This week in Adult Reconstruction

Jun 22–28, 2026 · 31 new studies, 8 reviews · Adult Reconstruction archive · All weeks

The new Adult Reconstruction research The Reduction sent the week of Jun 22–28, 2026, with the week’s most recent reviews, each with a one-line summary.

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New research

  1. Amyloid in Primary Hip Arthroplasty Specimens: An Opportunity for Early Detection of Amyloidosis?

    Journal of Arthroplasty · Sep 2026 · PubMed

    Routine THA specimens may incidentally harbor amyloid including cardiac transthyretin subtype, representing an opportunity for early detection and treatment of a now-targetable systemic disease.

  2. Effectiveness of Intraosseous Morphine for Pain Control in Total Knee Arthroplasty: A Double-Blinded, Randomized Trial.

    Journal of Bone and Joint Surgery (American) · Aug 19 2026 · PubMed

    Intraosseous morphine during TKA does not improve pain control or decrease narcotic consumption up to two weeks postoperatively.

  3. Significant Anxiolytic Effect and Enhanced Recovery Benefits of Perioperative Low-Dose Olanzapine in Patients with Anxiety Undergoing THA: A Randomized Controlled Trial.

    Journal of Bone and Joint Surgery (American) · Aug 05 2026 · PubMed

    Low-dose olanzapine reduced perioperative anxiety, pain, and nausea better than alprazolam or placebo in anxious THA patients.

  4. Influence of Conscious Sedation Versus Spinal Anesthesia on Range of Motion and Pain Scores Following Manipulation Under Anesthesia After Total Knee Arthroplasty.

    Journal of Arthroplasty · Jul 2026 · PubMed

    Monitored anesthesia care produced superior range of motion and pain control compared to spinal anesthesia for manipulation under anesthesia after TKA.

  5. Temporal Analysis of Patients Eligible for Randomized Controlled Trials in Total Hip Arthroplasty.

    Arthroplasty Today · Jun 2026 · PubMed

    Age exclusion criteria remain prevalent in hip arthroplasty trials despite demographic shifts; BMI restrictions increasingly exclude heavier patients needing arthroplasty.

  6. Total Knee Arthroplasty in the Presence of Congenital Heart Disease: An Under-Recognized Risk.

    Arthroplasty Today · Jun 2026 · PubMed

    TKA in patients with congenital heart disease and intracardiac shunts risks paradoxical cerebral embolism; urgent neuroimaging is warranted for new deficits.

  7. Intraoperative Analysis of Collateral Ligament Elongation Patterns by Coronal Plane Alignment of the Knee Classification Using Augmented Reality Navigation in Japanese Osteoarthritic Knees.

    Arthroplasty Today · Jun 2026 · PubMed

    AR navigation reveals that most osteoarthritic knees demonstrate normal collateral ligament elongation patterns during TKA, supporting individualized intraoperative soft tissue assessment.

  8. Do Adductor Canal Blocks Provide Additional Analgesic Benefit to Periarticular Injection Alone for Primary Total Knee Arthroplasty?

    Arthroplasty Today · Jun 2026 · PubMed

    Adding adductor canal block to periarticular injection reduced postoperative opioid consumption and pain in TKA during the first 24 hours.

  9. Arthroscopic Treatment of Patellar Clunk Syndrome After Total Knee Arthroplasty.

    Arthroplasty Today · Jun 2026 · PubMed

    Arthroscopic debridement for patellar clunk syndrome after total knee arthroplasty relieves pain and mechanical symptoms in nearly all patients with minimal change in range of motion.

  10. Clinical outcomes and Quality-Adjusted Life Years (QALY) after femoral head fractures: A retrospective cohort study of 101 patients.

    Injury · Jun 2026 · PubMed

    Early hip reduction under six hours and Pipkin type III fractures treated with primary total hip replacement yielded the best long-term functional outcomes and quality-adjusted life years.

  11. Are Age-based Cutoffs for THA Logically Consistent?

    Clinical Orthopaedics and Related Research · Jun 23 2026 · PubMed

    Withholding THA from 45-year-olds with hip disease is logically inconsistent with accepting it in 85-year-olds; younger patients accrue substantially more lifetime benefit.

  12. The Variable Axis Knee Prosthesis: A Legacy of Dr. David G. Murray.

    Journal of Bone and Joint Surgery (American) · Jun 22 2026 · PubMed

    Dr. Murray's Variable Axis knee prosthesis pioneered unconstrained cruciate-substituting design with modular tibial components now standard in modern prosthetics.

  13. United States Trends in Utilization and One-Year Revision Risk of Cementless Total Knee Arthroplasty: An Analysis of American Joint Replacement Registry Data.

