Orthopaedics & Traumatology-Surgery & Research最新文献

{"title":"Risk factors for implant-related infections after surgery for proximal femur fractures: retrospective analysis of 2572 patients.","authors":"Marija Velickovic Vukovic, Werner Vach, Martin Clauss, Saxer Franziska","doi":"10.1016/j.otsr.2026.104920","DOIUrl":"https://doi.org/10.1016/j.otsr.2026.104920","url":null,"abstract":"<p><strong>Introduction: </strong>Proximal femoral fractures (PFFs) are among the most common fragility fractures, with increasing incidence due to population ageing. Surgical treatment enabling early-mobilisation is the standard of care; however, implant-related infection (IRI), occurring in 1-7% of cases, remains a severe complication associated with increased mortality, prolonged recovery, and substantial healthcare costs. This study systematically evaluated risk factors for IRI using routine clinical data from a PFF cohort and compared the findings with existing literature.</p><p><strong>Patients and methods: </strong>This retrospective cohort study analysed electronic health records from a Swiss Level 1 trauma centre between 2009 and 2018. Patients aged ≥60 years undergoing surgery for PFF after low-energy trauma were included. IRIs were identified through chart review using consensus-based criteria. Clinical variables were extracted using a standardised protocol, and potential risk factors were evaluated using logistic regression. A structured review of previously reported risk factors was additionally performed.</p><p><strong>Results: </strong>A total of 2,572 patients (1,391 pertrochanteric and 1,181 femoral neck fractures) were included. Infection rates were 1.15% for pertrochanteric fractures and 1.52% for femoral neck fractures. Higher body mass index (BMI), greater burden of comorbidity, diabetes and longer operative time were associated with increased infection risk. Literature comparison supported the observed relationships but showed inconsistent findings regarding preoperative waiting time to surgery.</p><p><strong>Conclusions: </strong>IRI incidence was low, consistent with contemporary studies. Higher BMI, diabetes, and burden of comorbidity were associated with increased infection risk, highlighting the opportunity for targeted perioperative prevention strategies.</p><p><strong>Level of evidence: </strong>IV; retrospective study.</p>","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":" ","pages":"104920"},"PeriodicalIF":2.7,"publicationDate":"2026-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149172140","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparative outcomes of cannulated screws, dynamic hip screws and the femoral neck system for transcervical femoral neck fractures. A retrospective cohort study.","authors":"Mark Ibraheem, Lachlan Milne, Malcolm Keng Yee Teo, William Blakeney","doi":"10.1016/j.otsr.2026.104922","DOIUrl":"10.1016/j.otsr.2026.104922","url":null,"abstract":"<p><strong>Background: </strong>Internal fixation of transcervical femoral neck fractures remains associated with substantial failure and reoperation rates. The Femoral Neck System (FNS) was developed to improve rotational stability while remaining minimally invasive, but comparative data against traditional implants are limited.</p><p><strong>Hypothesis: </strong>We hypothesised that fixation with the FNS would be associated with lower reoperation rates compared with CS and DHS.</p><p><strong>Patients and methods: </strong>We performed a retrospective comparative cohort study of adults undergoing fixation of transcervical femoral neck fractures at two centres between 2019 and 2024, with a minimum of 12-months of outcome ascertainment. Data were collected from medical records and radiographs. Negative binomial regression evaluated time to surgery; logistic regression assessed fixation method against union, reoperation and complications, adjusted for age, Charlson Comorbidity Index, Garden classification, side and time to surgery.</p><p><strong>Results: </strong>After exclusions, 207 patients were analysed (CS 27, DHS 100, FNS 80). Age (CS 54.8, DHS 66.9, FNS 68.2 years; p = 0.02) and Garden distribution (Garden I 7/27 CS, 27/100 DHS, 52/80 FNS; p < 0.001) differed between groups; adjusted analyses accounted for these differences. Reoperation occurred in 37/207 (17.9%): 10/27 (37.0%) CS, 20/100 (20.0%) DHS and 7/80 (8.8%) FNS (p = 0.004). After adjustment, CS remained associated with reoperation versus FNS (OR 5.26, 95% CI 1.53-18.13), whereas DHS did not (OR 1.85, 95% CI 0.65-5.26). Union occurred in 184/207 (88.9%), with no association with fixation method (p = 0.065). Complications occurred in 61/207 (29.5%): 11/27 (40.7%) CS, 32/100 (32.0%) DHS and 18/80 (22.5%) FNS (p = 0.15); higher Garden classification was associated with more complications (Garden II OR 2.58, Garden III OR 3.44; p = 0.037). Time to surgery was shorter with DHS than FNS (IRR 0.49, 95% CI 0.35-0.69; p < 0.001), although the median was 1 day in all groups. Avascular necrosis occurred in 4/80 (5.0%) FNS, 11/100 (11.0%) DHS and 2/27 (7.4%) CS (p = 0.42).