EFORT Open Rev. 2025 Jun 2;10(6):345-351. doi: 10.1530/EOR-2025-0069.

ABSTRACT

Orthobiologics (OBs) have seen a constant increase in the number of available therapies and their clinical applications. Existing therapies can be categorized into blood-based (e.g., platelet-rich plasma (PRP)) and tissue/cell-based (e.g. mesenchymal stromal cells) approaches. While the popularity of OBs continues to grow, their diverse natures create unique challenges for the establishment of evidence-based guidelines. PRP has been reported by meta-analyses to increase patient-reported outcomes for conditions such as knee osteoarthritis (KOA), lateral epicondylitis and plantar fasciitis. However, the randomized controlled trials (RCTs) included often exhibit a high risk of bias due to the heterogeneity in the PRP preparation protocols and accompanying measures as well as inconsistent trial quality. The development pipeline of cell/tissue-based therapies is typically longer and more cost-intensive than that of blood-based therapies. Nevertheless, several products have demonstrated clinical safety. While some RCTs and meta-analyses on the outcome of cell/tissue-based therapies exist, their number is considerably lower than that of blood-based therapies and they focus mainly on KOA, with limited evidence on other orthopedic indications. Orthopedic societies such as ESSKA and AAOS have taken on the challenge of developing guidelines for OBs by combining high-level synthesized evidence with expert consensus. Patient stratification strategies represent a promising key to unlocking the full potential of OBs and are currently being investigated in ongoing studies. Further efforts to establish guidelines for the use of OBs should focus on developing frameworks for clinical trials and their reporting, alongside standardized protocols for the preparation, application and accompanying measures of OB therapies.

PMID:40459170 | PMC:PMC12139597 | DOI:10.1530/EOR-2025-0069

EFORT Open Rev. 2025 Jun 2;10(6):396-402. doi: 10.1530/EOR-2025-0052.

ABSTRACT

Shoulder arthroplasty is increasingly utilised among patients under 55 years of age due to rising incidences of traumatic injuries, inflammatory arthritis, avascular necrosis, degenerative joint diseases and heightened participation in demanding sports and occupational activities. Anatomic shoulder arthroplasty (ASA) remains the preferred surgical option for younger patients with intact rotator cuffs and minimal glenoid deformities, preserving natural biomechanics, strength and range of motion, and demonstrating high long-term implant survival rates at 10-15 years. Despite favourable outcomes, ASA carries potential long-term risks including implant wear, prosthetic loosening, glenoid erosion and progressive rotator cuff degeneration, particularly relevant for physically active younger patients. Reverse shoulder arthroplasty (RSA) offers a valuable alternative in complex clinical scenarios characterised by irreparable rotator cuff tears, extensive glenoid bone loss, severe anatomical disruption or previous surgical failures. RSA can be used as an alternative to ASR for primary osteoarthritis and an intact rotator cuff, with excellent clinical outcomes and survivorship in patients over 60. RSA is also being used successfully in patients under the age of 55 with excellent short-term results. There remain concerns regarding the longevity and reliability of RSA in younger, highly active individuals. ASA can be revised to RSA with good clinical outcomes, while failure of RSA is extremely challenging to address. If we accept that ASA will fail with time, then the primary ASA should allow for ease of revision to an RSA. Recent advances in modular prosthetic designs facilitate simpler revisions from ASA to RSA.

PMID:40459169 | PMC:PMC12139712 | DOI:10.1530/EOR-2025-0052

EFORT Open Rev. 2025 Jun 2;10(6):424-430. doi: 10.1530/EOR-2025-0055.

ABSTRACT

Crush injury arises from prolonged external force on soft tissues, resulting in muscle necrosis and systemic manifestations known as crush syndrome. Pathophysiology involves ischemia, reperfusion injury and the release of toxic metabolites, which lead to rhabdomyolysis, electrolyte imbalances, acute kidney injury and potential multi-organ failure. Early management emphasizes aggressive fluid resuscitation, urine alkalinization and electrolyte correction to avert life-threatening hyperkalemia and renal impairment. Controversies include the use of mannitol, indications for fasciotomy and optimal dialysis timing. Each must be individualized according to patient status and resource availability. Emerging therapies focus on addressing inflammation and oxidative stress, aiming to transition from largely supportive care to more causative interventions. Despite medical advances, prompt recognition, coordinated multidisciplinary care and proactive measures remain vital to reducing morbidity and mortality in crush syndrome, especially in disaster settings.

