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To evaluate whether constrained acetabular liners (CAL) used in total hip arthroplasty (THA) reduce the risk of dislocation and related complications in patients with neuromuscular disorders and unstable comminuted femoral intertrochanteric fractures (ITF). This retrospective cohort study included patients diagnosed with Evans type III-V ITFs who underwent hemiarthroplasty or THA at our institution from July 2011 to July 2016. Patients were divided into two groups: a hemiarthroplasty group and a CAL group. Radiological data, clinical records, and laboratory test results were meticulously collected. Differences between the two groups were analyzed to support clinical decision-making regarding treatment strategies. Significant differences were observed between the two groups in operation duration (90.50 ± 25.12 vs. 110.10 ± 26.38 min, P = 0.008), intraoperative blood loss (205.12 ± 68.50 vs. 275.58 ± 83.36 mL, P = 0.003) and blood transfusion rate (16.67% vs. 30.87%, P = 0.012). Compared to hemiarthroplasty, CAL was associated with a significantly higher risk of heterotopic ossification (HO) (Odds ratio = 1.198, 95% CI: 1.020-1.850), a higher risk of aseptic loosening (Odds ratio = 1.155, 95% CI: 0.708-1.782), and a lower risk of dislocation (Odds ratio = 0.120, 95% CI: 0.022-0.552). Among patients with neurological disorders undergoing HA for unilateral unstable comminuted femoral ITF, CAL THA was correlated with a lower postoperative dislocation rate but increased risks of aseptic loosening and HO. Despite reducing dislocation risk, the overall clinical benefits of CAL appeared limited. Additionally, no significant differences in long-term hip function outcomes were observed between CAL and conventional hemiarthroplasty.

There is increasing use of preoperative biomarker assessment in patients undergoing total knee arthroplasty. Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) are the commonly used measures of ongoing inflammation. The impact of discordance between these values on postoperative outcomes remains poorly understood. Three cohorts were identified: one with a mildly elevated ESR and normal CRP, the other with a mildly elevated CRP and normal ESR, and the third with a mildly elevated ESR and CRP, with laboratory values obtained within 1 month of primary total knee arthroplasty. Groups were compared to patients with normal markers. At 90 days postoperatively, patients with mildly elevated CRP and ESR had a significantly higher odds of periprosthetic joint infection (PJI) compared to patients with normal inflammatory markers (odds ratio [OR]: 3.90; 95% confidence interval [CI]: 2.28-6.68; P < .001). At 3 years postoperatively, patients with mildly elevated inflammatory markers had significantly higher odds of PJI (OR: 3.80; 95% CI: 2.41-6.00; P < .001), complications (OR: 1.34, 95% CI: 1.00-1.79; P = .047), and revision knee arthroplasty (OR: 3.34; 95% CI: 1.68-6.64; P < .001). At 90 days, patients with mildly elevated preoperative CRP (5.1-15 mg/L) and normal ESR demonstrated significantly increased odds of PJI compared to patients with normal markers (OR: 2.00, 95% CI: 1.37-2.87; P < .001). Mildly elevated CRP and ESR were significantly associated with an increased risk of PJI, revision arthroplasty, and composite complications. Elevated ESR with normal CRP was associated with a higher risk of composite complications at 3 years postoperatively.

Acute pulmonary thromboembolism is a serious complication of total hip arthroplasty that may be asymptomatic, underscoring the importance of early detection. Contrast-enhanced computed tomography is the standard diagnostic modality; however, its use is limited by its invasiveness, radiation exposure, contrast allergy, and renal dysfunction. Dynamic digital radiography is a novel, minimally invasive imaging technique that enables visualization of pulmonary perfusion without contrast agents. We report a case of a 58-year-old woman who underwent primary total hip arthroplasty. Post-operatively, the patient remained asymptomatic. One week after total hip arthroplasty, follow-up dynamic digital radiography demonstrated newly developed pulmonary perfusion abnormalities, with marked signal reduction in the right middle and lower lung zones, and a mild reduction in the left upper lung zone. Subsequent contrast-enhanced computed tomography confirmed bilateral pulmonary thromboembolism corresponding to perfusion defects detected using dynamic digital radiography. Anticoagulant therapy completely resolved the thromboembolism. This case highlights the potential utility of dynamic digital radiography for early detection of asymptomatic acute pulmonary thromboembolism following total hip arthroplasty.

