Journal of orthopaedics最新文献

{"title":"Spring ligament repair with and without augmentation demonstrates favorable outcomes in progressive collapsing flatfoot disorder: A systematic review","authors":"Jared Rubin ,&nbsp;Alexander Tham ,&nbsp;Reed Macey ,&nbsp;Nathaniel Mattera ,&nbsp;Michael Allen ,&nbsp;Samuel R. Montgomery Jr. ,&nbsp;Megan Donnelly ,&nbsp;Jay Zaifman ,&nbsp;John G. Kennedy","doi":"10.1016/j.jor.2026.01.014","DOIUrl":"10.1016/j.jor.2026.01.014","url":null,"abstract":"<div><h3>Background</h3><div>Spring ligament disruption is a primary contributor to the development of progressive collapsing flatfoot deformity (PCFD). The purpose of this systematic review is to evaluate the radiographic findings, clinical outcomes, complications, and failures following spring ligament repair with and without augmentation.</div></div><div><h3>Methods</h3><div>During December 2025, the PubMed, Cochrane, and EMBASE library databases were systematically searched to identify studies examining radiographic findings, clinical outcomes, complications, and failures in patients who underwent spring ligament repair with and without augmentation.</div></div><div><h3>Results</h3><div>Nine studies including 209 patients (212 feet) with spring ligament injuries were analyzed. Patients who underwent spring ligament repair with and without augmentation were evaluated. Both treatment approaches were associated with clinically meaningful improvements in radiographic alignment, with mean talo-first metatarsal angle (TFMA) correction of 12.9° following isolated repair and 11.0° following repair with augmentation. Clinical outcomes also improved, with mean increases in American Orthopaedic Foot and Ankle Society (AOFAS) scores of 24.1 and 29.8 points for isolated repair and repair with augmentation, respectively. Complication rates were low for both isolated repair (4.5 %) and repair with augmentation (6.7 %), with corresponding failure rates of 1.3 % and 3.3 %, respectively.</div></div><div><h3>Conclusion</h3><div>Spring ligament repair with and without augmentation is associated with meaningful improvements in radiographic alignment and clinical outcomes in patients with PCFD. Across the included studies, both treatment approaches also demonstrated low complication and failure rates. While suture augmentation may provide additional mechanical support in select patients, the available evidence precludes direct comparative conclusions regarding the superiority of the technique over isolated spring ligament repair. Further high-quality, comparative studies are warranted to definitively establish the optimal surgical method for managing spring ligament injuries.</div></div><div><h3>Level of evidence</h3><div>IV</div></div>","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":"74 ","pages":"Pages 226-233"},"PeriodicalIF":1.5,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146023380","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":"Legal blindness as a risk factor for complications and prolonged hospitalization after spinal fusion","authors":"Donald MacElroy ,&nbsp;Jay B. Ayar ,&nbsp;Samir Rao ,&nbsp;Merritt D. Kinon","doi":"10.1016/j.jor.2026.01.001","DOIUrl":"10.1016/j.jor.2026.01.001","url":null,"abstract":"<div><h3>Introduction</h3><div>Legally blind patients represent a vulnerable group who may face barriers to safe mobility, postoperative rehabilitation, and discharge planning. There is limited evidence describing perioperative course during spinal fusion surgery in this population. This study aimed to evaluate the association between legal blindness, operative complications and discharge disposition in patients undergoing cervical or lumbar spinal fusion.</div></div><div><h3>Methods</h3><div>The National Inpatient Sample was queried from 2016 to 2021, identifying adult hospitalizations for cervical or lumbar spinal fusion using ICD-10 procedure codes. The primary exposure was legal blindness (ICD-10-CM: H54.8). Outcomes included: major medical complications, non-home discharge and extended length of stay (&gt;3 days). Survey-weighted logistic regression was used to evaluate associations between legal blindness and complications.</div></div><div><h3>Results</h3><div>Among 338,578 hospitalizations for cervical or lumbar spinal fusion that met our inclusion criteria, 315 involved legally blind patients. In multivariate analysis adjusting for demographics, comorbidities and hospital level covariates, legal blindness was independently associated with higher odds of major medical complications (aOR 1.58, 95 % CI 1.08–2.32), non-home discharge (aOR 2.57, 95 % CI 1.98–3.32), and extended length of stay (aOR 1.67, 95 % CI 1.31–2.12).