACS) following lower extremity arterial injuries necessitates urgent fasciotomy to prevent limb loss, yet current diagnostic tools lack specificity for ischemia-reperfusion pathoph...
BACKGROUND: Acute compartment syndrome (ACS) following lower extremity arterial injuries necessitates urgent fasciotomy to prevent limb loss, yet current diagnostic tools lack specificity for ischemia-reperfusion pathophysiology. Our study aimed to develop a nomogram combining biomarkers and clinical indicators to predict fasciotomy risk, enhancing early risk stratification and optimizing surgical decision-making. MATERIALS AND METHODS: In this retrospective case-control study (2010-2024), data were sourced from a tertiary hospital in China. A total of 146 patients with traumatic femoral or popliteal artery injuries were stratified into fasciotomy (n = 45) and non-fasciotomy (n = 101) groups. Adhering to the events-per-variable (EPV) principle (10:1), predictors were selected via least absolute shrinkage and selection operator (LASSO) regression and bootstrap validation. A multivariable logistic regression model was internally validated using tenfold cross-validation and 1000 bootstrap replicates. RESULTS: Four independent predictors were retained: limb ischemia severity (odds ratio [OR] = 4.25, 95% confidence interval [CI]: 1.97-10.02), K (OR = 6.99, 95% CI: 2.60-21.73), creatine kinase (CK; OR = 1.18, 95% CI: 1.08-1.30), and neutrophils (NEU) with a nonlinear threshold effect (OR = 1.20, 95% CI: 1.10-1.33). The nomogram demonstrated excellent discrimination (area under the curve [AUC] = 0.877, 95% CI: 0.819-0.934), precise calibration (Hosmer-Lemeshow P = 0.417), and broad clinical utility (net benefit threshold: 3-87%). CONCLUSIONS: This study integrated accessible clinical and laboratory data and identified limb ischemia severity, K, CK, and NEU as factors associated with fasciotomy risk. A nomogram based on these variables demonstrated reliable predictive performance and strong clinical applicability, enabling timely risk assessment and early intervention in patients with lower extremity arterial injuries. LEVEL OF EVIDENCE: Level 4.
Comparison of the Frosch approach and the supra-fibular head approach in the treatment of posterolateral tibial plateau fractures combined with lateral column fractures.
Wang L, Dai X, Dai X … +5 more , Yue D, Zhong C, Wen Y, Qin J, Yuan T
J Orthop Traumatol · 2025 Nov · PMID 41219557 · Full text
OBJECTIVE: This study aimed to investigate the indications and clinical effects of the Frosch approach versus the supra-fibular head approach in the treatment of posterolateral tibial plateau fractures combined with late...
OBJECTIVE: This study aimed to investigate the indications and clinical effects of the Frosch approach versus the supra-fibular head approach in the treatment of posterolateral tibial plateau fractures combined with lateral column fractures (PTPL) on the basis of the morphological classification of the posterolateral cortex. METHODS: A retrospective analysis was conducted on patients treated between June 2018 and January 2024 for PTPL using either the Frosch approach (group A, n = 23) or the supra-fibular head approach (group B, n = 21). Fractures were classified according to the morphology of the posterolateral cortex into two types: intact cortex (type I, n = 24) and disrupted cortex (type II, n = 20). Patients with type I fractures were further divided into subtypes IA (Frosch, n = 12) and IB (supra-fibular head, n = 12), and those with type II fractures into IIA (Frosch, n = 11) and IIB (supra-fibular head, n = 9). Baseline characteristics and perioperative parameters were compared. Clinical effects was assessed using the Rasmussen radiological score, and knee function was evaluated using the Rasmussen functional score. RESULTS: The operative time was significantly longer in group A than in group B (130.0 ± 19.1 versus 110.1 ± 13.7 min, P < 0.05). In the type I subtype, operative time was longer in IA than in IB (138.3 ± 19.5 versus 111.9 ± 17.4 min, P < 0.05). In the type II subtype, operative time was significantly longer in IIA compared with IIB (120.9 ± 14.5 versus 107.8 ± 6.7 min, P < 0.05). Rasmussen radiological scores were significantly higher in IIA than IIB (17.6 ± 1.2 versus 17.0 ± 0.9, P < 0.05); similarly, functional scores were higher in IIA than IIB (29.1 ± 1.8 versus 27.7 ± 1.7, P < 0.05). CONCLUSIONS: Morphology-based classification of PTPL-according to the integrity of the posterolateral cortex-can provide valuable guidance for surgical decision-making. For fractures with cortical disruption, the Frosch approach offers superior reduction and enhanced stability. In contrast, for fractures with intact cortical continuity, the supra-fibular head approach is a less invasive and technically straightforward alternative with favorable clinical outcomes. LEVEL OF EVIDENCE: III, retrospective study.