Surgical treatment for forefoot deformities in patients with rheumatoid arthritis (RA) has recently shifted toward joint-preserving procedures for all toes. In contrast, resection arthroplasty was previously commonly performed for lesser toes. Advances in drug therapy have improved life expectancy, resulting in an increased number of long-term survivors who previously underwent resection arthroplasty. With increased activity levels, recurrence of plantar callosities in the forefoot has become more frequent, often leading to gait disturbance. In general, revision surgery for such cases often involves additional bone resection; however, this approach may result in further shortening of the metatarsals and increase the risk of further recurrence. Therefore, we applied metatarsal shortening offset osteotomy, which we typically perform as a primary procedure, as a salvage procedure to reduce the risk of recurrence. We report three cases treated using this strategy. In all cases, the second to fifth metatarsal heads had been resected, but the resection stumps were covered with pseudo-cartilaginous tissue. This allowed metatarsal shortening offset osteotomy to be performed as a procedure similar to that used in primary surgery, achieving the planned correction. Consequently, both radiographic and clinical improvements were observed. These findings suggest that metatarsal shortening offset osteotomy may be a possible salvage option after primary resection arthroplasty for forefoot deformity in patients with RA.

The incidence of periprosthetic distal femur fractures after total knee arthroplasty (TKA) is increasing in parallel with the increasing number of primary TKA procedures being performed. This number will continue to rise going forward. Treatment decisions depend on patient factors, fracture characteristics, and implant stability. It is important to have a thorough understanding of the available modalities for treatment, including their indications, advantages, and disadvantages, to effectively manage these injuries and optimize outcomes. Nonoperative treatment is indicated in select cases but is generally associated with inferior outcomes, including higher rates of nonunion, malunion, and medical complications secondary to prolonged immobility. Operative management is the gold standard, and options include open reduction internal fixation (ORIF) with plates and screws, intramedullary nailing (IMN), nail/plate combination constructs, and revision arthroplasty with distal femoral replacement (DFR). Locking plate fixation can be useful for comminuted or more complex fractures and poor bone stock, while IMN is less invasive, preserving biology and allowing for earlier mobilization in some cases, especially when combined with plating. DFR is indicated for cases of implant loosening or severe bone loss and has been associated with more reliable early weight-bearing at the expense of increased risks for infection and revision arthroplasty. Overall, each of the treatment modalities discussed is a viable option for the management of these complex injuries. Management should ultimately be tailored to the individual patient. The surgeon should consider patient factors, fracture characteristics, implant stability, and their own level of expertise when deciding on treatment.

&#xa0;Prospectively registering the primary trial outcome is important to reduce selective outcome reporting and increase the trustworthiness of findings, which guide clinical practice. The objectives of our systematic review were to explore and compare the reporting characteristics of prospectively and non-prospectively registered trials investigating exercise therapy following total knee arthroplasty. &#xa0;Randomized trials comparing effects of exercise therapy after total knee arthroplasty for osteoarthritis were identified in 4 databases from 2000 to August 12, 2024. One primary outcome per trial was extracted, using a pre-specified hierarchical algorithm, irrespective of outcome domain. Pooled standardized mean differences (SMDs) were calculated on pre-specified outcome domains, and risk-of-bias assessed using the Cochrane Risk-of-Bias tool v2. &#xa0;94 trials, comprising 9,396 participants, were included, of which 13 were prospectively registered, 33 retrospectively registered, and 48 unregistered. A single primary outcome was defined in 44% of the 94 trials, and 4 trials reported a primary outcome consistent with a prospective registration. The pooled SMD of primary outcomes was 0.06 (95% confidence interval [CI] -0.03 to 0.16) for prospectively registered trials, 0.67 (CI 0.22-1.11) for retrospectively registered trials, and 0.59 (CI 0.32-0.86) for unregistered trials. Lower risk-of-bias ratings and higher proportions of intention-to-treat adherence, dropout reporting, and adverse event reporting were observed among prospectively registered trials. &#xa0;Among prospectively registered trials we showed smaller effect size estimates between interventions with lower risk-of-bias ratings, and higher proportions of intention-to-treat adherence, dropout reporting, and adverse event reporting in contrast to trials without prospective registration; furthermore, clear specification of a single primary outcome was uncommon among trials evaluating exercise therapy after total knee arthroplasty.

