Int Orthop. 2025 Mar 5. doi: 10.1007/s00264-025-06451-1. Online ahead of print.

ABSTRACT

PURPOSE: While robotic-assisted total knee arthroplasty (RA-TKA) has demonstrated improved surgical precision, its impact on early postoperative pain management remains unclear. This study compared early postoperative pain outcomes between RA-TKA and conventional TKA (C-TKA).

METHODS: In this retrospective study, 230 consecutive patients (309 knees) who underwent primary TKA were analyzed: 143 patients (181 knees) in the C-TKA group and 87 patients (128 knees) in the RA-TKA group. Pain scores at rest and during movement were assessed using the Numerical Pain Rating Scale for 72 h postoperatively. Secondary outcomes included opioid consumption and length of hospital stay.

RESULTS: While pain scores at rest showed no significant differences between groups, RA-TKA patients reported significantly lower pain scores during movement at 24 h post-surgery (p = 0.023). The RA-TKA group demonstrated significantly reduced opioid consumption during the first 48 postoperative hours (p = 0.001 for 0-24 h; p = 0.03 for 24-48 h) and shorter length of hospital stay (p = 0.011). Subgroup analysis of unilateral procedures showed similar advantages in the RA-TKA group.

CONCLUSION: RA-TKA was associated with reduced pain during movement, decreased opioid consumption, and shorter hospital stay in the early postoperative period compared to C-TKA.

PMID:40042610 | DOI:10.1007/s00264-025-06451-1

Injury. 2025 Feb 28;56(4):112231. doi: 10.1016/j.injury.2025.112231. Online ahead of print.

ABSTRACT

INTRODUCTION: There have been no published studies evaluating the impact of humeral stem length on humeral shaft periprosthetic fractures. We sought evaluate the differences in fracture patterns between periprosthetic fractures around a short stem and standard stem humeral implants.

MATERIALS AND METHODS: This is a retrospective cohort study. Patients sustaining a humeral shaft periprosthetic fracture around shoulder arthroplasty implants from December 2011 to January 2021 were identified using ICD-9/10 codes. Three upper extremity trained surgeons evaluated all radiographs assessing fracture location and configuration, as well as signs of stem stability before and after the fracture. They classified the fractures based on two classification schemes: Wright & Cofield, and the Unified Classification System (UCS), and they recorded their recommended treatment for each case based on fracture pattens and implant stability.

RESULTS: 76 patients with periprosthetic humeral shaft fractures were identified and divided into two groups: short stem (n=18) and standard stem (n=58). Patients with a short stem were more likely to be classified as having an unstable prosthesis after fracture (67% versus 33%, p=0.01). Additionally, the proposed plan for treatment was different between the two groups (p=0.004): more patients in the standard stem group were recommended open reduction internal fixation (50% vs. 33%) or non-operative treatment (17% vs. 0%), and more patients in the short stem group were recommended revision arthroplasty (50% vs. 29%).

CONCLUSION: Patients sustaining a periprosthetic fracture around a short implant may be more likely to have an unstable prosthesis compared to a standard stem, which may have an impact on treatment options.

LEVEL OF EVIDENCE: Prognosis Study, Level III.

PMID:40043641 | DOI:10.1016/j.injury.2025.112231

J Bone Joint Surg Am. 2025 Mar 5;107(5):e15. doi: 10.2106/JBJS.24.01497. Epub 2025 Mar 5.

NO ABSTRACT

PMID:40042508 | DOI:10.2106/JBJS.24.01497

J Bone Joint Surg Am. 2025 Mar 5;107(5):e14. doi: 10.2106/JBJS.24.01097. Epub 2025 Mar 5.

NO ABSTRACT

PMID:40042507 | DOI:10.2106/JBJS.24.01097

J Bone Joint Surg Am. 2025 Mar 5;107(5):e13. doi: 10.2106/JBJS.24.01157. Epub 2025 Mar 5.

NO ABSTRACT

PMID:40042506 | DOI:10.2106/JBJS.24.01157

Int Orthop. 2025 Mar 4. doi: 10.1007/s00264-025-06464-w. Online ahead of print.

ABSTRACT

PURPOSE: Medializing displacement calcaneal osteotomies are part of conservative surgical treatments and represent a reliable option in valgus flatfoot deformities. Favorable short-term results of this procedure is well-known. However, there are few series with follow-up beyond five years. This study reports the clinical outcomes of calcaneal medialization osteotomy with a minimum follow-up of five years. The primary objective was to compare functional scores and radiographic measurements at the preoperative stage, immediately post operative, and at the final follow-up.

MATERIALS AND METHODS: This was a retrospective, single-centre, multi-operator study of 32 patients, who underwent a medialization calcaneal osteotomy for type II flatfoot. Clinical evaluation of the patients was conducted using the American Orthopaedic Foot and Ankle Surgery (AOFAS) score and the European Foot and Ankle Society (EFAS) score. Radiographic evaluation used the plantar arch angle angle, the talus-first metatarsal axis (T-M1) on lateral weight-bearing radiographs, and calcaneal valgus on Meary's angle in a hindfoot alignment view.

