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General Procedures

Core spinal surgical principles covering decompression, deformity correction, and fusion, with a focus on pedicle screw accuracy and the integration of MIS and robotics.

Overview

Total hip arthroplasty (THA) has faced scrutiny in the past decade due to harms associated with new implants, highlighting the need for rigorous registry surveillance and graduated introduction of novel devices [1]. The limited evidence on vitamin E highly cross-linked polyethylene compromises conclusions regarding clinical outcomes in primary total hip replacement, necessitating more randomized clinical trials with longer follow-up [3]. Definitive answers regarding whether minimally invasive approaches are superior or should be generally adopted remain unknown, requiring many years of follow-up and large patient studies [17].

There is no single best treatment for osteoarthritis of the hip; the procedure must be selected based on the specific features of each patient [52]. Arthrodesis, osteotomy, and arthroplasty each have appropriate indications for the treatment of osteoarthritis of the hip [52]. Utilization of the direct anterior approach as a one-size-fits-all strategy is not in the best interest of the patient, as both anterior and posterior approaches have justification for specific indications in total hip arthroplasty [18]. Enhanced recovery after surgery protocols can be associated with decreased length of stay even in the absence of neuraxial anesthesia in some surgical settings for primary total joint arthroplasty [45].

Surgeons who carry out procedures regularly achieve better outcomes, and teams used to dealing with complicated problems can deliver better, more cost-effective, and clinically excellent care [51]. Better selection of patients and improvement in surgical technique should increase the percentage of good results in custom press-fit arthroplasty of the hip [42]. Randomized, multicenter, prospective trials are needed to compare modern general anesthesia versus neuraxial anesthesia for primary total joint arthroplasty [45].

Anatomy & Pathophysiology

Osseous Anatomy and Trauma

Spinal anatomy encompasses vertebral components, development, segmentation variations, joints, ligaments, and musculature [86]. Physical examination of the spine utilizes inspection, palpation, range of motion testing, and neurologic evaluation to identify spinal pathology, nonspinal conditions, and signs of symptom magnification [13]. Spinal trauma management requires consideration of surgical approaches, decompression timing, instrumentation techniques, and imaging [26]. For accurate localization of vertebrae at surgery, a technique exists that is rapid, simple, and offers unparalleled accuracy in identifying the involved vertebral area without introducing a substance that cannot be readily removed [27]. Measurement of thoracic kyphosis (TK) with T2 on standing whole spinal radiographs results in a greater measurement error of up to 6.6° compared to upright computed tomography images [111].

In ankylosing spondylitis, cervical spine surgery involves specific challenges due to stiff kyphosis and unstable fractures, requiring tailored strategies for trauma and deformity correction that rely on principles distinct from standard protocols [103]. Percutaneous surgical treatment of thoracolumbar fractures in ankylosing spondylitis can improve pain, neurological function, and kyphotic deformity, achieving effects similar to traditional methods [105]. Preoperative planning for pedicle screw insertion in adolescent idiopathic scoliosis should be based on anatomical limitations in the apical vertebra region, apical vertebra level, and apical vertebral rotation degree [113].

Hip and knee osseous pathology also present distinct considerations. In patients with risk factors such as altered biomechanics from knee procedures, hip pain or stiffness may indicate a stress fracture of the ipsilateral femoral neck, as early radiographs may be negative [98]. The position of the femoral fovea can indicate hip instability and highly correlates with lesions of the ligamentum teres [108]. An improved type of arthroplasty of the hip joint restores normal mechanics by producing a normal angular thrust and eliminates hazards of dislocation [99]. A new four-part classification system for cemented femoral stem design and cementation techniques aids in comparing results and understanding implant biomechanics [11]. Orthopaedic trauma developments include clinically relevant advancements published or presented in 2019 or 2020 [109].

Ligamentous and Soft Tissue Pathology

The anterolateral ligament (ALL) of the knee demonstrates a role in controlling anterolateral laxity [102]. Posterior and posterior superior labral (PPS) injuries produce alterations in glenohumeral kinematics with implications for joint instability, increased joint loading, and potential joint damage [100].

Kinematics and Biomechanics

Variations in lumbosacral alignment may continue to impact patient outcomes following hip arthroscopy for femoroacetabular impingement and acetabular labral tears despite addressing deformities [101]. The Delta Angle (DA) can be reliably measured and serves as a valuable supportive parameter in the assessment of hip microinstability [108].

