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Distal radius fractures in adults primarily occur in the elderly, in whom comorbidity, polypharmacy, dependency, and limited functional demands often coexist. Most patients have been managed non-surgically with casting. However, only a few trials with high evidence exist on comparing non-surgical and surgical treatments in the elderly. Given the heterogeneity of the aging population, a universal approach to treatment selection may not be feasible. This educational article aims to discuss the advantages and disadvantages of non-surgical vs surgical management, radiological assessment, complication risks, and osteoporosis screening. Moreover, we suggest surgical technical tips, a treatment algorithm, and a decision-making strategy that considers both functional demands and individual needs.
This educational review outlines the core principles of humeral shaft fracture (HSF) management and is designed for orthopedic trainees, general orthopedic surgeons, emergency physicians, and allied health professionals who participate in the acute or postoperative care of patients with HSFs. The content integrates the authors' expert opinion with the current evidence. Humeral shaft fractures account for 1-3% of adult fractures, most often resulting from low-energy falls in older adults or high-energy trauma in younger patients. Although open fractures and neurovascular injuries are rare, primary radial nerve palsy (RNP) occurs in about 10% of cases. Diagnosis relies primarily on clinical evaluation and standard radiographs, with CT or MRI reserved for complex or pathological cases. Functional bracing has traditionally been the mainstay of nonsurgical treatment, achieving good long-term results but with nonunion rates up to 25%. Surgical fixation methods-including open reduction and internal fixation, minimally invasive plate osteosynthesis, and intramedullary nailing-allow earlier mobilization and more predictable fracture union but carry risks of iatrogenic RNP and infection. Management of primary RNP remains largely nonsurgical, with over 90% recovering spontaneously. Nonunion is frequently symptomatic and managed most often with compression plating. Surgery offers faster early recovery and lower nonunion rates, although long-term outcomes converge with successful bracing. Cost-effectiveness analyses suggest surgery may be more economical when productivity loss is considered, particularly for working-age patients. Optimal treatment selection depends on patient age, activity level, fracture characteristics, and patient preference, emphasizing shared decision-making.
Info — Since early 2025, Acta Orthopaedica has served as the official publisher of the International Society of Arthroplasty Registries (ISAR) congresses. Founded in 2005, ISAR (https://www.isarhome.org) is a global organization comprising national, regional, and institutional joint replacement registries. Its mission is to improve outcomes for patients undergoing joint replacement surgery worldwide. Since 2012, ISAR has organized annual congresses featuring register-based research. Following the 14th International Congress of Arthroplasty Registries, held in Christchurch, New Zealand, presenters were invited to submit their work to Acta Orthopaedica. Over the past year, this initiative has resulted in 13 publications covering a broad range of topics. This partnership has been extended, looking ahead to the 15th congress held in Lund May 30 to June 1, 2026. Presenters at the Lund Congress are welcomed to submit their studies to Acta Orthopaedic with a deadline of October 1, 2026.