</p><p><strong>Discussion: </strong>Union rates were high across fixation methods. FNS was associated with lower reoperation rates than CS and similar adjusted outcomes to DHS. Prospective studies with patient-reported outcomes are required to confirm these findings.</p><p><strong>Level of evidence: </strong>III; Retrospective cohort study.</p>","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":" ","pages":"104922"},"PeriodicalIF":2.7,"publicationDate":"2026-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149169032","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The impact of analgesic opioid use on fracture healing and nonunion: a systematic review and meta-analysis.","authors":"Humam Emad Rajha, Lana Abugharbieh, Maha Talhami, Osama Alkeilani, Syed Imran Ghori, Abdelrehim El Tayeh","doi":"10.1016/j.otsr.2026.104918","DOIUrl":"10.1016/j.otsr.2026.104918","url":null,"abstract":"<p><strong>Background: </strong>Bone fractures are a major global health issue, with nonunion being a serious complication. While NSAIDs are known to impair bone healing, prompting increased opioid use for pain, the effect of opioids on fracture healing is poorly understood. This article assesses: (1) whether chronic opioid use increases all-bone nonunion risk; (2) whether risk varies by anatomic site; (3) whether duration or NSAID co-use modifies risk; and (4) whether time-to-union is prolonged in opioid users.</p><p><strong>Methods: </strong>A systematic search of PubMed, Embase, Cochrane CENTRAL, and CINAHL was conducted up to January 1, 2026. Included retrospective cohort studies reported opioid exposure and fracture healing outcomes. Study quality was assessed, and adjusted odds ratios (ORs) for nonunion were pooled using quality-effects and random-effects models.</p><p><strong>Results: </strong>Seven studies, comprising over one million fracture cases, were included. Meta-analysis showed chronic opioid use was associated with higher odds of nonunion across all bone types (OR 5.10, 95% CI: 3.28-7.93). Site-specific analyses revealed elevated odds for the humerus (OR 4.28), radius (OR 4.93), tibia (OR 4.57), and metatarsals (OR 4.81). Concurrent use of opioids and NSAIDs was associated with higher odds compared to opioids alone in limited analyses. One study reported a modestly prolonged time to union in opioid users.</p><p><strong>Conclusion: </strong>Chronic opioid use is associated with a higher risk of fracture nonunion at multiple skeletal sites. This association appears stronger when opioids are combined with NSAIDs. These findings suggest caution regarding opioid safety in bone healing and highlight the need for cautious prescribing and exploration of multimodal, non-opioid analgesic strategies for fracture pain.</p><p><strong>Level of evidence: </strong>III.</p>","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":" ","pages":"104918"},"PeriodicalIF":2.7,"publicationDate":"2026-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149170254","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Correction of lower-limb deformities by intramedullary nailing.","authors":"Franck Accadbled, Jan Duedal Rölfing","doi":"10.1016/j.otsr.2026.104915","DOIUrl":"10.1016/j.otsr.2026.104915","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Osteotomy to correct lower-limb deformity may be necessary when residual growth precludes asymmetric epiphysiodesis. Interlocking intramedullary nailing (IMN) provides minimally invasive stable fixation, spanning fragile segments, and compatible with bone lengthening, but requires precise preoperative planning and meticulous operative technique, as the room for postoperative adjustment is very limited. Our aim here is to present practical indications, planning principles, instrumentation, operative steps and postoperative management for safe and effective correction of femoral and tibial deformities using IMN.