PMID:40459168 | PMC:PMC12139709 | DOI:10.1530/EOR-2025-0055

EFORT Open Rev. 2025 Jun 2;10(6):352-360. doi: 10.1530/EOR-2025-0058.

ABSTRACT

Surgical decompression of carpal tunnel syndrome is usually successful, and failure is rare. Diagnosis of persistent or recurrent carpal tunnel syndrome is based on thorough anamnesis and clinical examination, defining underlying comorbidities, nerve conduction studies and distinguish recurrent, persistent or new complaints. Management of failed carpal tunnel release may require revision surgery, which includes redo release of the transversal carpal ligament, external neurolysis and flaps. A hypothenar fat pad flap or other local, regional or distant flaps may be added to a redo release of the carpal tunnel. Currently, convincing evidence to superiority of additional flap surgery is lacking. Postoperative care is evolving toward early motion rather than immobilization, with nerve gliding exercises to prevent adhesions and promote nerve recovery. Virtual reality was recently added to postoperative protocol options.

PMID:40459165 | PMC:PMC12139599 | DOI:10.1530/EOR-2025-0058

EFORT Open Rev. 2025 Jun 2;10(6):431-438. doi: 10.1530/EOR-2025-0054.

ABSTRACT

Psychological consequences of trauma: Acute stress reactions and post-traumatic stress disorder are common psychological conditions that affect the healing process. Early interventions: Psychological first aid and psychoeducation are evidence-based approaches aimed at mitigating post-traumatic symptoms. Social support: It plays a central role in psychological stabilisation and promotion of functional recovery. Multidisciplinary approaches: Cooperation between orthopaedists, psychologists and social workers is crucial for optimal treatment results. Challenges in clinical practice: Limited time, stigmatisation of mental illness and inadequate resources are common barriers to effective care.

PMID:40459162 | PMC:PMC12139708 | DOI:10.1530/EOR-2025-0054

EFORT Open Rev. 2025 Jun 2;10(6):361-368. doi: 10.1530/EOR-2025-0053.

ABSTRACT

The French paradox cementing technique encompasses a canal filling highly polished stem with a thin (<1 mm) cement mantle. The technique has been developed by Pr Marcel Kerboull in the late 1960s after he observed the patterns of debonding of the original Charnley stem. The key point of the technique is based upon removal of the metaphyseal cancellous bone (with hollow reamers or aggressive broaches) especially at the supero-medial region. Only two stems have been validated with this technique: the Charnley-Kerboull (CK) and the Ceraver Osteal stem, both of which are collared. This technique is neither a taper slip (the stem does not subside at long-term follow-up) nor a composite beam (a highly polished stem is used). A 12% shortened stem CK has shown similar results to the standard-length stem, including the absence of stem subsidence. Combined with the Hueter anterior approach, this technique has demonstrated one of the lowest femoral PPF rate in elderly patients in the literature.

PMID:40459160 | PMC:PMC12139596 | DOI:10.1530/EOR-2025-0053

EFORT Open Rev. 2025 Jun 2;10(6):378-387. doi: 10.1530/EOR-2025-0051.

ABSTRACT

Patellar dislocations present predominantly during adolescence, with a higher incidence observed among female patients. Patellofemoral joint stability depends critically on both osseous anatomy and soft tissue structures. Patellofemoral pathology can be classified into three major groups: objective patellar instability OPI, potential patellar instability and painful patellar syndrome. Three primary risk factors predispose individuals to patellar dislocation: trochlear dysplasia, patella alta and increased tibial tuberosity-trochlear groove (TT-TG) distance. Three secondary risk factors should be considered: femoral and tibial rotational abnormalities and valgus deformity. MRI has become the imaging modality of choice, enabling precise quantification of OPI risk factors in a single imaging examination. The 'menu à la carte' approach guides the treatment of OPI by addressing the most relevant anatomical risk factors for each patient using statistical thresholds.

