Adult Reconstruction Archive

SUMMARY: This narrative review discusses how robotic platforms are being adopted in spine surgery and outlines training tools and ethical considerations needed to ensure surgeon proficiency.

SUMMARY: Large Medicare database analysis identified rheumatologic disease, obesity, coagulopathy, and anemia as key risk factors for PJI after THA, while heart failure, cancer, and dementia most strongly predicted 90-day mortality.

SUMMARY: Postoperative COX-2 inhibitors appear safe in chronically anticoagulated THA patients, showing no increased bleeding or complication risk and reduced opioid use through 180 days.

SUMMARY: In a propensity-matched study of unrestricted kinematic alignment TKA, patients with severe preoperative tibial varus (MPTA <84°) achieved comparable 2-year outcomes, satisfaction, and survivorship to those with less deformity and to mechanically aligned TKA, suggesting this threshold need not be a contraindication.

SUMMARY: A systematic review of 78 RCTs (8,515 TKA patients) found multimodal periarticular injection cocktails reduce pain and opioid use versus placebo, perform comparably to nerve blocks, and may benefit from corticosteroid additives, but no single optimal formulation was identified.

SUMMARY: This review highlights the lack of clear perioperative guidelines for managing biologic medications in nonrheumatologic TJA patients and calls for evidence-based protocols to balance infection and wound-healing risks.

SUMMARY: This narrative review finds that active wound dressings like silver-ion and closed-incision negative-pressure therapy may reduce infection risk after hip/knee arthroplasty, especially in high-risk patients, despite higher upfront cost than traditional dressings.

SUMMARY: Uncontrolled diabetes was linked to significantly higher rates of stroke, infection, transfusion, longer stay, and mortality after total joint arthroplasty compared to controlled diabetes or no diabetes.

SUMMARY: Better hip range of motion, stronger quadriceps, and less pain at 3 months after THA predicted higher (better) Forgotten Joint Score-12 at one year, highlighting early rehab targets.

SUMMARY: In TKA patients, hospital site—not neighborhood socioeconomic deprivation—predicted use of neuraxial anesthesia, which itself was linked to fewer 90-day ED visits.

SUMMARY: This review covers current evidence on arthroplasty implant choice, cemented versus uncemented fixation, and perioperative care advances for treating hip fractures.

SUMMARY: This review discusses how removal of hip/knee arthroplasty from Medicare's inpatient-only list and other financial pressures are reshaping surgeon, hospital, and ambulatory surgery center dynamics, advocating demand-matching to optimize care setting selection.

SUMMARY: In rabbit knee defects, repair cartilage became type II collagen-dominant over time but retained persistent type I collagen and lower proteoglycan content, never fully matching normal hyaline articular cartilage.

SUMMARY: A decision-analytic model shows that whether adopting a new surgical technique (e.g., direct anterior hip approach) helps or harms patients depends heavily on the individual surgeon's case volume and learning curve, not just published outcomes.

SUMMARY: Patients needing both lumbar fusion and total hip arthroplasty had delayed clinically meaningful recovery, but performing lumbar fusion before THA (rather than after) resulted in recovery timelines closer to THA-only patients.

SUMMARY: This review covers current surgical management trends for distal femur fractures, including locked plating, retrograde nailing, and newer nail-plate/double-plate constructs to reduce nonunion risk.

SUMMARY: Reviews periprosthetic joint infection after hip hemiarthroplasty, highlighting risk factors, differing microbiology, and the need for multidisciplinary surgical-antibiotic management.

SUMMARY: This review argues meniscal root tears should be repaired (typically via transtibial pull-out technique) when cartilage is intact, since repair reduces osteoarthritis/arthroplasty rates and healthcare costs versus meniscectomy or nonoperative care.

SUMMARY: In a randomized trial comparing direct anterior and posterolateral THA approaches, DAA patients had less early postoperative pain and faster functional recovery, with no differences by one year.

SUMMARY: This meta-analysis of 25 studies identifies male sex, obesity, diabetes, smoking, transfusion, high ASA score, and several perioperative factors as associated with periprosthetic joint infection after TKA.

SUMMARY: Hip arthroscopy with capsular plication for surgically confirmed microinstability produced patient-reported outcomes and revision rates comparable to matched non-instability arthroscopy controls at a minimum 2-year follow-up.

SUMMARY: Reviews hip and knee arthroplasty in obese patients, emphasizing higher complication risk, the value of preoperative weight optimization (including bariatric surgery/GLP-1 agonists), and multidisciplinary perioperative care.

SUMMARY: This review examines return-to-sport outcomes after hip arthroplasty, covering implant choice, fixation, and complication risks, while noting unresolved questions as patient demands rise.

SUMMARY: In cementless short-stem THA, cortical hypertrophy correlated with better functional scores in patients under 60 but had no impact in those over 75, suggesting it's an adaptive response in younger, active patients rather than a problem.

SUMMARY: Despite worse clinical outcomes, patients undergoing revision TKA for stiffness had similar postoperative pain scores and opioid consumption compared to those revised for other aseptic reasons.

SUMMARY: This review covers current recommendations for prophylactic antibiotic choice, timing, and dosing in total hip and knee arthroplasty, including management of penicillin allergy and outpatient settings.

SUMMARY: In a mouse model, vancomycin-loaded mesh significantly reduced staphylococcal infection after extensor mechanism reconstruction without compromising mesh strength, suggesting a promising future infection-prevention strategy.

SUMMARY: At 2 years, dual-mobility THA using the Trinity system showed high patient satisfaction and low, clinically insignificant blood metal ion levels, supporting its safety and efficacy.

SUMMARY: This review outlines surgical options—from direct repair to muscle transfers and synthetic augments—for managing abductor deficiency causing recurrent instability after THA.

SUMMARY: Discusses total hip arthroplasty in patients with rare pathologic or fragile bone conditions, highlighting the need for careful preoperative planning and readiness to manage intraoperative fractures.