Spinal cord stimulation (SCS) is an established therapy for refractory neuropathic pain following lumbar spine surgery and frequently allows for meaningful pain reductio, functional improvement, and minimizing reliance on pharmacotherapy and opioids. Despite its efficacy, hardware-related complications remain an important cause of treatment failure. We present a fictional teaching case of a 68-year old man with persistent bilateral radicular pain after lumbar decompression who experienced 80% relief following SCS implantation. Eight months later, after a motor vehicle collision, he developed abrupt loss of stimulation coverage and recurrence of severe neuropathic symptoms. This teaching case discusses appropriate next steps for evaluation and management in this particular clinical scenario.

Nerve injury is an uncommon but consequential complication following total hip arthroplasty (THA), with outcomes that range from full recovery to persistent long-term deficits. Despite decades of research, uncertainty remains regarding its true incidence, risk factors, and prognosis. This systematic review and meta-analysis synthesized data from 17 studies encompassing diverse designs, including large database analyses and focused case series. Clinical characteristics, surgical factors, nerve-injury patterns, management strategies, and recovery outcomes were extracted. Pooled proportions were calculated using a random-effects model, and predictors were assessed through meta-regression. Across 17 studies, the most frequently affected nerves were the sciatic, peroneal, and femoral branches, with the peroneal division consistently identified as most vulnerable. Immediate postoperative presentation was common, particularly in injuries related to traction, limb lengthening, or retractor compression, while delayed-onset injuries were often linked to hematoma, screw prominence, or pseudotumor formation. Pooled incidence of nerve injury after THA was 0.36% (95% CI 0.35-0.37%). Complete recovery occurred in 48.6% (95% CI 33.9-63.3%), whereas 50.5% (95% CI 36.0-65.0%) experienced residual deficits. Reoperation was required in 33.1% (95% CI 4.2-62.0%), and 39.8% (95% CI 25.1-54.4%) had permanent neurological impairment. Orthotic use was common due to persistent dorsiflexion weakness. Meta-regression identified comorbidity burden as the only significant predictor of nerve injury. Nerve injuries after THA remain clinically significant, with substantial variability in presentation, recovery, and long-term disability. Early detection, careful surgical technique, and risk stratification especially in patients with the multiple comorbidities are very important for prevention and improved outcomes.

Total Knee Arthroplasty (TKA) is a leading treatment for severe knee osteoarthritis, offering improved function and pain relief. While conventional TKA is well-established, robotic-assisted TKA provides enhanced precision in implant placement and soft tissue balance, potentially reducing surgery time and cost. However, its effectiveness and complication rates require further study to validate its benefits over conventional methods. This study aims to report the outcomes of CTKA and RTKA performed for the same patient as a bilateral staged TKA. It is a cross-sectional design conducted at a tertiary center. It includes collecting retrospective data on patients undergoing bilateral staged TKA performed by a single senior arthroplasty surgeon, analyzed using IBM SPSS 29.0.0. Our study analyzed 38 knee surgeries for 19 patients, split equally between robotic (RTKA) and conventional (CTKA) methods. Both groups showed similar demographics and surgical settings. RTKA had a longer mean operative time (105.3 minutes, SD=12.9) compared to CTKA (81.4 minutes, SD=10.8, p<0.001) and a shorter hospital stay (4.2 days vs.5.6 days, p=0.006). Complications were minimal, with no significant differences in blood loss, post-operative complications, or narcotic use after three weeks between the groups. Both groups showed significant functional gains with KOOS improved from 14.2-16.8 to 84.4-87.0 (p < 0.001), and WOMAC decreased from 83.9-85.3 to 18.5-26.2 (p < 0.001). Subdomain analysis revealed greater pain improvement in conventional TKA and superior daily activity and QoL gains in robotic TKA (p < 0.001). Our study reveals that robotic-assisted TKA results in longer operative periods, but shorter hospital stays compared to conventional TKA. Both methods show similar rates of blood loss, complications, and post-operative narcotic use. Robotic TKA offered better recovery in daily activities and quality of life while conventional TKA achieved greater pain reduction. Overall, both methods proved safe and effective for functional improvement after knee replacement.