Surgical Approaches and Planning

A plantar approach provides the best visualization of the pathological anatomy and most direct means of reduction for dorsal dislocation of the metatarsophalangeal joint of the great toe [112]. Developing a robotic spine surgery program faces challenges including obtaining technology, training, and managing the learning curve [110]. Spine robots demonstrate clear advantages in screw implantation accuracy, with different robots potentially achieving optimal results under specific surgical requirements [104].

Classification

Mnaymneh: Provides a classification system and management strategies for bone stock deficiency in total hip replacement [56].

Utheza: Used in daily practice and included in referenced retrospective studies [57].

Sanders: Used in daily practice and included in referenced retrospective studies [57].

Anglo-Saxon: Used for didactic purposes in an article focusing on a surgical technique [57].

New Four-Part System: Proposed to aid in the comparison of results and better understanding of implant biomechanics in cemented femoral stem design and cementation techniques [11].

Generic Implant Classification: Enables comparison across implant designs, as demonstrated by the Dutch Arthroplasty Register implant library [68]. This library contains characteristics of 32,500 orthopaedic implants, covering about 85 different hip and 85 different knee implants [68]. Registry data supports the classification of the GTS stem and its performance relative to the CLS stem [66].

Clinical Presentation

Preliminary and follow-up care are critical for surgical success [2]. Diagnostic workup includes imaging and laboratory exams [2]. Ethical standards are a general consideration in orthopedic practice [2]. Final results of interventions require many years of experience for thorough evaluation [5]. The routine use of patient-reported outcome measures (PROMs) reflects a growing recognition of the importance of patient perspectives in improving treatments [32]. Patient-reported experiences (PREMs) are expected to play a greater role in research, strategies, and clinical practice [32]. The minimal clinically important difference (MCID) and clinical importance difference (CID) are useful tools to define general guidelines for determining whether a treatment produces clinically meaningful effects [12]. Pitfalls associated with MCID and CID metrics require a detailed understanding of the methods to calculate them and their context of use [12].

Physical examination of the spine includes inspection, palpation, range of motion testing, and neurologic evaluation to identify spinal pathology, nonspinal conditions, and signs of symptom magnification [13]. Recognition of pseudo-obstruction of the colon requires thorough physical examination and early abdominal radiographs to avoid operative intervention [9]. Diagnosis of pelvic fractures with urogenital injuries relies on a combination of physical examination, urinalysis, and imaging [29]. Retrograde urethrogram and cystography serve as benchmarks for diagnosing pelvic fractures with urogenital injuries [29]. Diagnosis of deep infection in total hip arthroplasty can be established through clinical history, physical examination, and advanced imaging like indium111-labeled leukocyte scintigraphy [34].

Acute Achilles Tendon Rupture: Females have more symptoms compared to males after surgery for acute Achilles tendon rupture at 6 and 12 months [15]. The difference in symptoms between females and males after acute Achilles tendon rupture is not found when treated non-surgically [15].

Hip Pathology: Voluntary habitual dislocation of the hip should be treated conservatively by immobilization or without it because the prognosis is good and the condition resolves spontaneously [16]. Early diagnosis of congenital dislocation of the hip associated with central core disease is valuable as it may reduce soft-tissue tightness and improve outcomes [30].

Hand and Bone Metabolism: A brief knowledge of Hajdu-Cheney syndrome may help the hand surgeon to appropriately diagnose, assess, and refer patients to rheumatologists or bone metabolism specialists [36].

Patellar Pain: The clinical syndrome of patellar pain has several causes and should not be diagnosed as chondromalacia patellae [37]. The term chondromalacia patellae should be reserved for a description of articular cartilage lesions [37].

Gastrocnemius Syndrome: An unusual gastrocnemius muscle syndrome represents a definite clinical syndrome associated with a specific anatomical lesion that is amenable to surgical repair [33].

Investigations

Plain radiography: Preliminary and follow-up care are critical for surgical success, with general considerations for diagnostic workup, imaging, and laboratory exams outlined in orthopedic practice [2]. Radiology of skeletal trauma emphasizes optimum radiographic examination and diagnostic interpretation based on injury mechanism [59]. Serial roentgenographic studies are necessary to demonstrate the evolution of multiple stress fractures in rheumatoid arthritis [80]. Roentgenograms and technetium scans can demonstrate fracture union and absence of avascular necrosis in severe hip injuries [73]. Simultaneous biplane radiography can accurately assess the motion of total joint replacements in vivo [85]. Biplane radiography may become an important adjunct in postoperative management to detect early changes before clinical or radiographic evidence of loosening is apparent [85]. Double semitendinosus anterior cruciate ligament reconstruction stabilizes the evolution of degenerative lesions as shown by standing X-ray [82]. Recognition of pseudo-obstruction of the colon requires thorough physical examination and early abdominal radiographs to avoid operative intervention [9]. Surgeons must convert operative definitions from alignment guides into radiographic definitions to determine safe zones [24]. 'Roentgenogram' is the preferred eponymic term for radiographic images, while 'radiograph' and 'radiographic' are equally acceptable [58]. The terms 'x-rays' and 'x-ray films' are not accepted because the rays themselves are invisible [58].