Radial head fractures are among the most common elbow injuries in adults. The choice between osteosynthesis and radial head arthroplasty (RHA) remains controversial, particularly in comminuted or unstable fracture patterns. This study aims to compare functional and radiographic outcomes, complication rates, and patient satisfaction following osteosynthesis or arthroplasty in the surgical management of radial head fractures. A retrospective cohort of 35 patients treated surgically for radial head fractures between 2018 and 2022 was analyzed. Fractures were classified using the Mason classification and stratified by complexity. Clinical outcomes included the Mayo Elbow Performance Score, visual analog scale for pain, range of motion, and patient satisfaction. Radiographic follow-up identified complications such as pseudarthrosis and implant migration. Statistical comparisons were performed using nonparametric tests, with significance set at P < .05. Of 35 patients, 22 (63%) underwent osteosynthesis and 13 (37%) underwent RHA. The osteosynthesis group showed higher mean Mayo Elbow Performance Score (82.7 vs. 74.6) and lower mean visual analog scale (1.52 vs. 2.54) compared to the RHA group, although differences were not statistically significant. Satisfaction scores were similar (mean = 2.0) in both groups. Range of motion limitations were more frequent in complex fractures but not significantly associated with treatment type. Complication and revision rates were descriptively higher in the RHA group. Osteosynthesis may yield favorable functional outcomes and comparable satisfaction relative to arthroplasty, especially in noncomplex, reconstructable fractures. In our study, the trends favored screw fixation, but overall, these findings should be interpreted cautiously, as no statistically significant differences were observed and the analysis is subject to substantial confounding, supporting an exploratory interpretation. Treatment should be individualized, and long-term follow-up is crucial to assess recovery and detect complications.

There is a rising global burden of cancer cases reported annually, an increase to 35 million cases by 2050 is anticipated. Additionally, an increase in cancer survivorship due to modern oncology advancements exists. There is an increasing need for total hip arthroplasty (THA) in this cohort due to degenerative disease, metastatic disease or oncologic treatment induced bone disease. Advances in cancer treatment have led to an increasing population of cancer survivors who require orthopaedic arthroplasty procedures. The associated surgical risks are amplified in this group, including increased blood loss, decreased systemic reserves and overall frailty. Studies evaluating perioperative outcomes consistently demonstrate that patients with cancer experience increased morbidity and mortality after arthroplasty surgical procedures, compared to the general population. This underscores the need for a comprehensive understanding, risk stratification and multidisciplinary perioperative management to minimize potential surgical-associated risks. However, there are good reported outcomes with THA in cancer patients which are comparable to their controls. This review looks at the critical issues faced by reconstructive orthopaedic surgeons when treating patients with a history of cancer or active malignancy, particularly those undergoing THA. This narrative review aims to explore the bidirectional relationship between cancer and THA, outcomes and management strategies. It will describe the pertinent issues reconstructive surgeons face when treating patients with cancer. The goal is to highlight the clinical intersections, challenges, and necessary management strategies specific to this population. This is especially relevant in view of the rising number of cancer patients being reported globally. Key findings of the review include the elevated risks associated with cancer patients undergoing THA. Complications such as deep vein thrombosis (DVT) in patients with a history of malignancy, and early postoperative mortality in patients with active malignancy are reported. Furthermore, patients with disseminated cancer undergoing elective THA have significantly elevated risks for death and various postoperative complications. It is imperative that adequate preoperative work up, intraoperative planning and post operative management strategies are employed in such cases. The global cancer burden is increasing, along with improved survivorship, this has created a growing subpopulation of patients requiring THA. Surgery in cancer patients presents unique challenges and increased perioperative risks. This underscores the need for comprehensive risk stratification and a multidisciplinary management approach to minimize potential risks. THA offers vital functional and palliative benefits to cancer patients. Therefore, ongoing research and advances in this area are imperative for specialised and effective care for these patients.

