Functional alignment (FA) has emerged as a personalised alignment strategy in total knee arthroplasty (TKA), enabled by robotic-assisted technology. Although early clinical results are encouraging, evidence remains heterogeneous and long-term safety is uncertain. This systematic review aimed to evaluate functional outcomes, and early revision risk of robotic-assisted TKA performed under FA principles with a minimum follow-up of two years. This review was conducted according to PRISMA guidelines and registered in PROSPERO (CRD420251134340). PubMed/MEDLINE and Scopus were searched up to August 2025. Eligible studies included adult patients undergoing robotic-assisted primary TKA with FA, reporting outcomes at ≥2 years' follow-up. Data on demographics, robotic system, implant type, patient-reported outcome measures (PROMs), range of motion (ROM), complications, and revision rates were extracted. Risk of bias was assessed using ROB 2 and ROBINS-I. A random-effects single-arm meta-analysis of pooled proportions was performed for early aseptic revision risk. Twenty studies (5155 TKAs) were included, with a weighted mean follow-up of 2.5 years. All procedures were performed using the image-based robotic system. Postoperative PROMs were consistently high: Knee Society Score (KSS) Knee 92.4-94.5, KSS Function 91.4-93.4, and FJS 74.8-77.5. Kujala scores indicated minimal anterior knee pain (88.1-93.2). ROM improved from a mean preoperative flexion of 119.3° to 123°-124.8°. Complications were infrequent, most commonly stiffness requiring manipulation under anaesthesia. Across all cohorts, 18 aseptic revisions were reported (pooled proportion 0.35%, 95% CI 0.23-0.55). The single-arm meta-analysis of pooled proportions showed a negligible pooled early revision risk (rounded to 0.00; 95% CI 0.00-0.01; I² = 0%). Outcomes were comparable across age, gender, fixation type, and implant constraint, although obese patients accounted for all mechanical failures. Robotic-assisted TKA performed under FA principles yields favourable short- to mid-term functional outcomes and a low rate of early aseptic revision. Level III, systematic review and meta-analysis.

Definitive and successful treatment of end-stage ankle arthritis is either total ankle replacement (TAR) or ankle fusion (AF). The long-term implications of both treatments remain unclear. AF may predispose patients to subsequent hindfoot joint fusion, and TAR potentially risks high rates of complex revision surgery. The study investigates the risks of further surgery, adjacent joint surgery, and rare but serious complications following AF and TAR. An England population cohort study was performed using the Hospital Episode Statistics database, linked to Office of National Statistics (ONS) mortality data (1998-2023). The primary outcome was Kaplan-Meier curve analysis of revision surgery-free survival of TAR vs AF. Secondary outcome measures were the rates of adjacent joint/hindfoot fusion, any further re-intervention to the ankle, peri-operative mortality, 90-day complications, and serious adverse events. A total of 10 335 TARs and 30 704 AFs were analyzed. The AF revision rate was significantly lower than TAR at all time points including 5 years (2% vs 6.1%, relative risk [RR] 0.12, 95% CI 0.10-0.16), 10 years (2.5% vs 10.2%, RR 0.12, 95% CI 0.08-0.18), and 20 years (3.1% vs 13.55%, RR 0.12, 95% CI 0.01-0.23). There was no significant difference in the 25-year risk of adjacent joint fusion following AF (8.64%, 95% CI 7.79%-9.58%) vs TAR (6.82%, 95% CI 5.36% to 8.66%). TAR was associated with higher risks of intra-operative fracture (0.42% vs 0.10%, RR=4.35) and re-intervention for wound infection (0.26% vs 0.15%, RR 1.74) but a lower observed 90-day pulmonary embolus rate than AF (0.23% vs 0.58% respectively). Both TAR and AF are definitive treatments of ankle arthritis with low peri-operative risk. In this England-wide registry cohort, TAR showed higher cumulative revision risk than AF over long-term follow-up. Estimates at the furthest time points have lower certainty. Furthermore, AF did not appear to pre-dispose patients to hindfoot fusion and was not associated with a higher 25-year rate of hindfoot fusion than TAR. These estimates do not capture joint degeneration managed non-operatively.