PMID:40459157 | PMC:PMC12139600 | DOI:10.1530/EOR-2025-0051

EFORT Open Rev. 2025 Jun 2;10(6):403-415. doi: 10.1530/EOR-2025-0070.

ABSTRACT

BACKGROUND: Despite the growing burden of degenerative cervical myelopathy (DCM), consensus on the optimal timing of surgical intervention remains lacking, especially for patients with mild symptoms or asymptomatic cord compression or in the context of recent trauma. Different scores, such as the mJOA, Nurick scale and NDI are commonly used to classify disease severity, but guidelines for managing these patients do not provide a clear framework for intervention timing.

MATERIALS AND METHODS: We conducted a narrative review of the literature on the optimal timing of surgical intervention for DCM, using PubMed to identify relevant studies. The search was focused on surgical and non-operative management, clinical and radiological assessments, biomarkers and emerging technologies. The selected papers were reviewed for relevance and quality, with guidance from a senior author.

RESULTS: The initial search identified 6,705 articles, which were narrowed down to 136 relevant studies after applying filters for study type and clinical focus. A final selection of 87 papers was categorized by topics and the findings were synthesized to highlight trends, challenges and knowledge gaps in surgical timing for DCM.

FOCUS OF THE STUDY: This review article examines strategies for determining the optimal timing for surgery in DCM. It explores how radiological signs, clinical indicators and other markers may help identify patients at risk of rapid neurological deterioration, particularly in the 'grey-zone' population (mild symptoms or asymptomatic disease), enabling clinicians to assess correctly different clinical scenarios and to indicate timely surgical intervention.

PMID:40459154 | PMC:PMC12139713 | DOI:10.1530/EOR-2025-0070

EFORT Open Rev. 2025 Jun 2;10(6):416-423. doi: 10.1530/EOR-2025-0037.

ABSTRACT

Posterolateral tibial plateau fractures are complex injuries requiring a thorough understanding of the anatomical structures involved, including the popliteus tendon, lateral collateral ligament and posterior horn of the lateral meniscus. Standard anterolateral or midline approaches provide limited access to the posterolateral corner, often necessitating specific surgical techniques to achieve optimal fracture reduction and joint stability. This review explores the main surgical approaches used for these fractures outlining their indications, advantages and limitations. Each section provides a step-by-step guide for an effective surgical technique, based on experience from a high-volume trauma center, to optimize exposure, reduction and fixation. Understanding the biomechanical and anatomical aspects of these fractures is crucial for selecting the most appropriate surgical strategy, minimizing complications and improving patient outcomes.

PMID:40459152 | PMC:PMC12139710 | DOI:10.1530/EOR-2025-0037

EFORT Open Rev. 2025 Jun 2;10(6):336-344. doi: 10.1530/EOR-2025-0050.

ABSTRACT

Current non-surgical managements of osteoarthritis (OA) do not change the clinical course or arrest the progression of the disease, while joint replacement is indicated for end-stage disease. Given these limitations, there is an unmet clinical demand for new treatment modalities that can improve the pain and quality of life of patients suffering from OA without surgery. The recent surge of interest in regenerative medicine (RM) for OA is based on these circumstances. Unlike traditional medicine, RM products may be accompanied by many uncertainties and long-term consequences. Considering that OA directly affects quality of life rather than life and death, the 'first do no harm' principle is more important when applying RM technology to the disease. Presently, culture-expanded mesenchymal stromal cells (MSCs) and orthobiologics, including bone marrow aspirate concentrate, stromal vascular fraction from adipose tissue and platelet-rich plasma have been applied to patients in clinical trials. Results of randomized clinical trials using MSCs have demonstrated that structural improvement and reversal of the pathologic process in OA are not definitely shown, while symptomatic relief is apparent. Orthobiologics seem to have efficiency comparable to those of culture-expanded MSCs. With the advantage of avoiding the approval process from regulation agencies, orthobiologics might provide a less expensive and handier option to culture-expanded MSCs. High-quality data from a large number of patients and head-to-head comparisons of several RM products will be necessary to define the place of culture-expanded MSCs or orthobiologics for OA treatment and resolve the reimbursement issue.

