Journal of orthopaedics最新文献

{"title":"Xylosyltransferase-I in knee arthrofibrosis: Mechanistic insights and translational implications","authors":"Yong Huang ,&nbsp;Chao Lou ,&nbsp;Michael Jagodzinski","doi":"10.1016/j.jor.2026.02.031","DOIUrl":"10.1016/j.jor.2026.02.031","url":null,"abstract":"<div><h3>Background</h3><div>Arthrofibrosis is a frequent complication after total knee arthroplasty (TKA) and remains difficult to diagnose early due to the lack of reliable biomarkers. Excessive extracellular matrix (ECM) remodeling is driven by core signaling cascades, notably the Transforming Growth Factor-beta 1 (TGF-ß1) and Wnt/ß-catenin pathways. Xylosyltransferase-I (XT-I), a key enzyme regulating proteoglycan biosynthesis, has emerged as a critical downstream effector and potential indicator of early fibrotic activity.</div></div><div><h3>Methods</h3><div>This narrative review summarizes clinical and experimental findings on XT-I in joint fibrosis, with emphasis on its role within the molecular network of key pro-fibrotic signaling and its diagnostic and translational potential in knee arthrofibrosis.</div></div><div><h3>Results</h3><div>XT-I is consistently upregulated in fibrotic synovial fibroblasts and synovial fluid of arthrofibrotic knees, correlating with ECM remodeling and myofibroblast activation induced by both TGF-ß1and Wnt/ß-catenin signaling. XT-I demonstrates local rather than systemic diagnostic value and may serve as an early fibrosis indicator.</div></div><div><h3>Conclusion</h3><div>XT-I holds promise as a synovial biomarker and potential therapeutic target in arthrofibrosis. Targeting XT-I, potentially in combination with core pathway inhibitors (e.g., Wnt/ß-catenin inhibitors), may offer a refined strategy for early diagnosis and postoperative management in TKA patients.</div></div>","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":"75 ","pages":"Pages 40-45"},"PeriodicalIF":1.5,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146192676","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Calculating and comparing value in orthopaedic hip trauma: A systematic review","authors":"Lindsay Maier ,&nbsp;Zachary Chen ,&nbsp;Mithil Gudi ,&nbsp;Spencer Barlow ,&nbsp;Trae Hill ,&nbsp;Charles S. Day","doi":"10.1016/j.jor.2026.02.043","DOIUrl":"10.1016/j.jor.2026.02.043","url":null,"abstract":"<div><h3>Objectives</h3><div>To evaluate the existing literature on value comparisons between treatment strategies in orthopaedic hip fracture care using real-world clinical data and standardized cost-effectiveness metrics.</div><div>Materials and Methods</div></div><div><h3>Data sources</h3><div>A comprehensive search of PubMed, Embase, and Web of Science was conducted for studies published between January 1, 2003, and May 30, 2024. Only English-language articles were included.</div></div><div><h3>Study selection</h3><div>Eligible studies directly compared two or more treatment strategies for hip fracture care and included a value-based economic evaluation using clinical (non-simulated) data. Exclusion criteria included simulation models, protocols, case reports, systematic reviews, and meta-analyses.</div></div><div><h3>Data extraction</h3><div>Two independent reviewers screened titles, abstracts, and full texts using PRISMA guidelines. Discrepancies were resolved by a third reviewer. Extracted variables included study design, intervention type, cost perspective, quality metric used, and economic evaluation method.</div></div><div><h3>Data synthesis</h3><div>Studies were analyzed descriptively. Outcome measures included cost-effectiveness ratios such as ICER, ICUR, and NMB. QALYs were used to enable cross-study comparisons.</div></div><div><h3>Results</h3><div>Sixteen of 935 screened full-text articles met inclusion criteria. Most studies evaluated surgical interventions. Cemented hemiarthroplasty showed a favorable NMB compared to uncemented implants. Liposomal bupivacaine and tranexamic acid were cost-effective due to lower operating costs and shorter hospital stays. Internal fixation was more cost-effective than hemiarthroplasty in some settings despite lower quality outcomes. Operative treatment in frail, institutionalized patients offered minimal QALY benefit at high cost. Home-based post-acute care and fracture liaison services improved value, while outreach rehab lacked long-term cost-effectiveness. Most studies used public payer perspectives and EQ-5D-derived QALYs.