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;This is a narrative technique-focused synthesis drawing on the authors' surgical experience and current operative principles to guide patient selection, imaging, osteotomy level, implant selection and intraoperative strategy. Five main questions are addressed: RESULTS: Preoperative clinical examination includes assessment of the stability and range of motion of the joints adjacent to the deformed bone segment. A scaled full-length standing radiograph with patellae facing forward is necessary for preoperative planning, along with a true lateral view. Intraoperatively, the patient is placed supine on a standard table fitted with an alignment grid. Contraindications include very severe or complex deformities and current or recent bone infection. IMN is suitable for correction of most cases of valgus/varus, pro-/re-curvatum and rotational deformities, and intramedullary motorized lengthening nails can also be applied in case of limb length discrepancy. Diaphyseal and metaphyseal deformities around the knee are the best indications. Straight reamers are recommended for metaphyseal deformities. Reference Schanz screws are placed above and below the planned osteotomy level for rotation control. A tube system, introduced like a working portal into the bone, seals the joint completely and maintains the reamer at the entry point in a constant trajectory according to the preoperative plan. Holes are drilled at the osteotomy site and serve as venting holes to decrease the risk of fat embolism during reaming and to enhance bone healing, like autologous bone grafting. Blocking screws can be used to increase stability in case of a wide medullary canal and/or to allow large corrections. IMN typically allows at least partial immediate weight-bearing and free range of motion without immobilization. Patients undergoing limb lengthening should be followed up regularly in the outpatient clinic by a multidisciplinary team assessing bone formation, implant-related complications and joint contractures.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;Interlocking IMN is a versatile option for acute correction of most femoral and tibial diaphyseal and metaphyseal deformities, and for simultaneous length restoration using motorized nails when indicated. Success hinges on careful patient selection, planning based on t","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":" ","pages":"104915"},"PeriodicalIF":2.7,"publicationDate":"2026-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149118425","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Acute intra-articular calcaneal fractures: Currents concepts.","authors":"Julien Lucas Y Hernandez","doi":"10.1016/j.otsr.2026.104916","DOIUrl":"10.1016/j.otsr.2026.104916","url":null,"abstract":"<p><p>Calcaneal fractures are predominantly intra-articular and most commonly involve the subtalar joint, with an estimated incidence of 11,5 per 100,000 population and a male predominance. They occur mainly after high-energy trauma and are associated with substantial functional impairment and major socio-occupational consequences. Anatomical assessment (loss of height, posterior facet collapse, lateral wall widening, and varus displacement with superior migration of the tuberosity) determines prognosis and guides management. Plain radiographs (Böhler's and Gissane's angles) remain useful, but computed tomography is the reference standard for lesion characterization and preoperative planning. The surgery-versus -conservative debate has shifted with the development of minimally invasive techniques (sinus tarsi approach, percutaneous screw fixation and intramedullary nailing), which aim to restore hindfoot alignment, articular congruence and stability while reducing soft-tissue morbidity. Displaced Sanders II-III fractures represent the main indications for osteosynthesis, whereas Sanders type IV fractures are typically discussed between ORIF and primary subtalar arthrodesis. The most frequent complications remain soft tissue compromise and infection, as well as late sequelae (subtalar osteoarthritis, lateral subfibular impingement and residual varus). Current innovations focus on improving the reproducibility of reduction (arthroscopy-assisted techniques, balloon calcaneoplasty and navigation/robotics). LEVEL OF EVIDENCE: V, expert opinion.