    Journal of Arthroplasty · Jun 22 2026 · PubMed

    Cementless TKA utilization increased to 19% with modestly higher one-year revision risk, though absolute difference may lack clinical significance.

  14. Axial Plane Alignment of the Knee (APAK): A Bony-Based Framework for Describing Flexion-Plane Knee Phenotypes and Its Association With Intraoperative Flexion-Gap Patterns.

    Journal of Arthroplasty · Jun 19 2026 · PubMed

    APAK classification provides structured framework for flexion-plane knee phenotyping and predicts intraoperative flexion-gap patterns in TKA.

  15. Why Total Knees Fail and Re-Fail: An Analysis of 20,568 Revision Cases from the Swiss Implant Registry.

    Journal of Arthroplasty · Jun 18 2026 · PubMed

    Patellar complications drive first TKA revisions; infection dominates re-revisions, with increasing burden over a decade—targeted prevention strategies needed.

  16. Impact of Intervention Timing on the Failure of Debridement, Antibiotics, and Implant Retention for Acute Postoperative Periprosthetic Joint Infections: A Contemporary United States Population-Level Analysis.

    Journal of Arthroplasty · Jun 18 2026 · PubMed

    DAIR for acute postoperative periprosthetic joint infection has stable failure rates through 7 weeks; risk accelerates significantly beyond this threshold.

  17. Declining Medicaid Reimbursement for Total Hip and Knee Arthroplasty from 2014 to 2022: A Comparison of Expansion and Non-Expansion States.

    Journal of Arthroplasty · Jun 18 2026 · PubMed

    Medicaid reimbursement for total knee and hip arthroplasty declined significantly from 2014-2022 at similar rates regardless of state expansion status.

  18. Soft-Tissue Balance and Quadriceps Muscle Strength Are Associated with Patient-Reported Outcomes Following Total Knee Arthroplasty, Independent of Alignment Strategy: A Prospective Randomized Trial.

    Journal of Arthroplasty · Jun 18 2026 · PubMed

    Soft-tissue balance and muscle strength, not alignment strategy, independently predict satisfaction and function after total knee arthroplasty.

  19. Complications of Ceramic-on-Ceramic Total Hip Arthroplasty with Large Heads: 10-Year Minimum Follow-Up.

    Journal of Arthroplasty · Jun 12 2026 · PubMed

    Large-head fourth-generation ceramic-on-ceramic total hip arthroplasty shows excellent 10-year survival (99.1%) with no ceramic fractures, though late instability related to lumbar kyphosis remains a concern.

  20. The effect of early tourniquet release on primary total knee arthroplasty and an analysis of risk factors for deep vein thrombosis.

    The Knee · Jun 04 2026 · PubMed

    Early tourniquet release in primary total knee arthroplasty reduced proximal DVT incidence without affecting clinical outcomes or blood loss.

  21. A Machine Learning Approach to Determine the Optimal Age for Total Hip Arthroplasty: When Is Risk for Adverse Outcomes Lowest?

    Journal of the American Academy of Orthopaedic Surgeons · Jun 03 2026 · PubMed

    Machine learning identified optimal age for total hip arthroplasty between 52.5-71.5 years, with lowest risk for readmission, revision, and mortality in this range.

  22. Mechano-biological mechanisms of femoral head collapse in osteonecrosis: a multiscale zonal analysis.

    Hip International · Jun 02 2026 · PubMed

    In osteonecrosis of the femoral head, necrotic zones show severely degraded bone quality while surrounding sclerotic bone is stiff but brittle, creating stress concentrations that drive femoral head collapse.

  23. Increased cross-sectional area of the gluteus maximus after hip arthroscopy for femoroacetabular impingement correlates with patient-reported outcomes.

    Hip International · May 2026 · PubMed

    Hip arthroscopy for FAI increases gluteus maximus cross-sectional area, which correlates with improved patient-reported outcomes at one-year follow-up.

  24. Computed Tomography Overestimates Roentgenographic Posterior Tilt in Geriatric Garden I/II Femoral Neck Fractures.

    Journal of the American Academy of Orthopaedic Surgeons · May 27 2026 · PubMed

    CT overestimates posterior tilt in Garden I/II femoral neck fractures compared to radiographs, potentially increasing arthroplasty recommendations without evidence-based support.

  25. Differential Effects of Degenerative Spine Disease and Spinal Fusion on the Risk and Progression of Hip Osteoarthritis: A Nationwide Time-Varying Cohort Study.

    Journal of Arthroplasty · May 22 2026 · PubMed

    Both degenerative spine disease and spinal fusion independently increase hip osteoarthritis risk, with spinal fusion particularly associated with progression to total hip replacement.