</div></div><div><h3>Conclusion</h3><div>There is significant variability in how value is calculated and reported in hip fracture care. Standardized value frameworks using a hospital/clinic perspective, patient-reported outcomes transformed into QALYs, and cost-utility ratios compared with the ICER equation should be utilized in future studies.</div></div><div><h3>Level of evidence</h3><div>Level III (Systematic Review of Comparative Studies)</div></div>","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":"75 ","pages":"Pages 168-176"},"PeriodicalIF":1.5,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146192677","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Outcomes following single-level lumbar fusion in patients with myasthenia gravis","authors":"Danielle B. Heckert ,&nbsp;Julia Jezykowski ,&nbsp;Clare K. Green ,&nbsp;Joyce En-Hua Wang ,&nbsp;Ved A. Vengsarkar ,&nbsp;Wendy Novicoff ,&nbsp;Xudong Li ,&nbsp;Stephen Lockey","doi":"10.1016/j.jor.2026.02.027","DOIUrl":"10.1016/j.jor.2026.02.027","url":null,"abstract":"<div><h3>Introduction</h3><div>Patients with myasthenia gravis (MG) are at higher risk for postoperative complications after surgery. Knowledge concerning the impact of the condition on outcomes and complications after spine surgery is currently limited. Using a large-scale, national database, the purpose of this investigation was to compare the rate of medical and surgical complications, healthcare utilization, and need for revision surgery following single-level lumbar fusion between patients with and without MG.</div></div><div><h3>Methods</h3><div>Data was collected using the PearlDiver database and adult patients with and without MG who underwent single-level lumbar spine fusion from 2010 to 2022 were matched 1:4 on age, sex, and baselin comorbidities. Pearson's Chi-squared test and Welch's <em>t</em>-test were used to evaluate differences in demographic and clinical outcomes. Univariate analysis and multivariate logistic regression were performed to calculate odds ratios (ORs) and 95% confidence intervals (CIs) after controlling for potential confounders.</div></div><div><h3>Results</h3><div>A total of 537 (20.0%) patients with MG were matched with 2140 (80.0%) patients controls. At 90 days postoperatively, patients with MG experienced significantly higher rates of postoperative arrhythmia, cerebrovascular accident, atelectasis, respiratory failure, pleural effusion, pulmonary embolism, urinary retention, urinary tract infection, and renal failure. At two-year follow up, 27 (5.0%) patients with MG developed pseudoarthrosis compared to 48 (2.2%) controls (OR 2.32; 95% CI: 1.41-3.74; p &lt; 0.001), and 38 (7.1%) MG patients had undergone revision lumbar spine surgery compared to 61 (2.9%) controls (OR: 2.61; 95% CI: 1.70-3.95; p &lt; 0.001). Regarding healthcare utilization, patients with MG were more likely to present to the emergency department and require readmission at both 30 and 90 days postoperatively.</div></div><div><h3>Conclusion</h3><div>Patients with MG experienced more postoperative complications and higher healthcare utilization after single-level lumbar fusion. These findings highlight the importance of individualized perioperative planning to mitigate risks and inform surgeon counseling of patients and their families.</div></div>","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":"75 ","pages":"Pages 57-61"},"PeriodicalIF":1.5,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146192553","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation of early pelvic Fracture risk after rotational acetabular osteotomy: Finite element analysis of pelvic stress distribution","authors":"Tsuguaki Hosoyama ,&nbsp;Nobuhiro Kaku ,&nbsp;Yutaro Shibuta ,&nbsp;Kensei Tanaka","doi":"10.1016/j.jor.2026.02.022","DOIUrl":"10.1016/j.jor.2026.02.022","url":null,"abstract":"<div><h3>Background</h3><div>This study evaluated stress distribution across the entire pelvis following rotational acetabular osteotomy (RAO) for osteoarthritis secondary to acetabular dysplasia using finite element analysis (FEA). Additionally, we aimed to elucidate the mechanisms underlying postoperative posterior column and inferior pubic ramus fractures, which are recognized complications of RAO.