Recent orthopedic RCTs

Every randomized controlled trial the weekly pipeline has surfaced, appraised from the full text and ranked by rigour and impact — the shortlist for a journal club that wants Level I evidence.

Clinical Rehabilitation IF 2.6 Aug 27 2026 LoE I Full text read

Effects of short-term compression in people with knee osteoarthritis: A sham-controlled randomised trial

This three-arm sham-controlled RCT tested whether wrapping an elastic compression bandage around the knee for 20 minutes a day for four days helps pain and function in people with knee osteoarthritis, compared to a loosely-wrapped sham bandage or no bandage at all (90 patients, 30 per arm). At Day 6, the mean between-group difference in pain (VAS) for compression versus sham was -1.1 cm (95% CI -2.7 to 0.5), well short of the 1.75 cm minimal clinically important difference, and no comparison at any time point (Day 6 or Week 12) reached the MCID for pain, WOMAC subscales, or objective physical function tests.

AI summary · from the full text

Why it mattersCompression bandaging and soft braces are commonly recommended or self-applied for knee osteoarthritis pain, and this trial suggests short courses of simple elastic compression have no clinically meaningful benefit over a sham wrap or no treatment, which should temper enthusiasm for this low-cost adjunct.

RCTGeneraln = 24DOI ↗

Presenting this at rounds? Start here

?If short-term elastic compression shows no clinically meaningful benefit over sham, should clinicians stop recommending it as a stand-alone pain-relief strategy for knee OA, or is it still reasonable as an adjunct to encourage exercise participation?
?Given that both the sham and control groups also improved over time, how should this placebo/natural-history effect shape how surgeons counsel patients about the expected benefit of any conservative device-based therapy for knee OA?

Rigor × clinical importance

Rigor100Clinical66Editorial65

Strong76

JAMA IF 65.4 Jul 31 2026 LoE I Full text read

Initial HIV Therapy for Adults and Treatment-Associated Weight Gain

This randomized trial in South Africa compared two first-line HIV drug regimens in 600 antiretroviral-naive adults: one containing doravirine/lamivudine/tenofovir disoproxil fumarate versus the current standard dolutegravir/emtricitabine/tenofovir alafenamide. At 48 weeks viral suppression was similar between groups (89.0% vs 90.7%, meeting the noninferiority margin), but the doravirine-based regimen caused significantly less weight gain (median 3.0 kg vs 5.0 kg, difference -2.0 kg, P<.001), at the cost of greater bone mineral density loss and more resistance emergence among those who failed treatment.

AI summary · from the full text

Why it mattersWeight gain from modern HIV regimens is a major cardiometabolic concern worldwide, and this is the first head-to-head RCT designed specifically to test whether an alternative first-line regimen can reduce that risk without sacrificing viral control.

RCTSpinen = 600DOI ↗

Presenting this at rounds? Start here

?If a patient starting HIV treatment is already overweight or obese, should regimen choice now factor in expected weight gain rather than defaulting to the standard dolutegravir/tenofovir alafenamide combination?
?Given the bone density loss and resistance signal seen with the doravirine-based regimen, how should clinicians weigh metabolic benefits against these competing risks when counseling patients?

Rigor × clinical importance

Rigor83Clinical62

Sound57

British Journal of Sports Medicine IF 15.5 Jul 21 2026 LoE I Full text read

Effectiveness of an individualised swimming and education programme for chronic low back pain (EduSwim): a randomised controlled trial

This RCT randomized 76 adults with chronic non-specific low back pain to either an 8-week individualized swimming and education program (with physiotherapy telehealth coaching) or education alone. 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, 95% CI -4.5 to -0.5), but this difference shrank and was no longer statistically significant by 26 and 52 weeks, and the swimming group also had more (mostly minor) adverse events (22/39 vs 11/37, p=0.02).

AI summary · from the full text

Why it mattersSwimming is commonly recommended for chronic low back pain despite almost no prior trial evidence, so this is the first dedicated RCT testing whether it actually helps.

RCTSpinen = 76DOI ↗

Presenting this at rounds? Start here

?The control group received less clinician contact (up to 2 sessions) than the intervention group (4 sessions plus health coaching); how much of the early benefit could reflect nonspecific attention effects rather than swimming itself?
?Given that the benefit faded by 26-52 weeks alongside declining adherence, how would you counsel a patient about swimming as a long-term self-management strategy versus a short-term confidence-building tool?

