Advances in Orthopedics最新文献

{"title":"Reevaluating Projections: Total Knee Arthroplasty Volume Before and After COVID-19 in a Single Orthopedic Practice.","authors":"Mitchel Hawley, Lachlan F Anderson, Erica R Olfson, David N Shau","doi":"10.1155/aort/5527598","DOIUrl":"10.1155/aort/5527598","url":null,"abstract":"<p><strong>Introduction: </strong>The increasing demand for primary (pTKA) and revision total knee arthroplasty (rTKA) has been well documented, with previous literature projecting growth through the year 2030. However, the COVID-19 pandemic introduced a significant disruption to healthcare delivery, and its long-term impact on arthroplasty volume trends remains unclear. This study examines the trajectory of pTKA and rTKA volumes in a high-volume private orthopedic practice before and after the pandemic to assess potential lasting effects.</p><p><strong>Methods: </strong>This retrospective observational study included 11,589 pTKA and 857 rTKA procedures performed between January 1, 2018, and December 31, 2023. Quarterly volumes were analyzed using segmented interrupted time-series regression, with Q2 2020 (April-June) defined as the interruption. Models estimated the preinterruption trend, immediate level change, change in slope, and postinterruption trend using Newey-West standard errors. Sensitivity analyses excluded Q2 2020, modeled it as a temporary shutdown, and adjusted for calendar-quarter seasonality.</p><p><strong>Results: </strong>The preinterruption pTKA trend was +1.30 procedures per quarter (95% CI, -6.61-9.21; <i>p</i> = 0.735). At Q2 2020, pTKA volume decreased immediately by 90.33 procedures (95% CI, -156.21--24.45; <i>p</i> = 0.010). The postinterruption slope was +11.67 procedures per quarter (95% CI, 4.93-18.40; <i>p</i> = 0.002); however, the change from the preinterruption slope was not statistically significant (+10.37 procedures per quarter; 95% CI, -2.08-22.82; <i>p</i> = 0.098). The positive postrecovery pTKA slope persisted after excluding Q2 2020. No significant immediate level or slope changes were identified for rTKA, including a postinterruption slope of +0.63 procedures per quarter (95% CI, -0.68-1.93; <i>p</i> = 0.328).</p><p><strong>Conclusion: </strong>Within this single private orthopedic practice, the pandemic interruption was associated with an immediate reduction in pTKA volume followed by a positive postinterruption trend. However, the formal change from the pre-interruption slope was not statistically significant, and no significant trend changes were identified for rTKA. These findings represent temporal associations and may also reflect deferred care, outpatient migration, expanded ambulatory capacity, and other contemporaneous practice or policy changes.</p>","PeriodicalId":7358,"journal":{"name":"Advances in Orthopedics","volume":"2026 ","pages":"5527598"},"PeriodicalIF":1.5,"publicationDate":"2026-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13639843/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149102742","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":"CT-Based Radiostereometric Analysis: A Promising Alternative to Conventional Radiostereometric Analysis in Determining Polyethylene Wear in Total Hip Arthroplasty.","authors":"Elin Kramer, Olof Sandberg, Anders Brüggemann, Nils P Hailer, Olof Sköldenberg, Cyrus Brodén","doi":"10.1155/aort/8544470","DOIUrl":"10.1155/aort/8544470","url":null,"abstract":"<p><strong>Background: </strong>CT-based radiostereometric analysis (CT-RSA) enables the measurement of early implant migration after Total Hip Arthroplasty (THA) with high precision and accuracy at a low effective radiation dose. This study is the first to investigate whether CT-RSA might be comparable to conventional radiostereometric analysis(RSA) even for in vivo polyethylene liner wear measurements after THA.</p><p><strong>Purpose: </strong>To evaluate the comparability of CT-based RSA and conventional RSA for measuring polyethylene liner wear after THA.</p><p><strong>Materials and methods: </strong>A total of 8 patients treated with a reverse hybrid THA (cemented cup and uncemented stem) were included from an ongoing RSA study. CT-RSA and RSA images were taken immediately postoperatively and after 6 years to compare measurements of the polyethylene wear. Double examinations were performed to estimate the precision of the CT-RSA method.</p><p><strong>Results: </strong>Wear measured as median proximal translation of the femoral head into the cup at 6 years was 0.10 mm (IQR 0.02-0.17 mm) as measured by RSA and 0.13 mm (IQR 0.04-0.27 mm) by CT-RSA. Bland-Altman plots indicated good agreement between the methods; for proximal wear the mean difference between methods was 0.04 mm (limits of agreement -0.37-0.46 mm). Proximal wear precision was 0.16 mm for RSA and 0.15 mm for CT-RSA. The mean effective radiation dose was 0.2 mSv per CT scan and 0.04 mSv per RSA scan.