RCTs are a key block in the evidence pyramid, but their quality relies on detailed, consistent reporting, and one best-practice standard is prospective registration. Prospective trial registration was intended to reduce publication bias, and adherence to a prespecified protocol helps limit bias from selective reporting; any protocol or end point changes should be transparently documented and justified. However, the degree to which articles published in the leading journals on orthopaedic surgery comply with this best-practice standard has, to our knowledge, not been evaluated. (1) Do RCTs published in leading, general-interest orthopaedic surgery journals comply with best practices regarding prospective clinical trial registration? (2) Do major discrepancies exist between registered protocols and published orthopaedic RCTs? (3) Are there specific study types that are more likely to demonstrate discrepancies? A review was performed on RCTs published in the top five general-interest orthopaedic surgery journals, based on the 2022 scientific journal rankings (from SciMago): Journal of Bone and Joint Surgery, Bone and Joint Journal, Clinical Orthopaedics and Related Research®, Journal of the American Academy of Orthopaedic Surgeons (JAAOS), and Acta Orthopaedica. During the study period, all journals maintained editorial policies requiring prospective clinical trial registration as a condition of consideration for publication except for JAAOS. A systematic search on PubMed retrieved 705 potential publications, of which 324 RCTs fulfilled the inclusion criteria. For each trial, nine essential elements from the 24-item WHO minimum data set were extracted and compared between the published article and its trial registry entry, focusing on health condition, intervention, sample size, outcomes, and eligibility criteria. To answer our first question regarding compliance, we audited each article to identify the presence of a registry code. For our second question, we performed a side-by-side comparison of nine essential elements from the WHO trial registration data set (including primary outcomes, sample size, and eligibility criteria) to identify discrepancies between the registry and the final publication. Finally, to address our third question, we used chi-square tests to determine whether study characteristics, such as country of origin or subspecialty, were associated with higher rates of reporting shifts. Most orthopaedic RCTs published in leading journals complied with registration standards, with 95% (309 of 324) having an identifiable registry entry. However, 2% (8 of 324) were published without any registry identifier or justification for its absence, and 2% (7 of 324) were identified as long-term follow-up visits that did not have unique prospective entries. Major discrepancies between registered protocols and published manuscripts were frequent. Discrepancies in the sample size occurred in 33% (102 of 309) of trials. Discrepancies in the primary outcome occurred in 25% (78 of 309) of trials. Discrepancies in the secondary outcome occurred in 60% (185 of 309) of trials. Discrepancies in the inclusion criteria occurred in 33% (102 of 309) of trials. Discrepancies in the exclusion criteria occurred in 53% (165 of 309) of trials. Trials conducted in the United States or as multicenter international collaborations were more likely to update their final results in the registry compared with single-country trials conducted outside the US (37% versus 10%; p < 0.001). No other study characteristics, including publication year or subspecialty, were associated with the presence of reporting discrepancies. Prospective registration has become the standard for RCTs in high-impact orthopaedic journals. However, our findings suggest that a gap still exists between having a registry and the accuracy of the information contained within it. These findings suggest that registration is often treated as a procedural requirement rather than a rigorous commitment to a fixed study protocol. The orthopaedic research community should adopt stricter standards for trial registration, reporting, and verification of registry entries to reduce undisclosed protocol changes and improve confidence in published evidence.
The purpose of this study was to define the prevalence of os acromiale on magnetic resonance imaging (MRI) in patients presenting with shoulder pain, to document how often it coexists with rotator cuff tears, and to assess whether focused review detects this variant more reliably than routine radiology reporting.  Methods: A retrospective review was conducted on 3697 shoulder MRI examinations obtained between 2020 and 2025 at a tertiary referral center. All studies were independently evaluated by 2 fellowship-trained shoulder surgeons and 1 musculoskeletal radiologist, focusing specifically on the presence, subtype, and coexistence of os acromiale with rotator cuff pathology. Interobserver reliability was assessed using Cohen's kappa coefficient, and findings were compared with the original radiology reports.  Results: Os acromiale was identified in 26 cases, corresponding to a prevalence of 0.7%. Only 11 cases were mentioned in the original radiology reports. Interobserver agreement between shoulder surgeons was almost perfect (κ = 0.98) and excellent between surgeons and the radiologist (κ = 0.92). Subtypes included 12 preacromion, 13 mesoacromion, and 1 metaacromion. Rotator cuff tears were present in 20 of 26 patients with os acromiale (77%), including isolated supraspinatus tears (n = 9), combined supraspinatus-infraspinatus tears (n = 4), supraspinatus-subscapularis tears (n = 3), massive tears (n = 2), and cuff tear arthropathy (n = 2).  Conclusion: Os acromiale was uncommon in this MRI-based cohort but frequently coexisted with full-thickness rotator cuff tears. Although causality cannot be inferred, this coexistence may carry clinical relevance. Notably, focused evaluation documented more cases than routine radiology reports, underscoring the added value of targeted assessment.       Cite this article as: Birsel O, Yığman GT, Günerbüyük C, Baş A, Chodza M, Eren İ. Prevalence of os acromiale and concomitant rotator cuff tears: a focused assessment of 3697 shoulder magnetic resonance imagings. Acta Orthop Traumatol Turc. 2026; 60(1), 0714P doi: 10.5152/j.aott.2026.25714.