</p>","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":" ","pages":"104916"},"PeriodicalIF":2.7,"publicationDate":"2026-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149118442","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The French Referral Centers for Complex Bone and Joint Infections (CRIOAc) 18 years after their establishment: Organization, added value, and future perspectives","authors":"Tristan Ferry,&nbsp;Éric Senneville,&nbsp;Johan Courjon,&nbsp;Gwenaël Le Moal,&nbsp;Harold Common,&nbsp;Véronique Dubois,&nbsp;Anne-Laure Roux,&nbsp;Benoît Brunschweiler,&nbsp;Adrien Lemaignen,&nbsp;Jean-Yves Jenny,&nbsp;Simon Marmor,&nbsp;on behalf of the French CRIOAc Network","doi":"10.1016/j.otsr.2026.104804","DOIUrl":"10.1016/j.otsr.2026.104804","url":null,"abstract":"<div><h3>Background</h3><div>Complex bone and joint infections (BJIs) represent a major public health challenge because of their severity, functional consequences, and the complexity of their management. In 2008, France established a nationwide network of Referral Centers for Complex Bone and Joint Infections (CRIOAc), a pioneering organization based on specialized multidisciplinary team (MDT) meetings and comprehensive national territorial coverage.</div></div><div><h3>Methods</h3><div>We conducted a nationwide descriptive study of the CRIOAc network, assessing its activity and evolution since its establishment, including organizational changes, funding mechanisms, scientific output, and academic activities. Data were extracted from the national CRIOAc information system, which prospectively records all cases discussed during MDT meetings. A descriptive bibliometric analysis of publications citing the seminal CRIOAc article was also performed.</div></div><div><h3>Results</h3><div>The network expanded from 8 coordinating referral centers at its inception to 32 accredited centers in 2024, providing nationwide coverage. It is governed by a National Scientific Committee representing all specialties and geographic regions. Since its creation, 64,859 patients have been managed within the network. The annual number of MDT meetings increased from 698 in 2011 to 1760 in 2024, while the number of surgical admissions for BJI increased from 6148 to 11,340 over the same period. The proportion of cases classified as complex remained stable at approximately 60–65%. The CRIOAc network has contributed to the development of national and international clinical guidelines, the establishment of a national inter-university diploma, the conduct of multicenter research projects, and the implementation of innovative phage-related anti-infective therapies. Bibliometric analysis demonstrates the growing international dissemination of the CRIOAc model.</div></div><div><h3>Conclusions</h3><div>Eighteen years after its establishment, the CRIOAc network represents a pioneering and sustainable national model for the multidisciplinary management of complex BJIs, whose core principles are now supported by the international literature. Its mission has expanded beyond specialized clinical care to encompass research, education, and the evaluation of innovative therapeutic strategies. Further integration into European collaborative networks could strengthen its contribution to improving the management of complex bone and joint infections.</div></div><div><h3>Level of evidence</h3><div>IV; Retrospective study.</div></div>","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":"112 6","pages":"Article 104804"},"PeriodicalIF":2.7,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148610100","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Can large language models provide high-quality desk review decisions in an orthopaedic surgery journal? A concordance study comparing three AI models to human editorial decisions","authors":"Elise Lupon,&nbsp;Quentin Bérard,&nbsp;Henri Migaud,&nbsp;Philippe Clavert,&nbsp;Grégoire Micicoi","doi":"10.1016/j.otsr.2026.104801","DOIUrl":"10.1016/j.otsr.2026.104801","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background&lt;/h3&gt;&lt;div&gt;Artificial intelligence (AI) is increasingly integrated into scientific publishing workflows, yet no study has formally evaluated the ability of large language models (LLMs) to reproduce human editorial desk-review (R0) decisions in a general orthopaedic surgery journal. We investigated whether three commercially available LLMs could accurately replicate the editorial decisions of the Editorial Board of Orthopaedics &amp; Traumatology: Surgery &amp; Research (OTSR). The study addressed four questions: (1) Is the concordance between LLM and human R0 decisions satisfactory for editorial use? (2) Do LLMs exhibit a severity bias? (3) Do LLMs generate decision letters of acceptable quality, and do they reproduce the specific critiques of human reviewers? (4) Does prompt complexity influence LLM decision-making?