Return to sport after acetabular and pelvic ring fractures in amateur athletes: A retrospective study.
Rovere G, Smakaj A, De Mauro D … +6 more , Mattiacci V, Vicenti G, Bosco F, Camarda L, Farsetti P, Liuzza F
J Orthop Traumatol · 2025 Oct · PMID 41171555 · Full text
BACKGROUND: Acetabular fractures are complex hip injuries with high social and economic costs, as they affect individuals of working age. These fractures often result in long-term complications, including chronic pain an...
BACKGROUND: Acetabular fractures are complex hip injuries with high social and economic costs, as they affect individuals of working age. These fractures often result in long-term complications, including chronic pain and sexual dysfunction, which impair quality of life and limit physical activity. With growing interest in fitness, understanding factors that impact return to sport post injury is critical. This study examines how fracture type and surgical approach influence functional recovery and return to sport after acetabular and pelvic fractures. MATERIAL AND METHODS: This retrospective cohort study analyzed outcomes in patients with acetabular and pelvic ring fractures, focusing on their ability to return to sport. Patients treated between 2018 and 2022 at Policlinico Universitario A. Gemelli in Rome were included, specifically those with isolated fractures managed by open reduction internal fixation (ORIF) or closed reduction internal fixation (CRIF) techniques. Demographic and clinical data were collected, and fractures were categorized by Judet-Letournel (acetabular) or Young-Burgess (pelvic ring) classifications. Outcomes were assessed using four physical activity-related scores: Hip Sport Activity Scale (HSAS), Hip Outcome Score (HOS), Tegner Activity Scale (TAS), and Modifiable Activity Questionnaire (MAQ), alongside the 12-Item Short Form Health Survey (SF-12) for quality of life. Eligible participants, aged 18-65 years, had no prior surgeries or neurological/cardiopulmonary diseases, nor concurrent limb fractures or severe trauma. Data analysis used Student's t-test and chi-squared tests for continuous and categorical variables, respectively, with analysis of variance (ANOVA) for subgroup comparisons. RESULTS: The study included 35 patients, with 20 acetabular fractures (4:1 male/female ratio, average age 45.3 years) and 15 pelvic ring fractures (6.5:1 male/female ratio, average age 51.3 years). Follow-up averaged 1074 days for the acetabular group and 1446 days for the pelvic group. Clinical outcomes showed that both groups had similar Physical Component Summary (PCS-12) and Mental Component Summary (MCS-12) scores, with no statistically significant differences (p > 0.05). Total MAQ scores were higher in the pelvic group, mainly owing to higher work-related activity scores, while sport-related scores were similar. Hip Outcome Scores (HOS) also indicated comparable function in daily activities and sports, with acetabular fractures scoring 72.2 and pelvic fractures scoring 74.8. HSAS and TAS measures showed no significant difference between groups. Subgroup analysis found no significant outcome differences on the basis of fracture location (anterior versus posterior acetabulum or pelvic ring patterns). CONCLUSIONS: The study found no statistically significant differences in return-to-sport outcomes between acetabular and pelvic ring fractures, highlighting the complexity of both injuries. Future research with larger samples and standardized functional scores is recommended for clearer insights into recovery outcomes. LEVEL OF EVIDENCE: III.
Editorial: Bacteriophage therapy in orthopedics-Key questions and emerging answers.