 Periprosthetic joint infection (PJI) is a serious complication following total knee arthroplasty (TKA). Accurate reporting is essential for quality development and research based on data in the Norwegian Arthroplasty Register (NAR). Our study aimed to validate Norwegian orthopedic surgeons' reporting of reoperations for PJI.  We assessed detailed clinical, biochemical, and microbiological data on 423 patients reported to the NAR for reoperations after primary TKA performed in Western Norway in the period from 2010 to 2023. We used the Musculoskeletal Infection Society (MSIS) definition of PJI. For each cause of reoperation (including causes that could mimic PJI, such as aseptic loosening, prolonged wound drainage, and pain alone), we determined the sensitivity, specificity, negative and positive predictive values, and accuracy.  Of 423 reoperations, 170 were reported reoperations due to PJI. After validation, 94% (159 of 170) were confirmed to be due to PJI. Furthermore, 5% (13 of 253) of cases reported as reoperated due to causes other than deep infection were validated as PJI. The sensitivity, specificity, and accuracy for PJI reporting were 92%, 96%, and 94%, respectively. Accuracy for aseptic loosening, prolonged wound drainage, and pain alone was 97%, 94%, and 98%, respectively.  The accuracy of reporting of reoperations due to PJI is high, thereby affirming the quality of reoperation data concerning PJI submitted to the NAR. Our findings support the use of NAR data in quality development and research.
Surgical outcomes in patients with flexible adult-acquired flatfoot deformity (AAFD) have not been evaluated in large prospective register studies. Calcaneal osteotomy and hindfoot arthrodesis are commonly used. We aimed to compare the results of these 2 procedures using preoperative and 1-year postoperative patient-reported outcome data from the Swedish Quality Register for Foot and Ankle Surgery (Swefoot). We analyzed data regarding feet that had primary surgery for flexible (grade II) AAFD between 2017 and 2022 in Sweden. The primary outcome was the Self-Reported Foot and Ankle Score (SEFAS), range 0-48 (minimal important difference 5). Secondary outcomes were EQ-5D and satisfaction. 190 feet (63% women, median age 62 years, interquartile range 54-68) were surgically treated during the study period. Mean improvement in SEFAS score was 12 (95% confidence interval [CI] 10-13) in grade IIa and 10 (CI 8-12) in grade IIb, and in the EQ-5D index 0.27 (CI 0.20-0.34) and 0.23 (CI 0.15-0.31), respectively. Compared with preoperatively a higher percentage of patients were satisfied with postoperative foot appearance (77% vs 39%) and foot strength (66% vs 23%). The mean SEFAS score improvement was 11 (CI 10-13) in the osteotomy group and 10 (CI 5-15) in the arthrodesis group; adjusted mean difference was 2.7 (CI -1.2 to 6.5). Surgical treatment of flexible AAFD significantly improves function and quality of life at 1 year postoperatively. No differences in postoperative patient-reported outcomes were observed between patients who underwent calcaneal osteotomy compared with hindfoot arthrodesis.
