The Growing Impact of Severe Obesity on 90-Day Outcomes After Elective Primary Total Hip Arthroplasty: A National Propensity-Matched Study.

Collared Triple Taper Stems Have Superior Biomechanical Characteristics in Compromised Bone.

Radial head fractures are among the most common fractures in adults. In recent years, there has been an increasing trend in the use of radial head arthroplasty (RHA) for both traumatic and post-traumatic injuries. However, current literature on long-term outcomes after RHA remains scarce. The main objective of this study was to evaluate long-term implant survival and clinical outcomes following RHA. The secondary aim was to compare outcomes between press-fit and cemented implants. All patients who underwent primary RHA, using the Radial Head System (Tornier SAS, Montbonnot-Saint-Martin, France), between 2005 and 2022 at a single high-volume trauma center were retrospectively reviewed. A minimum follow-up of two years was required for inclusion. At final clinical follow-up, visual analogue scores (VAS) for pain, the Mayo elbow performance index (MEPI), and range of motion were assessed. Revision surgery was defined as any surgery in which the prosthesis was removed or replaced. Implant survival was calculated using the Kaplan-Meier method. A total of 68 patients were included in this study, with 48 (71%) being female. Press-fitted implants were used in the majority of patients (n=40, 59%). Median follow-up was 7.7 [IQR: 3.3-12.1] years. Overall implant survival at 15-years follow-up was 79% [95% CI: 70-90]. Cemented implants demonstrated superior 15-year implant survival compared to press-fitted implants 93% [95% CI: 84-100) vs 70% [95% CI: 57-86], p= 0.028). Revision rate was 17.6% with a median time to revision of 12.8 [IQR: 7.4-20.5] months. At the final follow-up, the median VAS for pain at rest and after exercise was 0 (IQR: 0-15) and 10 [IQR: 0-55], respectively. Median MEPI score was 85 (IQR: 85-100). Median flexion-extension and pronation-supination arcs were 130 (IQR: 120-135) and 150 (IQR: 140-160), respectively. Radial head arthroplasty demonstrates a 15-year survival rate of 79% [95% CI: 70-90], with cemented implants showing superior outcomes compared to press-fitted implants. Despite a relatively high early revision rate, long-term patient-reported outcomes measures and range of motion are positive after RHA.

Civilian penetrating traumatic brain injury (cpTBI) is a rare entity associated with severe and often devastating consequences. Guidelines recommend CT angiography (CTA), prophylactic antibiotics (AB) and antiseizure medication (ASM), early surgical revision with dural closure whenever feasible, and intracranial pressure (ICP)-guided therapy. The study aimed to investigate guideline compliance, as well as outcome after cpTBI for patients admitted to Oslo University Hospital (OUH). We identified and included cpTBI patients admitted to OUH between 2015 and 2023 through the Oslo TBI Registry - Neurosurgery. Guideline adherence was assessed and variables associated with 30-day mortality and Glasgow Outcome Scale (GOS) were examined using standard uni- and multivariable techniques. The incidence of cpTBI was 1.9/1.000.000 with a 30-day mortality rate of 42.3%. Among the survivors, 70% achieved a favourable outcome (GOS 4 and 5) at 6 months. CTA was obtained at an acceptable rate (81%) in concordance with guidelines, but the guideline compliance for AB (12%) and ASM (29%) was substantially lower-than-expected. Surgery started within 12h after injury in 58%, and ICP was monitored in 53.5% of patients with GCS < 9. Despite high mortality in cpTBI, most survivors achieved favourable outcome. We found a lower-than-expected guideline compliance for prophylactic AB and ASM, ICP monitoring, and surgical revision within 12h. Thus, we identified several key factors that can improve cpTBI treatment at our institution. For patients considered potential survivors, management should be aggressive and aligned with established TBI treatment principles, including early vascular imaging with CTA, prompt wound debridement with dural closure, and prophylactic administration of AB and ASM.