PMID:40459150 | PMC:PMC12139601 | DOI:10.1530/EOR-2025-0050

EFORT Open Rev. 2025 Jun 2;10(6):327-335. doi: 10.1530/EOR-2025-0057.

ABSTRACT

Charcot neuroarthropathy is the most severe complication of the diabetic foot. Its diagnosis is difficult and often overlooked, delaying management, with sometimes disastrous consequences. Its incidence is increasing due to the rapid global rise in the number of people with diabetes. Its pathophysiology remains unclear, although the activation of the RANK/RANK-L system appears to be involved, triggered either by neurotraumatic or neurovascular mechanisms, leading to the differentiation of monocytes into osteoclasts. Diagnosis relies on clinical and radiological arguments, particularly MRI. There are different types of Charcot foot depending on the evolution, according to Eichenholtz's classification and based on location according to Sanders and Brodsky's classifications. Treatment involves a multidisciplinary approach with diabetes management and addressing other general complications. Medical treatment is indicated as the first line, with offloading and immobilisation using a 'total contact cast'. In case of failure of this method, or if there is immediate deformity, surgical intervention is indicated, and techniques are evolving rapidly. Depending on the deformity, minimally invasive or arthroscopic procedures may be performed. In cases of significant deformity, foot reconstruction may be proposed, using the so-called 'super construct' technique if necessary. Infection will be treated concurrently or initially, depending on severity. Many complications are reported, but increasingly early and aggressive surgery improves patients' quality of life and reduces amputation rates.

PMID:40459148 | PMC:PMC12139603 | DOI:10.1530/EOR-2025-0057

EFORT Open Rev. 2025 May 5;10(5):316-326. doi: 10.1530/EOR-2024-0184.

ABSTRACT

PURPOSE: We conducted a systematic review of all proposed classifications of tibial plateau fractures (TPFs) to facilitate comparison and identify the most effective reduction methods.

METHODS: PubMed, Scopus, Embase, Web of Science and Cochrane Library databases were searched for all the articles involving the suggestion of a new method of TPF classification. The descriptions of classifications, along with their suggested management strategies, were recorded.

RESULTS: Out of the 2,712 identified records, 69 were included in the study. Schatzker's and Arbeitsgemeinschaft für Osteosynthesefragen/Orthopaedic Trauma Association (AO/OTA) classifications were the most frequently mentioned in the literature. The concept of a 'column' and posterior column fractures were introduced in 2010. Following this, posterior plateau fractures were further divided into posteromedial and posterolateral fractures. Proposed treatment approaches in most studies were based on the involved region and degree of displacement, while others considered fracture plane, deformity direction and type of fracture. The latest developments include the subclassification of the posterolateral column and consideration of associated injuries to the fibular head, eminentia, extensor mechanism and mechanical derangements along with the concept of the main deformity direction.

CONCLUSION: The understanding of TPF patterns, associated injuries, surgical approaches and fixation methods has evolved in a compelling stepwise manner. Currently, there is no gold standard classification that addresses fracture configuration, soft-tissue injuries, principal direction of deformity, central eminence avulsions, extensor mechanism disruptions and mechanical derangements, while maintaining a simple and reliable categorization. Therefore, employing individualized classification systems remains the most logical approach at present. This study offers invaluable assistance in this regard.

PMID:40326555 | PMC:PMC12061015 | DOI:10.1530/EOR-2024-0184

EFORT Open Rev. 2025 May 5;10(5):237-249. doi: 10.1530/EOR-2024-0156.

