Orthopedic Reviews最新文献

{"title":"Polymer-Based Resorbable vs Non-resorbable Implants for Pediatric Upper Extremity Fractures: A Systematic Review.","authors":"Kareem Elhigzi, Konstantinos Oikonomou, Benjamin Vanderkwaak, Benjamin Cassidy, Matthew Smith, Omar Protzuk, John Cyrus, Victoria Kuester","doi":"10.52965/001c.166443","DOIUrl":"10.52965/001c.166443","url":null,"abstract":"<p><strong>Background: </strong>Pediatric upper extremity fractures are common and frequently require surgical intervention. Traditional fixation methods using metallic implants, such as Kirschner wires and elastic stable intramedullary nails, offer reliable mechanical stability but necessitate secondary procedures for hardware removal. Polymer-based resorbable implants offer an advantage by eliminating the need for secondary procedures for hardware removal while maintaining efficacy. This systematic review evaluates the safety, efficacy, and clinical outcomes of resorbable compared to non-resorbable implants in pediatric patients.</p><p><strong>Methods: </strong>A systematic search of PubMed, Embase, and Web of Science was conducted according to PRISMA guidelines. Inclusion criteria targeted studies comparing outcomes of resorbable versus non-resorbable implants in pediatric upper extremity fractures. Risk of bias was assessed using the JBI critical appraisal tools. Nine studies met inclusion criteria, comprising one randomized controlled trial and eight retrospective cohort studies.</p><p><strong>Results: </strong>Nine studies including 391 pediatric patients were analyzed. The most common fractures involved the forearm (four studies), followed by lateral condyle (three studies) and medial epicondyle injuries (two studies). Mean patient age ranged from 5.6 to 11.6 years. Surgical site infections, skin irritation, postoperative pain, and nonunion were less common with resorbable implants with only one case requiring implant removal. Re-displacement was more frequent with resorbable implants but rarely required revision. Functional outcomes were comparable across groups.</p><p><strong>Conclusions: </strong>Resorbable implants are a safe and efficacious alternative to traditional metallic devices for pediatric upper extremity fractures. Their favorable complication profile and elimination of hardware removal procedures support wider clinical adoption. Further randomized trials are warranted.</p>","PeriodicalId":19669,"journal":{"name":"Orthopedic Reviews","volume":"18 ","pages":"166443"},"PeriodicalIF":1.6,"publicationDate":"2026-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13496981/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148796278","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical and demographic factors associated with coexisting carpal tunnel syndrome and trigger finger in Kazakhstan.","authors":"Assel Kaliyeva, Arman Batpen, Meiram Baubekov, Maksut Ibrayev, Samat Boirabayev, Yerzhan Karatayev, Arsen Kaliyev","doi":"10.52965/001c.166445","DOIUrl":"10.52965/001c.166445","url":null,"abstract":"<p><strong>Background: </strong>Carpal tunnel syndrome (CTS) and trigger finger (TF) are common hand disorders that frequently coexist. Most available data originate from North American, European, and East Asian populations, whereas data from Central Asian countries remain limited. This study aimed to estimate the prevalence of concurrent CTS and TF and identify associated demographic and clinical factors in a clinical cohort from Kazakhstan.</p><p><strong>Methods: </strong>This cross-sectional study included patients diagnosed with CTS, TF, or both conditions. Demographic characteristics, comorbidities, and clinical variables were analyzed. Group differences were assessed using chi-square tests and one-way analysis of variance. Multivariable logistic regression analysis was performed to identify factors associated with concurrent CTS and TF.</p><p><strong>Results: </strong>A total of 138 patients were included. Among them, 82 (59.4%) had CTS, 48 (34.8%) had TF, and 8 (5.8%) had both conditions. Significant differences between groups were observed for sex (p = 0.001), ethnicity (p < 0.001), diabetes mellitus (p = 0.008), thyroid disease (p = 0.010), and hormone therapy (p = 0.030). In multivariable logistic regression analysis, diabetes mellitus was strongly associated with concurrent CTS and TF (OR = 72.96; 95% CI 2.41-2208.9; p = 0.014), whereas increasing age was associated with lower odds of coexistence (OR = 0.77; 95% CI 0.63-0.92; p = 0.005).</p><p><strong>Conclusions: </strong>Concurrent CTS and TF were identified in a limited number of patients in this cohort. Diabetes mellitus and age were associated with their coexistence. These findings provide clinical data from an understudied Kazakhstani population.