&#xa0;Stiffness after total knee arthroplasty (TKA) is a common early complication and multiple risk factors are recognized. We aimed to investigate the risk factors for manipulation under anesthesia after primary TKA and for the subsequent revision TKA in patients requiring manipulation using national healthcare registers. &#xa0;We used the comprehensive register data of the PERFECT project that included data from the Finnish arthroplasty register (FAR) and the Care Register of Health Care (CRHC). We excluded patients under 40 years old. The Aalen-Johansen estimator and Cox proportional hazards regression model were used in the risk assessment. &#xa0;154,883 patients had primary TKA in Finland in 1999-2020 , of which 3,861 patients required manipulation within 1 year of primary TKA. The 1-year cumulative incidence of manipulation was 2.5%. In the multivariable analysis, female sex (hazard ratio [HR] 1.53, CI 1.42-1.64), diabetes mellitus (HR 1.19, CI 1.08-1.31), coronary artery disease (HR 1.25, CI 1.12-1.39), and hypercholesterolemia (HR 1.16, CI 1.06-1.28) were associated with an increased risk of manipulation. Increasing age was associated with a decreased risk of manipulation (multivariable HR 0.94 per year, CI 0.94-0.94). Patients requiring manipulation within 1 year of primary TKA had a significantly increased risk of revision TKA (HR 2.26, CI 2.05-2.50). The 10-year cumulative risk of revision TKA after manipulation was 15% (CI 14-16). &#xa0;Manipulation was more likely to be performed for females, relatively younger patients, and patients with diabetes mellitus, coronary artery disease, or hypercholesterolemia. Patients who had manipulation within 1 year of primary TKA had an increased risk of revision with a 10-year cumulative risk of revision of 15%.

Postoperative resilience varies widely among older adults, yet the biological drivers of recovery remain unclear. We evaluated whether preoperative immune profiles-measured in plasma and through ex vivo whole-blood stimulation-predict resilience to the acute stress of total knee arthroplasty. A total of 152 adults (&#x2265;60 years) in the PRIME-KNEE cohort underwent elective total knee arthroplasty and had available blood samples for measurement of 45 immune biomarkers, quantified in plasma and in whole blood stimulated ex vivo for 24 hours with lipopolysaccharide (LPS) or influenza antigen (FLU). Resilience was assessed using Expected Recovery Differential (ERD) and Resilience Trajectory (RT) across pain severity, pain interference, lower-extremity physical activities of daily living (LE-PADLs), and step counts. An exploratory stability-selection framework using LASSO identified biomarker predictors of postoperative outcomes. Plasma and stimulated biomarkers showed broadly similar predictive performance. A shared set of biomarkers-including LBP, leptin, TNFR1, CD30, and LIF-was consistently selected across models. Immune predictors explained &#x223c;12-24% of the variance in resilience outcomes. Distinct immune signatures emerged for pain versus functional recovery: pain-related predictors mapped to local inflammatory and neuroimmune pathways, whereas function-related predictors reflected systemic inflammatory load and cytokine signaling. Preoperative immune biomarkers, whether measured in plasma or after ex vivo stimulation, capture meaningful variance in postoperative resilience. The divergence between pain-related and function-related immune signatures highlights biologically distinct pathways underlying different dimensions of recovery and supports further development of immune-based perioperative risk assessment. In this study, we explored why recovery after knee replacement surgery varies so widely among older adults. While many people regain mobility and experience pain relief, others continue to struggle with discomfort and limited function. We asked whether differences in the immune system before surgery might help explain these outcomes. To do this, we measured a wide range of immune signals in blood samples collected before surgery and then followed participants over several months, tracking their pain, daily activities, and physical movement. We found that patterns in these immune signals were linked to how well people recovered. Importantly, some of the signals that predicted pain recovery were different from those linked to improvements in physical function, suggesting that these aspects of recovery are driven by distinct biological processes. Our findings place the immune system at the center of recovery from major surgery and highlight its potential as a tool for identifying who may need more support. In the future, this knowledge could help guide more personalized approaches to care and improve recovery for older adults undergoing surgery.