RESULTS: Mean follow-up was seven years. AOFAS score improved from 46 to 87 and EFAS score from 11 to 20 (p < 0.05). Each radiographic parameter was significantly modified between the preoperative and immediate postoperative periods.

CONCLUSION: We observed a significant and lasting improvement in functional scores at a mean follow-up of seven years. The correction of the evaluated radiographic parameters was significant and remained stable over time.

PMID:40035852 | DOI:10.1007/s00264-025-06464-w

SICOT J. 2025;11:12. doi: 10.1051/sicotj/2025005. Epub 2025 Mar 4.

ABSTRACT

INTRODUCTION: Although the surgical techniques and functional outcomes of conventional total knee arthroplasty (TKA) are well-established, there is limited data available on robotic arm-assisted TKA (RATKA) in the context of valgus knee arthroplasty. The purpose of this study is to assess the efficacy of RATKA in the correction of moderate to severe valgus knee deformities using minimally constrained implants and to evaluate the short-term functional outcomes associated with this technique.

METHODS: This prospective study was conducted on patients with moderate to severe grade valgus knee deformity who underwent RATKA from August 1, 2020 to May 31, 2022. Of 873 primary RATKA cases, 48 cases had valgus knee deformities. Among these, 27 had grade 2-3 valgus with intact medial collateral ligament (MCL), two had grade 3 valgus with incompetent MCL, 14 had grade 1 valgus, and five had post-traumatic valgus deformities. Over a two-year follow-up period, functional outcomes were assessed using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and Knee Society Score (KSS), and complications were documented; however, radiological outcomes were not analyzed.

RESULTS: Among 27 patients with Grade 2-3 valgus, the final cohort included 21 patients (24 knees). The mean age was 58.33 ± 9.63 years and 70.8% were female. Ten (41.7%) patients had rheumatoid arthritis and 14 (58.3%) had degenerative osteoarthritis (OA). The median surgical time was 68.00 (13.00) minutes, and the median blood loss was 478.45 (176.25) mL. The valgus grade was reduced from a baseline value of 22.43 ± 7.05 degrees to 5.26 ± 1.53 degrees at 6 weeks. The WOMAC scores improved from 67.58 ± 7.27 at baseline to 1.38 ± 0.57 in the second year post-operatively. Similarly, the KSS scores improved from 26.67 ± 10.34 at baseline to 181.96 ± 7.20 in the second year. One patient sustained a Type II supracondylar femur fracture after a fall, managed with distal femur arthroplasty, while another had delayed tibia pin tract healing, treated with antibiotics and dressings.

CONCLUSION: RATKA facilitates precise correction of moderate to severe valgus deformity through enhanced surgical planning and execution, achieving adequate functional outcomes with minimal complications through the application of functional alignment philosophy.

PMID:40035462 | PMC:PMC11878094 | DOI:10.1051/sicotj/2025005

Injury. 2025 Feb 20;56(4):112225. doi: 10.1016/j.injury.2025.112225. Online ahead of print.

ABSTRACT

Lacerations rank as the most common paediatric injury that requires a physician evaluation. Glass is a frequent cause of such lacerations, however there is currently little to no information on this. Hence, this paper aims to describe the burden and characteristics of such injuries in Singapore. This study is a retrospective review of glass-related trauma presented to paediatric hospital KKH Emergency Department between 1st January 2017 and 4th July 2023. Data on patient and injury characteristics, as well as treatment plans were collected. 680 patients up to 18 years old (average 6.93) were included in the study. 420 (62 %) were male. The number of glass-related injuries were stable at about 100 per year from 2017 to 2023. 649 (95 %) cases were unintentional. 528 (78 %) injuries occurred indoors.159 (23 %) children had adult supervision at time of injury. A majority of 458 (67 %) injuries occurred during the weekday. Primary blunt injuries were the highest at 414 (61 %), followed by 230 (34 %) penetrating injuries. 317 (37 %) injuries occurred at the lower limb, 305 (36 %) at the upper limb, and 105 (12 %) at the face. 596 (87.6 %) patients had "None to mild" injuries, 31 (4.6 %) with "Moderate" injuries, and 53 (7.8 %) with "Severe" injuries. Glass doors led to 315 (46 %) cases, with glass shards and glass panels causing 85 (12.5 %) and 84 (12.5 %) cases respectively. 555 (82 %) of patients received definitive treatment in the Emergency Department and 74 (11 %) required surgery. The average duration of hospitalization of all patients is 0.36 days. 430 patients averaged 3.66 weeks of follow-up, while 247 were discharged immediately. 85 (13 %) patients required inpatient care. Only 1 patient required fluid resuscitation in the Emergency Department. Most glass injuries are unintentional, caused by glass doors, occur indoors and are, fortunately, mild cases.

PMID:40037263 | DOI:10.1016/j.injury.2025.112225