Archives of Bone and Joint Surgery-ABJS最新文献

{"title":"Imaging Atlas of Osseous Pathology in the Ankle and Foot.","authors":"Pegah Sahafi, Mohammad Hadi Samadi, Alireza Mousavian, Vahid Reza Dabbagh Kakhki, Ramin Sadeghi","doi":"10.22038/ABJS.2026.93807.4233","DOIUrl":"10.22038/ABJS.2026.93807.4233","url":null,"abstract":"<p><p>This study aimed to characterize the imaging patterns of osseous pathologies of the ankle and foot using bone scintigraphy and 99mTc-MDP SPECT/CT. Illustrative cases of traumatic, degenerative, infectious, metabolic, and neoplastic lesions were evaluated. The findings of bone scintigraphy and SPECT/CT were compared with those of radiography, CT, and MRI. SPECT/CT improved the localization and characterization of lesions in the anatomically complex ankle-foot region. Distinguishing normal from abnormal uptake patterns helped reduce potential misdiagnoses. 99mTc-MDP bone scintigraphy and SPECT/CT are valuable imaging modalities for detecting and characterizing ankle and foot pathologies, enhancing diagnostic confidence and guiding clinical management.</p>","PeriodicalId":46704,"journal":{"name":"Archives of Bone and Joint Surgery-ABJS","volume":"14 4","pages":"321-328"},"PeriodicalIF":1.6,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13231259/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148165164","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":"Evaluation of Implant Removal Difficulty in Distal Femur Fractures: A Comparison between Stainless Steel and Titanium Locking Compression Plate.","authors":"Hamed Tayyebi, Nicholas Frane, Victoria Greenstein, Arjun Vohra, Clayton Hui, Michael McKee, Niloofar Dehghan","doi":"10.22038/ABJS.2025.84756.3858","DOIUrl":"10.22038/ABJS.2025.84756.3858","url":null,"abstract":"<p><strong>Objectives: </strong>Objectives: Titanium plates may offer advantages in fracture healing, yet concerns remain regarding hardware removal due to risks such as screw stripping and cold welding. Whether titanium removal is more difficult than stainless steel remains uncertain. This study compared the ease of implant removal, focusing on distal femur fractures treated with titanium versus stainless-steel plates.</p><p><strong>Methods: </strong>We conducted a retrospective cohort study of patients with distal femur fractures who underwent implant removal after fixation with either stainless-steel or titanium plates. The primary outcome was difficulty of removal, including cold welding, screw stripping, hardware breakage, and use of advanced tools (screw removal set, trephine, burr). The secondary outcome was operative duration.</p><p><strong>Results: </strong>Seventy-two patients were included: 31 stainless steel and 41 titanium. Mean in-vivo implant time was 421 ± 498 days for stainless steel and 360 ± 409 days for titanium (P = 0.57). Difficulties with removal occurred in 13% of stainless-steel cases and 12% of titanium cases (P = 0.92). Screw removal sets were required in 9.7% and 9.8% of patients, respectively (P = 0.99). Advanced extraction tools were used in 3 patients per group (P = 0.72). Cold-welded or stripped screws occurred in 2 patients in each group (P = 0.77). Mean operative time was 155 ± 80 minutes for stainless steel versus 118 ± 67 minutes for titanium (P = 0.06).</p><p><strong>Conclusion: </strong>In distal femur fractures, titanium plate removal is not associated with increased technical difficulty compared with stainless steel implants.</p>","PeriodicalId":46704,"journal":{"name":"Archives of Bone and Joint Surgery-ABJS","volume":"14 4","pages":"3037-3312"},"PeriodicalIF":1.6,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13231266/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148165228","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":"Surgeon Referral for Extraction of Inadvertent Deep and Nonpalpable Contraceptive Implants That Place Major Peripheral Nerves at Risk: A Systematic Review of Case Reports and Case Series.","authors":"Jason Noor, Stephanie Price, David Ring","doi":"10.22038/ABJS.2025.88821.4033","DOIUrl":"10.22038/ABJS.2025.88821.4033","url":null,"abstract":"<p><strong>Objectives: </strong>Implantable contraceptive implants placed at the medial arm are often misapplied relatively deep, sometimes in muscle or adjacent to neurovascular structures. We reviewed the available evidence regarding non-palpable medial arm implants and factors associated with deep application to help inform specialists who may be asked to assist with removal in order protect nearby nerves.