MRI: Ultrasonography is an effective alternative to MRI for diagnosing musculoskeletal pathology, offering real-time imaging, excellent soft-tissue contrast, and high spatial resolution without radiation exposure [31]. Ultrasonography remains underutilized in orthopaedic surgery compared to other imaging modalities [31]. Magnetic resonance imaging indicates that donor sites after autologous osteochondral mosaicplasty are resurfaced with fibrous tissue [79].

CT: O-ARM CT-guided navigation for percutaneous iliosacral screw fixation meets basic principles of computer-assisted surgery by minimizing X-ray dose, invasiveness, and morbidity [69].

Bone scan: Radionuclide scintigraphy serves as a succinct and complete summary of nuclear medicine relevant to orthopaedic practice, enhancing the diagnostic armamentarium [75].

Aspiration: Aspiration of the hip joint should be performed in selected patients rather than routinely, specifically when a detailed clinical history suggests infection or if radiographs demonstrate focal lysis, aggressive non-focal lysis, or periostitis [83].

Other Considerations: Radiation therapy aids in the prevention of massive ectopic bone formation when administered early after surgery [65]. Radiation therapy is of doubtful value for preventing ectopic bone once it is visible on radiography [65]. All biceps tenodesis techniques (subpectoral, suprapectoral, and top-of-groove) resulted in excellent clinical improvement based upon patient-reported outcome measures from a global registry [81].

Treatment

Non-Operative Management

Continued treatment with saturated doses of potassium iodide provides the best results for blastomycosis in animals [7]. Nonsurgical management of adhesive capsulitis of the hip is often successful but can take a protracted amount of time and requires patient compliance [23]. Voluntary habitual dislocation of the hip should be treated conservatively by immobilization or even without it, as the prognosis is good and the condition resolves spontaneously [16]. Osteochondritis dissecans lesions of the trochlear groove can be successfully managed nonoperatively with a locked knee brace, allowing return to full activity in 5 months without complication [71]. Conservative management is indicated for spinal fractures and dislocations complicating ankylosing spondylitis in patients without neural involvement [74]. Moderate nonprogressive coxa vara in childhood often does not require surgery [77]. Excellent functional outcomes can be achieved with a conservative approach for open antero-lateral dislocation of the elbow, even after extensive soft tissue damage from minor injury [91]. The solution for arthritic contractures of the wrist and fingers lies in the refinement of conservative indications and treatment rather than further development of operative methods [96]. Extracorporeal shock wave therapy is a safe modality that has a detectable clinical effect in patients with chronic plantar fasciitis [53].

Operative Management

Indications: Surgical management of coxa vara in childhood is indicated for progressive, painful, unilateral deformity or leg-length discrepancy [77]. Immediate exploration followed by fusion is indicated for spinal fractures and dislocations complicating ankylosing spondylitis in patients with progressive neural involvement or instability [74]. In non-elite patients, persistent grade 2 or 3 medial collateral ligament (MCL) laxity beyond 12 weeks in the setting of anterior cruciate ligament (ACL) rupture should prompt combined ACL reconstruction with MCL repair and reconstruction [78]. Treatment options for hallux rigidus and osteoarthrosis of the first metatarsophalangeal joint range from non-operative measures to various surgical procedures including cheilectomy, arthroplasty, and arthrodesis, with selection depending on disease stage and patient factors [88].

Surgical Approach / Technique: Proper indication for autologous osteochondral grafting relies on identifying and simultaneously correcting malalignment and/or traumatic changes in affected joints [46]. Utilization of the direct anterior approach as a one-size-fits-all approach for total hip arthroplasty is not in the best interest of the patient; both anterior and posterior approaches have justification for specific indications [18]. Responder analysis showed no significant difference in the proportion of patients achieving minimum clinically important difference in any patient-reported outcomes (PROs) between surgical approaches for total hip arthroplasty, with conclusions considering HOOS JR ceiling effects at 6 months [49]. Definitive answers regarding whether minimally invasive approaches are better or should be generally adopted are not yet known and will require many years of follow-up and large patient studies [17]. Understanding the current evidence and appropriate indications of emerging technologies in orthopaedic trauma is of critical importance for their utilization [14].