Although os acromiale is often noted on preoperative imaging in patients undergoing reverse total shoulder arthroplasty (rTSA), its clinical significance is ill-defined. The purpose of this study was to compare the clinical outcomes in shoulders with an os acromiale undergoing rTSA with a matched control group. We conducted a retrospective review of a prospectively collected shoulder arthroplasty database for patients who underwent primary rTSA with a minimum 2-year clinical follow-up. Preoperative imaging studies taken within 6 months of surgery were assessed for an os acromiale. Sixty-four shoulders with os acromiale were identified and were matched in a ratio of 1:5 to a control group (n = 320) based on age (within 3 years), sex (exact), preoperative diagnosis, preoperative forward elevation (within 5&#xb0;) and American Shoulder and Elbow Surgeons score (within five points). Clinical outcome scores, shoulder strength, and active range of motion assessed preoperatively and at latest follow-up as well as the incidence of complications were compared between cohorts. Outcomes of meso- and meta-acromion were grouped and compared with preacromion shoulders. The incidence of os acromiale was 9.7% (64/663) in our institution. Of these, 55% (n = 34) were preacromion, 38% (n = 24) were mesoacromion, and 8% (n = 5) were meta-acromion. No statistically significant differences were found in any outcome score, shoulder strength, or range of motion measures between shoulders with os acromiale and matched controls. Similar proportions of each cohort achieved a clinically significant benefit (minimal clinically important difference/substantial clinical benefit) for the Shoulder Pain and Disability Index, Simple Shoulder Test, American Shoulder and Elbow Surgeons score, constant score, abduction, forward flexion, external rotation, and internal rotation. Shoulders with os acromiale had a similar overall complication rate compared with matched controls (14% vs. 12%; P = 0.658). No statistical difference in outcomes were observed between the pre- and meso-/meta-acromion shoulders. Patients with os acromiale undergoing rTSA have similar postoperative functional outcomes and pain relief compared with matched controls. &#x2162;, Retrospective Matched Cohort Study.

Tranexamic acid (TXA) reduces blood loss and transfusion requirements in patients who underwent primary total hip arthroplasty (THA). However, the optimal route of TXA administration remains unclear. This randomized controlled trial evaluated whether intraosseous (IO) TXA administration was noninferior to intravenous (IV) or topical administration. In this equal-proportion, noninferior randomized controlled trial, 126 patients undergoing primary THA from October 2024 to April 2025 were randomized to IO (20 mg/kg TXA applied in the cancellous bone of the femur and ilium), IV (20 mg/kg TXA applied five minutes before incision), or topical (20 mg/kg TXA applied before suture) group. The primary outcome was hemoglobin (Hb) reduction on the day of surgery (DOS) and postoperative days one to three (POD one to three). The secondary outcomes included blood loss, transfusion rate, and adverse events. Demographics were similar among the groups. The mean Hb reduction was comparable on the DOS, POD one, POD two, and POD three (P = 0.431, 0.532, 0.479, and 0.443, respectively). Exploratory analyses showed lower mean calculated total blood loss in the IO group on the DOS and POD one than in the other groups (DOS and POD one: P = 0.005 and 0.016, respectively), although the clinical relevance of this finding remains uncertain. Transfusion rates were 2.3, 7.1, and 2.3% in the IO, IV, and topical group, respectively (P = 0.434). There was one patient in the topical group who developed deep vein thrombosis; no pulmonary embolism or infections were reported. The blood-sparing efficacy of IO TXA administration is noninferior to that of IV and topical administration, with potential benefit in early postoperative blood loss control. Further high-quality studies are needed to confirm its superiority and establish its clinical value.

A common feature of knee osteoarthritis (OA) gait is a stiff-knee pattern characterized by minimal range of motion and more constant loading through the stance phase. Previous work has shown that knee joint kinematics and kinetics following arthroplasty surgery often do not return to age-matched control levels for most patients. Quantification of these gait patterns has traditionally relied on laboratory-based optoelectronic motion capture and synchronized force plates, which are costly, spatially constrained, and limit the clinical scalability of relevant gait metrics. The purpose of this study was to establish an inertial measurement unit (IMU) protocol capable of representing clinically relevant features of the knee adduction and flexion moments during gait in patients with knee OA, with the goal of supporting out of laboratory OA kinetic gait assessment. Multivariate relationships between the knee flexion and adduction moment patterns representing 'stiff-knee' kinetic gait patterns and lower extremity accelerations and angular velocities from lower-extremity worn inertial sensors were examined in patients with end-stage knee OA. Shank-mounted IMU models explained significant variance in the pattern of the knee flexion and adduction moment waveforms (R2&#xa0;=&#xa0;0.55-0.64, p&#xa0;<&#xa0;0.01), and inclusion of foot-mounted sensors further improved model performance (R2&#xa0;=&#xa0;0.67-0.69, p&#xa0;<&#xa0;0.01). Agreement analyses demonstrated minimal bias with moderate limits of agreement between IMU-predicted and motion capture-derived PC2 scores. These findings demonstrated that OA-specific, clinically relevant temporal features of knee moments can be reasonably estimated using IMU data, supporting the potential for real-world OA gait assessment.