</p>","PeriodicalId":19669,"journal":{"name":"Orthopedic Reviews","volume":"18 ","pages":"166445"},"PeriodicalIF":1.6,"publicationDate":"2026-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13496980/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148796325","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Infraneural Approach to Lumbar Transforaminal Epidural Steroid Injections: A Practical Review for Trainees and Interventionalists.","authors":"Jamal Hasoon, Christopher L Robinson, Cyrus Yazdi, Ivan Urits, Alan D Kaye","doi":"10.52965/001c.166794","DOIUrl":"10.52965/001c.166794","url":null,"abstract":"<p><p>Lumbar transforaminal epidural steroid injections (TFESIs) are commonly performed for the treatment of lumbosacral radicular pain related to disc herniation, foraminal stenosis, lateral recess stenosis, and degenerative spinal conditions. The conventional supraneural or subpedicular approach targets the superior aspect of the neural foramen, historically described as the \"safe triangle.\" This is what is commonly taught in pain medicine fellowships. However, this region may contain radicular or radiculomedullary arteries, and inadvertent intra-arterial injections have been implicated in rare but catastrophic complications, including spinal cord infarction and paralysis. The infraneural approach, often described in relation to Kambin's triangle, targets the lower portion of the neural foramen below the exiting nerve root. This technique is a valuable alternative route that may reduce needle placement in the superior-anterior foraminal region while maintaining targeted delivery to the affected nerve root and ventral epidural space. This concise review examines the anatomic rationale, technical considerations, potential advantages, limitations, and safety implications of the infraneural approach for lumbar TFESIs. Although available evidence suggests that infraneural TFESI can provide similar clinical outcomes to traditional approaches in appropriately selected patients, the literature remains limited by technique, injectate selection, and outcome reporting. Careful preprocedural imaging review, fluoroscopic guidance, contrast injection, and preferential use of non-particulate steroid remain essential regardless of approach.</p>","PeriodicalId":19669,"journal":{"name":"Orthopedic Reviews","volume":"18 ","pages":"166794"},"PeriodicalIF":1.6,"publicationDate":"2026-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13496982/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148796273","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Calcified Thoracic Disc Herniation: Surgical Management, Surgical Approaches, and Decision-Making.","authors":"Stylianos Kapetanakis, Mikail Chatzivasiliadis, Benjamin Cappin, Paschalis Tsioulas, Lazaros Poultsides, Panagiotis Konstantinou, Christos Siopis, Iosafat Pinto, Konstantinos Ditsios","doi":"10.52965/001c.166441","DOIUrl":"https://doi.org/10.52965/001c.166441","url":null,"abstract":"<p><p>Calcified thoracic disc herniation is an uncommon but clinically important spinal pathology that may cause progressive myelopathy, neurological deterioration, and complex ventral spinal cord compression. Compared with non-calcified thoracic disc disease, calcified lesions are often more rigid, centrally located, and adherent to the dura, making surgical management technically demanding. Although anterior, anterolateral, posterolateral, minimally invasive, and endoscopic approaches have all been described, no universally accepted surgical strategy exists. Approach selection remains dependent on lesion morphology, degree of calcification, canal compromise, neurological status, patient comorbidity, and surgeon experience. This narrative review summarizes the current evidence on surgical management of calcified thoracic disc herniation, with emphasis on preoperative evaluation, decision-making variables, indications, limitations, and outcomes of the major operative corridors. Central, giant, densely calcified lesions may favor anterior or anterolateral access for direct ventral decompression, whereas paracentral or lateral lesions may be suitable for posterolateral, minimally invasive, or endoscopic approaches in selected patients. Emerging evidence suggests that posterior and endoscopic techniques may also be feasible in more complex calcified lesions when performed by experienced surgeons. Optimal management should therefore be individualized, balancing adequate neural decompression with approach-related morbidity and the technical capabilities of the treating team.</p>","PeriodicalId":19669,"journal":{"name":"Orthopedic Reviews","volume":"18 ","pages":"166441"},"PeriodicalIF":1.6,"publicationDate":"2026-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13475797/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148765229","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparative Effectiveness of Nonpharmacological Therapies for Pregnancy-Related Low Back and Pelvic Pain: A Systematic Review and Meta-analysis of Randomized Controlled Trials.","authors":"Ayesha Alnashwan","doi":"10.52965/001c.165086","DOIUrl":"https://doi.org/10.52965/001c.165086","url":null,"abstract":"<p><strong>Background: </strong>Pregnancy-associated low back and pelvic pain is a common musculoskeletal condition associated with substantial pain, impaired mobility, and functional limitation during pregnancy. Pharmacologic pain management is constrained by maternal and fetal safety considerations, increasing reliance on conservative musculoskeletal interventions.