Implant Selection: Autologous Matrix-Induced Chondrogenesis (AMIC) is an effective and safe method for treating symptomatic full-thickness chondral defects of the knee in appropriately selected cases [4]. Vitamin E highly cross-linked polyethylene reduces mid-term wear in primary total hip replacement, though the limited number of included studies compromises conclusions regarding clinical outcomes [3]. Novel treatment strategies for Staphylococcus aureus periprosthetic joint infection, including copper-coated implants, show promise as adjunct therapies but require further clinical validation [55]. Re-use of explanted osteosynthesis devices via a rigorous decontamination protocol and generalized inspection criteria is a reliable and inexpensive reprocessing method for efficiently screening a large volume of devices [50].

Other Considerations: Females have more symptoms compared to males after surgery for acute Achilles tendon rupture at 6 and 12 months, a difference not found when treated non-surgically [15]. Successful results following primary surgical treatment for Morton neuroma are expected in 51% to 85% of patients, with 70% having some limitations in shoe wear and up to 38% requiring activity restriction [54]. Attention must be paid to the highly demanding technical aspects of bilateral total hip arthroplasty in ankylosing spondylitis to reduce the risk of significant complications [22]. The minimum clinically important difference (MCID) and clinically important difference (CID) are useful tools to define general guidelines to determine whether a treatment produces clinically meaningful effects, but pitfalls associated with these metrics require a detailed understanding of the methods to calculate them and their context of use [12]. Expansion of indications, evolving patient demographics, and the necessity of innovation in total hip arthroplasty must be considered alongside the need for rigorous registry surveillance and graduated introduction of new devices [1]. Optimization of blood management is as important in orthopaedic surgery as it was a decade ago, despite the markedly improved safety of allogenic blood [60]. The aim of reviewing persistent wound drainage (PWD) after total hip and knee arthroplasty is to consolidate the risk factors and management strategies available [97]. No improvement in clinical outcome in terms of fracture reduction and functional outcome has been established for 3D-assisted operative treatment of pelvic ring injuries [21].

Complications

Other Considerations: New implants have caused harms in total hip arthroplasty (THA) [1]. Revision surgery has inferior clinical results compared to primary surgery [64]. Revision surgery has higher complication rates compared to primary surgery [64]. There is a paucity of data regarding long-term outcomes associated with newer robotic systems such as Mako and TSolution One in total hip arthroplasty [20]. The limited number of studies compromises conclusions regarding clinical outcomes for vitamin E highly cross-linked polyethylene, necessitating more randomized clinical trials with longer follow-up [3]. Although no detrimental clinical effect was found in intermediate-term follow-up for modular femoral heads with an extended flange-reinforced neck, findings warrant concern for adverse effects after more long-term follow-up [10]. Long-term follow-up is necessary to determine if increased bone turnover in Paget’s disease will cause prosthetic loosening after total hip arthroplasty [25]. The total length of stay is reduced by about one-half in one-stage bilateral total hip replacement compared with two-stage replacements, with a similar incidence of local and systemic complications [47]. Patients with previous procedures have a much higher incidence of ectopic ossification following total hip replacement [89]. Major primary complications occur after bipolar radial head arthroplasty [95]. There is a high incidence of radiographic signs of degenerative changes after 8.8 years following bipolar radial head arthroplasty [95]. In a series of metallic osteosynthesis for bone fractures, four out of ninety-one cases experienced complications, all of which were ultimately healed by repeated operations and additional therapy [90].

Recovery

Preliminary and follow-up care are critical for surgical success [2]. Ethical standards are a general consideration in orthopedic practice [2].

Light activity (weeks): Specific timelines for light activity are not defined in the current evidence base. However, nonsurgical management for adhesive capsulitis of the hip is often successful but can take a protracted amount of time and requires patient compliance [23].

Full activity (months): Specific timelines for full activity are not defined in the current evidence base. For high tibial osteotomy, patients with a preoperative symptom duration of two years or greater do not experience inferior patient-reported outcomes or clinical outcomes than patients with a symptom duration of less than 2 years at mid-term follow-up [107].