</p><p><strong>Conclusion: </strong>This exploratory study suggests that CT-RSA provides wear measurements comparable to those obtained with conventional RSA and may therefore represent a viable alternative for evaluating liner wear in future implant studies. <b>Trial Registration:</b> ClinicalTrials.gov: NCT02254980.</p>","PeriodicalId":7358,"journal":{"name":"Advances in Orthopedics","volume":"2026 ","pages":"8544470"},"PeriodicalIF":1.5,"publicationDate":"2026-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13583166/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148987796","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":"Osseointegrated Dental Implants as Retention Systems for Digit Prostheses in Finger Amputations.","authors":"Ahmad Alzoubi, Iasmina Alhiasat, Ahmad Almigdad, Ali Rababah, Ahmed Al-Khawaldeh","doi":"10.1155/aort/6755229","DOIUrl":"10.1155/aort/6755229","url":null,"abstract":"<p><strong>Introduction: </strong>Finger amputation significantly impairs hand function and self-image. When surgical reconstruction or replantation is not possible, a finger prosthesis can provide cosmetic and functional benefits. However, conventional prostheses are limited by poor retention and lack of sensation. In this study, we evaluate an alternative method using osseointegrated dental implants to anchor finger prostheses, which provide stable fixation and, in turn, improve function and sensory feedback.</p><p><strong>Method: </strong>Four patients with traumatic amputations of a single finger each (thumb, index, middle, and ring fingers) underwent a two-stage surgical procedure. In the first stage, a titanium dental implant was placed into the medullary canal of the residual bone. After a three-month osseointegration period, a second-stage surgery attached a skin-penetrating abutment. Finally, a custom-made, color-matched silicone prosthesis was secured to the abutment. Outcomes were evaluated through clinical and radiographic follow-up, along with patient-reported satisfaction.</p><p><strong>Results: </strong>Three of four patients achieved successful osseointegration by three months. One thumb reconstruction was complicated by nonunion and implant loosening, requiring implant removal. One superficial abutment-site infection resolved with conservative treatment. Functional outcomes were favorable, with improved grip and pinch strength, preserved joint motion, enhanced sensibility, and high patient satisfaction with cosmetic and functional results.</p><p><strong>Conclusion: </strong>Osseointegrated dental implants may offer a feasible option for retention of digital prostheses in selected patients. Although short-term outcomes were encouraging, complications can occur, and careful patient selection and biomechanical planning are essential. Larger studies with longer follow-up are needed to confirm long-term safety, durability, and implant survival.</p>","PeriodicalId":7358,"journal":{"name":"Advances in Orthopedics","volume":"2026 ","pages":"6755229"},"PeriodicalIF":1.5,"publicationDate":"2026-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13547949/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148904745","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":"Advancements in Surgical Management of Carpal Tunnel Syndrome: A Comparative Review of Open, Endoscopic, and Ultra-Minimally Invasive Techniques.","authors":"Nikeeta Nancoo, Ira Bhasin, Nasir Kharma, Yousef Al Shahomi, Amar Shamsah, Ezzeldin A Shalaby, Amanda Jane Abel, Aaron Samuel, Helal Salem Alhajri, Najeeb Ansari, Bramaes Dahal, Manju Rai","doi":"10.1155/aort/9652002","DOIUrl":"10.1155/aort/9652002","url":null,"abstract":"<p><strong>Purpose: </strong>Carpal tunnel syndrome (CTS) is the most common entrapment neuropathy, with surgical decompression as the definitive treatment for refractory or severe cases. With the evolution of surgical techniques, from open carpal tunnel release (OCTR) to endoscopic (ECTR) and ultra-minimally invasive ultrasound-guided approaches, there remains a need for a comprehensive comparative evaluation. This review aims to critically assess contemporary surgical modalities for CTS and to provide an evidence-based framework for patient-centered surgical decision-making.