&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Hypothesis&lt;/h3&gt;&lt;div&gt;LLMs used without task-specific fine-tuning or prior exposure to the study corpus would demonstrate at least moderate concordance (κ ≥ 0.40) with human editorial decisions.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Material and methods&lt;/h3&gt;&lt;div&gt;A corpus of 32 manuscripts randomly selected from submissions to OTSR between 2025 and 2026 (n = 10 outright rejected at R0: 3 out of scope, 3 plagiarism/dual submission, 4 direct desk rejection; n = 11 accepted for peer review; n = 11 rejected after full peer review) was anonymised and independently evaluated, without task-specific fine-tuning or prior exposure to the study corpus, by ChatGPT (GPT-5.5, OpenAI), Gemini (3.1, Google), and Claude (Sonnet 4.6, Anthropic) using a structured prompt incorporating the OTSR guidelines. The primary outcome was assessed using Cohen's kappa between LLM and human binary decisions. Secondary outcomes included accuracy, inter-LLM agreement, domain-specific scoring, ARCADIA quality scoring of 115 eligible decision letters by two blinded raters with ICC, human-performed content concordance analysis, sensitivity analysis (structured vs. minimal prompt), and test–retest reproducibility at 24 h.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;Overall accuracy (i.e. the decision was similar for LLM and editorial decision) was 59.4% for ChatGPT (19/32) and Claude (19/32), and 62.5% for Gemini (20/32). Cohen's kappa was near-zero for ChatGPT (κ = −0.05) and Gemini (κ = 0.00), and low for Claude (κ = 0.15). All LLMs showed systematic over-rejection of accepted manuscripts. No LLM identified plagiarism or simultaneous dual submission as a rejection motive. Test–retest concordance was 84.4–90.6 % across models. ARCADIA quality scoring (n = 115 scorable letters, inter-rater ICC = 0.86, 95% CI 0.80–0.90) showed Claude achieved the highest scores (4.46 ± 0.32 /5), significantly above the human OTSR letters (4.01 ± 0.44, p &lt; 0.001), ChatGPT (3.81 ± 0.49, p = 0.002), and Gemini (3.28 ± 0.49, p &lt; 0.001). LLMs reproduced 30–41 % of human reviewer-specific critiques, with Claude achieving the highest match (40.5%) without hallucinations. Switchi","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":"112 6","pages":"Article 104801"},"PeriodicalIF":2.7,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148586104","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"What would be the ideal robotic companion in orthopaedic surgery in 10 years?","authors":"Alberto Fogacci,&nbsp;Pascal Kouyoumdjian,&nbsp;Tarik Ait Si Selmi,&nbsp;Sophie Putman,&nbsp;Christophe Jacquet,&nbsp;Sebastien Lustig","doi":"10.1016/j.otsr.2026.104803","DOIUrl":"10.1016/j.otsr.2026.104803","url":null,"abstract":"<div><h3>Background</h3><div>Robotic-assisted surgery is now an established part of contemporary orthopaedic practice, particularly in knee arthroplasty, where it has reliably improved the accuracy and reproducibility of implant positioning and bone preparation compared with conventional techniques. Better technical execution, however, has not consistently translated into better patient outcomes or implant survivorship, suggesting that the next decade of development may depend less on additional precision than on addressing clinical needs that remain unmet.</div></div><div><h3>Purpose</h3><div>To examine the current strengths and limitations of robotic-assisted orthopaedic surgery and to define, from the surgeon’s perspective, the characteristics of an ideal robotic companion over the next decade across five domains: smarter planning and clinical decision support, simpler workflow and wider accessibility, better intraoperative assessment of soft tissues and biomechanics, greater patient-specific adaptability, and integration into surgical education.</div></div><div><h3>Methods</h3><div>Narrative review of the current literature on robotic-assisted orthopaedic surgery, with particular focus on total knee arthroplasty and on emerging enabling technologies.</div></div><div><h3>Results</h3><div>Progress in artificial intelligence, imaging analysis, augmented reality, sensor technologies and simulation could extend the robotic role well beyond surgical execution, towards planning, intraoperative decision support, patient-specific adaptation and training. Realising this potential will require solid clinical validation, improved cost-effectiveness, smooth workflow integration, and careful attention to the ethical and medicolegal questions these systems raise.