  26. Abnormal preoperative tibiotalar tilt predicts residual ankle pain after mechanical-alignment total knee arthroplasty: A retrospective cohort study.

    The Knee · May 21 2026 · PubMed

    Abnormal preoperative tibiotalar tilt independently predicts residual ankle pain after mechanical-alignment total knee arthroplasty.

  27. Emerging Concepts in Periprosthetic Joint Infection Research: RNA, DNA, and Protein Sequencing Tools for the Characterization and Diagnosis of Periprosthetic Joint Infection.

    Journal of Arthroplasty · May 14 2026 · PubMed

    Next-generation sequencing tools improve detection of organisms and host response in culture-negative periprosthetic joint infections, guiding targeted antimicrobial therapy.

  28. Should Inter-Prosthetic Screws Be Placed When Prophylactically Plating a Femur?

    Journal of Arthroplasty · May 13 2026 · PubMed

    Bicortical screws between intramedullary femoral implants create stress risers reducing failure strength; bridging constructs are preferred for interprosthetic distances less than 10 cm.

  29. The coronal plane alignment of the knee (CPAK) classification has three-dimensional limitations: Evidence from EOS imaging.

    Knee Surgery, Sports Traumatology, Arthroscopy · May 05 2026 · PubMed

    CPAK classification shows weak correlation with 3D knee alignment parameters; integration of kinematic and soft tissue data improves TKA planning.

  30. Does Patellar Resurfacing Impact Patient-Perceived Outcomes Following Primary Total Knee Arthroplasty? A Propensity-Matched Analysis.

    Journal of Arthroplasty · Apr 21 2026 · PubMed

    Patellar resurfacing provides no significant difference in complications or patient outcomes compared to non-resurfaced TKA in propensity-matched analysis.

  31. Effect of Season on Patient-reported Outcomes and Discharge Disposition in Total Hip and Knee Arthroplasty.

    Journal of the American Academy of Orthopaedic Surgeons · Dec 30 2025 · PubMed

    Fall-season hip and knee arthroplasty associate with shorter length of stay and lower rehabilitation discharge; seasonality minimally impacts long-term patient-reported outcomes.

Recent reviews

  1. A Specialist-Led Care Model: Aligning the Patient and Specialist for the Greatest Impact.

    Journal of Arthroplasty · Sep 2023 · PubMed

    Orthopedic surgeons are best positioned to lead value-based musculoskeletal care models, balancing risk management with patient outcomes.

  2. Hospital Revenue, Cost, and Contribution Margin in Inpatient Versus Outpatient Primary Total Joint Arthroplasty.

    Journal of Arthroplasty · Feb 2023 · PubMed

    For Medicare THA patients, outpatient surgery yields significantly higher contribution margins than inpatient, raising access-to-care concerns if financial disincentives push vulnerable patients away from inpatient care.

  3. P-Values and Power in Orthopedic Research: Myths and Reality.

    Journal of Arthroplasty · Oct 2022 · PubMed

    P-values alone without power analysis can mislead study interpretation; confidence intervals and effect sizes provide more meaningful assessment of orthopedic research results.

  4. Revision knee replacement surgery in the NHS: A BASK surgical practice guideline.

    The Knee · Mar 2021 · PubMed

    High-volume revision knee centers and surgeons achieve better outcomes; network service models with standardized metrics optimize revision TKA care.

  5. Direct Anterior Approach for Revision Total Hip Arthroplasty: Anatomy and Surgical Technique.

    Journal of the American Academy of Orthopaedic Surgeons · Mar 01 2021 · PubMed

    Direct anterior approach for revision THA requires understanding extensile maneuvers and soft-tissue anatomy for safe acetabular and femoral exposure.

  6. Pseudotumors and High-Grade Aseptic Lymphocyte-Dominated Vasculitis-Associated Lesions Around Total Knee Replacements Identified at Aseptic Revision Surgery: Findings of a Large-Scale Histologic Review.

    Journal of Arthroplasty · Oct 2019 · PubMed

    Over 7% of revision knee replacements show pseudotumors or high-grade metal-debris reactions correlating with worse functional outcomes.

  7. Setting Yourself Up for Success: Locked Plating for Vancouver B1 Fractures.

    Journal of Orthopaedic Trauma · Sep 2019 · PubMed

    Vancouver B1 periprosthetic hip fractures require careful preoperative evaluation and locked plating techniques to ensure stability and healing.

  8. A systematic approach to the hip-spine relationship and its applications to total hip arthroplasty.

    The Bone & Joint Journal · Jul 2019 · PubMed

    Hip-spine workgroup consensus standardizes spinopelvic terminology to guide acetabular component positioning in total hip arthroplasty planning.

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