</p><p><strong>Methods: </strong>A structured narrative review was conducted using PubMed/MEDLINE, Scopus, Cochrane Library, and Web of Science, covering studies from 1985 to February 2026. Eligible studies included randomized controlled trials, cohort studies, systematic reviews, and meta-analyses reporting clinical outcomes of OCTR, ECTR, and ultrasound-guided techniques. Outcomes assessed included symptom relief, functional scores, complications, recurrence, return to work, and cost-effectiveness. Data were synthesized thematically due to heterogeneity.</p><p><strong>Results: </strong>OCTR and ECTR demonstrate comparable long-term symptom relief and functional outcomes. ECTR offers advantages in early postoperative recovery, including reduced pain and faster return to work. Ultra-minimally invasive ultrasound-guided techniques show promising early outcomes and accelerated recovery in selected patients, though long-term data remain limited. Complication rates are low across techniques and are influenced more by surgical expertise and completeness of release than by approach alone. Economic analyses suggest early recovery may offset higher procedural costs in working populations.</p><p><strong>Conclusion: </strong>Long-term outcomes of CTS surgery are broadly equivalent across techniques when adequate decompression is achieved. The surgical approach should be individualized based on disease severity, patient factors, occupational demands, and surgeon expertise. Further high-quality, long-term comparative studies are needed to define the role of emerging ultra-minimally invasive techniques.</p>","PeriodicalId":7358,"journal":{"name":"Advances in Orthopedics","volume":"2026 ","pages":"9652002"},"PeriodicalIF":1.5,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13528443/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148863160","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":"Current Procedural Terminology Codes Combined With Hip and Femur Diagnosis-Related Groups Provide a More Accurate Assessment of Costs.","authors":"Robert A Hymes, Daniel L Rodkey, Max A Schulman, Christopher Kuenze, Jeff E Schulman, Jalen N Broome, Sydney L Payne, Greg E Gaski","doi":"10.1155/aort/5644038","DOIUrl":"10.1155/aort/5644038","url":null,"abstract":"<p><strong>Introduction: </strong>Diagnosis-Related Groups (DRGs) have become the basis of the Center of Medicare & Medicaid Services (CMS) hospital reimbursement system. Wide variability of patient factors and procedures bundled into a single DRG may contribute to significant cost variation and limited usefulness when analyzing economic performance. This investigation sought to analyze variation in hip and femur fracture inpatient costs as assessed by DRG and Current Procedural Terminology (CPT) codes.</p><p><strong>Materials and methods: </strong>Patients age ≥ 18 treated with operatively managed fractures of the hip and femur at a Level 1 trauma center from 2019 to 2021 were retrospectively reviewed. Patients categorized as DRG 480, with major comorbidity/complication; 481, with comorbidity/complication; and 482, without comorbidity/complication were eligible. Seven common CPT codes were analyzed after exclusion of patients with low frequency CPT codes (< 50 instances). The primary outcome was total direct costs by DRG and CPT codes. Total direct costs were compared among CPT codes within each DRG using an ANOVA model. Costs were also compared among DRGs for each CPT code. Secondary outcomes include comparison of total direct costs by surgeon within DRG and within each CPT code.</p><p><strong>Results: </strong>A total of 896 patients were analyzed. Significant variation in costs was observed among different DRGs for specific CPTs (<i>p</i> < 0.001). Similarly, notable variation in total direct costs was recorded among different CPTs within each given DRG (<i>p</i> < 0.001). Although cost variations were observed between surgeon and DRG (<i>p</i> < 0.001), no significant interaction was observed once specific procedural (CPT) data were included in the model (CPT 27245: <i>F</i> = 1.077, <i>p</i> = 0.378; CPT 27506: <i>F</i> = 0.934, <i>p</i> = 0.504).</p><p><strong>Conclusions: </strong>While direct costs are influenced by the complexity of DRG assignment within the hip and femur fracture DRG family, the data may be limited in its applicability given the heterogeneity of patients and procedures captured within each DRG. Evaluating costs using a DRG-CPT combination, instead of DRG alone, may provide a more comprehensive and accurate understanding of costs of care.</p><p><strong>Level of evidence: </strong>Economic and Decision Analyses Level III.