</div></div><div><h3>Conclusions</h3><div>Legal blindness is independently associated with increased major medical complications, extended hospital stays and higher rates of non-home discharge following spinal fusion procedures. These findings highlight the importance of recognizing visual impairment as a marker of perioperative vulnerability in the context of spinal fusion surgery and highlight the need for targeted perioperative strategies to support this underrepresented population.</div></div>","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":"74 ","pages":"Pages 152-156"},"PeriodicalIF":1.5,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145927805","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":"Association between red cell distribution width-albumin ratio and osteoarthritis in middle-aged and older adults: Analysis of NHANES data (1999-2018)","authors":"Ge Qiu ,&nbsp;Zhengxiang Dai","doi":"10.1016/j.jor.2026.02.007","DOIUrl":"10.1016/j.jor.2026.02.007","url":null,"abstract":"<div><h3>Objective</h3><div>This study aimed to investigate the association between the Red blood cell distribution width-to-albumin ratio (RAR) and osteoarthritis (OA) in middle-aged and elderly populations, and to assess its potential value as a predictive indicator for OA risk.</div></div><div><h3>Methods</h3><div>Based on data from the National Health and Nutrition Examination Survey (NHANES) 1999–2018, this study included 19,967 participants aged 40 years and older. Weighted logistic regression models were used to analyze the association between RAR and OA, with robustness verified through stepwise adjustment for confounding factors. Restricted cubic splines (RCS) and threshold effect analyses were further employed to explore the dose-response relationship between the two, and subgroup analysis was conducted to evaluate potential interactions among variables. Additionally, LASSO regression was utilized to screen key predictive variables to construct an RAR-based OA risk prediction model. The model's discriminatory ability and clinical utility were evaluated using receiver operating characteristic (ROC) curves and decision curve analysis (DCA). Meanwhile, this study compared the predictive performance of five machine learning algorithms and employed five-fold cross-validation to assess model robustness.</div></div><div><h3>Results</h3><div>Weighted logistic regression results showed that RAR was significantly positively associated with OA in the middle-aged and elderly population, and this association remained stable across three progressively adjusted models. RCS analysis indicated a nonlinear relationship between RAR and OA, with a critical inflection point at RAR = 3.42. The prediction model constructed based on LASSO regression was presented in the form of a nomogram, with an AUC of 0.723 (95% CI: 0.714–0.733). DCA results demonstrated that the model had favorable clinical net benefit. Among the five machine learning models, the Random Forest model showed consistently excellent predictive performance in both training and validation sets. Five-fold cross-validation further supported the good robustness of this model.</div></div><div><h3>Conclusion</h3><div>RAR is significantly positively associated with OA risk in the middle-aged and elderly population, suggesting its potential value as a predictive biomarker for OA. However, limited by the cross-sectional study design and data from a single population, the clinical application of this association and the prediction model requires further validation in prospective studies and independent cohorts.</div></div>","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":"74 ","pages":"Pages 332-344"},"PeriodicalIF":1.5,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146170269","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":"Opioid prescriptions after total shoulder arthroplasty are associated with new persistent opioid use: a retrospective cohort study","authors":"Eve R. Glenn ScB ,&nbsp;Alexander R. Zhu BA ,&nbsp;Henry Maxwell Fox MD ,&nbsp;James H. Padley MD ,&nbsp;Laurence Okeke MD ,&nbsp;Edward G. McFarland MD","doi":"10.1016/j.jor.2026.02.009","DOIUrl":"10.1016/j.jor.2026.02.009","url":null,"abstract":"<div><h3>Background</h3><div>Pain management after total shoulder arthroplasty (TSA) can be challenging. We examined the association between early postoperative opioid prescribing and postoperative (up to 1 year) outcomes of new persistent opioid use (NPOU), nonopioid substance use disorders, depressive episodes, and all-cause mortality among previously opioid-naive TSA patients. We hypothesized that early opioid prescribing would be associated with higher NPOU and differences in follow-up duration.