</div></div><div><h3>Methods</h3><div>FEA was conducted based on the computed tomography (CT) images of a 26-year-old female patient who developed a posterior column fracture following RAO. Three pelvic models were constructed: preoperative, immediately postoperative, and 1 year postoperatively, in which osseous union was achieved between the rotated fragment and the ilium; however, the osteotomy site at the superior pubic ramus resulted in nonunion. Additionally, a Union model, simulating the continuity of the superior pubic ramus in both postoperative stages, was created for comparison with the Nonunion model. A load of 500 N was applied in a sitting position, with the von Mises stress distribution and element failure patterns analyzed.</div></div><div><h3>Results</h3><div>In the Nonunion model, von Mises stress at the inferior pubic ramus was approximately 3.6 times higher immediately after surgery than preoperatively (43.0 MPa) and approximately 2.6 times higher than in the Union model. Similarly, the stress in the posterior column increased approximately 5.1-fold (53.9 MPa) immediately postoperatively in the Nonunion model, which was approximately 3.2 times higher (34.2 MPa) than in the Union model. Furthermore, element failure was observed in areas where stress exceeded 30 MPa, with a high incidence of failure in the immediate postoperative Nonunion model.</div></div><div><h3>Conclusion</h3><div>Early post-RAO fractures of the posterior column and inferior pubic ramus are significantly influenced by the continuity of the superior pubic ramus. Notably, even before weight-bearing begins, the presence of a gap at the pubic osteotomy site immediately after RAO may substantially elevate fracture risk.</div></div>","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":"75 ","pages":"Pages 120-125"},"PeriodicalIF":1.5,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146192552","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reassuring early serum metal ion levels with a specific modular dual mobility system","authors":"Michael J. Archibeck,&nbsp;Brenna E. Blackburn,&nbsp;Claire R. Kapron,&nbsp;Lucas A. Anderson,&nbsp;Jeremy M. Gililland,&nbsp;Christopher L. Peters,&nbsp;Christopher E. Pelt","doi":"10.1016/j.jor.2026.02.012","DOIUrl":"10.1016/j.jor.2026.02.012","url":null,"abstract":"<div><h3>Introduction</h3><div>The popularity of modular dual mobility (MDM) acetabular components has increased. Concerns have been raised about the potential for corrosion related complications in these modular implants. The purpose of this study was to prospectively monitor serum ion levels in a series of patients with a modular dual mobility system.</div></div><div><h3>Methods</h3><div>Twenty-six patients with the Zimmer Biomet G7 DM construct were enrolled and followed for a minimum of one year. Serum cobalt, chromium, and titanium levels were obtained prior to six-weeks postoperatively and at one and two-years postoperatively. Five-year labs were obtained if previous labs were elevated.</div></div><div><h3>Results</h3><div>At 0-6 weeks postoperatively, 4/26 patients had mildly elevated cobalt levels (1-2.8 μg/L) and 2/26 had mildly elevated chromium levels (1.6, 2.0 μg/L). None of the 19 patients showed elevated cobalt levels at one or two years, while 4/19 reported mildly elevated chromium levels (1.1-1.3 μg/L) at one-year with a slight decrease (1-1.4 μg/L) at two-years. No patients at any time point had metal ion levels exceeding the initial early threshold of 5 μg/L. No patient was symptomatic and no MRIs were indicated or obtained.</div></div><div><h3>Discussion</h3><div>In this series of a specific modular DM system, the early mildly elevated cobalt levels in four patients all subsequently normalized. Chromium was mildly elevated in four patients through year two. While these findings are reassuring in the short term as mildly elevated chromium (&lt;2 μg/L) has not been associated with clinical toxicity, additional follow-up is needed to establish the long-term safety and efficacy of this specific modular DM implant.