</p>","PeriodicalId":7358,"journal":{"name":"Advances in Orthopedics","volume":"2026 ","pages":"5644038"},"PeriodicalIF":1.5,"publicationDate":"2026-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13523068/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148849552","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":"Thermal Effects of Burr and Saw Cutting Tools in Total Knee Arthroplasty.","authors":"Vivek Sharma, Mahbub Alam, Dhiraj Sharma, Lokesh Sharoff, Barbara Pierscionek, Richard Smith, Timothy Parratt","doi":"10.1155/aort/4182322","DOIUrl":"10.1155/aort/4182322","url":null,"abstract":"<p><strong>Aims: </strong>Aseptic loosening after total knee arthroplasty (TKA) can follow thermal bone injury produced by power tools. This study compared the intraoperative bone temperatures generated by rotary burrs used in robotic-assisted TKA (rTKA) with those from oscillating saws used in conventional TKA (cTKA).</p><p><strong>Methods: </strong>A single-centre observational trial employed infrared thermography (30 Hz, ±0.05°C) to record surface temperatures during the distal femoral cut in 14 primary TKAs (rTKA = 6, cTKA = 8). Burr cuts used a 6-mm spherical burr at 80,000 rpm; saw cuts used Stryker sagittal blades. Peak and mean temperatures and the time spent above 47°C, 56°C and 70°C were extracted from the recordings and compared with Mann-Whitney tests.</p><p><strong>Results: </strong>All procedures exceeded the osteonecrosis threshold (47°C); maximal temperatures surpassed 90°C in every burr case and in 5/8 saw cases. Median cutting time was 241 s with the burr versus 26 s with the saw (<i>p</i> = 0.002). The bone remained above 47°C for a median 107 s (IQR 138) with the burr, nearly four-fold longer than with the saw (8 s; IQR 10; <i>p</i> < 0.001). Similar differences were observed above 56°C (65 s vs. 3 s) and 70°C (15 s vs. 0.5 s). Mean temperatures (∼51°C) did not differ significantly between devices.</p><p><strong>Conclusion: </strong>Rotary burrs and oscillating saws both generate potentially harmful heat during TKA, but burrs markedly prolong exposure to cytotoxic temperatures and lengthen operative time. These findings suggest a higher theoretical risk of thermally mediated bone injury and subsequent implant loosening when burrs are used without active cooling. Larger controlled studies should assess mitigation strategies such as irrigation, cooled instrumentation or modified cutting protocols.</p>","PeriodicalId":7358,"journal":{"name":"Advances in Orthopedics","volume":"2026 ","pages":"4182322"},"PeriodicalIF":1.5,"publicationDate":"2026-08-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13481704/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148786960","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":"Inflammatory Bowel Disease and Risk of Periprosthetic Joint Infection After Total Joint Arthroplasty: A Systematic Review of the Current Literature.","authors":"Greta Tanzi Germani, Doriana Di Costa, Antonio Bove, Pierluigi Puca, Franco Scaldaferri, Giulio Maccauro, Raffaele Vitiello","doi":"10.1155/aort/4460484","DOIUrl":"10.1155/aort/4460484","url":null,"abstract":"<p><strong>Background: </strong>Periprosthetic joint infection (PJI) is a severe complication after total joint arthroplasty (TJA). Inflammatory bowel disease (IBD) may plausibly increase this risk because of chronic systemic inflammation, intestinal barrier dysfunction, malnutrition, and exposure to immunosuppressive therapies; however, the available orthopedic literature is sparse and heterogeneous.</p><p><strong>Methods: </strong>This systematic review was revised in accordance with PRISMA 2020 principles and the PRISMA 2020 for Abstracts recommendations. The primary review question was whether patients with IBD undergoing total hip arthroplasty (THA) or total knee arthroplasty (TKA) are at increased risk of PJI or septic revision. Cohort and case-control studies reporting arthroplasty-related infectious outcomes in patients with Crohn's disease, ulcerative colitis, or unspecified IBD were eligible for the primary analysis. To ensure the study is scientifically sound, case reports describing nonprosthetic osteomyelitis were excluded from the primary quantitative analysis and evaluated separately using CARE principles as contextual qualitative evidence. No prospective protocol registration was completed before the original review process.</p><p><strong>Results: </strong>The revised review identified two retrospective cohort studies suitable for the primary analysis and two case reports retained in a separate qualitative appendix. The primary analysis included 22,320 arthroplasty patients with IBD studied against much larger non-IBD comparator cohorts. One THA registry study found a higher risk of septic revision in patients with IBD, whereas one TKA database study found higher postoperative PJI odds in both Crohn's disease and ulcerative colitis. Direct quantitative pooling was considered inappropriate because the studies differed in joint type, follow-up duration, and outcome definition.