This study analyzed patients who underwent colostomy revision to identify risk factors and complications, aiming to provide evidence-based recommendations for the guidelines. Of 339 colostomy patients treated between 2016 and 2023, 58 who underwent colostomy revision were designated as the study group and compared with 281 non-revision patients in the control group. Of the 339 patients, 58 (17.1%) underwent 78 revision procedures (mean: 1.34 revisions per patient). Early revisions (within 30days) comprised 60.3% of all procedures (n = 47), primarily due to necrosis (38.3% of early revisions) and retraction (29.8% of early revisions). Late revisions (after 30days) accounted for 39.7% (n = 31), mainly for parastomal hernia (25.8% of late revisions) and stenosis (19.4% of late revisions). Twenty patients (34.5%) required multiple revisions; the revision group had a higher mean age (66.1 ± 11.8 vs. 61.8 ± 12.1 years, p = 0.021), more females (53.4% vs. 38.0%, p = 0.045), and more emergency surgeries (58.6% vs. 40.5%, p = 0.003). Transverse colostomies had a higher revision rate (24.7%) than sigmoid colostomies (13.8%), p = 0.045. Colostomy revision is associated with significant morbidity and mortality rates. Advanced age, female sex, emergency surgery, and transverse colostomy were identified as independent risk factors. Early complications (necrosis and retraction) differ from late complications (hernias and stenosis). Many patients require multiple revisions, highlighting the need for tailored surgical strategies and updated guidelines to minimize the number of revisions and improve the outcomes.

CSF shunt placement is a common pediatric neurosurgical procedure. Early failure of newly placed CSF shunts is a considerable risk, occurring in 8% of infants. Significant racial and ethnic disparities in pediatric surgical outcomes have been demonstrated previously; however, the association of race and ethnicity with shunt outcomes is understudied. The objective of the authors' study was to evaluate the association of race and ethnicity with early unplanned CSF shunt revision. The authors hypothesized that non-Hispanic Black and Hispanic infants would have higher risk of early unplanned CSF shunt revision compared to non-Hispanic White peers. This retrospective cohort study analyzed data from the National Surgical Quality Improvement Program-Pediatric (NSQIP-P) database from 2016 to 2021. The authors included children < 1 year of age who underwent first-time permanent shunt placement. Early unplanned shunt revision was defined as any revision or reoperation within 30 days postoperatively. The authors estimated adjusted risk ratios (aRRs) for race and ethnicity using multivariable log-binomial regression. In this study, p values < 0.05 were considered significant. During the study period, 4478 children < 1 year of age underwent first-time CSF shunt placement. Of those, 375 (8.4%) required early unplanned shunt revision. Compared with White infants, Black infants had a 35% increased risk of revision (aRR 1.35, 95% confidence interval [CI] 1.08-1.69, p = 0.008). Hispanic infants had a similar risk to White infants (aRR 1.03, 95% CI 0.79-1.34, p = 0.820). When results were stratified on the basis of gestational age, the racial disparity remained significant among full-term infants (aRR for Black vs White, 1.47; 95% CI 1.07-2.01, p = 0.017) but not among preterm infants (aRR 1.31, 95% CI 0.97-1.79, p = 0.082). Black infants had higher risk of early unplanned CSF shunt revision compared to White infants. These findings underscore the importance of equitable application of preventative strategies to reduce CSF shunt complications across all pediatric populations.

Periprosthetic Fractures of the Acetabulum: A Rare, but Serious Complication of Total Hip Arthroplasty.

BACKGROUND Total hip arthroplasty (THA) is an acceptable method of treatment in healed tubercular (TB) arthritis; however, the role of THA remains debatable in advanced active (stage 3 and 4) TB arthritis of the hip (TB hip) in adults. Single-stage THA in advanced active TB hip is fraught with many challenges, including but not limited to disease reactivation, hip instability, and early revision surgery. These complications may lead to suboptimal clinical outcome in the given patient population. AIM To investigate the challenges and clinical outcome of single-stage primary THA in advanced active TB hip in Indian adult patients. METHODS In this prospective study, 21 Indian adults having advanced active TB hip without active sinus were treated by single-stage primary THA by posterior approach. The minimum duration of preoperative antitubercular treatment was 6 weeks. Tthe type of THA included cemented (n = 18), cementless (n = 2), and hybrid (n = 1). The mean duration of post-operative antitubercular treatment was 15 months. The mean follow-up period was 30 months. Patients were evaluated for disease reactivation, Harris Hip score, implant loosening, and dislocation. RESULTS Intraoperative challenges include increased blood loss 465 ± 48 mL (390-510 mL) in all patients, cortical breach of the femur (n = 1), acetabular reconstruction to prevent a high hip center (n = 1), and conversion from cementless to cemented THA (n = 2). Post-operative complications included disease reactivation at 3 months after surgery (n = 1) and hip dislocation with wound dehiscence (n = 1). There was no neurovascular complication. There was no implant loosening at the time of last follow-up. The preoperative mean Harris Hip score showed a statistically significant improvement at the time of final follow-up [27.38 ± 6.3 (range 20-35) vs 78.47 ± 5.24 (range 78-88); P &lt; 0.001]. CONCLUSION Single-stage primary THA in advanced TB hip is associated with a relatively high rate of complications in certain selected patients.