Transparent and complete reporting is essential to the credibility and utility of health research, yet the quality of such reporting remains inconsistent. Also, in osteoarthritis (OA) research, poor reporting undermines reproducibility, synthesis, and translation into practice and policy. Therefore, clear and accurate reporting is not merely a bureaucratic exercise but foundational because it establishes trust and confidence in the reported outcomes. This editorial emphasizes the ultimate importance of adopting reporting guidelines developed by the Enhancing the Quality and Transparency of Health Research (EQUATOR) Network. Such guidelines include CONSORT for randomized trials, STROBE for observational studies, PRISMA for systematic reviews, and SPIRIT for protocols. Altogether, these helpful tools provide structured frameworks that enhance clarity, rigor, and reproducibility across study designs. We also adapt the concept of "value streams" from lean management as a metaphor for scientific reporting: each checklist item coherently contributes incremental value within a logical, unidirectional flow that transforms research into coherent and trustworthy publications. Early adoption of these value streams and reporting guidelines by authors-and their integration into the publishing process, including reviewer training-will strengthen the quality, relevance, and long-term value of OA research and help ensure that reporting frameworks are truly transparent and accessible.
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 After total knee arthroplasty (TKA), 10-20% of patients remain unsatisfied. Well-performing clinical prediction models can provide individualized risk estimates and stratification in terms of poor outcomes, resulting in unnecessary surgeries being avoided and patients being counseled preoperatively. We aimed to create a precise, well-performing prediction model for clinical application using different machine learning algorithms to predict those patients who will have residual pain, a low total Oxford Knee Score (OKS) and the patient group who do not achieve minimally clinical important difference (MCID) in OKS 1 year after TKA.  We conducted a retrospective cohort study based on patients who had undergone primary TKA at our institution combined with 751 patient-related variables. The multivariable models used were based on the results of univariate analysis. We used the machine learning method Extreme Gradient Boosting (XGBoost). The discrimination capability of the models was measured with the area under the curve (AUC).  11,755 patients were included in this study. There were 850 (7.2%) patients who experienced persistent pain 1 year after TKA. The AUC was 0.67. For the secondary outcomes, the AUC values were similar. The most important variables in the model were lower preoperative OKS, younger age, valgus malalignment, lower preoperative pain OKS, use of mild opioid, neuropathic pain medicine and thyroxine, and higher body mass index.  The prediction models achieved poor AUCs. It seems clear that the prediction of pain and functional outcome after TKA is difficult, even with a large patient cohort combined with 751 patient-related variables and sophisticated machine-learning algorithms.
Effective pain management in older patients with a hip fracture is critical for postoperative recovery. Our primary objective was to compare intraoperative methadone with placebo on postoperative morphine consumption over 72 hours. Patients aged ≥ 60 years with hip fractures were randomized to receive methadone (0.10 mg/kg) or placebo intraoperatively. The primary outcome was postoperative morphine consumption measured in 24-hour intervals over 72 hours. Secondary outcomes included pain scores, time to mobilization, and discharge. Harms were assessed as adverse and serious adverse events. 129 patients were included. The primary endpoint analysis demonstrated that postoperative morphine consumption over 72 hours differed significantly between groups (likelihood-ratio test, P = 0.02). Model-based estimates suggested lower morphine consumption in the methadone group at 0-24 hours (least square mean [LSM] 7.1 [SE 1.2] vs placebo 10.1 [SE 1.7] mg) and at 24-48 hours (4.1 [SE 0.8] vs placebo 5.3 [SE 0.9] mg). At 48-72 hours, the model suggested lower morphine consumption in the placebo group (3.2 [SE 0.6] vs methadone 4.6 [SE 0.9] mg). Secondary outcomes were similar between groups, except that time to hospital discharge was longer in the methadone group (LSM 5.6 vs 4.5 days; mean difference -1.3 days, 95% confidence interval -2.3 to -o.4; P < 0.01). Harms appeared comparable, although the low event rate precluded formal analysis. A single intraoperative dose of methadone significantly alters postoperative morphine consumption over 72 hours after hip fracture surgery, without major safety concerns.