ABSTRACT

This review highlights the role of existing spasticity treatment methods in reducing muscle tone and improving function. The surgical methods today mainly include selective dorsal rhizotomy, selective neurotomy, intrathecal baclofen treatment (ITB), etc. These techniques (except ITB) can lower patients' muscular tone in the long term and improve function to some extent. The young procedures, contralateral C7 nerve transfer and T1 neurotomy, are still under research. ITB and nonsurgical treatment methods, botulinum toxin A (BoNT-A) and extracorporeal shockwave therapy (ESWT), can reduce muscle tone in the short term, but the long-term efficacy is unsatisfactory. In addition, the effects of improving function are relatively controversial. The economic cost of these treatment methods is also heavy for patients. In addition, some studies have reported that some kinds of electrical/magnetic stimulation can improve the patients' function. They can potentially be used as an adjunctive treatment for spasticity. According to current studies and our own experience, surgery methods (except ITB) are still recommended for patients, whose spasticity has a major detrimental influence on their everyday lives, taking into account patient benefits and cost-effectiveness. There are also some problems in the current research on spasticity treatment, such as incomplete guidelines and a relative lack of high-quality studies, which is what the doctors need to strive for. Further exploration is needed to find the treatment methods that can reduce muscle tone while improving patients' function to better benefit patients.

PMID:40326554 | PMC:PMC12061021 | DOI:10.1530/EOR-2024-0156

EFORT Open Rev. 2025 May 5;10(5):258-266. doi: 10.1530/EOR-2024-0133.

ABSTRACT

PURPOSE: Controversy exists on whether a drug holiday is necessary for patients on antiresorptive medication for osteoporosis or bone metastasis and undergoing dental procedures to lower the risk of medication-related osteonecrosis of the jaw (MRONJ). This study evaluated the effects of discontinuing different antiresorptive regimens on MRONJ in these patients.

METHODS: Publications from PubMed, EMBASE, Cochrane Library and EBSCO Open Dissertations were searched from inception to September 2023 following PRISMA guidelines, and the review was registered in PROSPERO. Eligibility criteria included clinical studies on the effects of continued and discontinued antiresorptive medications for osteoporosis or bone metastasis in patients undergoing dental procedures. The involved antiresorptive agents were oral bisphosphonates (BPs), intravenous (IV) BPs and denosumab (Dmab). Relative risk (RR) with 95% confidence interval (CI) was estimated using a random-effects model.

RESULTS: Of the 2,590 records identified, six studies (n = 717) were included. Discontinued use of oral BPs had a lower MRONJ risk than discontinuation of IV BPs (RR = 0.05; 95% CI: 0.00-0.83) and continuation of IV BPs (RR = 0.03; 95% CI: 0.00-0.46). Continuing oral BPs also resulted in a lower MRONJ risk compared to both discontinuation and continuation of IV BPs, with RR = 0.04 (95% CI: 0.00-0.67) and RR = 0.03 (95% CI: 0.00-0.37), respectively. No significant difference was found between continuation and discontinuation of oral BPs, along with other comparisons.

CONCLUSIONS: A drug holiday may not be necessary before dental procedures for oral BPs. Temporary discontinuation of IV BPs or Dmab is also unlikely to reduce MRONJ risk compared to continued medication.

PMID:40326547 | PMC:PMC12061011 | DOI:10.1530/EOR-2024-0133

EFORT Open Rev. 2025 May 5;10(5):297-308. doi: 10.1530/EOR-2024-0122.

ABSTRACT

The long head of the biceps tendon (LHBT) has recently emerged as a therapeutic option for various shoulder pathologies. Synthetic materials and allografts have not shown sufficient resistance or favorable outcomes to restore rotator cuff native tissue properties, leading to consideration of using LHBT as biological augmentation. LHBT mimics adjacent structures, such as the rotator cuff, is easily accessible during surgery, and is a good source of live autologous cells for regenerative augmentation in rotator cuff repair, as a superior capsular reconstruction in irreparable cuff tears, in subscapularis augmentation in shoulder replacement and as a stabilizer in anterior shoulder instability. This narrative review aims to collect, synthesize and critically evaluate the literature on the use of the LHBT and its current applications in the field of shoulder surgery, improving the understanding of the terminology and consolidating the concepts related to the various procedures in shoulder surgery.