</div></div>","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":"75 ","pages":"Pages 6-11"},"PeriodicalIF":1.5,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146192678","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Isolated lateral release or lateral lengthening for non-instability indications: A systematic review","authors":"Cailan L. Feingold ,&nbsp;Eric H. Lin ,&nbsp;Andrew B. Barcenas ,&nbsp;Brandon A. Young ,&nbsp;Ji S. Chin ,&nbsp;Austin V. Stone ,&nbsp;Joseph N. Liu","doi":"10.1016/j.jor.2026.02.020","DOIUrl":"10.1016/j.jor.2026.02.020","url":null,"abstract":"<div><h3>Purpose</h3><div>Isolated lateral release (LR) and lateral lengthening (LL) may have a role in the management of knee pain without instability, but these indications have not been clearly defined. This study sought to evaluate the use of isolated lateral release and lateral lengthening for non-instability indications of the knee.</div></div><div><h3>Methods</h3><div>PubMed, Embase, and Web of Science were queried for terms related to lateral release and lateral lengthening of the knee. Included studies investigated isolated LR or LL as an intervention for non-patellofemoral instability indications of the knee that were published in English and in peer-reviewed journals. Studies were excluded if they investigated LR or LL for patellofemoral instability or during total knee arthroplasty, published before 2000, systematic reviews, biomechanical studies, and case reports. Surgery indications, patient demographics, patient-reported outcome measures (PROMs), complications and subsequent surgeries, were collected.</div></div><div><h3>Results</h3><div>Seven studies with 404 patients were included, 4 of which investigated LR/LL for lateral patellar compression syndrome (LPCS), 1 for anterior knee pain, 1 for patellofemoral arthritis, and 1 for patellofemoral arthrofibrosis following anterior cruciate ligament reconstruction. All seven studies reported significant improvements in PROMs and clinical outcomes, regardless of indication. The most common complications were postoperative hemarthrosis, medial patellar instability, and fibrosis.</div></div><div><h3>Conclusion</h3><div>Isolated LR and LL are viable options for the management of LPCS, anterior knee pain, and postoperative patellofemoral arthrofibrosis that lead to improvements in PROMs. Medial patellar instability is a feared complication of LR/LL but appears to be more likely in patients undergoing LR.</div></div><div><h3>Study design</h3><div>Systematic Review; LOE IV</div></div>","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":"75 ","pages":"Pages 62-66"},"PeriodicalIF":1.5,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146192680","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Epidemiology of combat sport-related fractures treated in United States emergency departments","authors":"Zayd Chishti ,&nbsp;Albert Brotgandel ,&nbsp;Carson Balen ,&nbsp;Rebecca Lipscomb ,&nbsp;D. Trey Remaley ,&nbsp;John Kiel","doi":"10.1016/j.jor.2026.02.047","DOIUrl":"10.1016/j.jor.2026.02.047","url":null,"abstract":"<div><h3>Objectives</h3><div>To determine the incidence and demographic characteristics of combat sport-related fractures treated in U.S. emergency departments and compare demographic variables, injury characteristics, and disposition among boxing-, wrestling-, and martial arts (MA)-related fractures.</div></div><div><h3>Methods</h3><div>The National Electronic Injury Surveillance System (NEISS) was queried for boxing, wrestling, and MA-related fractures from 2014 to 2023. Analyses included descriptive statistics and comparative tests (chi-square, Fisher's, Mann-Whitney U, Kruskal-Wallis).</div></div><div><h3>Results</h3><div>Of 22,233 combat sport-related injuries, 4391 (19.7%) were fractures: 929 boxing (21.2%), 1938 wrestling (44.1%), and 1524 MA (34.7%). NEISS weighted estimates correspond to 80,182 injuries and 14,555 fractures annually. Fractures comprised the greatest proportion of total injuries in boxing (21.6%) (p = 0.002), and the mean age at the time of fracture was highest in the boxing group (25.18 ± 11.49 years) (p &lt; 0.001). Boxing fractures most often involved the hand (50.4%), wrestling the shoulder (15.7%), and MA the toes (15.9%) (p &lt; 0.001). Pediatric patients (&lt;18 years) represented 64.9% of fractures, most commonly lower arm (15.2%), while adults most often sustained hand fractures (31.0%) (p &lt; 0.001). Wrestling (88.2%) and MA (56.3%) fractures occurred mainly in pediatric patients, whereas boxing fractures were more frequent in adults (69.6%) (p &lt; 0.001). Males accounted for 85.2% of fractures, most often involving the hand (16.7%), while females most frequently sustained shoulder fractures (14.5%) (p &lt; 0.001). Patients with boxing fractures were the most likely to be treated and released (96.3%) (p &lt; 0.001).