Previous reports on incidences rates of Scandinavian pediatric extremity fractures have varied, as they are often anatomically specific and based on institution-specific findings. To gain knowledge of current and future burden on the healthcare system, a national cohort assessment is necessary. We aimed to assess the proportion and incidence within anatomical distributions of pediatric extremity fractures in relation to age, sex, and time trends. We retrieved a 20-year population-based cohort from the Danish National Patient Registry 1999-2018. We included all children aged 0-15 years with an extremity fracture diagnosis (ICD-10). We estimated fracture proportions and incidence rates (IRs) in different anatomical regions stratified by sex, age groups, and periods. IRs were estimated based on national population counts. We included 668,595 pediatric fractures corresponding to an overall IR of 3,164 (95% confidence interval 3,157-3,172) per 100,000 persons/year. The highest proportion and IR were in the lower arm, but the proportions differed within the age groups. The IR increased with age and was higher in boys. The overall IR increased during the study period. In upper and lower leg fractures a decrease was seen, with all other anatomical sites increasing. We found an increased IR during the study period for all fractures except for the upper and lower leg. The study gives important knowledge to the healthcare system when coordinating the right resources.
 There is no universal consensus on evaluating the quality of pediatric fracture care. While U.S. News ranks hospitals based on surgical timing and procedural benchmarks, additional metrics such as complication rates, reoperations, and patient-reported outcomes could provide a more comprehensive assessment. We aimed to evaluate pediatric fracture care outcomes at a Level I trauma center, emphasizing standardization and transparency in benchmarking.  This retrospective study reviewed all fractures diagnosed at HUS New Children's Hospital, Helsinki from 2018 to 2022. U.S. News criteria were applied to completely dorsally displaced supracondylar humerus (Gartland III) fractures, femoral shaft fractures, and displaced forearm fractures to evaluate timeliness, method of treatment, and anesthesia use. The modified Clavien-Dindo-Sink system was used in complex fractures. Permanent iatrogenic nerve injuries and deep infections were registered in all fractures.  10,144 fractures were diagnosed, of which 18% were treated in the operative room. Surgery started within 18 h in 173 (87%) of Gartland III and 108 (79%) of femoral shaft fractures. Open reduction rate was 24% in Gartland III fractures. Most (60%) displaced forearm fractures were managed without general anesthesia. The overall complication rate for Gartland III and femoral shaft fractures was 13%; unplanned return to surgery occurred in 2.2% respectively. Permanent iatrogenic nerve injuries and deep infections were rare (0.04% and 0.3%) in all fractures.  Surgical treatment of supracondylar humerus and femoral shaft fractures in children was performed safely and effectively at our institution. The majority of pediatric forearm fractures were managed in the emergency department without anesthesia. The incidence of iatrogenic nerve injuries and postoperative infections was very low. Incorporating broader metrics such as complications, outcomes, and satisfaction would offer a more complete assessment of care quality.
 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.  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.  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.  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.
Soft tissue sarcomas are a heterogeneous group of malignant tumors with a high risk of metastasis, primarily to the lungs, making accurate survival prediction an essential part of long-term planning. No machine learning (ML) survival prediction models have been developed using a modern, population-based dataset from Scandinavia. We aimed to develop and compare ML models with logistic regression in predicting 5-year survival in soft tissue sarcoma patients and identify key predictive variables. This retrospective cohort study included patients diagnosed with deep-seated, high-grade soft tissue sarcomas of the extremities and trunk wall in Denmark from 2000 to 2016. Logistic regression was compared with 4 developed ML models, including random forest. Performance was assessed using the area under the curve (AUC), sensitivity, specificity, and calibration metrics, with a 70:30 training-test split and 5-fold cross-validation to evaluate the models. 516 patients were included, of whom 226 (44%) died within 5 years following surgery. Random forest demonstrated the best ML performance on the training set and was compared with logistic regression on the test set. Logistic regression achieved an AUC of 0.74 (95% confidence interval [CI] 0.66-0.82), outperforming random forest's AUC of 0.65 (CI 0.56-0.74). Logistic regression also had higher sensitivity (0.65 vs 0.59) and specificity (0.72 vs 0.69), while random forest had a lower Brier score (0.38 vs 0.41). Although the developed random forest ML model performed well during training, logistic regression outperformed it after internal validation. Soft tissue sarcomas located in the trunk, grade 3 tumors, and chemotherapy within 3 months of surgery demonstrated the highest negative effect on survival, consistent with current treatment protocols in which patients with high-risk disease are managed with more aggressive multimodal therapy. Further external validation and assessment of clinical utility are required before potential clinical implementation.