</p><p><strong>Methods: </strong>Following PRISMA guidelines, the authors systematically reviewed PubMed, Embase, and Cochrane Library for case series and reports of complications associated with the removal of nonpalpable contraceptive implants in September of 2025. Rates and features of routine and problematic implant removal were studied. Factors potentially related to deep placement were identified. The NIH tool for case series (2021) was used to assess study quality.</p><p><strong>Results: </strong>We identified 16 case series and 10 case reports related to problematic implant removal from an initial search of 219 publications. In a series of routine insertions and removals, nonpalpable surgical implant removal was uncommon. Compared to routine removal, problematic removal was associated with subfascial implants, intramuscular implants, and previous attempts. A subset of implants was removed in the operating room. Transient paresthesia of the ulnar, median, and medial antebrachial cutaneous nerves was common after surgical removal of deep nonpalpable implants. Factors potentially associated with non-palpable implants included provider training, time since insertion, greater BMI, and weight gain during implant use. Among the 10 case reports, 6 orthopedic surgeons and one plastic surgeon performed removal.</p><p><strong>Conclusion: </strong>Hand surgeons may receive requests for assistance removing deep, nonpalpable contraceptive implants in order to limit the potential for neurovascular damage given that the medial arm insertion site is associate with the possibility of injury to adjacent to major nerves.</p>","PeriodicalId":46704,"journal":{"name":"Archives of Bone and Joint Surgery-ABJS","volume":"14 2","pages":"90-97"},"PeriodicalIF":1.6,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13150706/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147869943","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":"Infection Following ACL Reconstruction: From Prevention to Treatment.","authors":"Mohammad Zarei Dezkouh, Sanaz Zabihi, Reza Binava, Reza Ganji, Amir Shahriar Ariamanesh, Hadi Makhmalbaf, Mohammad H Ebrahimzadeh, Robert F LaPrade","doi":"10.22038/abjs.2026.96314.4319","DOIUrl":"10.22038/abjs.2026.96314.4319","url":null,"abstract":"<p><p>Postoperative infection is a rare but serious complication following anterior cruciate ligament reconstruction (ACLR). This review integrates current epidemiological trends, risk factors, and novel diagnostic and therapeutic approaches reported in the existing literature. The estimated incidence of septic arthritis (SA) after ACLR typically ranges from 0.14% to 2.6%. Male sex, smoking, hamstring autograft use, diabetes mellitus, and elevated body mass index (BMI) were identified as risk factors in earlier studies. Intraoperative presoaking of the graft in vancomycin, known as the 'vancomycin wrap' technique, has reduced infection rates and improved prophylactic practice. Diagnosis relies on patient history, physical assessment, and laboratory findings, including synovial fluid analysis and C-reactive protein (CRP). Management often involves urgent arthroscopic debridement and individualized antibiotic treatment, with the primary aim of preserving the ACL graft. Although graft retention is successful in many cases, persistent infection may require graft removal, which is associated with poorer outcomes.</p>","PeriodicalId":46704,"journal":{"name":"Archives of Bone and Joint Surgery-ABJS","volume":"14 8","pages":"500-509"},"PeriodicalIF":1.6,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13544421/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148898060","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":"Open Reduction and Internal Fixation (ORIF) for Acetabular Fractures in the Elderly: A Systematic Review and Meta-Analysis.","authors":"Mohamad Yegane Shali, Parham Talebian, Sina Javidmehr, Mohammadreza Golbakhsh, Babak Siavashi, Hanie Abbasi","doi":"10.22038/abjs.2026.88320.4002","DOIUrl":"10.22038/abjs.2026.88320.4002","url":null,"abstract":"<p><strong>Objectives: </strong>To evaluate the outcomes of open reduction and internal fixation (ORIF) in older adults with acetabular fractures, with a focus on postoperative complications, mortality, and conversion to total hip arthroplasty (THA).</p><p><strong>Methods: </strong>We systematically reviewed studies published between September 2013 and February 2025 in Web of Science, PubMed, Embase, Scopus, and the Cochrane Library. Studies reporting postoperative outcomes of ORIF in elderly patients aged ≥65 years were included. Data extraction and quality assessment were performed independently by two reviewers. Statistical analyses were conducted using Comprehensive Meta-Analysis software, version 3.0.