Rigor × clinical importance

Rigor60Clinical59

Limited48

Knee Surgery Sports Traumatology Arthroscopy IF 3.3 Sep 11 2026 LoE II Full text read

Functional alignment robotic‐assisted TKA improves clinical outcomes compared with conventional mechanical alignment TKA: A single‐surgeon randomised controlled non‐inferiority trial with 2‐year follow‐up

This single-center RCT randomized 180 patients undergoing primary TKA to either robotic-assisted total knee arthroplasty using a functional-alignment (kinematic-based) technique (FA-RATKA) or conventional mechanically-aligned TKA (MA-CTKA), following them for 2 years with a battery of knee scores. FA-RATKA showed statistically significant but small improvements over time in several patient-reported outcomes, including KSS Function (p<0.001, r=0.173), KSS Satisfaction (p<0.001, r=0.214), KSS Symptoms (p=0.004, r=0.138), Oxford Knee Score (p<0.001, r=0.185), VAS pain (p<0.001, r=0.188) and EQ-5D index (p=0.006, r=0.141), while other measures (KSS Expectations, LEAS, FJS-12, EQ-5D VAS) showed no difference. No revisions, deep infections or periprosthetic fractures occurred in either group by 2 years.

AI summary · from the full text

Why it mattersThis adds single-surgeon RCT data to the ongoing debate about whether robotic functional alignment TKA meaningfully improves patient-reported outcomes over conventional mechanically-aligned TKA, a question directly relevant to whether surgeons should adopt costly robotic platforms.

RCTArthroplastyn = 163DOI ↗

Presenting this at rounds? Start here

?If the observed differences (effect sizes r=0.12-0.21) are statistically significant but below typical MCID thresholds for KSS and OKS, should surgeons change their alignment philosophy based on these results alone?
?Given that a larger, multicenter, blinded RASKAL trial found no differences between functional and mechanical alignment, how should a surgeon weigh a single high-volume operator's favorable results against that contrasting multicenter evidence when counseling patients about robotic TKA?

Rigor × clinical importance

Rigor64Clinical54Editorial49

Limited44

BMC Musculoskeletal Disorders IF 2.3 Jul 20 2026 LoE I Full text read

A randomized controlled trial of brachial plexus block manipulation versus steroid injection in conscious patients for moderate to severe shoulder stiffness

This single-center RCT in China randomized 112 patients with moderate-to-severe frozen shoulder to either an 'Enhanced Recovery After Manipulation' (ERAM) protocol (ultrasound-guided brachial plexus block plus manipulation under anesthesia, intra-articular steroid, and rehab) or standard intra-articular steroid injection plus rehab alone. At every follow-up point through 6 months, the ERAM group had better Constant-Murley shoulder scores, pain scores, and range of motion than the steroid-only group (all P<0.05), and imaging at 8 weeks showed no rotator cuff injury from the manipulation.

AI summary · from the full text

Why it mattersFrozen shoulder is extremely common and often slow to resolve with steroid injection alone, so a same-day, ultrasound-guided manipulation protocol that avoids general anesthesia could change how orthopedic surgeons manage refractory stiffness in the clinic.

RCTSportsn = 112DOI ↗

Presenting this at rounds? Start here

?The trial is single-center, unblinded (patients could tell which treatment they received), and reports only 'P<0.05' rather than exact effect sizes and confidence intervals in the text; does the lack of blinding and precise numbers undermine confidence in the magnitude of benefit?
?If ERAM is adopted, what training, ultrasound equipment, and anesthesia support would a typical orthopedic clinic need to replicate this protocol safely, especially given the one reported case of transient nerve-related weakness?

Rigor × clinical importance

Rigor61Clinical51

Limited41

Journal of Orthopaedics and Traumatology IF 3.5 Sep 9 2026 LoE II Full text read

Pulsed electromagnetic fields (PEMFs) in complex regional pain syndrome type I (CRPS-I) of the foot: a randomised controlled trial

This small RCT randomized 32 patients with chronic CRPS-I of the foot or ankle (all previously treated with IV neridronate but still symptomatic) to either standard rehabilitation exercise alone or the same exercise plus a home pulsed electromagnetic field device (I-One, 4h/day for 60 days). Over 12 months of follow-up, both groups improved from baseline, but the PEMF group had significantly greater reductions in pain (VAS 1.8 vs 5.5 at 12 months), better AOFAS scores (89 vs 64), and more resolution of allodynia and hyperalgesia. Oedema and NSAID use improved in both groups without significant between-group differences at most timepoints.

AI summary · from the full text

Why it mattersCRPS-I of the foot/ankle is a difficult, disabling condition with limited proven adjuncts, so evidence about a home-use, non-invasive PEMF device is relevant to orthopedic and rehabilitation practice even though this trial is small and unblinded.

RCTFoot & Anklen = 14DOI ↗

Presenting this at rounds? Start here

?If a patient remains symptomatic with CRPS-I pain (VAS ≥5) after IV neridronate, would you now add a home PEMF device to their rehabilitation plan, and how would you counsel them about the strength of the evidence?
?Given that oedema and NSAID use did not differ significantly between groups, would you use PEMF specifically to target pain and allodynia rather than as a broad anti-inflammatory therapy?