</div></div><div><h3>Conclusion</h3><div>A robotic companion should never replace surgical judgement; its role is to provide clinically meaningful information that helps surgeons decide better, tailor treatment and improve care. Future systems should be judged on clinical grounds rather than technical sophistication — not by how advanced they are, but by whether they solve the problems surgeons and patients actually face.</div></div><div><h3>Level of evidence</h3><div>V; Expert opinion.</div></div>","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":"112 6","pages":"Article 104803"},"PeriodicalIF":2.7,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148594627","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Artificial intelligence: Let’s revolutionize efficiency in the operating room!","authors":"Louis Dagneaux,&nbsp;Carla Tournoud,&nbsp;Jesse I. Wolfstadt,&nbsp;Johnathan Lex,&nbsp;Julian Costantini,&nbsp;Joshua C. Rozell,&nbsp;Stanislas de Couasnon","doi":"10.1016/j.otsr.2026.104732","DOIUrl":"10.1016/j.otsr.2026.104732","url":null,"abstract":"","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":"112 6","pages":"Article 104732"},"PeriodicalIF":2.7,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147823494","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"French Innovations in Lower Limb arthroplasty that have Become “Gold Standards”: an overview","authors":"Jean-Marie Philippeau,&nbsp;Nazim Mehdi,&nbsp;Henri Favreau,&nbsp;Marion Di Schino,&nbsp;David Dejour,&nbsp;Denis Huten,&nbsp;Jacques Yves Nordin,&nbsp;Bernard Augereau,&nbsp;Moussa Hamadouche","doi":"10.1016/j.otsr.2026.104802","DOIUrl":"10.1016/j.otsr.2026.104802","url":null,"abstract":"<div><div>This paper aims at reviewing some of the major French innovations in lower limb arthroplasty. This achievement could happen only through substantial efforts from pioneers that understood they had to adhere to the general principles of research through well designed studies, robust evaluation tools, and long-term follow-up studies. One of the major inventions in total hip arthroplasty (THA) was dual mobility cups (DMC). The concept of DMC has clearly demonstrated clinical efficiency in the prevention and treatment of postoperative dislocation both in primary and revision THAs. Another landmark progress in THA was introduced through alumina ceramic bearings. This material has exceptional tribological properties leading to an extremely low volume production of wear particles. Concerning major bone defects in revision THAS, Marcel Kerboull introduced a reinforcement device that could bridge the inferior margin of the acetabulum to the ilium in association with bone reconstruction using allograft. The reported results have been favorable, and together with DMC, this type of construct has become largely diffused internationally, in particular in Japan. Another topic that has emerged from France is related to total ankle arthroplasty (TAA). Major progress was made in the mid-90 s including a keeled tibial component, talar resurfacing, and a mobile PE insert. The French TAA registry also represents a major advancement demonstrating the French contribution to the development of TAA. In total knee arthroplasty (TKA), an original approach was introduced by the Lyon school of surgery through the third condyle concept to reproduce knee kinematics and reduce complications related to the post-cam mechanism. This design provided favorable clinical outcomes and high survival, and was the basis of modern implants and personalized knee arthroplasty. Also an innovative fixed-hinge TKA, the GUEPAR, was designed by French surgeons in the 1970s with further versions to deal with complex situations. However, due to specific complications related to the use of polyethylene and later metallic bushings and to the transverse axle, fixed-hinge TKAs were progressively abandoned and currently replaced by rotating-hinge designs.</div><div>These examples demonstrate the extremely active participation of the French orthopaedic community to the development and knowledge of lower limb arthroplasty in order to provide the patients with optimal care.</div></div><div><h3>Level of evidence</h3><div>V; expert opinion.</div></div>","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":"112 6","pages":"Article 104802"},"PeriodicalIF":2.7,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148586045","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}