Injuries after primary total hip arthroplasty (THA) can be compensated through the National Swedish Patient Insurance Company (Löf). This study examined injury incidence, types, consequences, and subgroup differences in compensated claims following primary THA for osteoarthritis (OA) in Sweden over 10 years. Data from Löf and the Swedish Arthroplasty Register were used for compensated claims following primary THA between 2012 and 2021. Injury incidence and subgroup differences by sex, age, OA diagnosis, and surgical volume were analyzed. Injury types, severity, reoperation rate, and surgical approach were evaluated. Absolute risk differences (ARD) and incidence rate ratios (IRR) were calculated. 1,343 injuries were followed up. The injury incidence was 1.3%. Injury rates were higher in patients < 65 years than ≥ 65 years (ARD 0.2%, 95% confidence interval [CI] 0.1-0.3), in OA due to hip dysplasia compared with primary OA (IRR 1.78, CI 1.31-2.35), and at low- and medium-volume compared with high-volume hospitals (IRR 1.35, CI 1.11-1.64; IRR 1.27, CI 1.14-1.42). In surgery-related injuries (n = 1,251), infection (38%, CI 35-41) and nerve injury (22%, CI 20-25) were the most common injury types, and direct lateral incisions were more frequent than national reference proportions of all THAs during the study period (ARD 9%, CI 6-12). Permanent disability occurred in 74% (CI 72-77) of the claims, and the 2-year reoperation rate was 51% (CI 48-54) (0.4% of the total population). The injury incidence after primary THA was 1.3% and frequently resulted in permanent disability and reoperation. Infection and nerve injury were the most common injury types. Higher injury rates in younger patients, hip dysplasia, and lower-volume hospitals highlight potential areas for prevention and increased awareness.
The Masquelet technique is a 2-stage surgical method used for the reconstruction of critically sized bone defects due to various etiologies. Estrogen is known to have anabolic effects on bone metabolism. In this study, based on literature data, the aim is to systematically evaluate the histological and immunohistochemical effects of adding different doses of estrogen to polymethylmethacrylate cement on induced membrane tissue.  Methods: Twenty-eight male rats were included in the study and divided into 4 groups. Three experimental groups received different doses of estradiol, a subtype of estrogen mixed with bone cement, while a control group received only bone cement. Approximately 10 mm defects were created in single femurs of all rats. Bone cement appropriate for each experimental group was placed in these defects, and bone fixation was performed with mini plates and screws. Tissue samples taken from all animals at the end of the sixth week were evaluated by histological and immunohistochemical methods.  Results: Histological and immunohistochemical evaluations of the induced membranes obtained at the end of the experiment revealed signs of bone formation in all subgroups. A significant increase in bone formation was observed with increasing doses in groups E1, E2, and E3 compared to the control group (P < .05). The histological scores of the study groups were found to increase statistically significantly with increasing estrogen dose (P < .05). Furthermore, immunohistochemical analyses revealed that the immuno-reactive scores for bone morphogenetic protein-4 and insulin-like growth factor-1 expression were significantly higher in the E3 group compared to the other groups (P < .05).  Conclusion: In this study, it was found that enriching the cement content with estrogen during bone cement placement, the first step of the Masquelet technique, improved the quality of the formed membrane. This improvement in membrane quality is promising for increasing treatment efficacy and shortening the treatment duration.    Cite this article as: Çiftçi MU, Purelku M, Özönder F, et al. Dose-dependent effects of estrogen-enriched bone cement on membrane quality in the masquelet technique: experimental rat model. Acta Orthop Traumatol Turc., 2026; 60(1), 0355, doi: 10.5152/j.aott.2026.25355.