The release of a pneumatic tourniquet during total knee arthroplasty (TKA) causes an abrupt increase in blood flow to the lower limb, which may result in transient haemodynamic instability. The aim of this study was to quantify the magnitude and duration of these changes in a real-world clinical setting. A multicentre retrospective observational study was conducted including 149 patients undergoing primary TKA under pneumatic tourniquet ischemia. Systolic (SBP), diastolic (DBP), and mean arterial pressure (MAP), heart rate (HR), respiratory rate (RR), and oxygen saturation (SpO2) were recorded at three time points: baseline (pre-release), 3&#x2009;minutes (T3), and 6&#x2009;minutes (T6) after tourniquet release. Statistical analysis was performed using repeated-measures ANOVA or the Friedman test, according to data distribution, with p&#x2009;<&#x2009;0.05 considered statistically significant. Following tourniquet release, a significant immediate decrease in SBP and DBP was observed (p&#x2009;<&#x2009;0.001), with mean reductions of 19.8% and 21.2%, respectively, at T3. HR showed a mild but significant increase (p&#x2009;=&#x2009;0.012). SpO2 decreased slightly (p&#x2009;=&#x2009;0.034) without clinical relevance. Transient arrhythmias were recorded in 8.7% of patients. At 6&#x2009;minutes post-release, all parameters returned to baseline values. Tourniquet release during TKA is associated with transient haemodynamic changes and early recovery. These findings support the need for reinforced monitoring in patients classified as ASA III and/or with ischemia times longer than 85&#x2009;minutes, and provide a rationale for future prospective studies incorporating advanced haemodynamic monitoring. Level of evidence Level III, retrospective study.

Patient-reported outcome measures (PROMs) are important markers to assess patient improvement after total joint arthroplasty (TJA). PROMs are increasingly relevant because of new PROM-reporting requirements for elective inpatient TJA from the Centers for Medicare & Medicaid Services. Social determinants of health (SDOH) disparities have been associated with various worse outcomes after TJA, but to our knowledge, it is not yet known how PROM completion may be affected by SDOH disparities. Among patients undergoing TJA, (1) are there SDOH disparities (such as insurance, transportation access, and living alone) that are associated with differences in PROM completion? (2) Are there neighborhood metrics, including Social Vulnerability Index (SVI) and the Area Deprivation Index (ADI), that are associated with differences in PROM completion? This study was a retrospective, comparative single-institution study of 12,842 patients who underwent primary, unilateral TJA for osteoarthritis between 2019 and 2022. Study participants had a mean &#xb1; SD age of 67 &#xb1; 10 years, 45% (5745) were men, and 86% (10,131 of 11,833) were White. Mean &#xb1; SD national ADI score was 34 &#xb1; 21, and SVI score was 0.4 &#xb1; 0.3. PROMs were collected within the first year preoperatively and at 6 months, 1 year, and 2 years postoperatively per institutional protocol. Patient demographic and socioeconomic factors were collected from the institutional medical record. We examined whether PROM noncompletion and completion differed in terms of SDOH, including living alone, transportation access, and insurance type. Race and ethnicity were self-reported by patients. We additionally examined whether PROM noncompletion and completion differed in terms of neighborhood metrics including SVI and ADI scores. For proportions, a clinically important difference was defined by a 15% change. We found no clinically important differences regarding SDOH disparities in terms of PROM noncompletion and completion; specifically, there were no differences in PROM completion based on Black race (preoperative: 13% [312 of 2332] versus 9% [884 of 9501]; p < 0.001; 1 year: 11% [886 of 8015] versus 8% [310 of 3818]; p < 0.001), lack of transportation access (preoperative: 3% [67 of 2002] versus 2% [199 of 8494]; p = 0.01; 1 year: 3% [205 of 7050] versus 2% [61 of 3446]; p = 0.001), living alone (preoperative: 23% [466 of 1988] versus 21% [1750 of 8452]; p = 0.01; 1 year: 23% [1577 of 6999] versus 19% [639 of 3441]; p < 0.001), and commercial insurance preoperatively (62% [1577 of 2563] versus 65% [6675 of 10,279]; p < 0.001). For neighborhood-level metrics, we found no clinically important difference for PROM noncompletion and completion in terms of mean &#xb1; SD ADI scores nationally (preoperative: 36 &#xb1; 23 versus 34 &#xb1; 21; p = 0.004; 1 year: 39 &#xb1; 21 versus 33 &#xb1; 20; p < 0.001) and SVI scores (preoperative: 0.4 &#xb1; 0.3 versus 0.4 &#xb1; 0.3, mean difference 0.1 [95% CI 0.53 to 0.73]; p < 0.001; 1 year: 0.4 &#xb1; 0.3 versus 0.4 &#xb1; 0.3, mean difference 0.1 [95% CI 0.61 to 0.80]; p < 0.001). No clinically important difference was found for various SDOH disparities and neighborhood metrics investigated in this study. Considering these findings, lack of transportation access, living alone, race, insurance type, and address-related neighborhood disadvantage may not be strong indicators of PROM completion after TJA. However, SDOH disparities still require further investigation to understand the relationship between other SDOH disparities and different populations outside of our urban institution. Level III, prognostic study.