</p><p><strong>Results: </strong>Twenty-one studies involving 2,410 patients were included in the analysis. Follow-up duration ranged from 12 to 96 months. The pooled mortality rate after ORIF was 11.0% (95% CI: 7.0%--16.7%). The pooled complication rate was 26.5% (95% CI: 21.3%--32.4%), and the pooled rate of conversion to THA was 20.0% (95% CI: 15.2%--26.0%). The pooled infection rate was 5.8% (95% CI: 4.2%--7.9%). Fixation failure occurred in 12.6% of patients (95% CI: 9.8%--15.9%) and was primarily attributed to secondary loss of reduction, implant loosening, or hardware breakage, often requiring revision surgery or conversion to THA.</p><p><strong>Conclusion: </strong>ORIF in elderly patients with acetabular fractures is associated with substantial risks, including a high complication rate and a notable likelihood of conversion to THA. Alternative treatment strategies, such as primary THA or nonoperative management, should be considered in selected patients.</p>","PeriodicalId":46704,"journal":{"name":"Archives of Bone and Joint Surgery-ABJS","volume":"14 8","pages":"491-499"},"PeriodicalIF":1.6,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13544427/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148898093","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 Kinematic Analysis of Automatic Postural Responses during Predicted and Unpredicted Postural Perturbations in People with Low Back Pain.","authors":"Abbas Fatehi Peykani, Maryam Saadat, Shahla Zahednegad, Shahin Goharpey, Saeideh Monjezi","doi":"10.22038/abjs.2025.87584.3968","DOIUrl":"10.22038/abjs.2025.87584.3968","url":null,"abstract":"<p><strong>Objectives: </strong>Limited evidence exists on alterations in postural response kinematics following external perturbations in individuals with chronic low back pain (LBP). Therefore, this study aimed to investigate differences in automatic postural responses between individuals with chronic LBP and asymptomatic controls during forward translation of the support surface.</p><p><strong>Methods: </strong>A total of 21 participants with chronic non-specific low back pain (LBP) and 21 age- and sex-matched healthy adults participated in this study. Participants were exposed to both predicted and unpredicted perturbations through forward translation of the support surface, which were analyzed using a motion analysis system. Angular displacements of the trunk and lower limbs were measured across four predefined time intervals corresponding to anticipatory postural adjustments (APA) and compensatory postural adjustments (CPA).</p><p><strong>Results: </strong>In the unpredicted condition, trunk angular displacement during the APA1 phase was significantly lower in the LBP group compared with the control group (P = 0.04). A significant main effect of group was observed for hip (P = 0.009, ηp² = 0.17), knee (P = 0.01, ηp² = 0.16), and ankle (P = 0.01, ηp² = 0.14) displacements during the CPA1 phase. Moreover, a significant group effect was found for knee (P = 0.01, ηp² = 0.20) and ankle (P = 0.04, ηp² = 0.09) displacements during the CPA2 phase. Participants with LBP exhibited greater lower-limb joint displacements than controls under predicted and unpredicted conditions.</p><p><strong>Conclusion: </strong>Individuals with chronic low back pain (LBP) demonstrated altered kinematic strategies of the trunk and lower-limb joints in response to forward translation of the support surface. These findings suggest clinicians should consider evaluating and addressing automatic postural responses in this population.</p>","PeriodicalId":46704,"journal":{"name":"Archives of Bone and Joint Surgery-ABJS","volume":"14 5","pages":"349-355"},"PeriodicalIF":1.6,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13240798/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148200469","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":"Perioperative Ketamine and Esketamine for Postoperative Mood Symptoms After Orthopaedic Surgery: A Systematic Review of Randomized Controlled Trials.","authors":"Ali Dabbagh, Firoozeh Madadi, Maryam Fallah, Negarsadat Namazi","doi":"10.22038/ABJS.2026.94686.4270","DOIUrl":"10.22038/ABJS.2026.94686.4270","url":null,"abstract":"<p><strong>Objectives: </strong>Perioperative anxiety and depression are common following major orthopaedic surgery and may adversely affect postoperative recovery. Ketamine and esketamine have rapid psychotropic effects; however, their effectiveness in reducing postoperative mood symptoms in orthopaedic patients remains uncertain. We systematically reviewed randomized evidence on the effects of these agents on postoperative anxiety, depression, and adverse events.