</div></div><div><h3>Methods</h3><div>This retrospective study of 22,684 patients used the TriNetX Research Network database. Patients underwent TSA between July 31, 2004, and July 31, 2024, and were categorized into 2 cohorts: 1) those who received at least 1 opioid prescription within 30 days after TSA (opioid cohort, n = 7610) and 2) those who did not receive an opioid prescription during that period (nonopioid cohort, n = 15,074). Outcomes assessed between 90 days and 1 year after TSA were NPOU, nonopioid substance use disorders, depressive episodes, and all-cause mortality. Analyses were performed using propensity score matching and Kaplan-Meier survival curves. After matching, each cohort comprised 6977 patients. Alpha = .05.</div></div><div><h3>Results</h3><div>Mean follow-up duration was 261 ± 141 days. After matching, the opioid cohort had a higher incidence of NPOU (10%) than the nonopioid cohort (7.7%) (<em>P</em> &lt; .001), corresponding to a risk difference of 2.3% and a relative risk of 1.3. The opioid cohort had a lower incidence of nonopioid substance use disorders (1.2%) than the nonopioid cohort (1.6%) (<em>P</em> = .04), with no differences in depressive episodes (<em>P</em> = .82) or all-cause mortality (<em>P</em> = .74).</div></div><div><h3>Conclusion</h3><div>In previously opioid-naive patients undergoing TSA, early postoperative opioid prescribing was associated with greater risk of NPOU, whereas no differences were observed in depressive episodes or all-cause mortality. A lower incidence of nonopioid substance use disorders was seen in the opioid cohort. These findings underscore the need for tailored, multimodal pain management strategies after TSA.</div></div><div><h3>Level of evidence</h3><div>III</div></div>","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":"74 ","pages":"Pages 389-394"},"PeriodicalIF":1.5,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146170270","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":"Removal rates of subtalar arthroereisis implants in adult flexible planovalgus correction: A case series","authors":"Daniel Carter,&nbsp;Thomas Ward,&nbsp;Sayyied Kirmani","doi":"10.1016/j.jor.2026.02.028","DOIUrl":"10.1016/j.jor.2026.02.028","url":null,"abstract":"<div><h3>Background</h3><div>Subtalar arthroereisis is used for the surgical correction of flexible planovalgus and in adults is often used as an adjunct to a multi-step procedure. The theorised role of subtalar arthroereisis in adults is to offload the medial soft tissue reconstruction achieved during flexible planovalgus correction to facilitate fibrosis and healing. A common complication is sinus tarsi pain caused by the subtalar implant, with symptoms often only improving upon implant removal.</div></div><div><h3>Methods</h3><div>This single-surgeon case series analysed an adult population who underwent surgical correction of flexible planovalgus to identify the rate of subtalar implant removal. Data was collected from local online operating systems and all operations occurred between August 2022 and May 2024. Those who met the inclusion criteria were retrospectively followed up using clinic letters for one year or until discharged if prior to one year of follow-up.</div></div><div><h3>Results</h3><div>Ten patients met the inclusion criteria and the subtalar implant used in all of these was the Arthrex ProStop® arthroereisis screw. The size of implants used were 7 mm, 8 mm or 10 mm. Nine patients did not experience any complications. One patient required subtalar implant removal due to sinus tarsi pain which, upon further investigation, was due to subtalar implant migration. Symptoms resolved upon implant removal.</div></div><div><h3>Conclusion</h3><div>Within the adult population in this case series, there was a subtalar implant removal rate of 10% (95% CI 0.3 – 44.5%; Clopper-Pearson exact) after one year of follow-up. This was based on arthroereisis implant sizes of 10 mm or less. Further large-scale studies are required to verify whether using implants within this size range could obviate the routine removal of the implants in the management of flexible planovalgus in the adult population, unless symptomatic.</div></div><div><h3>Limitations</h3><div>small sample size; single-surgeon cohort; reporting bias from clinic letters; no validated scoring systems to assess follow-up; short follow-up period.