Knee osteoarthritis is a leading cause of pain and disability and frequently results in total knee arthroplasty (TKA). Decisions about surgery and postoperative management rely largely on subjective pain scales and patient-reported outcome measures (PROMs), and 10-15% of patients remain dissatisfied after TKA despite technically successful surgery. Evidence suggests that pain is partly reflected in peripheral immune signalling, yet this neuroimmune interface has not been studied in patients with joint pain due to knee osteoarthritis. This study will explore whether peripheral immune responses (interleukin-1 beta, IL-1&#x3b2;) are associated with pain and may serve as objective pain biomarkers in patients with painful knee osteoarthritis compared with pain-free controls and how these markers relate to pain and psychological (anxiety, depression and pain catastrophising) PROMs. This will be the first study to correlate pain markers (peripheral immune responses) with subjective pain levels in orthopaedic patients with symptomatic knee osteoarthritis. This is a protocol for a prospective cross-sectional matched-subject observational study. We will include 20 adults undergoing unilateral primary TKA for painful advanced knee osteoarthritis, their contralateral pain-free knees as internal controls and 20 age and sex matched healthy controls without joint pain or functional limitation. All participants will undergo standardised clinical assessment and complete pain and psychological PROMs. In patients with TKA, venous blood will be collected pre-operatively. During TKA surgery, synovial fluid will be aspirated from the painful operated knee and the contralateral pain-free knee. Healthy controls will provide a single venous blood sample at a hospital visit. Peripheral blood mononuclear cells and synovial fluid mononuclear cells will be stimulated ex vivo with toll-like receptor 2 and 4 agonists to quantify IL-1&#x3b2; release. In parallel, hyperspectral imaging will characterise unstimulated immune cell phenotypes. Multivariable statistical and machine-learning approaches will relate biomarker profiles to pain and psychological PROMs. The study has been approved by the Southern Adelaide Local Health Network (SALHN) HREC (references: 2024/HRE00253, SSA 2024/SSA00641). Written informed consent will be obtained from all participants. Study results will be disseminated through peer-reviewed publications and presentations at national and international scientific conferences. ACTRN12626000084381.