</p><p><strong>Conclusions: </strong>The currently available evidence suggests that IBD may be associated with an increased risk of infection-related failure after arthroplasty, but the certainty of evidence is low to very low because only two retrospective cohort studies directly addressed this question. Future research should use standardized PJI definitions, report disease activity and immunosuppressive treatment in detail, and prospectively evaluate whether the excess risk is related to IBD itself or to modifiable perioperative factors.</p>","PeriodicalId":7358,"journal":{"name":"Advances in Orthopedics","volume":"2026 ","pages":"4460484"},"PeriodicalIF":1.5,"publicationDate":"2026-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13424604/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148652833","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":"Endoscopic vs Open Surgeries for Piriformis Syndrome: A Systematic Review and Meta-Analysis.","authors":"Fanny Indra Warman, Jifaldi Afrian Maharaja Dinda Sedar, Muhammad Hanun Mahyuddin, Williem Harvey","doi":"10.1155/aort/5126019","DOIUrl":"10.1155/aort/5126019","url":null,"abstract":"<p><strong>Background: </strong>Piriformis syndrome (PS) is a neuromuscular condition caused by compression or irritation of the sciatic nerve near the piriformis muscle, resulting in buttock pain that may radiate to the lower limb. Although most patients improve with conservative treatment, some develop refractory PS and require surgery. Endoscopic decompression has emerged as a minimally invasive alternative to open surgery. This study evaluated the available evidence on surgical outcomes for refractory PS.</p><p><strong>Methods: </strong>This systematic review and meta-analysis followed PRISMA guidelines. PubMed, Scopus, Medline, and ScienceDirect were searched without year restriction. Because no direct comparative studies between endoscopic and open surgeries were identified, both approaches were analyzed separately. Eligible studies reported pain outcomes using the visual analog scale (VAS) and functional outcomes using the modified Harris hip score (mHHS).</p><p><strong>Results: </strong>Twelve studies met the inclusion criteria, including nine endoscopic and three open-surgery studies. Nine studies were eligible for quantitative synthesis. Pooled analysis of six endoscopic studies showed a significant reduction in VAS (mean difference -4.7; 95% CI -5.2--4.2) and improvement in mHHS (mean difference +25.6; 95% CI +16.0-+35.3). Endoscopic complication rates ranged from 0% to 12% and were mostly minor. Open-surgery evidence was limited and synthesized narratively only.</p><p><strong>Conclusion: </strong>Endoscopic decompression appears to provide favorable outcomes in carefully selected patients with refractory PS. However, definitive superiority over open surgery cannot be established from the current literature.</p>","PeriodicalId":7358,"journal":{"name":"Advances in Orthopedics","volume":"2026 ","pages":"5126019"},"PeriodicalIF":1.5,"publicationDate":"2026-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13422639/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148629215","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 Outcomes of Resurfacing vs Total Hip Arthroplasty: A Systematic Review and Meta-Analysis.","authors":"Christoforos Demosthenous, Christos Pittalis, Gregoris A Orphanides, Konstantinos Antoniou, Efthimios Demetriou, Petros Kyriakou, Vasilis Stylianides, Foteini Moniati","doi":"10.1155/aort/4661645","DOIUrl":"10.1155/aort/4661645","url":null,"abstract":"<p><strong>Background: </strong>Total hip arthroplasty (THA) and resurfacing hip arthroplasty (RHA) are widely used for treating hip joint disorders. While THA is the gold standard for hip replacement, RHA is increasingly used in younger, active patients due to bone preservation. This systematic review and meta-analysis compare functional outcomes, metal ions, complications, revision rates, survivorship and satisfaction between THA and RHA.</p><p><strong>Methods: </strong>A systematic search of EMBASE, Cochrane Library and PubMed was conducted (inception-August 2024) to identify primary research articles for THA and RHA. Risk of bias was assessed using the Newcastle-Ottawa Quality Assessment Scale. A meta-analysis using MATLAB applied a random-effects model to calculate pooled effect sizes for functional scores, revision rates, complications and metal ions.