Rigor × clinical importance

Rigor62Clinical47Editorial49

Limited38

Shoulder & Elbow IF 1.5 Jul 21 2026 LoE I Full text read

Restoring the anatomic tension relationship of the long head of the biceps during tenodesis: A prospective, randomized controlled trial

This RCT of 160 patients undergoing biceps tenodesis (mostly with concomitant rotator cuff or other shoulder procedures) compared a standard landmark-based tensioning technique to a patient-specific anatomic tensioning technique. At final follow-up (mean 19.6 months), ASES scores, VAS pain, forward flexion, and external rotation were statistically similar between groups (p=0.604, 0.308, 0.171, 0.726 respectively), though the intervention group had significantly higher ASES scores at 6 weeks (mean difference 9.1, 95% CI 0.1-18.0, p=.048) and, oddly, significantly lower ASES scores at 12 months (mean difference -16.8, 95% CI -33.1 to -0.5, p=.044).

AI summary · from the full text

Why it mattersBiceps tenodesis is common and lacks a standardized tensioning technique, so evidence on whether a more meticulous patient-specific method actually improves outcomes helps surgeons decide if the extra technical effort is worthwhile.

RCTShoulder & Elbown = 81DOI ↗

Presenting this at rounds? Start here

?The primary outcome (ASES at final follow-up) was not significant, yet a significant result appeared at 6 weeks and an unexplained significant worse result appeared at 12 months among six time points tested without correction for multiplicity: how much of this is chance given multiple comparisons?
?If you perform tenodesis routinely, does a possible early (6-week) functional advantage with patient-specific tensioning change your technique, given no advantage was seen at 3, 6, or 12 months, or at final follow-up?

Rigor × clinical importance

Rigor40Clinical45

Limited31

Spine IF 2.6 Jul 30 2026 LoE II Full text read

Effect of Intrawound Vancomycin Powder on the Pathogen Spectrum and Antimicrobial Susceptibility of Postoperative Infections in Elective Lumbar Fusion

This is a secondary microbiological analysis of a randomized trial of 292 patients undergoing elective posterior lumbar interbody fusion, comparing standard IV antibiotics alone versus IV antibiotics plus 1g of intrawound vancomycin powder. Among the 22 patients who developed any surgical site infection, gram-positive organisms still dominated in both groups (87.5% control vs 100% vancomycin, p=1.000), all tested isolates remained fully vancomycin-susceptible, and rates of non-wound infections like UTIs were similar between groups (5.3% vs 4.3%, p=0.788).

AI summary · from the full text

Why it mattersMany spine surgeons already use intrawound vancomycin powder for SSI prophylaxis, and this trial addresses a lingering safety worry from retrospective data that it might shift infections toward resistant or gram-negative organisms.

RCTSpinen = 292DOI ↗

Presenting this at rounds? Start here

?If gram-positive organisms and preserved vancomycin susceptibility remain the norm regardless of intrawound vancomycin use, should empiric antibiotic choice for suspected post-fusion SSI change at all based on prophylaxis history?
?Given the very small number of culture-positive infections in this cohort, how much weight should surgeons place on this reassurance when deciding whether to continue routine intrawound vancomycin powder in lumbar fusion?

Rigor × clinical importance

Rigor40Clinical45

Limited31

JAMA Network Open IF 10.5 Jul 27 2026 LoE I Full text read

Restrictive vs Liberal Transfusion Strategy After Myocardial Infarction

This is a post hoc Bayesian reanalysis of the MINT trial, which randomized 3504 patients with myocardial infarction and anemia to a restrictive (transfuse below Hgb 7-8 g/dL) versus liberal (keep Hgb above 10 g/dL) transfusion strategy. The original frequentist result for 30-day death or MI was borderline (crude risk ratio 1.16, 95% CI 1.00-1.35, with 16.9% events in the restrictive arm vs 14.5% in the liberal arm), so the authors reanalyzed the same data using Bayesian methods and found an 89.1% to 98.8% posterior probability that the liberal strategy reduced death or MI, at the cost of a modestly higher (60.6%-80.0% probability) risk of heart failure.

AI summary · from the full text

Why it mattersAnemic MI patients are common in both cardiology and perioperative orthopedic settings, and this reanalysis illustrates how a 'negative' P=.07 trial can be reframed as supportive evidence using Bayesian statistics, a distinction trainees should recognize when reading transfusion literature.

RCTGeneral🇨🇦 Canadian authorsn = 3,504DOI ↗

Presenting this at rounds? Start here

?For an anemic patient with a recent MI who needs orthopedic surgery, should the perioperative transfusion threshold be raised toward 10 g/dL despite the small added heart failure risk this analysis suggests?
?How should surgeons weigh a borderline (P=.07) frequentist trial result against a Bayesian reanalysis suggesting high probability of benefit when deciding transfusion thresholds for their own anemic surgical patients?

Rigor × clinical importance

Rigor40Clinical45

Limited31