</p><p><strong>Methods: </strong>PubMed, Embase, and the Cochrane Library were searched for randomized controlled trials enrolling adults undergoing major orthopaedic procedures. Eligible studies compared ketamine or esketamine administered preoperatively, intraoperatively, or postoperatively with placebo or no ketamine-class agent. The primary outcomes were postoperative anxiety and depression assessed using validated scales. Secondary outcomes included drug-related adverse events.</p><p><strong>Results: </strong>Nine randomized controlled trials were included, with follow-up durations ranging from 24 hours to 12 months. Five trials assessed postoperative anxiety using validated scales; four reported significantly lower anxiety scores with ketamine or esketamine at early postoperative time points, whereas one trial using a single preoperative dose of ketamine found no significant anxiolytic effect. Overall, perioperative ketamine or esketamine may be associated with lower early postoperative anxiety and depressive symptom scores in selected orthopaedic populations. Regarding safety, ketamine or esketamine did not appear to increase the incidence of common adverse events.</p><p><strong>Conclusion: </strong>Perioperative ketamine or esketamine appears to reduce early postoperative anxiety and depressive symptoms in orthopaedic patients without increasing postoperative nausea, vomiting, or dizziness. Further standardized trials are needed before firm conclusions can be drawn.</p><p><strong>Level of evidence: </strong>II.</p>","PeriodicalId":46704,"journal":{"name":"Archives of Bone and Joint Surgery-ABJS","volume":"14 9","pages":"561-570"},"PeriodicalIF":1.6,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13596988/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149026159","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":"Is Pharmacologic Prophylaxis for Venous Thromboembolism Necessary in People With Hemophilia After Total Knee and Hip Arthroplasty?","authors":"E Carlos Rodriguez-Merchan, Hortensia De la Corte-Rodriguez, William J Ribbans","doi":"10.22038/abjs.2025.88708.4023","DOIUrl":"10.22038/abjs.2025.88708.4023","url":null,"abstract":"<p><p>Pharmacologic thromboprophylaxis for postoperative venous thromboembolism (VTE) after total knee arthroplasty (TKA) and total hip arthroplasty (THA) in people with hemophilia (PWH) is highly controversial. In PWH the prevalence of symptomatic VTE after TKA and THA is between 0 to 5%, while the prevalence of asymptomatic VTE is between 7.5% and 10%. In PWH many clinicians have not used pharmacologic thromboprophylaxis. Others have used low molecular weight heparin (LMWH) and reduced doses of DOAC [direct oral anticoagulants (thrombin inhibitors and Factor Xa inhibitors)]. It appears that pharmacologic thromboprophylaxis should only be carried out in PWH undergoing TKA and THA who have VTE risk factors [e.g., old age, prior VTE, varicose veins, general anesthesia, cancer, Factor V (Leiden) mutation, and obesity]. After TKA and THA in PWH, early mobilization is essential. Some authors have advocated additional mechanical thromboprophylaxis (pneumatic compression devices). In conclusion, for all PWH experiencing TKA and THA mechanical prophylaxis is sensible. Some form of pharmacologic prophylaxis should be strongly considered for PWH with clear risk factors. The main area of doubt is in PWH without risk factors. More prospective multicenter studies are required. Difficulties will be getting agreement on universal regimes to be followed; and the relatively small numbers of PWH experiencing TKA and THA.</p>","PeriodicalId":46704,"journal":{"name":"Archives of Bone and Joint Surgery-ABJS","volume":"14 2","pages":"98-103"},"PeriodicalIF":1.6,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13150713/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147870005","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 Effect of Iliotibial Band Tightness and Its Release on Postoperative Pain after Total Knee Arthroplasty in Patients with Varus Gonarthrosis: A Randomized Clinical Trial.","authors":"Hosseinali Hadi, Mohammad Zarei Dezkooh, Mohammad H Ebrahimzadeh","doi":"10.22038/abjs.2026.89903.4090","DOIUrl":"10.22038/abjs.2026.89903.4090","url":null,"abstract":"<p><strong>Objectives: </strong>This study aimed to evaluate the effect of iliotibial band (ITB) release on postoperative pain and functional outcomes following total knee arthroplasty (TKA) in patients with varus gonarthrosis.