Migliorini F, Rivera F, Eschweiler J
J Orthop Traumatol · 2025 Oct · PMID 41143937 · Full text
Musculoskeletal infections remain among the most challenging conditions in orthopaedic practice, often requiring prolonged antibiotic therapy, repeated surgical interventions, and extensive rehabilitation. The emergence...
Musculoskeletal infections remain among the most challenging conditions in orthopaedic practice, often requiring prolonged antibiotic therapy, repeated surgical interventions, and extensive rehabilitation. The emergence of antimicrobial resistance and the persistence of bacterial biofilms further complicate management, particularly in chronic osteomyelitis, infected fracture fixations, and periprosthetic joint infections. In this context, bacteriophage therapy has re-emerged as a promising adjunctive strategy. Bacteriophages offer targeted antibacterial activity, including the ability to disrupt biofilms and self-replicate at the site of infection. Contemporary approaches, such as phagograms, customised phage cocktails, and local delivery techniques, have addressed many historical limitations related to phage specificity and accessibility. A growing number of case reports and small clinical series have documented successful applications of phage therapy in orthopaedic infections, with encouraging safety profiles and infection resolution in refractory cases. Early-phase clinical trials are now systematically evaluating the feasibility, pharmacokinetics, and immunogenicity of phage therapy in musculoskeletal settings. Furthermore, synergistic effects with antibiotics and the potential to overcome biofilm-related antibiotic tolerance highlight the added therapeutic value of this approach. While regulatory and manufacturing challenges persist, the integration of bacteriophages into multidisciplinary orthopaedic care marks a paradigm shift toward precision microbiology. Rather than replacing conventional treatment, phage therapy complements surgery and antibiotics, offering a biologically rational and patient-specific adjunct in the fight against recalcitrant infections.
The role of subtalar extrarticular screw arthroereisis (SESA) in surgical treatment of tarsal coalitions.
De Pellegrin M, Marcucci L, Guindani N … +2 more , Brogioni L, Fracassetti D
J Orthop Traumatol · 2025 Oct · PMID 41123821 · Full text
BACKGROUND: Talocalcaneal (TCC) and calcaneonavicular (CNC) coalitions are the most common cause of rigid symptomatic flatfoot in children. After resection, calcaneal lengthening osteotomy or arthrodesis are usually repo...
BACKGROUND: Talocalcaneal (TCC) and calcaneonavicular (CNC) coalitions are the most common cause of rigid symptomatic flatfoot in children. After resection, calcaneal lengthening osteotomy or arthrodesis are usually reported as second step surgery for correction of the most frequent valgus hindfoot deformity. More recently, coalition resection and minimally invasive subtalar extraarticular screw arthroereisis (SESA) for hindfoot valgus correction in one step have been described. We report the functional mid-term results of patients treated in adolescence with resection and valgus correction with SESA. METHODS: Between 2008 and 2024 data were collected from 25 patients (18 M, 7 F) affected by TCC (n = 16, 7R, 9L) and CNC (n = 16, 8R, 8L), all with symptomatic rigid flatfeet (n = 32). Average age at surgery was 12.8 ± 1.4 years (9.8-16.4 years, median 12.8). All patients underwent resection and SESA for correction of residual hindfoot valgus deformity; 31/32 feet had postoperative American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot score. Mann-Whitney test was used for comparison between TCC and CNC outcomes. RESULTS: Average follow-up (FU) was 4.7 ± 3.2 years (6 months-11.9 years, median 3.7) with a mean age at FU of 17.5 ± 3.3 years (13.2-25.4 years, median 16.8). Overall average AOFAS Ankle-Hindfoot score was 95.6 ± 5.7 and 94.3 ± 6.6 for TCC and 96.7 ± 4.6 for CNC, respectively. Subgroup scores for pain, function, and alignment were 37.3 ± 4.6, 48.7 ± 2.4, and 8.3 ± 2.4 for TCC and 38.1 ± 4.0, 48.6 ± 6.2, and 10.0 for CNC, respectively, showing a statistically significant difference between TCC and CNC only for alignment (p = 0.014). No patients had additional surgery for complications or valgus recurrence. CONCLUSIONS: Symptomatic rigid flatfeet affected by TCC and CNC and treated in adolescence with coalition resection and SESA for residual hindfoot valgus correction achieved good to excellent results in all cases. Further surgery to correct malalignment was avoided. LEVEL OF EVIDENCE: Level IV, retrospective study.