Unicompartmental knee arthroplasty (UKA) offers benefits over total knee arthroplasty (TKA), but some studies indicated higher revision rates, often involving conversion to TKA. The infection risk associated with UKA to TKA conversion compared to primary TKA is not definitively established. This systematic review and meta-analysis aimed to determine if patients undergoing UKA to TKA conversion had a higher rate of periprosthetic joint infection (PJI) compared to primary TKA. Following preferred reporting items for systematic reviews and meta-analysis guidelines, PubMed, EMBASE and SCOPUS were searched for clinical studies comparing PJI rates in adult patients undergoing UKA to TKA conversion versus primary TKA. Data on reoperations and component use were also extracted. A random-effects model was used for the meta-analysis. Six retrospective studies involving 456 UKA to TKA conversion and 719 primary TKAs were included. No significant difference in the rate of PJI was found between the UKA to TKA conversion cohort (0.66%) and the primary TKA cohort (0.70%) (odds ratio [OR] 1.21, 95% confidence interval [CI] [0.27, 4.46]; p = 0.91). However, UKA to TKA conversion was associated with a significantly higher likelihood of requiring augments (15.6% vs. 3.9%; OR 8.71, 95% CI [1.29, 58.80]; p = 0.03) and stems (36.6% vs. 1.7%; OR 45.83, 95% CI [9.53, 220.55]; p < 0.00001), indicating greater surgical complexity. Based on current literature, UKA to TKA conversion is associated with a similar surgical site infection/PJI rate compared to primary TKA. UKA to TKA conversion procedures necessitated significantly more revision-specific components. Level III.

To compare short-term patient-reported outcomes (PROMs) and revision rates between autologous hand-minced cartilage implantation (MCI) and autologous chondrocyte implantation (ACI) for knee cartilage lesions. All patients undergoing MCI or ACI at a single centre were retrospectively analysed from a prospectively maintained database. Propensity score matching was performed based on age, defect localisation, defect size, general health status (ASA class), and prior surgery. PROMs, including the COMI, IKDC score and VAS for pain, were obtained preoperatively and at 6, 12, and 24 months postoperatively. Statistical comparisons were performed for PROM absolute values, improvement from baseline, Patient Acceptable Symptom State (PASS) and Maximum Outcome Improvement (MOI). Postoperative complications and revision surgeries were also compared. After matching, 25 patients per group were compared. Both groups demonstrated statistically significant improvements in all PROMs when compared against baseline: COMI scores improved from 5.0 ± 1.5 to 2.6 ± 2.0 for ACI and from 5.3 ± 1.7 to 2.0 ± 2.0 for MCI. IKDC scores improved for ACI (49.8 ± 14.0 to 71.3 ± 18.7, p < .001) and MCI (49.4 ± 15.8 to 74.3 ± 15.9, p < 0.001). The VAS score for pain decreased significantly for both ACI (5.0 ± 2.2 to 2.2 ± 2.1, p < 0.001) and MCI (4.2 ± 2.5 to 2.2 ± 2.0, p < 0.001). ACI and MCI differed neither statistically nor clinically in PROMs. Gender, defect localisation, defect size, and concomitant interventions had no substantial influence on outcomes. Overall, 60% and 68% of ACI patients and 68% and 80% of MCI patients achieved PASS for IKDC and COMI scores at 24 months (p = n.s.). Re-operation rates were comparable between both groups. Patients undergoing single-stage MCI or two-stage ACI for medium to large knee chondral defects achieve comparable and favourable short-term outcomes with low rates for adverse event. MCI is an efficient and effective alternative treatment option for patients seeking a single-stage solution or in areas where ACI is inaccessible. Level III.