</p><p><strong>Methods: </strong>This clinical trial included patients with varus gonarthrosis undergoing total knee arthroplasty (TKA). Participants were stratified into three groups: Group A, patients with a tight ITB who did not undergo ITB release; Group B, patients with a tight ITB who underwent ITB release; and Group C, patients with a loose ITB who did not undergo release. Outcome measures included the Knee Society Score (KSS) knee and function subscales and the Oxford Knee Score (OKS), which assesses pain and functional status. Evaluations were performed preoperatively and at three months and one year postoperatively.</p><p><strong>Results: </strong>No significant differences were observed among the three groups regarding age or gender (P > 0.05). At baseline, Group B demonstrated a significantly lower mean KSS compared with the other groups (P = 0.017). Although Group B showed improvement in mean KSS at the final follow-up, no statistically significant differences in postoperative KSS (P = 0.468) or OKS (P = 0.194) were found among the groups at any follow-up time point. Furthermore, the incidence of subluxation and the severity of varus deformity were comparable across all groups.</p><p><strong>Conclusion: </strong>In patients with a tight ITB undergoing TKA, ITB release is associated with improvement in functional scores compared with preoperative values; however, it does not lead to significant differences in clinical or radiographic outcomes when compared with patients who do not undergo ITB release. These findings suggest that ITB release may have a limited effect on overall postoperative outcomes, underscoring the need for further studies to more comprehensively evaluate the role and indications of surgical release techniques.</p>","PeriodicalId":46704,"journal":{"name":"Archives of Bone and Joint Surgery-ABJS","volume":"14 2","pages":"113-120"},"PeriodicalIF":1.6,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13150714/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147869990","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 Outcomes and Complication Rates in Fast-Track Versus Routine after Total Knee Arthroplasty: A Systematic Review and Meta-analysis.","authors":"Abdul Qadim Esehaqzai, Mohammad H Ebrahimzadeh, Masoumeh Sadeghi, Amir Moayedpour, Mohammad Zarei Dezkooh, Shahram Rahimi, Mahdieh Samei","doi":"10.22038/ABJS.2026.95214.4278","DOIUrl":"10.22038/ABJS.2026.95214.4278","url":null,"abstract":"<p><strong>Objectives: </strong>Fast-track or enhanced recovery after surgery (ERAS) pathways have been increasingly adopted in total knee arthroplasty (TKA) to optimize perioperative care, yet their comparative effectiveness and safety relative to routine pathways remain incompletely defined. This systematic review and meta-analysis compared the effects of fast-track versus routine perioperative care on length of hospital stay (LOS), postoperative pain, complications, and readmissions in patients undergoing primary TKA.</p><p><strong>Methods: </strong>A systematic search of PubMed, Embase, Cochrane Library, Scopus, and Web of Science was performed from inception to January 2025 using MeSH terms. Primary outcomes were LOS and postoperative pain, with complications and readmissions assessed as secondary outcomes. Risk of bias was assessed using Cochrane RoB 2 for RCTs and ROBINS-I for non-randomized studies. A random-effects meta-analysis was conducted due to anticipated heterogeneity.</p><p><strong>Results: </strong>Nine studies (total 2607 patients) met inclusion criteria. Fast-track care significantly reduced LOS (WMD: -2.41 days, 95% CI: -3.18 to -1.64). Postoperative pain was slightly higher in the fast-track group at 24h (MD: 0.98, 95% CI: -0.1 to 2.05) and at 2 weeks (MD: 0.33, 95% CI: -0.04 to 0.7), neither reaching statistical significance. Methodological quality was limited, with moderate to serious risk of bias in non-randomized studies and high risk of bias in all randomized trials.</p><p><strong>Conclusion: </strong>Overall, the available evidence suggests that fast-track rehabilitation following TKA substantially reduces hospitalization without clinically meaningful or sustained increases in postoperative pain. These findings support the use of fast-track pathways to enhance perioperative efficiency in TKA, while highlighting the need for higher-quality randomized studies to better define their effects on pain and safety outcomes.</p>","PeriodicalId":46704,"journal":{"name":"Archives of Bone and Joint Surgery-ABJS","volume":"14 6","pages":"371-379"},"PeriodicalIF":1.6,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13424349/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148654813","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}