Retrospective study. To assess the revision rate of lateral lumbar interbody fusion (LLIF) with lateral plate fixation (LLIF+LP) and to evaluate the preoperative radiological parameters associated with the need for revision. LLIF is a minimally invasive option that provides indirect decompression and favorable fusion rates; however, stand-alone LLIF has been associated with substantial early revision rates. The addition of lateral plate fixation (LLIF+LP) enhances segmental stability, yet the predictors of revision following LLIF+LP remain poorly defined. Patients who underwent LLIF+LP were categorized into two groups: non-revision and revision. Central canal stenosis, lateral recess stenosis, foraminal stenosis, facet joint degeneration, endplate Modic changes, ligamentum flavum hypertrophy (>4 mm), and fat infiltration (FI) grade of the lumbar multifidus muscle were evaluated. Clinical efficacy was determined using the Visual Analog Scale (VAS), Oswestry Disability Index (ODI), and Japanese Orthopaedic Association (JOA) scores, assessed both preoperatively and at the final follow-up. A total of 163 patients were included in the study, consisting of 144 in the non-revision group and 19 in the revision group, yielding an overall revision rate of 11.7% (19/163). Univariate and multivariate logistic regression analyses demonstrated that ligamentum flavum hypertrophy and the FI grade of the lumbar multifidus muscle were significantly associated with the revision rate (p<0.05). No significant differences were observed between the revision and non-revision groups in preoperative or postoperative patient-reported outcomes for VAS back pain, VAS leg pain, ODI, and JOA scores (p>0.05). LLIF+LP surgery yields favorable outcomes for lumbar degenerative diseases with a low reoperation rate. Preoperative evaluation of ligamentum flavum hypertrophy and the FI grade of the lumbar multifidus muscle may assist in guiding surgical planning, preoperative discussions, and management of patient expectations.

Durability of surgical treatment is important to patients, providers, and payers. Lumbar diskectomy is one of the most commonly performed spinal surgeries. Understanding the specific indications for revision surgery can help guide future research and quality improvement initiatives. A multisurgeon, single-institution database was queried for revision surgery following a primary lumbar diskectomy (CPT = 63,030) from 2014 to 2018 with a minimum follow-up of 4 years (N = 1,133). The mean patient age was 44.93 years, levels decompressed was 1.08, mean body mass index was 30.45 kg·m -2 , mean American Society of Anesthesiologists (ASA) score was 2.33, length of stay was 0.44 days, and mean OR time was 115.41 minutes. Primary indication for revision surgery was collected through medical record analysis. A total of 185 of 1,133 patients (16%) underwent unplanned revision surgery during the study period. The most common indication for revision surgery was repeat decompression (N = 80, 7%) at a mean of 334.2 days postoperatively. The second most common indication was instability requiring fusion (N = 53, 5%) at a mean of 640.89 days postoperatively. Surgery for infection (N = 22, 1.9%) occurred at a mean of 37.77 days postoperatively. Other indications for revision surgery were less common and included: adjacent segment disease (N = 13, 1.1%) at a mean of 682.31 days postoperatively, durotomy repair (N = 13, 1.1%) at a mean of 26.77 days postoperatively, evacuation of hematoma/seroma (N = 4, 0.3%) at a mean of 6.75 days postoperatively. Binary logistic regression showed that age ( P = 0.368), number of surgical levels ( P = 0.694), and ASA grade ( P = 0.152) were not associated with revision surgery. The only factor associated with revision surgery was BMI ( P = 0.005; odds ratio: 1.042; 95% CI, 1.01-1.07). The results of this study show that lumbar diskectomy is a relatively durable procedure (84%) as currently indicated and performed in a large multisurgeon spine center. Early revision surgery (<90 days) for infection, hematoma/seroma, or durotomy repair is rare (3.3%). Late revision surgery (>90 days) for same segment pathology including recurrent stenosis with or without instability (12%) is much more common than adjacent segment disease (1.1%). These data can help guide clinicians and researchers in future quality improvement initiatives.