Persistent pain after total hip arthroplasty (THA) is a common complication requiring extensive diagnostic effort and is often associated with potentially invasive and morbid treatment options. With THA volume expected to steadily increase there is a similarly growing need for creative and effective diagnostic and therapeutic options for these clinically challenging patients. Hip arthroscopy has emerged as a promising tool in the setting of persistent pain after THA with expanding indications and promising outcomes. The purpose of this article was to provide a review of the current state of literature regarding arthroscopic and endoscopic solutions for common causes of persistent pain after THA with a focus on patient selection, indications, surgical considerations, outcomes, and complications. The most common indication for hip arthroscopy after THA is iliopsoas tendinopathy, showing excellent outcomes with symptom resolution in greater than 90% of patients after arthroscopic iliopsoas release or lengthening. The second most common indication is diagnostic arthroscopy in the setting of otherwise negative extensive work-up, which has shown diagnostic value for occult implant loosening, capsular fibrosis, and metal hypersensitivity. Endoscopic decompression for the treatment of ischiofemoral impingement and sciatic nerve decompression has also shown consistent improvements in pain and function. In addition to these well described indications, future utilization of hip arthroscopy for loose body removal, capsular plication for instability, and management of prosthetic joint infection are potentially emerging indications. Hip arthroscopy after THA is a safe and effective tool for the management of common causes of persistent pain after THA with robust support for iliopsoas pathology and emerging evidence and outcomes for less common indications. Future research will both expand and narrow these indications as diagnostic criteria, patient selection, and surgical techniques are refined.

&#xa0;Intraoperative fluoroscopy during primary total hip arthroplasty (THA) can be used to assist in component positioning in order to optimize placement and restore hip kinematics. Whether fluoroscopy leads to superior outcomes is subject to debate. We aimed to examine the use of fluoroscopy in the Netherlands and determine the association between the use of fluoroscopy and short-term revision risk following primary THA via the direct anterior approach (DAA). &#xa0;We included 49,878 primary THAs, performed via DAA, registered in the LROI from 2022-2024. Competing risk analysis and multivariable Cox-regression analyses were used to assess differences in implant survival between use of fluoroscopy and conventional surgery. Hazard ratios (HR) were adjusted for body mass index, previous surgeries, and fixation, and stratified for age, ASA class, and diagnosis. &#xa0;Unadjusted cumulative incidence of revision after 6 months, 1, 2, and 2.5 years did not show significant differences: the 2.5-year revision rate was 1.7% (95% confidence interval [CI] 1.5-1.9) for the fluoroscopy group, and 2.0% (CI 1.8-2.3) in the conventional group. Multivariable analysis demonstrated that the use of fluoroscopy was associated with a significantly lower risk of revision than conventional surgery (HR 0.8, CI 0.7-0.9). &#xa0;The use of intraoperative fluoroscopy in primary THA via DAA in the Netherlands is associated with a significantly lower short-term risk of revision. The data showed no major differences in revision due to malalignment and periprosthetic fractures. Revision rates were low in both groups and clinical differences were only small.

Litigation related to total hip arthroplasty (THA) is a growing concern. Manufacturer-specified contraindications for femoral implants may influence legal outcomes, particularly when common patient characteristics such as obesity are listed. This study identified manufacturer-listed contraindications for femoral implants used in primary THA and evaluated their medicolegal implications within the frameworks of medical negligence and informed consent law in England and Wales. The 11 most commonly used femoral implants were identified from the National Joint Registry of England, Wales, and Northern Ireland. For each implant, manufacturer surgical technique guides were reviewed to extract contraindications, relative contraindications, and warnings. A structured medicolegal analysis was conducted within the frameworks of medical negligence and informed consent law, drawing on landmark case law and peer-reviewed medicolegal scholarship, supplemented by consultation with legal professionals who specialize in orthopaedic device litigation. Two implants cited obesity or morbid obesity as a contraindication; four reported obesity as a warning. Nine implants listed inadequate bone quality as a contraindication, and two as a relative contraindication. Neuromuscular disease was contraindicated in nine implants, and a relative contraindication in two. Infection was contraindicated in all eleven implants. Vascular deficiency was a contraindication in six implants, and a relative contraindication in two. Deficient musculature was contraindicated in five implants and a relative contraindication in two. Many manufacturer-listed contraindications correspond to clinical characteristics commonly found in THA patients. These contraindications do not preclude implant use when supported by evidence and sound clinical judgement, but carry significant medicolegal implications under negligence and informed consent law. Once a manufacturer has communicated a contraindication, medicolegal scrutiny may shift to the surgeon's decision-making under two distinct frameworks, namely the standard of care and informed consent. Surgeons should know their implant-specific contraindications, ensure decisions are evidence-based and documented, and explicitly disclose elevated risks to patients.