Recent orthopedic cohort studies

New cohort and registry evidence from the weekly pipeline — hottest first.

5 papers· updated weekly · ranked by rigour & impact

OTA International The Open Access Journal of Orthopaedic Trauma · Jul 20, 2026 · LoE III

HEAT

Despite lower fracture rates, homeless patients have worse outcomes after geriatric ground-level falls: an analysis of National Trauma Data Bank

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.

AI summary · from the full text

Why it mattersThis highlights that housing status is an independent driver of trauma outcomes and resource utilization, prompting orthopaedic trauma teams to consider social determinants of health in discharge planning for geriatric fall patients.

CohortTrauman = 326,403DOI ↗

Rigor

Impact

Fragility index 59 and first evidence on the question, offset by no power calculation.

Presenting this at rounds? Start here

?The homeless cohort had substantial missing/underdocumented comorbidity data and lacked frailty scoring; how might unmeasured confounding (e.g., undiagnosed chronic disease, injury severity misclassification) affect the interpretation of the adjusted odds ratio for extended length of stay?
?Given that homeless patients were more likely to be discharged home or leave against medical advice rather than to skilled nursing facilities, how should orthopaedic trauma services adapt discharge planning and follow-up care pathways for this population?

Journal of Hand Surgery (European Volume) · IF 1.3 · Jul 22, 2026 · LoE III

HEAT

A five-year radiostereometry study of cup fixation and implant survival in 484 Moovis trapeziometacarpal arthroplasties

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.

AI summary · from the full text

Why it mattersThis provides some of the longest-term RSA-validated fixation and survivorship data for a widely used press-fit trapeziometacarpal cup, reassuring hand surgeons about its durability compared with earlier failure-prone designs.

CohortArthroplastyn = 484DOI ↗

Rigor

Impact

Effect exceeds the MCID on QuickDASH and blinded outcome assessment, offset by no power calculation and no comparator.

Presenting this at rounds? Start here

?RSA analysis was unusable in 84 hands and only 148 hands had 5-year RSA data (versus 484 implanted); how might this substantial and selective loss of migration data, combined with the wide range of actual follow-up times (2-9 years), bias the reported migration and survival estimates?
?Given that all 13 intraoperative trapezium fractures occurred in the first 20% of cases (suggesting a learning curve), what specific technical safeguards should surgeons adopting this implant put in place during their early experience to avoid this complication?

The American Journal of Sports Medicine · IF 4.5 · Jul 23, 2026 · LoE III

HEAT

Minimum 5-Year Outcomes After Arthroscopic Subspine Decompression in Patients With Femoroacetabular Impingement: A Propensity-Matched Study

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).

AI summary · from the full text

Why it mattersFor residents learning hip arthroscopy, this suggests that treating subspine impingement concurrently with FAI correction does not compromise, and may even extend, the durability of surgical results at mid-term follow-up.

CohortArthroplastyn = 111DOI ↗

Rigor

Impact

Patient-important outcome and adequately powered, offset by effect below the MCID on mHHS, NAHS, HOS-SSS, iHOT-12, VAS and no correction for multiple comparisons.

Presenting this at rounds? Start here

?This was a retrospective, single-surgeon cohort study with no blinded outcome assessment and no mention of correction for the many statistical comparisons performed across five PRO instruments and subgroup analyses; how might these factors have inflated the apparent robustness of the findings?
?Given that the SSD group had more severe intra-articular pathology (more femoroplasty and loose-body removal) yet achieved outcomes comparable to a less-diseased control group, how should this inform patient selection and threshold for performing SSD intraoperatively?

Journal of Orthopaedic Surgery and Research · IF 2.8 · Jul 21, 2026 · LoE III

HEAT

Refracture after implant removal of the clavicle: a retrospective cohort analysis

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.

AI summary · from the full text

Why it mattersRefracture is an uncommon but recognized complication of elective clavicle hardware removal, and this is the largest cohort to date suggesting fracture morphology, not implant retention time, should guide the decision to remove plates.

CohortTrauman = 37DOI ↗

Rigor

Impact

Patient-important outcome and adequate follow-up, offset by no power calculation and no comparator.

Presenting this at rounds? Start here

?With only 21 refracture events driving the multivariable Cox model, and the authors themselves flagging overfitting risk and wide confidence intervals (HR 6.70, 95% CI 1.49-30.12), how much weight should be placed on AO 15.2C as an independent predictor?
?If a patient with a healed AO 15.2C midshaft clavicle fracture requests implant removal purely for cosmetic or mild discomfort reasons, how should this refracture risk data change your counseling and shared decision-making?

Spine · IF 2.6 · Jul 20, 2026 · LoE III

HEAT

Cognitive Impairment as an Effect Modifier of Perioperative Risk in Elderly Patients Undergoing Lumbar Fusion Surgery

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).

AI summary · from the full text

Why it mattersThis suggests that preoperative cognitive screening could help identify elderly spine surgery patients in whom frailty, diabetes, and blood management deserve extra perioperative attention, though the retrospective, single-center, exploratory design limits how much should change in practice today.

CohortSpinen = 243DOI ↗

Rigor

Impact

Effect exceeds the MCID on ODI, VAS back, VAS leg and adequately powered, offset by only 6 months of follow-up and no correction for multiple comparisons.

Presenting this at rounds? Start here

?Given only 57 patients in the CI subgroup and a stated limitation of reduced model stability, how confident can we be in the three specific interaction effects (diabetes, frailty, transfusion) versus finding them by chance among many variables tested without correction for multiplicity?
?If a patient screens positive for cognitive impairment preoperatively, how would you translate this study's findings into a concrete perioperative plan around glycemic control, frailty prehabilitation, and blood management, and what would you tell the patient about expected functional recovery?