Musculoskeletal disorders are one of the most common causes that lead to disability throughout the world and routinely present with only limited or short-term symptom relief following traditional treatments. Recent developments, such as platelet-rich plasma (PRP) and mesenchymal stem/stromal cell (MSC) interventions, are being used as regenerative biologic adjuncts in musculoskeletal medicine, yet significant variability exists in preparation strategies, activation methods, and dosing protocols. In addition, clinical interpretation remains limited by inconsistent biologic characterization and protocol variability. A comprehensive review of current clinical evidence regarding dosing parameters, activation methods, and functional outcomes of PRP and MSC therapies for musculoskeletal recovery, focusing on protocol variability and clinical reproducibility. A structured literature search was conducted using predefined search terms in PubMed, BMJ Journals, and SpringerLink to identify human clinical studies evaluating platelet-rich plasma and mesenchymal stem cell therapies for musculoskeletal conditions. Studies published between January 2016 and December 2025 were screened. An updated search extending through December 31, 2025 identified additional records published after February 2025; however, none met the predefined inclusion criteria. Five controlled trials featuring PRP or MSC techniques met inclusion criteria. Significant heterogeneity was observed across studies in biologic preparation techniques, leukocyte content, activation methods, cell expansion protocols, dosing regimens, and follow-up duration. While improvements in pain and functional scores were reported across both types of interventions, dose-response relationships were inconsistently evaluated and direct protocol comparisons were limited. Although regenerative biologic therapies such as PRP and MSC are associated with improvements in musculoskeletal rehabilitation, significant variability and inconsistent reporting in dosing, activation, and preparation limit generalizability and reproducibility. Prospective clinical trials featuring standardized biologic characterization and uniform reporting frameworks are necessary to begin defining evidence-informed dosing recommendations and rehabilitation delivery.

Acetabulum fractures, often resulting from high-energy trauma, increasingly affect both younger and older adults, impacting hip joint function and quality of life. Acute total hip arthroplasty (THA) offers a critical solution, especially beneficial for elderly patients or those with poor bone quality. This case series presents six patients with varying medical histories, all experiencing significant hip-related injuries necessitating total hip arthroplasty (THA). Cases range from complex acetabular fractures due to falls or motor vehicle accidents to complications following previous surgical interventions. Surgical techniques adapted to each patient's specific fracture patterns and medical conditions, employing approaches such as the Extended Smith-Peterson, Kocher-Langenbeck, and modified Smith-Petersen. Outcomes were generally positive, with patients reporting significant pain relief and restored mobility.

In recent years collared femoral stems have been increasingly utilized in total hip arthroplasty (THA) for their ability to improve rotational stability, metaphyseal load transfer, and prevent periprosthetic femoral fracture (PFF). While literature has demonstrated their benefit over collarless stems, the clinical and biomechanical implications of a postoperative collar-calcar gap (CCG) after implantation remain incompletely understood. The purpose of this scoping review was to evaluate existing literature around CCG in primary THA. A PRISMA Scoping Review literature search was conducted across Ovid MEDLINE, Embase, Cochrane CENTRAL, and Scopus databases. Studies were included if they reported CCG incidence, subsidence, remodeling, or biomechanical performance in primary THA. Two independent reviewers screened studies and extracted data, and clinical study quality was assessed using the Newcastle-Ottawa Scale. A total of 408 studies were identified and 11 met inclusion criteria. The incidence of postoperative CCG varied from 18.7% to 53.9%. Most gaps demonstrated closure over time (66-76%). Biomechanical and finite element studies showed improved stability, reduced micromotion, and decreased periprosthetic fracture risk when direct collar-calcar contact was achieved. In contrast, stems with persistent gaps demonstrated increased subsidence (up to 19% vs 1.3%) and biomechanical behavior comparable to collarless designs. CCG is common following THA. The majority of gaps resolve, however biomechanical evidence demonstrates that the advantages of collared stems depend on calcar contact. Preventing CCG may optimize early implant stability, though surgical technique must balance mechanical engagement with preservation of proximal femoral bone stock.