To investigate whether the treatment method of a concomitant lateral meniscus (LM) injury during primary anterior cruciate ligament (ACL) reconstruction (ACLR) affects ACL revision rates in football (soccer) players, nonfootball pivoting athletes and nonpivoting patients differentially, when compared to controls. Data from the Swedish Knee Ligament Registry (SKLR) from 2005 to 2022 were used in univariate and multivariate logistic regression. The study compared two groups: patients with isolated ACLR and patients with ACLR and concomitant LM injury. These groups were further divided into activity type during injury (football, nonfootball pivoting and nonpivoting), as well as meniscal treatment type (repair, resection and left in situ). The outcome of interest was the ipsilateral ACL revision rate at 5 and 10 years after primary ACLR, when comparing the LM treatments among different activities at the time of injury. Five-year data were available for 21,848 patients, and 10-year data were available for 10,827 patients. Football players had higher odds of revision ACLR at 5 (odds ratio [OR]: 1.51 [1.34-1.72]; p < 0.0001) and 10 years (OR: 1.51 [1.27-1.79]; p < 0.0001). When compared to isolated ACLR in nonfootball pivoting athletes, nonfootball pivoting athletes with concomitant LM injury left in situ had higher odds of revision ACLR at 5 years (OR: 1.87 [1.07-3.30]; p = 0.0029) and 10 years (OR: 2.50 [1.18-5.29]; p = 0.017). Additionally, nonpivoting patients with concomitant LM injury left in situ had higher odds of revision ACLR at 10 years (OR: 2.34 [1.03-5.34]; p = 0.043) compared to nonpivoting patients undergoing isolated ACLR. Repair or resection of LM injuries were not associated with increased rates of revision ACLR in any of the study groups (p > 0.05). LM tears left untreated increased the odds of revision ACLR in nonfootball playing patients in the current study. However, in football players, who were observed to have increased odds of failure, there were no significant associations between LM management and revision ACLR. Level III.

Abstract Objective Emerging evidence suggests a potential association between chronic rhinosinusitis (CRS) and obesity. With the increasing utilization of weight loss medications in the management of obesity, we aimed to assess the impact of glucagon‐like peptide‐1 receptor agonist (GLP‐1RA) prescription on the revision rate of functional endoscopic sinus surgery (FESS) and the use of biologics post‐FESS. Study Design Retrospective cohort analysis. Setting US Collaborative Network within the TriNetX Analytics platform. Methods We queried the TriNetX Analytics platform for all adult CRS with nasal polyps (CRSwNP) patients with obesity who have undergone at least one prior FESS (based on Current Procedural Terminology [CPT] code). The incidence of revision surgery and first‐time biologic prescriptions (dupilumab, mepolizumab, and omalizumab) within a 1‐ and 5‐year follow‐up period was assessed, comparing those with and without GLP‐1R agonist prescriptions. Results After 1:1 propensity matching, there were a total of 1391 patients in each patient group. The GLP‐1RA cohort had a significantly reduced incidence of revision FESS compared to the non‐GLP‐1RA cohort at 1‐year (RR: 0.64; 95% CI: 0.41‐0.98, P = .04) and 5‐year follow‐up periods (risk ratio [RR]: 0.60; 95% CI: 0.44‐0.0.81, P = .001). At the 5‐year follow‐up, the first‐time biologic prescription was lower in the GLP‐1RA cohort compared to the non‐GLP‐1RA cohort (RR: 0.72; 95% CI: 0.52‐0.98, P = .04). Conclusion Our results indicate that GLP‐1RAs are associated with reduced postoperative revision FESS at up to a 5‐year follow‐up in CRSwNP patients. Future mechanistic and prospective studies are needed to confirm the association between GLP‐1R agonists and improved post‐sinus surgery outcomes identified in this study.