Introduction: Periprosthetic femur fractures (PPFx) are a major cause of early revision after total hip arthroplasty (THA), accounting for nearly 20% of early failures. Cementless fixation, though widely used, has been associated with an increased risk of early PPFx, particularly in elderly or osteoporotic patients. Cemented femoral fixation may reduce this risk in high-risk populations. Case Presentation: We performed a retrospective review of 430 consecutive primary THAs conducted between July 2022 and July 2025 at a single institution. Cementless fixation was used in 390 patients and cemented fixation in 40 high-risk patients (mean age 81.7 vs. 65.9 years; BMI 24.5 vs. 30.3). The primary outcome was early PPFx within 90 days postoperatively; secondary outcomes included femoral loosening, prosthetic joint infection (PJI), reoperation, and medical readmission. All cemented cases used fourth-generation cementation techniques and were graded radiographically for cement mantle quality. Discussion: No periprosthetic fractures, femoral loosening, PJIs, or reoperations occurred in the cemented cohort. Five patients (12.5%) were readmitted for medical reasons unrelated to surgery. All cemented stems achieved Barrack A or B mantle quality. In contrast, the cementless group included cases of early postoperative PPFx. Despite being older and lower BMI, patients in the cemented group had superior short-term outcomes, consistent with literature demonstrating fracture risk reduction with cemented fixation. Conclusion: Cemented femoral fixation eliminated early PPFx in this high-risk cohort. Selective use of cemented stems in elderly or osteoporotic patients remains an effective strategy to prevent early periprosthetic complications and improve short-term outcomes following THA.

Purpose:This study aimed to identify metabolic biomarkers and pathways that might be associated with total joint arthroplasty (TJA) early revision for heterogeneous failure modes using an individual data meta-analysis of metabolomics.Methods:Two independent osteoarthritis (OA) cohorts were included. Revision records of patients with primary knee and hip OA were extracted at an average of 11.1 and 7.8 years after primary TJA, respectively. Preoperative fasting plasma was metabolomically profiled. Concentrations of metabolites/metabolism indicators were natural log-transformed, and their associations with early revision for all reasons in each individual cohort were assessed using logistic regression; the summary statistics from each cohort were then subjected to random-effects meta-analysis modelling.Results:Five hundred seventy-two patients with primary OA in The Newfoundland Osteoarthritis Study and 368 in the Longitudinal Evaluation in the Arthritis Program: Osteoarthritis Study were included. The revision rates were 4% and 6%, and mean times to revision were 1.7 and 2.1 years, respectively. No metabolite reached the prespecified significance threshold for multiple testing correction. However, 119 metabolites including choline, tryptophan betaine, indole, ornithine, three acylcarnitines, four cholesteryl esters, two lysophosphatidylcholines, five long-chain diglycerides, and 101 unsaturated (very) long-chain triglycerides were nominally significant with P < 0.05, suggesting potential links between these metabolites and early revision. Among these, indole and one acylcarnitine were positively associated with revision (odds ratio ≥1.73), while all others were negatively associated (odds ratio ≤0.73).Conclusion:Overactivation of the tryptophan-indole metabolic pathway may be associated with early revision after primary TJA. However, the findings were suggestive and represented a composite signal from heterogeneous failure modes.

Intraoperative calcar fracture (IOCF) can compromise initial stability, leading to stem subsidence and instability. We aimed to compare 2-year complications and revision rates between patients who sustained IOCF and matched controls without IOCF using short stem total hip arthroplasty (THA). Patients who underwent short stem THA from November 2010 to October 2023 were included. They were categorized into those who sustained IOCF and were treated intraoperatively with double-loops cerclage wiring, and those without IOCF. Propensity score matching was performed to balance baseline characteristics between the two groups. The following outcomes were evaluated at twoyears: femoral stem subsidence, periprosthetic femoral fracture (PFF), periprosthetic joint infection (PJI), dislocation, aseptic femoral loosening, and revision. Initially, 844 cases were identified. After matching, 80 and 640 cases were included in IOCF and non-IOCF groups respectively. There was one case (1.25%) of stem subsidence in the IOCF group and 11 cases (1.72%) in the non-IOCF group, with no significant difference (p = 0.76). PFF occurred in one case (1.25%) of the IOCF group and fourcases (0.63%) of the non-IOCF group; the difference was not significant (p = 0.53). In the non-IOCF group, there were five cases (0.78%) of PJI, 11 cases (1.72%) of dislocation, onecase (0.16%) of aseptic femoral loosening and 13 cases (2%) of revisions. There was no revision in the IOCF group. Short stem THA complicated by IOCF, when promptly recognized and treated intraoperatively, did not increase complications or revision rates at twoyears.

Complication rates in patients with diabetic neuropathy undergoing total joint arthroplasty.

Is robotic-assisted reverse shoulder arthroplasty economically justified? A break-even analysis.

Does lateralization and distalization affect revision rates and patient experience in primary stemmed reverse total shoulder arthroplasty?

Why Are Total Knee Arthroplasties Failing Today: What Has Changed After Two Decades?