</div></div>","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":"74 ","pages":"Pages 400-403"},"PeriodicalIF":1.5,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146170274","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":"Global research trends and hotspots of rheumatoid arthritis and mitogen-activated protein kinase-a bibliometrics and visualization analysis","authors":"Jian Gao ,&nbsp;Jing Xu ,&nbsp;Hui Li ,&nbsp;Chong Gao","doi":"10.1016/j.jor.2025.12.065","DOIUrl":"10.1016/j.jor.2025.12.065","url":null,"abstract":"<div><h3>Background</h3><div>Rheumatoid arthritis (RA) is a common autoimmune disease characterized by synovial hyperplasia and bone erosion, which ultimately leads to joint deformity and disability. The mitogen-activated protein kinase (MAPK) signaling pathway is one of the critical pathways in eukaryotic cells involved in regulating cell mitosis, differentiation, and apoptosis, as well as inflammation and stress responses, and is closely related to the development of RA. Intra-articular cytokines in patients with RA can bind to the corresponding receptors and activate intracellular upstream modulators, which activate the MAPK signaling pathway in a tertiary enzyme-linked manner.</div></div><div><h3>Methods</h3><div>This study aimed to explore the research hotspots in the RA and MAPK signaling pathway research and the research focus and intrinsic connections by identifying the number of papers published annually, authors, institutions, keywords, and journals.</div></div><div><h3>Results</h3><div>Through bibliometric analyses, it was found that the number of publications surged from 2000 to 2023, and the number of publications in 2017 exceeded 100 articles/year for the first time; it was also the year with the most significant number of publications, the most considerable number of publications was from China, with 536 articles, and the second-ranked was from the United States, with 384 articles; and the most significant number of authors was from the University of California, USA, with Firestein, Gary s. professor, with 28 articles; the first institution with the most significant number of articles is univ calif san diego from the U.S.A., with 37 articles; in the keyword analysis, the frequency and centrality of the keywords are Nf kappa b (347, 0.04), Activation (231, 0.06), Activated protein kinase (211, 0.08), Gene expression (169, 0.09), Tumor necrosis factor (146, 0.07),The trend is still increasing, suggesting that many publications exploring this area will continue to be reported in the future.</div></div><div><h3>Conclusion</h3><div>This study will help scholars better understand the rheumatoid arthritis and mitogen-activated protein kinase of hotspots in this field and may provide some inspiration for research in this area.</div></div>","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":"74 ","pages":"Pages 272-288"},"PeriodicalIF":1.5,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146078725","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":"Underreporting of social determinants of health in randomized control trials related to total hip and knee arthroplasty: Systematic review 2019–2024","authors":"Michelle R. Shimizu,&nbsp;Muhammad H. Ilyas,&nbsp;Isaiah A. Freeman,&nbsp;Hahn Kang,&nbsp;William T. Sampson,&nbsp;Carlo Mannina,&nbsp;Young-Min Kwon","doi":"10.1016/j.jor.2026.02.015","DOIUrl":"10.1016/j.jor.2026.02.015","url":null,"abstract":"<div><h3>Background</h3><div>Race, ethnicity, and social determinants of health (SDoH) are essential in achieving equitable access and care in patients with total hip (THA) and total knee arthroplasty (TKA). Previous studies indicated the low prevalence of reporting SDoH and demographic factors in orthopaedic randomized control trials (RCTs). This study investigates updated trends in reporting the prevalence of patient demographics and SDoH in THA and TKA-related RCTs published between 2019 and 2024.</div></div><div><h3>Methods</h3><div>A systematic review of all PubMed-indexed journals relating to arthroplasty was conducted for all RCTs published between 2019 and 2024. Data on the publication year, type of surgery, inclusion of race, ethnicity, insurance, income, education, treatment or exposure, and measured outcomes were recorded.</div></div><div><h3>Results</h3><div>Of 391 studies, only 12 (3.1%) considered race, ethnicity, insurance, income, education, and employment in their research. Less than 2% of papers reported race. No significant differences were found between journal type, publication year, and type of surgery. Insurance, income, education, and/or employment were minimally reported (n = 6; 1.5%). The most common treatments or exposures in studies that included SDoH variables were related to postoperative management (n = 5) and analgesia/anesthesia protocol (n = 3). Commonly measured outcomes were pain and analgesia consumption (n = 6) and functional outcome (n = 4).