Hydrocephalus due to intraventricular hemorrhage (IVH) during prematurity represents a challenging form of CSF circulation disturbance. It remains unresolved as to which temporary measures are best for intracranial pressure relief before sufficient body weight is reached to perform shunt implantation. The international Treatment of Posthemorrhagic Hydrocephalus in neonates (TROPHY) registry was designed to compare the safety and efficacy of 4 different methods of temporary treatment. The aim of this study was to investigate 6-month follow-up data from the TROPHY registry to characterize and compare perioperative measures, reoperations, complications, and shunt dependency among the different treatment methods. An online registry designed for multicenter international prospective data collection was reviewed for patients with complete datasets that included 6-month follow-up data. Eligible patients were neonates with IVH and progressive ventricular enlargement necessitating surgical pressure relief. Four possible methods of intervention were assessed: ventricular access device (VAD) placement, external ventricular drainage (EVD), ventricular subgaleal shunt (VSGS) placement, and neuroendoscopic lavage (NEL). Preoperative data, perioperative aspects of surgery, and 6-month follow-up data were collected in a standardized manner. Of 238 patients with posthemorrhagic hydrocephalus (PHH) included in this analysis, 47 received a VAD, 34 received EVD, 75 received a VSGS, and 82 received NEL. After 6 months of follow-up, differences were seen in the rate of unilateral frontal tissue defect at the entry point (p < 0.001, highest in the NEL group and lowest in the VAD group), multiloculated hydrocephalus (p < 0.05, highest in the EVD group and lowest in the NEL group), parenchymal defect (p < 0.05, highest in the VAD and lowest in the EVD group), and the proportion of patients needing a permanent shunt (p < 0.001, highest in the VSGS group and lowest in the NEL group). No significant differences were seen in rates of complications or revisions among the groups. Analysis of 6-month follow-up TROPHY registry data provided further insights into treatment options for PHH after neonatal IVH. NEL had the lowest probability of needing a shunt at 6 months. Further research will be performed to draw clearer conclusions.

Background Osteogenesis imperfecta (OI) is a rare hereditary disorder characterized by bone fragility and deformity, frequently requiring surgical intervention to restore limb alignment and stability. Traditional intramedullary fixation devices are limited in growing children. The Fassier-Duval (FD) nail, designed to elongate with growth, offers potential advantages when combined with corrective osteotomy. This study retrospectively evaluated the clinical outcomes of FD nail fixation with osteotomy for long bone fractures and deformities in children with OI. Methods We retrospectively reviewed 33 pediatric OI patients (23 males, 10 females) who underwent FD nail implantation for 63 long bones of the lower extremities (42 femurs, 21 tibias) between December 2016 and September 2023. According to Sillence classification, 5 patients were type I, 18 type III, and 10 type IV. Thirty-two bones presented with acute fractures, 9 with isolated deformities, and 22 with fracture plus deformity. Radiographic outcomes, number of osteotomies, complication rates, revision surgeries, and functional results (PODCI and BAMF scores) were analyzed. Results The mean age at initial surgery was 7 years, with a median follow-up of 55 months. The average time to bone union was 5.3 weeks (range, 4–7). For patients with deformities, mean preoperative coronal and sagittal angulations were 31.9° and 34.5°, corrected postoperatively to 0.9°and 1.1°, respectively. Thirteen revision surgeries were required, with an overall revision rate of 20.63%. Complications included refracture ( n = 4) and nail failure ( n = 9); no nonunion, nerve injury, or infection occurred. PODCI scores improved from 40.4 to 45.5, and BAMF scores from 3.1 to 6.1 (both P &amp;lt; 0.0001). Conclusions FD nail fixation combined with osteotomy is effective for treating long bone fractures and deformities in children with OI. It provides reliable deformity correction, promotes rapid bone healing, and significantly improves motor function and quality of life, with acceptable complication and revision rates.

