Orthopedic research archive

This Australian RCT randomized 76 adults with chronic non-specific low back pain to either an individualized 8-week swimming program plus education (delivered via four telehealth physiotherapy sessions) or education alone (up to two sessions). At 8 weeks, the swimming group had significantly less disability on the Roland Morris Disability Questionnaire than the education-only group (mean difference -2.5 points, 95% CI -4.5 to -0.5), but this advantage shrank over time and was no longer statistically significant by 52 weeks; pain intensity showed only a small, possibly non-meaningful benefit, and the swimming group had more adverse events (56% vs 30%), almost all non-serious.

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This phase 3 randomized controlled trial (POETYK PsA-2) tested deucravacitinib, a first-in-class oral selective TYK2 inhibitor, against placebo (with apremilast included only as a safety reference) in 729 adults with active psoriatic arthritis who were biologic-naive or had limited prior TNF inhibitor exposure. By week 16, significantly more patients on deucravacitinib achieved an ACR20 response than those on placebo (54.2% vs 39.4%, p=0.0002), and improvements in joint disease, skin disease (PASI75), physical function (HAQ-DI), and quality of life were sustained through 52 weeks with a stable, well-tolerated safety profile and no new safety signals.

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This retrospective study from three Japanese spine centers compared complication rates between 407 patients who had corpectomy-containing anterior cervical surgery (ACCF or hybrid ACDF/ACCF) and 617 patients who had non-corpectomy anterior surgery (mostly ACDF) for degenerative cervical myelopathy. Corpectomy patients had far more perioperative local complications (38.1% vs 16.5%), dural injury (17.4% vs 1.5%), reoperation (9.8% vs 2.4%), and upper-extremity weakness (13.0% vs 4.2%), but after adjusting for how many levels were operated and whether the upper cervical spine was involved, the extra risk from corpectomy itself largely disappeared (adjusted OR fell from 1.82 to 1.12, no longer significant). The authors conclude that much of the added morbidity reflects the underlying OPLL pathology and greater surgical extent rather than corpectomy as a technique per se.

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This study combined an umbrella review of 16 prior systematic reviews/meta-analyses with a newly reconstructed meta-analysis of 38 primary studies to ask whether NSAIDs impair bone healing, and if so, in whom. Pooling roughly 82,000 NSAID-exposed and 756,000 unexposed patients, NSAID use was associated with higher odds of nonunion (OR 1.56, 95% CI 1.18-2.11), with the risk concentrated in adults, traumatic (not elective) fractures, long bones (not spine), and higher-dose regimens, while short courses of 14 days or less and pediatric patients showed no significant increase in risk.

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This network meta-analysis pooled 112 randomized trials to compare pain-control techniques (nerve blocks, periarticular injection, intrathecal morphine, and combinations) after total hip arthroplasty, using minimal clinically important difference (MCID) thresholds rather than statistical significance alone. No single technique produced a clinically meaningful reduction in postoperative day 1 pain scores, though intrathecal morphine (ITM) and iliopsoas block plus periarticular infiltration reduced 24-hour opioid consumption, and the pericapsular nerve group (PENG) block and ITM shortened hospital length of stay.

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This retrospective registry-based cohort study followed 4,412 adults who had multilevel posterior cervical spine surgery (2009-2023) at a large US integrated health system, comparing laminoplasty (PCL, 29.3%) to laminectomy with fusion (PLF, 70.7%). After adjusting for patient and surgical factors, PCL was associated with a lower risk of reoperation for adjacent segment disease (hazard ratio 0.42) and lower all-cause reoperation (hazard ratio 0.51) over a median 4.7 years of follow-up, with no difference in mortality, 90-day ED visits, or readmissions.

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This RCT of 160 patients undergoing arthroscopic shoulder surgery with biceps tenodesis compared a standard landmark-based tenodesis technique to a newer patient-specific method for restoring the biceps tendon's natural length-tension relationship. At final follow-up (mean 19.6 months), ASES functional scores, pain scores, and range of motion were statistically similar between groups (e.g., ASES mean difference only 2.0 points, p=.604), though the patient-specific group had modestly higher ASES scores at 6 weeks (mean difference 9.1, p=.048) that did not persist.