</div></div><div><h3>Conclusion</h3><div>Reporting on race, ethnicity, and SDoH in RCTs conducted in patients undergoing hip and knee total joint arthroplasty remains insufficient, and no improvements in reporting patterns have been observed over time when comparing the periods included in this study and previous literature. Including these variables in RCTs is of utmost importance to improve the quality of arthroplasty research and orthopaedic care for patients of all backgrounds.</div></div>","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":"74 ","pages":"Pages 382-388"},"PeriodicalIF":1.5,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146170182","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":"Robotic-assisted total knee arthroplasty in patients with moderate-to-severe coronal deformities: A systematic review","authors":"Hassaan Abdel Khalik ,&nbsp;Mohamed Aldawodi ,&nbsp;Darius L. Lameire ,&nbsp;Thomas J. Wood ,&nbsp;Vickas Khanna ,&nbsp;Anthony Adili","doi":"10.1016/j.jor.2026.02.017","DOIUrl":"10.1016/j.jor.2026.02.017","url":null,"abstract":"<div><h3>Background</h3><div>Patients with moderate-to-severe varus or valgus deformities present with unique considerations. Therefore, this systematic review aims to evaluate the effectiveness of robotic-assisted total knee arthroplasty (RA-TKA) in addressing moderate-to-severe coronal plane deformities.</div></div><div><h3>Methods</h3><div>MEDLINE, Embase, and Web of Science were searched from inception to January 4, 2025, for single-arm or comparative studies assessing the efficacy of robotic-assisted total knee arthroplasty (RA-TKA) in patients with moderate-to-severe coronal plane deformities undergoing primary surgery. Primary outcome included patient-reported outcomes (PROs), radiographic outcomes, operative times, and complication rates.</div></div><div><h3>Results</h3><div>Eight studies (1274 knees) were included in this study. Of 1244 knees (97.6%) replaced with RA-TKA, 599 presented with pre-operative varus deformity group (47.0%), 82 with valgus deformity group (6.4%), and 563 with minimal to no preoperative deformity (44.2%) used as a control. The remaining 30 patients were in a conventional technique (C-TKA) control group (2.4%). PROs at 1-year postoperatively and beyond were comparable across both varus and valgus knees, and their respective comparator groups. Only one study reported a significant difference in radiographic outlier between RA-TKA and C-TKA, in favor of the former. Operative times were conflicting when comparing RA-TKA versus C-TKA. Limited studies demonstrated no difference in complication rates.</div></div><div><h3>Conclusion</h3><div>RA-TKA reliably attains target radiographic alignment with favorable patient reported outcomes. Several methodological concerns have been highlighted to aid in the development of future studies including the standardization of moderate-to-severe deformity, reporting on associated soft-tissue releases as well as minimization of heterogenous implant use within studies.</div></div><div><h3>Loe</h3><div>IV</div></div>","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":"74 ","pages":"Pages 404-411"},"PeriodicalIF":1.5,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146170183","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":"Robot-assisted rehabilitation following total knee arthroplasty: A meta-analysis of pain, strength, and functional recovery outcomes","authors":"Quintin Norris ,&nbsp;Vraj Amin ,&nbsp;Samuel Hovland ,&nbsp;McKenzie D. Brandt ,&nbsp;Darius Moezzi","doi":"10.1016/j.jor.2026.02.023","DOIUrl":"10.1016/j.jor.2026.02.023","url":null,"abstract":"<div><h3>Aims</h3><div>Robot-assisted rehabilitation (RAR) has emerged as a novel strategy to enhance recovery after total knee arthroplasty (TKA). This meta-analysis evaluates the impact of RAR on postoperative pain, muscle strength, range of motion (ROM), and functional recovery in comparison with conventional physical therapy (PT).</div></div><div><h3>Methods</h3><div>A systematic search through October 2025 across PubMed, EMBASE, CINAHL, Web of Science, Cochrane CENTRAL, ProQuest Dissertations &amp; Theses, Google Scholar, and ClinicalTrials.gov identified randomized controlled trials (RCTs) comparing RAR versus conventional PT after primary TKA. Outcomes were pooled using random-effects models, and risk of bias was assessed with the Cochrane tool.