Optimizing lordosis preservation in monosegmental lumbar spondylodesis: evaluating the efficacy of a novel noninvasive technique using intraoperative hip hyperextension.
Contreras LAN, Karantzoulis V, Trenado C … +6 more , Velazquez K, Suárez-Gutiérrez MA, Mantilla-Mayans P, Sanchez-Porras R, Santos E, Vazifehdan F
J Orthop Traumatol · 2025 Oct · PMID 41081979 · Full text
BACKGROUND: Loss of lumbar lordosis after spinal fusion can lead to complications such as chronic low back pain, abnormal sagittal balance, and accelerated adjacent segment degeneration. This study aims to evaluate a nov...
BACKGROUND: Loss of lumbar lordosis after spinal fusion can lead to complications such as chronic low back pain, abnormal sagittal balance, and accelerated adjacent segment degeneration. This study aims to evaluate a novel intraoperative positioning technique for lumbar spondylodesis, involving hip hyperextension in the prone position with an inflatable bladder under the thigh to preserve lumbar lordosis. MATERIALS AND METHODS: This prospective, pilot, interventional study included 100 patients undergoing monosegmental lumbar fusion at L4 or L5. Patients with degenerative disc disease and no prior spine surgery were enrolled. Lateral X-rays were obtained preoperatively, intraoperatively, and postoperatively, measuring sacral slope (SS), pelvic tilt (PT), pelvic incidence (PI), and distal lordosis (DL). Spine types were categorized using the Roussouly classification. Data were analyzed using multivariate regression, accounting for age, body mass index (BMI), and spine type, with subgroup and sensitivity analyses. RESULTS: The mean patient age was 68.1 years, with 54% classified as overweight (mean BMI: 26.6 kg/m). Significant improvements in distal lordosis were noted: preoperative (16.68° ± 8.85), intraoperative before reduction (17.60° ± 8.80), after reduction (21.44° ± 10.19), and postoperative (22.23° ± 10.13) (Z = -7.757, p < 0.005). The Sacral Slope increased postoperatively by 2.67° [t(99) = 2.671, p = 0.009]. The hip hyperextension technique improved lordosis independently of age, BMI, and spine type (p < 0.05). Patients with higher BMI (p < 0.01) and Roussouly type 3 (p < 0.05) benefited the most. CONCLUSIONS: This study introduces a novel positioning technique that effectively preserves lumbar lordosis during spinal fusion without additional implants or complex procedures. The technique shows promise for optimizing outcomes and warrants further investigation with larger cohorts and extended follow-up. Trial Registration Retrospectively registered with the institutional ethics committee (Approval No. F-2023-073). Informed consent was obtained from all participants. Level of Evidence Level IV, case series.
Additional cartilage treatment for small defects in chronic ankle instability shows no mid-term benefit and delays recovery: a randomized controlled trial.
Figa Barrios R, Mora-Guix JM, Roza Miguel PO … +1 more , Vila-Rico J
J Orthop Traumatol · 2025 Oct · PMID 41065921 · Full text
BACKGROUND: The presence of chondral lesions in patients with chronic ankle instability is common and has been suggested as a possible cause of persistent pain in some cases, even after successful ligament reconstruction...