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This retrospective cohort study used the National Trauma Data Bank (2021-2022) to compare outcomes after ground-level falls in 1,136 homeless versus 325,267 housed adults aged 50 and older. Despite being younger and having significantly lower fracture rates (51.2% vs 59.3%), homeless patients had worse outcomes: longer hospital stays (8.82 vs 6.63 days), more ICU admissions (25.3% vs 19.8%), and more complications (11.5% vs 6.3%), with homelessness independently associated with 1.5-fold higher odds of extended length of stay after adjusting for comorbidities and injury severity.

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This prospective single-center study followed 484 Moovis dual-mobility thumb basal joint implants in 407 patients, using precise radiostereometric analysis (RSA) to track cup migration alongside clinical and patient-reported outcomes for up to 9 years. Cup migration stabilized early (0.28 mm at 3 months, only rising to 0.39 mm by 5 years), grip strength, pain, and QuickDASH scores improved and held steady after 1 year, and 9-year implant survival was 98% for aseptic cup loosening and 87% for any component revision, with 96% patient satisfaction at 5 years.

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This multicenter study followed 154 skeletally mature adolescents with bilateral pars defects or low-grade spondylolisthesis for a median of 10.5 years to see how the condition behaves after growth stops. Vertebral slip itself rarely worsened (7.1%), but MRI-detected disc degeneration progressed in 30.5%, low back pain worsened in 44.2%, and new neurologic symptoms appeared in 4.5%, so that 56.5% of patients showed progression in at least one domain; L5-level disease, paraspinal sarcopenia, and sedentary behavior independently predicted this overall progression.

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This retrospective database study used TriNetX electronic health records to compare fragility fracture risk in about 133,600 propensity-matched adults with type 2 diabetes who started a GLP-1 receptor agonist versus a DPP-4 inhibitor. Over 3 years, fragility fractures occurred in 2,030 GLP-1 RA users versus 2,484 DPP-4i users, corresponding to a 21% lower relative risk (HR 0.79) that appeared independent of weight loss or glucose control, though the effect weakened by year 3 and was not seen in patients without diabetes.

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This retrospective, propensity-matched cohort study from a single high-volume hip preservation center followed 94 patients who underwent arthroscopic subspine decompression (SSD) for AIIS impingement alongside FAI correction and compared them to 188 matched controls who had FAI surgery alone. At a mean follow-up of about 6 years, the SSD group showed large, statistically significant improvements in all patient-reported outcome scores (P<.0001), with rates of achieving meaningful clinical improvement (MCID/PASS) and conversion to hip arthroplasty (5.3% vs 17.4%, not statistically significant) similar to controls, while time to revision arthroscopy was significantly longer in the SSD group (52.0 vs 32.8 months).

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This retrospective single-center study followed 575 adults who had clavicle plates removed after confirmed fracture healing and asked how often the bone rebroke afterward. Refracture occurred in 21 patients (3.7%), most within the first two years and typically after a new trauma at the original fracture site; the only significant risk factor identified was complex, comminuted midshaft fracture morphology (AO type 15.2C), which carried roughly a 6.7-fold higher hazard of refracture than other fracture types. Age, sex, BMI, smoking, ASA class, and how long the implant stayed in before removal were not associated with refracture risk.

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This retrospective single-center study followed 243 patients aged 75 or older undergoing lumbar fusion, comparing 57 with preoperative cognitive impairment (CI, by education-adjusted MMSE) to 186 without. Major postoperative complications were more common in the CI group (42.1% vs 33.9%), and CI amplified the harmful effects of frailty, diabetes, and intraoperative transfusion volume on complication risk (significant interaction terms), while also independently predicting worse functional recovery (lower MCID achievement on ODI and VAS scores).

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