</p><p><strong>Results: </strong>Initial search collated 2265 studies, of which 11 met inclusion criteria (2013-2021). Most frequently reported outcomes included complications, revision rates and UCLA. RHA showed better UCLA, HHS and chromium levels, while THA had better WOMAC and cobalt levels, although differences were nonsignificant. Total complications were higher with THA, though nonsignificant. The most common complications were aseptic loosening and dislocation for RHA and THA, respectively. Notably, when the dislocation rate was analysed in isolation, a statistically significant higher dislocation rate was demonstrated with THA. Revision rates were higher for THA, and survivorship was 85.5% compared to 89.5% (RHA), however, with no statistical difference. Statistically significant higher preference for RHA (66.1%) was reported in one study. Satisfaction was greater for RHA (87.8% vs 83.9%) and more patients perceived their hip as natural. One study reported significantly higher quality of life with THA.</p><p><strong>Conclusion: </strong>Patient-reported outcomes, metal ions, complications, revision rates and survivorship were broadly similar between RHA and THA. However, dislocations were more frequent with THA, a key consideration when treating athletic patients. Greater satisfaction and preference with RHA suggest that it may be preferable when outcomes are otherwise comparable.Christoforos Demosthenous and Christos Pittalis are joined-first authors.</p>","PeriodicalId":7358,"journal":{"name":"Advances in Orthopedics","volume":"2026 ","pages":"4661645"},"PeriodicalIF":1.5,"publicationDate":"2026-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13341940/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148410004","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":"Short-Term Clinical Outcomes of a Manual \"Inside-Out\" Algorithm for Correcting Ranawat Grade II and III Valgus Deformity in Total Knee Arthroplasty.","authors":"Medhat Mohamed Hassan, Molham Mahmood Mohammad, Khalid Mohamed Abdelhaleem Hafez, Alaa El-Din Mohy El-Din Soliman","doi":"10.1155/aort/7006795","DOIUrl":"10.1155/aort/7006795","url":null,"abstract":"<p><strong>Background: </strong>Total knee arthroplasty (TKA) in the fixed valgus knee is technically demanding due to lateral soft-tissue contractures and the risk of peroneal nerve injury. This study evaluates the clinical and radiographic outcomes of a manual \"inside-out\" soft-tissue balancing algorithm for Ranawat Grade II and III valgus deformities.</p><p><strong>Materials and methods: </strong>We prospectively evaluated 30 knees (24 patients) with advanced arthritis and valgus deformity (> 10°) treated between 2016 and 2019. Surgical correction followed a sequential \"inside-out\" protocol: posterior cruciate ligament (PCL) resection, posterolateral capsule (PLC) release, and selective iliotibial band (ITB) pie-crusting within a strict 1-cm safety zone. Clinical outcomes were measured using the Knee Society Score (KSS). Radiographic analysis focused on the tibiofemoral angle and component alignment. Results were compared with traditional manual techniques and novel robotic-assisted data.</p><p><strong>Results: </strong>The mean KSS improved significantly from 19.63 preoperatively to 87.17 at the final follow-up (<i>p</i> < 0.001). The mean tibiofemoral valgus angle was corrected from 24.28° to 4.97°. Absolute medial stability was achieved in 96.6% of cases. Notably, in our series, no cases of peroneal nerve palsy were observed (0%; 95% CI: 0.0%-11.6%), suggesting a high safety profile for the inside-out technique. Two intraoperative periprosthetic fractures (6.6%) occurred and were managed successfully.</p><p><strong>Discussion: </strong>Our manual algorithm achieved safety and alignment outcomes comparable to novel robotic-assisted TKA series. The \"inside-out\" approach provides excellent exposure and controlled lengthening of contracted structures while protecting neurovascular anatomy.</p><p><strong>Conclusion: </strong>The manual \"inside-out\" technique is a safe, reproducible, and cost-effective method for correcting severe valgus deformity. It provides high precision in gap balancing and effectively eliminates the risk of peroneal nerve palsy in Ranawat Grade II and III cases. It ensures high precision in gap balancing and effectively minimizes the risk of peroneal nerve palsy, providing a reliable alternative in settings where robotic technology is inaccessible.</p>","PeriodicalId":7358,"journal":{"name":"Advances in Orthopedics","volume":"2026 ","pages":"7006795"},"PeriodicalIF":1.5,"publicationDate":"2026-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13316951/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148359103","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}