PMID:40326542 | PMC:PMC12061019 | DOI:10.1530/EOR-2024-0122

EFORT Open Rev. 2025 May 5;10(5):224-236. doi: 10.1530/EOR-2024-0116.

ABSTRACT

Clinicians, scientists and regulators do not use a common set of definitions and terminology to classify and code periprosthetic tissue reactions to wear debris of arthroplasty implants and a limited granularity is present to allow early identification of associated adverse events. Adverse local tissue reactions (ALTRs) is an umbrella term, which has been used in particular for periprosthetic tissue reactions to metal wear debris. In this review, it has been extended to all implant materials and adverse reaction to metallic debris as a subset of ALTR caused by or associated with metallic particulate debris. The high variability in the terminology of ALTRs used by national arthroplasty registries, various coding systems and clinicians impedes their accurate reporting and interpretation, crucial for evaluating the reasons for implant failure and revision arthroplasty. Histopathological examination of periprosthetic soft tissue and bone uses standardized criteria for the diagnoses of reactions to wear particles, significantly contributing to their understanding and refining their interdisciplinary terminology. This review critically analyzes the current gap in coding ALTRs due to arthroplasty implants' wear in national registries and classification systems of adverse events and the use of key terms. A comprehensive unified lexicon and classification system grounded on evidence-based histopathological analyses is proposed, implementing the following findings. (a) Pseudotumor is a descriptive term for ALTR, which cannot be used for codification. (b) Metallosis is a term lacking quantitative and qualitative determination and thus not a codifiable term for ALTR. (c) Aseptic lymphocyte dominant vasculitis-associated lesion (ALVAL) should not be used due to absence of histological findings diagnostic of vasculitis. (d) Metal delayed hypersensitivity and metal allergy should be codified as separate categories of adverse events. (e) ALTR is to be classified in due consideration of definition of predominant lymphocytic or predominant macrophage infiltrate. (f) Granulomatous reaction should be reserved to sarcoid-like, immune granulomas separated from the macrophage infiltrate with/without foreign body giant cell reaction. (g) Macrophage infiltrate containing particulate wear debris with or without lymphocytic component associated with macrophage induced osteolysis/aseptic loosening should be considered as a type of ALTR.

PMID:40326541 | PMC:PMC12061016 | DOI:10.1530/EOR-2024-0116

EFORT Open Rev. 2025 May 5;10(5):250-257. doi: 10.1530/EOR-2024-0085.

ABSTRACT

A comprehensive overview of current Asian joint arthroplasty registries, highlighting their strengths and weaknesses and providing a case for establishing registries nationwide, is given. Pertinent information required for the future establishment and improvement of Asian joint arthroplasty registries is given. Six registries in Asia were identified, with three, Indian Joint Registry, Japanese Orthopaedic Association National Registry and Pakistan National Joint Registry having developed official websites and published annual reports. The majority of both hip and knee surgeries in India and Pakistan were carried out on men, in contrary to Japan, where the majority of knee surgeries were conducted in women. Osteoarthritis was the primary indication for knee surgery, whereas osteonecrosis was the main indication for hip surgery in India and Pakistan, compared to osteoarthritis in Japan. Many countries in Asia have attempted to report data on joint arthroplasties, though little information on nationwide registries is available, with three countries - Japan, India and Pakistan - having made their joint registry data available to the public.

PMID:40326532 | PMC:PMC12061010 | DOI:10.1530/EOR-2024-0085

EFORT Open Rev. 2025 May 5;10(5):277-285. doi: 10.1530/EOR-2024-0020.

ABSTRACT

PURPOSE: The objective was to investigate the consistency in cumulative revision rates (CRRs) for a selection of total hip arthroplasty cups and stems across national/regional hip arthroplasty registries worldwide.

METHODS: Ten cups and ten stems from total hip systems were randomly selected. Two frequently used implants across registries were added, totalling 11 cups and 11 stems. CRRs and 95% CIs were extracted from the latest annual registry reports using these implants. CRRs were pooled for each cup or stem, and differences between cup-stem combinations and between registries were investigated.