The aim of this study was to investigate patient safety, defined using in-hospital complications, early readmissions, mortality, and days alive and at home (DAH), after day-case and non-day-case hip and knee arthroplasty in a public healthcare setting. This multicentre cohort study included consecutive patients who underwent primary total hip arthroplasty (THA), total knee arthroplasty (TKA), or unicompartmental knee arthroplasty (UKA) between September 2022 and May 2024. All eight public hospitals which were involved followed the same standardized protocol with consistent eligibility for day-case surgery and discharge criteria. Postoperative hospital contacts within 30 days were recorded using the patients' medical records and electronic questionnaires. Day-case surgery was defined as discharge on the day of surgery to the patient's own home. A total of 12,607 patients were included, of whom 3,159 (25%) were day-case and 9,430 (75%) were non-day-case patients. The mean length of hospital stay (LOS) was one day (0 to 70); 5% of patients (95% CI 4.9 to 5.5) had a LOS of > two days, primarily due to mobilization issues (1.4%) and pain (1.3%). The overall readmission rate was 0.5% (95% CI 0.4 to 0.7) within 48 hours and 4.4% (95% CI 4.1 to 4.8%) within 30 days. Readmission rates were 0.7% (95% CI 0.5 to 1.1) and 1.9% (95% CI 1.5 to 2.5) for day-case patients, and 0.5% (95% CI 0.3 to 0.6) and 5.3% (95% CI 4.8 to 5.8) for non-day-case patients within 48 hours and 30 days, respectively. When stratified by the type of surgery, there were only minor variations. No patients died within 48 hours, and the overall 30-day mortality was 0.08% (n = 10), with no deaths among day-case patients. The median DAH30 was 30 (IQR 30 to 30) for day-case patients and 29 (IQR 29 to 29) for non-day-case patients. These findings indicate that fast-track surgery with a one-day LOS and a 25% day-case rate in a national, publicly funded healthcare system is safe, based on low rates of in-hospital complications, early readmission, mortality, and a high DAH30.
Inducible displacement CT (ID-CT) is an emerging method for diagnosing implant loosening by (i) acquiring CT scans under different joint loading conditions, (ii) analyzing scans via segmentation and registration, and (iii) quantifying and visualizing relative implant-bone displacement. With multiple centers approaching these steps differently, this scoping review aimed to summarize current methodologies and key challenges. PubMed, Cochrane, and Embase were searched for clinical and experimental ID-CT studies on spinal and arthroplasty implants. Data was extracted using a table based on updated CT-radiostereometric analysis (RSA) guidelines, including study characteristics, CT acquisition parameters, image analysis methods, validation approaches, outcomes, and loading protocols. Diagnostic studies were assessed with QUADAS-2. 22 studies were included concerning the hip (10), knee (7), spine (4), and wrist (1), covering clinical and experimental (phantom and cadaveric) designs. Loading protocols varied widely, applying compressive, rotational, and angular forces with external stabilization or loading devices. CT acquisition ranged from µCT to conventional and weight-bearing CT, with variation in kVp, mAs, reconstruction spacing, and metal artefact reduction. Image-analysis workflows were broadly similar, though reporting of algorithms and displacement metrics was often incomplete. Diagnostic validation was limited by variable reference standards, non-prespecified loosening thresholds, and non-blinded assessments, undermining true performance. Technical validation, although often precise, did not cover the full ID-CT pipeline (i.e., complete loading protocol), leaving key sources of measurement variance untested. We showed that ID-CT is used with a wide variation in approach and limited reporting prevents the establishment of its true diagnostic accuracy.