</div></div><div><h3>Conclusion</h3><div>Combat sport-related fractures show distinct patterns by sport, age, and sex, insights that can inform targeted injury prevention and safety strategies.</div></div>","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":"75 ","pages":"Pages 106-112"},"PeriodicalIF":1.5,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146192518","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sociodemographic variables are rarely reported in randomized controlled trials investigating posterior spinal fusion for adult spinal deformity: A systematic review","authors":"Kenneth T. Nguyen ,&nbsp;Erin L. Brown ,&nbsp;Bhavesh R. Koppala ,&nbsp;Daman P. Dhunna ,&nbsp;Neil Samant ,&nbsp;Hanna House ,&nbsp;Alexander Kuzma ,&nbsp;Nikolas Baksh","doi":"10.1016/j.jor.2026.02.016","DOIUrl":"10.1016/j.jor.2026.02.016","url":null,"abstract":"<div><h3>Purpose</h3><div>Adult spinal deformity (ASD) affects approximately 68% of patients over age 65 and can significantly reduce quality of life. Posterior spinal fusion (PSF) is a common corrective procedure, but sociodemographic disparities may influence outcomes. This study evaluates the frequency of sociodemographic variable reporting in randomized controlled trials (RCTs) investigating PSF for ASD, hypothesizing significant underreporting and their potential as modifiable confounders of treatment outcomes.</div></div><div><h3>Methods</h3><div>A systematic literature review was conducted on April 15, 2024, in accordance with PRISMA guidelines using PubMed, Embase, and Scopus to identify RCTs on ASD and PSF. Studies were included if they were full-length RCTs and excluded if non-English, unavailable, cadaveric, technical, or non-RCT. Two spine surgeons independently screened studies, with a third reviewer resolving disagreements. Data on demographic and socioeconomic variables were extracted. Descriptive statistics and chi-squared or Fisher's exact tests (P &lt; 0.05) were used for analysis.</div></div><div><h3>Results</h3><div>The search yielded 32 studies; after removing duplicates and ineligible studies, five RCTs published between 2008 and 2020 met inclusion criteria. All reported age and sex (100%), but none included race, ethnicity, employment, education, housing, or income, and only one reported insurance status (20%). Demographic and socioeconomic variables were significantly underreported compared to age and sex (P &lt; 0.001), with no differences by journal or publication year.</div></div><div><h3>Conclusion</h3><div>Age and sex were consistently reported in ASD RCTs, but broader sociodemographic data were largely absent. Future trials should include these variables to better understand disparities and improve equitable care for ASD patients.</div></div>","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":"75 ","pages":"Pages 1-5"},"PeriodicalIF":1.5,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146192682","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical outcomes and structural integrity after arthroscopic partial repair with patch augmentation for large to massive rotator cuff tears","authors":"Chang Hee Baek,&nbsp;Bo Taek Kim,&nbsp;Jung Gon Kim,&nbsp;Chaemoon Lim,&nbsp;Seung Jin Kim","doi":"10.1016/j.jor.2026.02.037","DOIUrl":"10.1016/j.jor.2026.02.037","url":null,"abstract":"<div><h3>Introduction</h3><div>Complete anatomic repair of large to massive rotator cuff tears (RCTs) is often not feasible because of tendon retraction, poor tissue quality, and advanced muscle degeneration. This study evaluates short-term clinical outcomes, complications, and postoperative structural integrity following arthroscopic partial rotator cuff repair with patch augmentation in patients with large to massive rotator cuff tears.</div></div><div><h3>Methods</h3><div>From May 2023 to December 2023, patients who underwent arthroscopic partial rotator cuff repair with patch augmentation for large to massive RCTS were retrospectively reviewed. Inclusion criteria were full-thickness supraspinatus tears with or without infraspinatus involvement, anteroposterior tear size &gt;30 mm, and intraoperative confirmation that complete footprint coverage was not achievable. Exclusion criteria were loss to follow-up, prior shoulder instability surgery, and incomplete clinical data. Clinical outcomes were assessed preoperatively and at final follow-up using VAS pain, Constant, ASES, and SANE scores, range of motion (ROM), and forward elevation strength. Postoperative cuff integrity was evaluated with MRI, with subgroup analyses based on repair integrity.