Trigeminal neuralgia is a debilitating facial pain condition characterized by recurrent, electric shock-like episodes within the trigeminal nerve distribution. While first-line treatment involves pharmacologic therapy, treatment options are limited for patients who are refractory or poor surgical candidates. We present a 75-year-old female with long-standing idiopathic trigeminal neuralgia refractory to combination anticonvulsant therapy and nerve block, with notable medication-related side effects. The patient underwent percutaneous cryoneurolysis targeting the maxillary (V2) and mandibular (V3) divisions of the trigeminal nerve under fluoroscopic guidance. She experienced immediate pain reduction and complete symptom resolution at a one-month follow-up with no complications. This case highlights percutaneous cryoneurolysis as a minimally invasive treatment option for selected patients with refractory trigeminal neuralgia who are not candidates for open surgical intervention.

The foot and ankle deformities associated with fibular hemimelia are considered the most complex aspect of the disease. The goal of treatment at the end of treatment for fibular hemimelia is a plantigrade foot. The main scope of the treatment before the last decade was amputation, which was thought to be the only option to provide the best functional outcome. Over the last two decades, many procedures have been published with variable outcomes. This article provides a focused review of the foot and ankle aspects of fibular hemimelia, along with multiple surgical options described in the literature and their associated outcomes.

Hallux rigidus is a degenerative arthropathy of the first MTP causing significant discomfort and pain to the patient. Treatment options include a conservative and surgical approach. This report and review describe cases of using all-ceramic implants for 3 patients, conceptualized through a comprehensive literature review. This prospective case series reports 3 patients undergoing surgery on implanting an all-ceramic implant to the first MTP with 6-month follow-up. The comprehensive literature review for the use of ceramic implants was done. 3 patients underwent implantation of an all-ceramic first MTP. The AOFAS score was calculated before surgery and during follow-up. Results show improvement in the AOFAS score and preservation of the results over time. The radiographic examination revealed stability of the implant. The results of this case series align with early reports in the literature suggesting promising short-term benefits of ceramic MTP joint arthroplasty. While case series with longer follow-up report controversial results, the limitations of studies and lack of RCTs show the need for additional investigations. Ceramic MTP joint arthroplasty offers significant short-term relief and functional gains. Longer-term follow-up is essential to identify whether these improvements are sustained and assess the risk of complications.

The etiology of Idiopathic Congenital Talipes Equinovarus (ICTEV) remains poorly understood. Several theories have been proposed, including genetic factors. Unlike genes, which are essentially static in composition and size, transcriptome or microRNA (miRNA) varies greatly and might be influenced by multiple variables. This research aims to determine the expression of MiRNA that influences the occurrence of ICTEV in the Indonesian population. A cross-sectional study was conducted using samples obtained from patients with ICTEV under the age of three years. Transcriptome profile evaluation was carried out through Nanostring analysis using nSolver Analysis to obtain miRNAs that play a role in the regulation of ICTEV. Among the 25 most upregulated miRNAs identified, two candidates were selected: miR-584-5p and miR-125a-3p. There were just two miRNAs which were downregulated namely miR-26a-5p and miR-548d-5p. Bioinformatics analysis using Diana-miRPathv4 for upregulated microRNA using gene union and pathway union, revealed results related to the regulation of actin cytoskeleton, HIF-1 signaling pathway, Hippo signaling pathway and TGF-β signaling pathway. Bioinformatics analysis for downregulated miRNAs found that these miRNAs are affecting TGF-β regulation, actin cytoskeleton regulation and apoptotic pathway. These miRNAs act in the TGF-β signaling pathway which regulate cellular processes such as proliferation, apoptosis, differentiation, and extracellular matrix formation. These findings suggest a potential role of TGF-β signaling in the pathogenesis of ICTEV. Meanwhile, the other intersection pathway, the actin cytoskeleton is related to Filamin B (FLNB), in which mutation on FLNB causes skeletal deformity, dysregulation of muscle differentiation and presenting ICTEV appearance. miR-584-5p, miR-125a-3p, miR-26a-5p and miR-548d-5p were identified as potential biomarker candidates for detecting ICTEV. In the development of biomarkers, validation of these discovered miRNA candidates is required, including expression testing and further analysis of their individual involvement in regulating the ICTEV-related genes.