Aesthetic flat closure (AFC) after mastectomy is increasingly chosen by patients who forgo traditional breast reconstruction. Despite rising demand, there is limited evidence guiding optimal surgical techniques or evaluating patient-reported outcomes (PROs). We performed a systematic review according to PRISMA guidelines. Four databases (OVID MEDLINE, Central, Embase, and Web of Science) were searched from inception through May 29, 2024, for studies addressing surgical techniques or outcomes related to AFC. Inclusion criteria required original data on incision patterns, tissue handling, closure methods, or PROs in patients undergoing oncologic mastectomy. Risk of bias was assessed using the ROBINS-I tool. Of 142 screened studies, 6 met inclusion criteria (n = 1,577 patients). Three studies described specific surgical techniques-Angel Wing (AW) and a single-incision approach-primarily in obese patients. The AW technique showed no increase in arm lymphedema (15.6% vs 11.1%, p = 0.18) or decreased range of motion (11% vs 15.2%, p = 0.22) compared to non-AW closure. The single-incision method had a 40% wound complication rate and 20% revision rate. Three studies evaluated PROs using investigatorgenerated surveys. Common concerns included asymmetry, excess skin, and inadequate surgeon communication. No studies used validated PRO instruments. Evidence on AFC remains limited, with only a few studies describing operative approaches and none using validated PRO tools. Future research should aim to standardize surgical techniques, incorporate validated outcome measures, and address patient-surgeon communication to improve satisfaction and aesthetic outcomes. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Introduction:Total hip arthroplasty (THA) is a commonly performed orthopaedic procedure, yet the correlation of patient sex with outcomes has been inadequately explored. Previous studies have been limited by population/database constraints. Thus, 90-day adverse event and 5-year outcome differences were assessed in a large national database.Methods:Patients undergoing THA from the 2010 to 2022 M165 Ortho PearlDiver Mariner Database were identified. Male and female patients were matched 1:1 based on age and Elixhauser Comorbidity Index. Ninety-day adverse events were assessed and compared with multivariable analysis adjusting for multiple comparisons. Five-year survival to revision, dislocation, and periprosthetic fracture was assessed by Kaplan-Meier analysis.Results:Of 780,745 THA patients, 333,974 (42.7%) were male and 446,771 (57.3%) were female. After matching, there were 327,978 male and 327,978 female patients. At 90 days, female patients had greater odds of any adverse events (odds ratio [OR], 1.36), serious adverse events (OR, 1.76), minor adverse events (OR, 1.43), and readmissions (OR, 1.25; P < 0.001). Female patients had higher rates of surgical site infection, deep vein thrombosis, urinary tract infection, and wound dehiscence but lower rates of cardiac events, pneumonia, and acute kidney injury. At 5 years, female patients had higher rates of revision (1.8% vs. 1.4%, P < 0.001), fracture (1.2% vs. 0.7%, P < 0.001), and dislocation (1.8% vs. 1.2%, P < 0.001).Conclusion:This study identified notable sex-based differences in THA outcomes. Female patients had greater odds of perioperative complications and 5-year adverse events. These findings may inform patient counseling, surgical planning, and care pathways.

Performing a direct anterior approach (DAA) for THA without the use of a traction table requires precise leg manipulation and exposure. We developed a novel frame-based horizontal one-piece drape with an impermeable cover enabling repeated leg hyperextension while maintaining sterility. However, the efficiency and revision risks of this frame-based DAA for THA on a standard table remain unevaluated, which may concern surgeons who are considering the technique. (1) Does the frame-based DAA for THA technique require less time for setup and surgery than the traditional stockinette-based technique with its multipiece cover? (2) Is the frame-based DAA for THA technique associated with a higher infection revision rate or overall revision rate compared with other institutions as measured in the national joint registry? This retrospective, comparative cohort study described the frame-based DAA for THA technique and evaluated its efficiency and safety. Efficiency was assessed as operative setup time and surgery duration using hospital data from consecutive unilateral DAA THAs performed by a single surgeon between January 2008 and December 2013. The control group included 387 patients (43% [167] male; mean ± SD age 73 ± 10 years; 64% [246] uncemented) using the traditional stockinette-based technique, while the intervention group comprised 385 patients (49% [188] male; age 70 ± 10 years; 89% [342] uncemented) using the frame-based technique. Safety was evaluated as 5-year revision rates and reason for revision from the mandatory Swiss National Joint Registry (SIRIS, covering 98% of all THAs in Switzerland), which also included patients who underwent revision at a different hospital than where the primary THA was performed. We compared 9973 DAA THAs performed at our institution (frame-based technique 46% [4612] male; age 67 ± 11 years; BMI 26 kg/m2 ± 5; 98% [9799] cementless) with 88,443 DAA THAs performed nationwide (any other technique 48% [42,607] male; age 69 ± 11 years; BMI 27 ± 5 kg/m2; 86% [75,649] cementless) between January 2014 and December 2024. The groups were comparable in terms of ASA classification and indication. The frame-based DAA for THA technique had a shorter median (IQR) setup time (37 minutes [30 to 47] versus 47 minutes [39 to 57]; p < 0.001) and a shorter median (IQR) surgery duration (63 minutes [56 to 75] versus 72 minutes [63.0 to 81.5]; p < 0.001) compared with the stockinette-based DAA for THA technique. When compared with the national benchmark for DAA THAs performed using other techniques, the frame-based technique demonstrated a lower 5-year revision rate for periprosthetic joint infection (PJI) (0.43% [16 of 3651] [95% confidence interval (CI) 0.31% to 0.60%] versus 0.94% [292 of 31,070] [95% CI 0.88% to 1.02%]) and a lower overall 5-year revision rate (1.34% [49 of 3651] [95% CI 1.10% to 1.62%] versus 3.52% [1094 of 31,070] [95% CI 3.39% to 3.67%]; p < 0.001 for both comparisons). The frame-based draping technique for DAA THAs on a standard table is simple, efficient, and safe. Compared with the traditional stockinette-based method, the frame-based technique with its one-piece drape shortens setup time and eliminates the risk of contamination when lowering the legs into hyperextension. Compared with other DAA for THA techniques, it is not associated with higher revision rates, particularly regarding PJI. Level III, therapeutic study.