BACKGROUND: The presence of chondral lesions in patients with chronic ankle instability is common and has been suggested as a possible cause of persistent pain in some cases, even after successful ligament reconstruction. For this reason, some authors have proposed combining ankle stabilization with cartilage microfracture; however, the results reported in literature are contradictory. MATERIALS AND METHODS: The study was designed as a prospective randomized clinical study with two parallel arms. Patients with an anterior talofibular ligament tear causing pain and instability, associated with a Berndt-Harty stage I-IIb talar osteochondral lesion of < 150 mm that had not responded to conservative treatment, were blindly assigned to either isolated ligament reconstruction (REC) or reconstruction plus microfracture (REC + MIC). Evaluators were also blinded. RESULTS: A total of 71 patients were included in the study, with 36 in the REC group and 35 in the REC + MIC group. The groups were comparable in terms of anthropometry and pathology. The operating time was significantly longer in the REC + MIC group (48.0 ± 4.5 min) compared with the REC group (24.9 ± 3.9 min; p < 0.001). At the end of follow-up, both patient groups showed similar results on the American Orthopaedic Foot and Ankle Society (AOFAS) score (p = 0.755), Self-Reported Foot and Ankle Score (SEFAS) (p = 0.862), Karlsson score (p = 0.993), and visual analog scale (VAS) (p = 0.870). However, the time to recovery differed between the groups, with patients in the REC group recovering faster from before the operation (pre-op) through the third month after the operation (post-op). The difference in recovery at 3 months post-op was statistically significant on the AOFAS (p < 0.001), SEFAS (p < 0.001), and Karlsson (p < 0.001) scores. No statistically significant difference was observed in terms of pain (p = 0.342). The failure rate was also comparable between the groups, with four (11.1%) reoperations in the REC group and five (14.3%) in the REC + MIC group (p = 0.735). CONCLUSIONS: At 2 years post surgery, no differences were observed in function (according to the AOFAS, SEFAS, and Karlsson scores), pain, or complications in patients with ankle instability and associated chondral damage treated with or without microfractures. However, patients who underwent microfractures experienced a significantly slower recovery of function. LEVEL OF EVIDENCE: Level 1. TRIAL REGISTRATION: ClinicalTrials.gov Identifier NCT06947317 (retrospectively registered). Date: 1 May 2025. ( https://clinicaltrials.gov/study/NCT06947317 ).
Active and passive physical therapy in patients with chronic low-back pain: a level I Bayesian network meta-analysis.
Baroncini A, Maffulli N, Manocchio N … +5 more , Bossa M, Foti C, Schäfer L, Klimuch A, Migliorini F
J Orthop Traumatol · 2025 Oct · PMID 41042338 · Full text
BACKGROUND: Chronic low back pain (cLBP) is common. Physiotherapy is frequently indicated as a non-pharmacological management of these patients. This Bayesian network meta-analysis compared active versus passive physioth...
BACKGROUND: Chronic low back pain (cLBP) is common. Physiotherapy is frequently indicated as a non-pharmacological management of these patients. This Bayesian network meta-analysis compared active versus passive physiotherapy versus their combination in terms of pain and disability in patients with mechanical and/or aspecific cLBP. METHODS: In June 2025, the following databases were accessed: PubMed, Web of Science, Google Scholar and Embase. All the randomised controlled trials (RCTs) which evaluated the efficacy of a physiotherapy program in patients with LBP were accessed. Data regarding pain scores, the Roland-Morris Disability Questionnaire (RMQ) and the Oswestry Disability Index (ODI) were collected. The network meta-analyses were performed using the STATA (version 14; StataCorp, College Station, TX, USA) routine for Bayesian hierarchical random-effects model analysis, employing the inverse variance method. The standardised mean difference (STD) was used for continuous data. RESULTS: Data from 2768 patients (mean age 46.9 ± 10.9 years, mean BMI 25.8 ± 2.9 kg/m) were collected. The mean length of follow-up was 6.2 ± 6.1 months. Between groups, comparability was found at baseline in terms of mean age, proportion of women, mean BMI, symptom duration and patient-reported outcome measures (PROMs). By the end of the follow-up period, the active group evidenced the lowest pain scores (SMD 1.00; 95% CI -3.28 to 5.28). The active group evidenced the lowest RMQ score (SMD 0.94; 95% CI -4.96 to 3.09). The active group evidenced the lowest ODI score (SMD -1.23; 95% CI -9.83 to 7.36). CONCLUSION: Active physiotherapy showed better results than passive physiotherapy and a combination of both for the management of mechanical and/or non-specific cLBP. LEVEL OF EVIDENCE: Level I, Bayesian network meta-analysis of RCTs.
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