</div></div><div><h3>Results</h3><div>Six RCTs (309 patients; 155 intervention, 154 control) met inclusion, with overall moderate quality and low-to-moderate risk of bias. Pooled analysis showed no significant differences in ROM for knee extension at 1 week (MD: 0.38, p = 0.54) or 2 weeks (MD: 0.41, p = 0.47), or knee flexion at 1 week (MD: 1.55, p = 0.45). Knee extension strength was also comparable (MD: 0.01, p = 0.88), though knee flexion strength was significantly improved with RAR (MD: 0.09, p &lt; 0.0001). No significant difference was observed in postoperative pain (MD: −10.77, p = 0.13), walking speed (MD: 0.05, p = 0.36), or length of stay (MD: −1.57, p = 0.23).</div></div><div><h3>Conclusion</h3><div>RAR after TKA produced outcomes similar to PT across ROM, pain, strength, walking speed, and length of stay, with only knee flexion strength showing significant improvement. Restricting to RCTs and TKA-only populations yielded more conservative results than prior reviews, likely reducing bias. However, additional large-scale, long-term trials are needed to define durability, cost-effectiveness, and optimal candidates.</div></div>","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":"74 ","pages":"Pages 412-418"},"PeriodicalIF":1.5,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146170184","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":"Preoperative blood transfusion is an independent risk factor for postoperative infection, readmission, and mortality following surgery for femoral shaft fractures","authors":"Jason M. Dayan,&nbsp;Peter K. Twining,&nbsp;Bruce B. Zhang,&nbsp;David H. Mai,&nbsp;Carl B. Paulino,&nbsp;Qais Naziri,&nbsp;Aden N. Malik","doi":"10.1016/j.jor.2025.12.050","DOIUrl":"10.1016/j.jor.2025.12.050","url":null,"abstract":"<div><h3>Background</h3><div>Femoral shaft fractures (FSFs) are often associated with significant blood loss, frequently necessitating preoperative blood transfusion, which may increase the risk of complications. This study evaluated the relationship between preoperative transfusion and postoperative outcomes, including infection, readmission, reoperation, hemodynamic complications, and mortality in patients undergoing surgical fixation for FSF.</div></div><div><h3>Methods</h3><div>A retrospective cohort analysis was conducted using the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database from 2012 to 2021. Adult patients (≥18 years) who underwent surgical fixation for FSF were included. The primary exposure was transfusion of ≥1 unit of whole or packed red blood cells within 72 h before surgery. Patients were grouped by transfusion status. Demographic, clinical, and procedural variables were compared using chi-square tests, and multivariable regression adjusted for potential confounders. Primary outcomes were 30-day postoperative infection, hospital readmission, reoperation, hemodynamic complications, and mortality.</div></div><div><h3>Results</h3><div>Of 6812 patients identified, 373 (5.5 %) received a preoperative transfusion. Most patients were 80–89 years, White, female, non-Hispanic, ASA 3, with normal BMI, independent functional status, hypertension, low hematocrit, normal WBC, and non-emergent cases. Most were nonsmokers and without major comorbidities (COPD, CHF, cancer, diabetes, immunosuppression, bleeding disorders, or weight loss) [Table 1]. After adjustment, preoperative transfusion was independently associated with increased odds of postoperative infection (OR 1.67, 95 % CI 1.12–2.42, p = 0.009), hospital readmission (OR 1.49, 95 % CI 1.03–2.13, p = 0.031), and mortality (OR 1.73, 95 % CI 1.15–2.55, p = 0.007). No significant associations were found for reoperation (p = 0.207) or hemodynamic complications (p = 0.57) [Table 4].</div></div><div><h3>Conclusions</h3><div>Preoperative blood transfusion in patients undergoing surgical fixation for femoral shaft fractures is associated with higher risks of infection, readmission, and mortality. No significant differences were observed for hemodynamic complications or reoperation. These findings can help guide surgeons as they balance optimal hemoglobin levels preoperatively with risks of postoperative complications associated with transfusion.</div></div><div><h3>Level of evidence</h3><div>Level III.</div></div>","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":"74 ","pages":"Pages 17-23"},"PeriodicalIF":1.5,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145839445","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}