RESULTS: CRRs were available for ten cups and eight stems from eight registries, totalling 552,148 cups and 727,447 stems. Follow-up was 1-20 years. The 5-year CRR pooled for all cups was 2.9% (95% CI: 2.3-3.6) and for all stems, 3.0% (95% CI: 2.4-3.8). Homogeneous (consistent) CRRs with respect to both associated implant and country were observed for two cups and three stems. Significant differences in CRR were identified in one cup by associated implant only, in one cup by registry only, and in two cups and four stems for both. Sparse data prevented evaluation of four cups and one stem.

CONCLUSION: Registries' annual reports provide a large amount of publicly available information on CRRs of specific implants. These CRRs can be synthesised to improve the assessment of implant performance over time. Our CRR analysis represents a promising approach to detect implants with a consistent low- or high-risk pattern across registries.

PMID:40326530 | PMC:PMC12061013 | DOI:10.1530/EOR-2024-0020

EFORT Open Rev. 2025 May 5;10(5):213-223. doi: 10.1530/EOR-2023-0100.

ABSTRACT

Arthroscopic ankle arthrodesis (AAA) has been performed for 40 years for end-stage ankle osteoarthritis. Along with open ankle arthrodesis (OAA) and total ankle replacement (TAR), it forms one arm of the triumvirate of commonly performed procedures for this condition. The aim of this article is to review the state of the art for AAA and compare outcomes with OAA and TAR. This narrative review of the literature traces the development of this technique through case series and systematic reviews. Traditional OAA techniques carry a nonunion rate of 11%, necessitating revision surgery in most cases. As individual and communal experience of AAA has grown, the range of pathology and deformity successfully corrected by this technique has developed. There is evidence that AAA offers greater and more rapid union rates, with reduced hospital stay and better long-term outcomes. However, the technique requires mature surgical skills and still carries a significant complication rate. No single procedure is suitable for all patients. AAA can be seen as the new gold standard for patients with isolated ankle osteoarthritis and no/minimal deformity, either within the talocrural joint or hindfoot or patients with systemic and/or local comorbidities that would benefit from minimal disturbance to the soft-tissue envelope. However, in older patients, the presence of concomitant hindfoot osteoarthritis or significant deformity, TAR and OAA remain valuable procedures in the foot and ankle surgeon's armamentarium.

PMID:40326529 | PMC:PMC12061018 | DOI:10.1530/EOR-2023-0100

EFORT Open Rev. 2025 May 5;10(5):286-296. doi: 10.1530/EOR-2023-0184.

ABSTRACT

The piriformis muscle (PM) is important for posture and preventing falls. It is a key landmark for hip surgery. The PM function is reported to be increasingly important for improving total hip arthroplasty (THA) outcomes and reducing complications. This scoping review aims to map and summarize the literature on the anatomy and function of the PM and the outcomes of clinical studies on THA preserving the PM to improve readers' understanding and identify areas for further research. A scoping review following the PRISMA guidelines was conducted using PubMed and Scopus from their inception until June 2023. We used the search term 'piriformis' or 'PM' to include all PM-related studies. Two independent reviewers screened abstracts and full texts to select key aspects of PM anatomy and function and the main clinical THA studies reporting outcomes on PM preservation. Fifty-seven studies published between 1980 and 2023 met our inclusion criteria. During hip surgery, the PM anatomy, including its origin and insertion, muscle belly, and relation to other short hip rotators and the sciatic nerve, can vary greatly, making it difficult to recognize. The current literature on PM-preserving THA and hemiarthroplasty clinical studies is limited. It suggests potential benefits in terms of hip stability, dislocation risk, and functional outcomes compared to no PM preservation in short-term follow-up. Identifying and preserving the PM during hip surgery may be difficult due to its variable anatomy and its relation to surrounding structures. Although the literature supporting PM preservation potentially indicates better outcomes, further high-level research studies are needed.

PMID:40326528 | PMC:PMC12061017 | DOI:10.1530/EOR-2023-0184