</p><p><strong>Methods: </strong>A systematic review and meta-analysis of randomized controlled trials was conducted in accordance with PRISMA 2020. PubMed/MEDLINE, Scopus, and Web of Science were searched from database inception through February 2026. Eligible studies included pregnant women with pregnancy-associated low back pain, pelvic girdle pain, or mixed lumbopelvic pain syndromes receiving conservative musculoskeletal interventions. Primary outcomes were pain intensity and functional disability assessed using validated instruments. Random-effects meta-analysis using standardized mean differences with Hedges g correction and 95% confidence intervals was performed.</p><p><strong>Results: </strong>Six randomized controlled trials met inclusion criteria for qualitative synthesis, of which four studies involving 254 participants contributed directly extractable data for the primary quantitative meta-analyses. Conservative musculoskeletal interventions were associated with significant reductions in pain intensity (SMD -0.85, 95% CI -1.18 to -0.53; P < 0.001; I² = 34%) and functional disability (SMD -0.84, 95% CI -1.31 to -0.37; P < 0.001; I² = 66%). Subgroup analysis demonstrated numerically larger pain effects for device-assisted interventions, followed by acupuncture-based and manual or manipulative approaches, although subgroup differences were not statistically significant (P = 0.26). One trial was judged at high risk of bias, while the remaining studies were classified as having some concerns.</p><p><strong>Conclusions: </strong>Conservative musculoskeletal interventions were associated with improvements in pain intensity and functional disability among women with pregnancy-associated low back and pelvic pain. However, limited trial numbers, methodological heterogeneity, and risk of bias constrain treatment-specific conclusions. Larger, adequately powered, methodologically rigorous randomized controlled trials are needed to inform higher-confidence clinical recommendations.</p>","PeriodicalId":19669,"journal":{"name":"Orthopedic Reviews","volume":"18 ","pages":"165086"},"PeriodicalIF":1.6,"publicationDate":"2026-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13475796/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148760892","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"osteopoikilosis and fracture healing: the bone quantity-quality paradox-a case report and systematic review with synthesis without meta-analysis.","authors":"Rathapoom Suwanaratana, Pichaya Thanindratarn, Nuttawut Chanalithichai","doi":"10.52965/001c.165508","DOIUrl":"10.52965/001c.165508","url":null,"abstract":"<p><strong>Introduction: </strong>Osteopoikilosis is a rare sclerosing bone dysplasia that may mimic osteoblastic metastases and complicate fracture assessment. Its influence on bone quality, fixation stability, and fracture healing remains unclear.</p><p><strong>Objective: </strong>To report a tibial plateau fracture in a patient with osteopoikilosis and systematically synthesize published evidence on fracture characteristics, management, and healing outcomes in osteopoikilosis.</p><p><strong>Methods: </strong>We integrated an index case with a systematic review and synthesis without meta-analysis. The index case involved a 66-year-old woman with a Schatzker type II tibial plateau fracture and incidental osteopoikilosis, evaluated using dual-energy X-ray absorptiometry (DXA), trabecular bone score (TBS), and ¹⁸F-NaF PET/CT. A systematic literature search through January 2026 synthesized fracture characteristics and healing outcomes.</p><p><strong>Results: </strong>In the index case, the fracture occurred within intervening bone, sparing sclerotic lesions. This localization revealed a bone quantity-quality paradox: sclerotic lesions artifactually elevated BMD, whereas low TBS identified underlying systemic fragility. The systematic review (N=11) demonstrated fractures across the axial and appendicular skeletons, including both upper and lower extremities. Management ranged from conservative care to operative fixation with intramedullary nails, locking plates, and headless cannulated screws. Fracture union was consistently achieved, with no reported technical failures or delayed healing.</p><p><strong>Conclusion: </strong>Osteopoikilosis may mask underlying systemic osteoporosis, as evidenced by fractures occurring in the \"spared\" bone despite high BMD. TBS serves as a critical diagnostic safeguard to unmask this fragility. Clinically, however, the condition does not compromise biological repair; standard fracture management principles yield excellent outcomes without the need for modified fixation strategies.</p>","PeriodicalId":19669,"journal":{"name":"Orthopedic Reviews","volume":"18 ","pages":"165508"},"PeriodicalIF":1.6,"publicationDate":"2026-08-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13464400/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148725852","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Regional Anesthesia Strategies in Orthopedic Trauma.","authors":"Kashif Javid, Damon Ross, Muhammad J Abbas, Ali Mehaidli, Stefana Rafiroiu, Annamarie Pantuso, Joseph Hoegler, Patrick Forrest, Wililam M Hakeos, Stuart T Guthrie, Lindsay M Maier","doi":"10.52965/001c.166125","DOIUrl":"10.52965/001c.166125","url":null,"abstract":"<p><strong>Purpose: </strong>Orthopedic trauma patients have variable analgesic and anesthetic requirements dependent on injury pattern, severity, and comorbidities. Inadequate pain control can delay rehabilitation, prolong hospitalization, and contribute to chronic pain and opioid dependence. This review aims to summarize contemporary regional anesthesia (RA) strategies in orthopedic fracture care and highlight their indications, benefits, and limitations in the trauma setting.