Background:While the rate of anterior cruciate ligament (ACL) injuries and reconstruction procedures in children and adolescents is increasing, evidence of long-term outcomes after ACL reconstruction in skeletally immature patients is still lacking.Purpose:To assess the long-term survivorship from revision and reoperations and to analyze the functional results and patient-reported outcomes (PROs) in skeletally immature patients (with an open physis present at magnetic resonance imaging evaluation) who underwent ACL reconstruction with hamstrings tendon with an over-the-top (OTT) technique and a lateral extra-articular tenodesis (LET).Study Design:Case series; Level of evidence, 4.Methods:The database of a single institution was retrospectively searched for skeletally immature patients who underwent ACL reconstruction. Ipsilateral and/or contralateral reoperations were recorded. Knee injury and Osteoarthritis Outcome Score (KOOS), Lysholm, and Tegner Activity Level scores were collected at final follow-up. Survivorship was inspected through Kaplan-Maier method with ipsilateral ACL revision as endpoint. Differences in demographics and PROs were assessed through Student t test.Results:A total of 43 patients (mean age at surgery, 13.3 ± 1.6 years), all of whom underwent an OTT technique associated with a LET, at mean follow-up of 11.0 ± 2.7 years were included. Four patients (9%) underwent revision ACL in the ipsilateral knee at a mean of 5.3 ± 2.4 years after surgery, with a revision rate of 5% at 5-year and 10% at 10- and 15-year follow-ups. Four patients (9%) underwent arthroscopy for a new meniscal tear, and a further 5 patients (12%) underwent staple removal because of local discomfort. A total of 11 patients (26%) underwent ≥1 reoperation in the ipsilateral knee after a mean of 3.0 ± 2.1 years; and 8 patients (19%) underwent contralateral ACL reconstruction after a mean of 3.7 ± 3.0 years after surgery. Mean KOOS subscales were all above the Patient Acceptable Symptom State. Patients <13 years old at surgery showed worse Lysholm (82.0 vs 94.6; P = .025) and KOOS–Activities of Daily Living (96.7 vs 99.9; P = .025) compared with those ≥13 years.Conclusion:Patients showed high survivorship (90% of cases) from ACL revision at long-term follow-up. Still, more than one-quarter (26%) of skeletally immature patients who underwent physeal-sparing OTT plus LET technique needed a further operation in the ipsilateral knee. Higher rate of hardware removal procedures and lower functional reported outcomes were detected in patients aged <13.

Hip arthroplasty for acute femoral neck fracture: Hemiarthroplasty, dual mobility, or conventional total hip arthroplasty? A comparative analysis of 37,169 hip arthroplasties from the Swiss National Joint Registry.

Outcomes of collared uncemented stems in total hip arthroplasty for primary osteoarthritis: A Swiss National joint registry analysis.

Aseptic loosening in non-augmentable versus augmentable tibial baseplate total knee arthroplasty designs: a single-centre comparative 10-year outcomes study.

Patients prefer In-Office Needle Arthroscopy (IONA) over traditional surgical arthroscopy.

Primary total knee arthroplasty in patients under 55 years of age: is the mid-term revision rate worrying?

Fix the phalanx: A meta-analysis comparing intramedullary screws, pinning, plates, and lag screws for closed extra-articular proximal phalanx fractures.

Surgical management of the discoid meniscus.

Breast implant explantation with mastopexy in patients using GLP-1 receptor agonizts: A retrospective comparative analysis.