Robotic-assisted unicompartmental knee arthroplasty (R-UKA) is an emerging procedure; however, its benefits over conventional manual unicompartmental knee arthroplasty (C-UKA) are controversial, especially the revision and failure rates, and existing studies failed to reach a consensus on this issue. The literature search was conducted on four databases (PubMed, Embase, Cochrane Library and Web of Science) from inception to 28 April 2025 according to the guidelines for Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA). Eligibility criteria were studies that were written in English and reported any causes for a revision or failure subsequent to UKA with comparisons between R-UKA and C-UKA. The quality of each article was assessed using the Cochrane collaboration risk of bias tool or the Newcastle-Ottawa Scale. A total of 15 studies incorporating 29,982 patients with 30,099 knees (22,290 in the C-UKA group and 7809 in the R-UKA group) were analyzed. Compared with R-UKA, C-UKA showed higher total revision rates (RR: 1.58; 95% CI: ~1.33-1.87; P < 0.00001; I2 = 43%). Prosthesis loosening, infection, pain, and progression of disease were the main reasons for R-UKA revision, whereas for C-UKA revision, loosening, progression of disease, infection, and limb malalignment were the major causes. Loosening was the predominant reason in both groups across all follow-up periods; early revisions were also due to infection and disease progression. Within 2-5years, the secondary reasons differed, being limb malalignment for C-UKA and pain for R-UKA. Compared with C-UKA, R-UKA may lower the risk of revision related to loosening, disease progression, and limb malalignment. Loosening remains the primary revision cause for both. Large-scale prospective trials with unified technical details are warranted to draw more rigorous conclusions in the future. PROSPERO CRD420251042604.

IntroductionRevision lumbar spine surgery is an increasing challenge, often necessitated by adjacent segment disease (ASD), recurrent stenosis, or implant-related complications. This study aimed to analyze the etiology and short-term outcomes of revision lumbar surgeries at a tertiary spine center.Materials and methodsA prospective observational study was conducted at our institute, including all revision lumbar surgeries performed during the defined study period. Data collected included patient demographics, details of the index surgery, presenting complaints, indications for revision, characteristics of the revision procedure, and six-month postoperative outcomes (Visual Analogue Score (VAS) and Oswestry Disability Index (ODI)).ResultsA total of 103 revision surgeries (mean age 58.3 years; 54 females, 49 males) were included. Those in Group A were revised within two years (n=50, 49%); Group B were revised between two to five years (n=25, 24%); and Group C were revised more than five years after the index surgery (n=28, 27%). In Group A, revisions were predominantly in patients who had fusion procedures in the first surgery. In contrast, Group C had more patients whose index procedure was non-fusion. Analysis of the preoperative radiographs of previous surgeries revealed overlooked ASD, foraminal stenosis, and inadequately decompressed stenotic segments. Statistically significant improvement in pain and functional outcomes was noted at the six-month follow-up.ConclusionPrevention of early revision lumbar surgery requires adequate decompression during the primary procedure, identification and prophylactic treatment of partially stenotic adjacent levels, and recognition and decompression of the foraminal stenosis.

We aimed to determine the relationship between near-infrared spectroscopy (NIRS) changes and shunt use, and the role of wakefulness in detecting early neurological events during carotid endarterectomy (CEA) surgeries performed under local anesthesia (LA) while the patient was awake. Patients who underwent CEA under LA were included in the study. All data were obtained retrospectively from patient files in our institution's archives. Shunt use, decreases in NIRS values, internal carotid artery (ICA) closure technique, and clamping time were recorded during the procedure. Patients were divided into two groups: Those with and those without contralateral total occlusion (CTO). These groups were compared in terms of decrease rates in NIRS values and shunt use. Present study included 635 patients (68% male, mean age: 66.7±5.6 years). One hundred thirty-four (21.1%) of the patients had bilateral ICA stenosis of 70% or greater. The patients were divided into two groups: With and without CTO. CTO was detected in 97 (15.3%) patients. In all groups, shunts were applied to patients with a 30% or more decrease in NIRS values. In the CTO group, percentage decreases in NIRS values were greater and statistically significant (p<0.001), except for decreases below 10% (p<0.001). Shunt usage in the CTO group was found to be statistically significant (p=0.042). However, shunt use was associated with a decrease in NIRS rather than the presence of CTO (r=0.747, p<0.001). The most common complications in the postoperative period were voice disorder and hoarseness at a rate of 20.8%. With carotid surgery performed under LA, significant neurological deficits were detected early and necessary revisions were performed. We also found that a decrease in NIRS values is significant for shunt use, and a decrease of more than 30% in NIRS could be note worthy for shunt use.