</p><p><strong>Methods: </strong>A comprehensive literature search was conducted across PubMed, Google Scholar, and Web of Science to identify relevant studies on regional anesthesia techniques in orthopedic trauma. Search terms included \"regional anesthesia,\" \"peripheral nerve block,\" \"orthopedic trauma,\" \"fracture,\" \"perioperative analgesia,\" and \"multimodal analgesia.\" Following initial broad search, focused secondary searches were conducted for specific regional techniques. Review articles, randomized controlled trials, prospective and retrospective cohort studies, and landmark technique descriptions were all considered.</p><p><strong>Results: </strong>Advances in ultrasound-guided regional anesthesia have significantly improved the precision, safety, and reliability of neuraxial and peripheral nerve block techniques. RA has been associated with superior early pain control, reduced opioid consumption, improved patient satisfaction, and facilitation of early mobilization when compared to systemic analgesia or general anesthesia alone. Although concerns persist regarding hemodynamic instability, masking of acute compartment syndrome, and peripheral nerve injury, current evidence supports the use of RA when appropriately indicated.</p><p><strong>Conclusion: </strong>RA is an increasingly important component of multimodal analgesia in orthopedic trauma care. Familiarity with available techniques, anatomic considerations, and injury-specific applications allows orthopedic surgeons to collaborate effectively with anesthesia teams and optimize perioperative pain management. These strategies can improve functional recovery while minimizing opioid requirements.</p>","PeriodicalId":19669,"journal":{"name":"Orthopedic Reviews","volume":"18 ","pages":"166125"},"PeriodicalIF":1.6,"publicationDate":"2026-08-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13464397/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148725047","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Meta-analysis of Randomized Controlled Trials of Adjunctive Biophysical Stimulation for Bone Regeneration Across Distraction Osteogenesis, Limb Reconstruction, and Delayed Union.","authors":"Mohammed M Tarabishi","doi":"10.52965/001c.165096","DOIUrl":"10.52965/001c.165096","url":null,"abstract":"<p><strong>Background: </strong>Impaired bone regeneration remains a major challenge in orthopedic reconstruction, particularly in distraction osteogenesis, limb reconstruction, and delayed union, where prolonged healing increases treatment burden and complication risk. Adjunctive biophysical stimulation, including low-intensity pulsed ultrasound and pulsed electromagnetic field stimulation, has been investigated as a noninvasive strategy to improve bone-healing outcomes, but evidence in reconstructive orthopedic settings remains limited and heterogeneous.</p><p><strong>Methods: </strong>A systematic review and meta-analysis of randomized controlled trials was conducted in accordance with PRISMA 2020. PubMed/MEDLINE, Scopus, and Web of Science were searched from database inception to March 21, 2026. Eligible studies evaluated adjunctive low-intensity pulsed ultrasound or pulsed electromagnetic field stimulation in distraction osteogenesis, limb reconstruction, or delayed union using comparative control groups. Random-effects meta-analysis was performed for clinically comparable outcomes. Fixation-normalized healing outcomes were pooled as mean differences, radiographic healing outcomes as standardized mean differences, and methodological quality was assessed using RoB 2.</p><p><strong>Results: </strong>Seven randomized controlled trials met eligibility criteria for qualitative synthesis. Two studies contributed to quantitative pooling of fixation-normalized healing efficiency, demonstrating significantly shorter healing duration with adjunctive intervention compared with control (mean difference, -16.78 days/cm; 95% CI, -22.72 to -10.83; P < 0.001; I² = 0%). Three studies contributed to radiographic meta-analysis, showing a significant benefit favoring adjunctive biophysical stimulation (SMD, 0.40; 95% CI, 0.07-0.74; P = 0.02; I² = 42.1%). Secondary clinical burden and safety outcomes were not suitable for quantitative pooling because of heterogeneous reporting. Six studies were judged as having some concerns and one as high risk of bias.</p><p><strong>Conclusions: </strong>Adjunctive biophysical stimulation was associated with favorable healing-related outcomes in selected distraction osteogenesis, limb reconstruction, and delayed-union settings. However, the evidence base remains limited by small study numbers, methodological heterogeneity, and inconsistent outcome reporting, supporting the need for larger contemporary randomized trials.