</div></div><div><h3>Results</h3><div>After exclusion of 16 patients, 90 patients were included, with a mean follow-up duration of 26.3 ± 2.1 months. Significant improvements were observed in pain, patient-reported outcome measures, ROM, and shoulder strength at final follow-up compared with preoperative values (all p &lt; .001). Postoperative retear occurred in 18 patients (20.0%). Patients with intact repairs showed significantly superior pain relief, functional outcome scores, ROM, and strength compared with those who experienced retears (all p &lt; .001). Other complications included shoulder stiffness in 8 patients (8.9%), infection in 2 patients (2.2%), and progression of glenohumeral arthritis in 3 patients (3.3%).</div></div><div><h3>Conclusion</h3><div>Arthroscopic partial repair with patch augmentation resulted in significant short-term improvements in pain, functional outcomes, ROM, and shoulder strength in patients with large to massive RCTs. Patients with intact repairs demonstrated superior clinical outcomes and achieved higher rates of clinically meaningful improvement compared with those in the retear group.</div></div><div><h3>Study design</h3><div>Case series; Level of evidence, IV.</div></div>","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":"75 ","pages":"Pages 148-153"},"PeriodicalIF":1.5,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146192521","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hemiarthroplasty for unstable intertrochanteric hip fractures: A systematic review and meta-analysis","authors":"Zeremy Tang ,&nbsp;Ryan Wai Keong Loke ,&nbsp;Jonathan Jia En Boey ,&nbsp;Alexander Xi Xuan Ang ,&nbsp;Darren Keng Jin Tay","doi":"10.1016/j.jor.2026.01.019","DOIUrl":"10.1016/j.jor.2026.01.019","url":null,"abstract":"<div><h3>Background</h3><div>Unstable intertrochanteric hip fractures remain prevalent in the elderly with impacts on function and quality of life. Both hemiarthroplasty and internal fixation methods have been surgical options, with consensus yet to be reached on the optimal approach. This review compares intraoperative and postoperative clinical outcomes between the two techniques.</div></div><div><h3>Methods</h3><div>Systematic review and meta-analysis was conducted, searching four databases for studies on patients who received either internal fixation (IF) or hemiarthroplasty (HA) for unstable intertrochanteric hip fractures. The primary outcome was Harris Hip Score (HHS), with secondary outcomes of intraoperative and postoperative clinical findings. Intra-study risk of bias was graded using ROBINS-I and Cochrane Risk-of-Bias tool, with assessment of evidence certainty using the GRADE approach.</div></div><div><h3>Results</h3><div>HHS for HA was significantly greater at 3 and 6-month post-operation compared to IF, with a weighted mean difference of 12.5 (95% CI: 8.6-16.4) and 5.3 (95% CI: 2.9-7.7) respectively. Furthermore, HA's relative risk (RR) of reoperations was lower at 0.6 (95% CI: 0.3-1.0), RR of nonunion of fractures was lower at 0.5 (95% CI: 0.3 - 0.9) and RR of prosthesis failure lower at 0.4 (95% CI: 0.2-1.0). Intraoperatively, HA had a longer operation time by 12.2 min (95% CI: 6.6-17.9) and greater blood loss of 152.8 mL (95% CI: 108.1-197.6). Post-operatively, HA had a higher RR of 1-year mortality rate at 1.6 (95% CI: 1.2 - 2.1) and higher RR of SSI at 1.4 (95% CI: 1.0-2.1). Otherwise, there is no difference in post-operative complications of deep vein thrombosis, limb length deformity and periprosthetic fractures.</div></div><div><h3>Conclusion</h3><div>HA provided superior early functional outcome and a reduced relative risk of mechanical complications at the cost of increased intraoperative burden, higher early post-operative mortality and SSI risk. IF hence offers lowered intraoperative stress and reduced post-operative morbidity. Surgical choice should ultimately be individualised based on patient priorities and risk profile.</div></div>","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":"75 ","pages":"Pages 73-81"},"PeriodicalIF":1.5,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146192709","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}