</p>","PeriodicalId":19669,"journal":{"name":"Orthopedic Reviews","volume":"18 ","pages":"165096"},"PeriodicalIF":1.6,"publicationDate":"2026-08-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13464719/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148723620","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Physician Perceptions of Particulate Versus Non-Particulate Steroids in Epidural Steroid Injections.","authors":"Jamal Hasoon, Ovie Enaohwo, Roshan Mara, Gentry Mower, Christopher L Robinson, Omar Viswanath, Alan D Kaye, Thomas T Simopoulos, Jatinder Gill","doi":"10.52965/001c.166434","DOIUrl":"10.52965/001c.166434","url":null,"abstract":"<p><strong>Background: </strong>Epidural steroid injections (ESIs) are widely used for the treatment of chronic spinal pain, particularly in cervical and lumbar radiculopathy. Corticosteroids used in ESIs are broadly classified as particulate or non-particulate formulations, each with distinct safety and pharmacologic profiles. Comparative efficacy remains controversial. However, safety concerns regarding particulate steroid use in transforaminal injections are well established. However, physician perception of steroid effectiveness may influence clinical decision-making and practice patterns.</p><p><strong>Objective: </strong>To evaluate physician perceptions regarding the comparative efficacy of particulate versus non-particulate corticosteroids in ESIs.</p><p><strong>Methods: </strong>A survey-based study was conducted assessing physician beliefs on the duration and effectiveness of pain relief achieved with particulate and non-particulate steroids in ESIs. Responses were analyzed descriptively and compared to current literature.</p><p><strong>Results: </strong>Most physicians perceived particulate steroids to provide either equivalent or longer-lasting pain relief compared to non-particulate steroids, with a slight majority favoring particulate formulations. Very few respondents believed particulate steroids were inferior. These findings align with existing literature demonstrating largely comparable efficacy between steroid types, with inconsistent evidence suggesting minor differences in duration of pain relief.</p><p><strong>Conclusions: </strong>Despite mixed evidence regarding comparative efficacy, physician perception continues to favor particulate steroids for longer duration of analgesia. Given the known safety risks associated with particulate steroids, clinical decision-making should incorporate both efficacy data and patient-specific risk profiles. These findings highlight the importance of aligning physician perception with evolving evidence and safety guidelines.</p>","PeriodicalId":19669,"journal":{"name":"Orthopedic Reviews","volume":"18 ","pages":"166434"},"PeriodicalIF":1.6,"publicationDate":"2026-08-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13464596/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148721441","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The impact of depression on outcomes in revision knee replacement surgery.","authors":"Bekim Arifaj, Mohamed Habad, Mubaraq Hamzat, Abdullah Shakeel","doi":"10.52965/001c.166115","DOIUrl":"10.52965/001c.166115","url":null,"abstract":"<p><strong>Introduction: </strong>Revision total knee arthroplasty is associated with more variable functional recovery and greater postoperative burden than primary surgery. Depression may influence recovery, but its effect in revision knee replacement remains incompletely defined.</p><p><strong>Objective: </strong>To synthesise evidence on the association between depression or poor preoperative mental health and outcomes after revision total knee arthroplasty.</p><p><strong>Methods: </strong>PubMed, MEDLINE, and Embase were searched on August 12, 2025. Adult revision total knee arthroplasty studies assessing depression or mental health in relation to postoperative outcomes were eligible. Owing to heterogeneity in exposure definitions, outcomes, and follow-up, findings were narratively synthesised.</p><p><strong>Results: </strong>Of 103 records identified, 44 duplicates were removed and 59 records screened; 6 studies were included. Depression or poorer preoperative mental health was associated with worse postoperative function, persistent pain, greater narcotic analgesic use, lower satisfaction, infection, reoperation or re-revision, readmission, emergency department attendance, prolonged stay, non-home discharge, and higher costs. However, patients with poorer mental health could still achieve clinically meaningful functional improvement.</p><p><strong>Conclusion: </strong>Depression is associated with poorer outcomes after revision total knee arthroplasty but should not be considered a contraindication to surgery. Mental health recognition, expectation-setting, and multidisciplinary optimisation may improve perioperative care.</p>","PeriodicalId":19669,"journal":{"name":"Orthopedic Reviews","volume":"18 ","pages":"166115"},"PeriodicalIF":1.6,"publicationDate":"2026-08-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13464700/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148725905","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}