Complete recovery / outcome plateau (months): Long-term follow-up is necessary to determine if increased bone turnover in Paget's disease will cause prosthetic loosening after total hip arthroplasty [25]. Final results for the self-locking metal hip prosthesis require many years of experience for thorough evaluation [5]. Eight of twelve patients with coccidioidal spondylitis were alive and well with no evidence of active infection an average of eleven years after onset [114].

Rehabilitation protocol: Specific rehabilitation protocols are not defined in the current evidence base. For endoprosthetic replacement of the humerus combined with trapezius and latissimus dorsi transfer, functional results do not justify two separate approaches and a prolonged operation time [62].

Functional milestones: The Musculoskeletal Function Assessment Questionnaire was more responsive than the SF-36 and more efficient in measuring changes in function between baseline and follow-up values [70].

Other Considerations: The limited number of studies compromises conclusions regarding clinical outcomes for vitamin E highly cross-linked polyethylene in primary total hip replacement, necessitating more randomized clinical trials with longer follow-up [3]. Autologous Matrix-Induced Chondrogenesis (AMIC) is an effective and safe method for treating symptomatic full-thickness chondral defects of the knee in appropriately selected cases [4]. The 1.5-stage revision does not show inferior results compared to the two-stage technique and reduces the number of additional surgical procedures [6]. Continued treatment with saturated doses of potassium iodide has given the best results for blastomycosis in animals [7]. Stepwise or graduated introduction of new prostheses is important, requiring substantial study periods and registry surveillance to identify risks [8]. No detrimental clinical effect was found for a modular femoral head with an extended flange-reinforced neck in intermediate-term follow-up, but findings warrant concern for adverse effects after more long-term follow-up [10]. Pooling data from retrospective studies was necessary for bilateral total hip arthroplasty meta-analysis due to the scarcity of randomized clinical trials [19]. Future analyses on bilateral total hip arthroplasty should focus on the ideal time interval between staged procedures to allow for accurate comparisons [19]. There remains a paucity of data regarding long-term outcomes associated with newer robotic systems such as Mako and TSolution One in total hip arthroplasty [20]. No improvement in clinical outcome in terms of fracture reduction and functional outcome has been established for 3D-assisted operative treatment of pelvic ring injuries [21]. Experience in orthopaedic management of Schwartz syndrome is scanty as none of the reported patients were followed beyond the age of twelve years [28]. Secondary reconstruction with other prosthesis types resulted in better outcomes for Judet arthroplasty due to foreign-body reaction to nylon prostheses, though long-term follow-up was inadequate [76]. Mobile and fixed-bearing (all-polyethylene tibial component) total knee arthroplasty designs functioned equivalently at the time of early follow-up in a low-to-moderate-demand patient group [106]. The mortality rate for radical operative treatment of the tuberculous hip is 12.4 percent, while the number of fusions which occur is only 58.6 percent [115]. Direct exchange for infection after total hip replacement can yield a rate of success comparable with that of delayed exchange if antibiotic-loaded cement and appropriate postoperative antibiotics are used [116].

Key Evidence

  • [L5] The authors agree that the past decade has been unsettling and disappointing due to harms from new implants but argue that expansion of indications, evolving patient demographics, and the necessity of innovation must be considered alongside the need for rigorous registry surveillance and graduated introduction of new devices. (10.1016/j.arth.2013.10.012)
  • [L1] The limited number of included studies compromises conclusions regarding clinical outcomes, necessitating more RCTs with longer follow-up. (10.1302/2058-5241.6.200072)
  • [L4] AMIC is an effective and safe method of treating symptomatic full-thickness chondral defects of the knee in appropriately selected cases. (10.1007/s00167-010-1042-3)
  • [L4] Final results require many years of experience for thorough evaluation. (10.2106/00004623-195739040-00005)
  • [L1] The 1.5-stage revision does not show inferior results compared to the two-stage technique and reduces the number of additional surgical procedures. (10.1016/j.arth.2025.10.075)
  • [L5] The authors agree that stepwise or graduated introduction of new prostheses is important, requiring substantial study periods and registry surveillance to identify risks, but disagree with using Darwinian natural selection as the sole approach to innovation. (10.1016/j.arth.2013.10.013)
  • [L4] Recognition by thorough physical examination and early abdominal radiographs is essential if operative intervention is to be avoided. (10.2106/00004623-198365060-00030)
  • [L4] The authors propose a new four-part classification system to aid in the comparison of results and better understanding of implant biomechanics. (10.1302/2058-5241.5.190034)
  • [L5] The MCID and CID are useful tools to define general guidelines to determine whether a treatment produces clinically meaningful effects, but the many pitfalls associated with these metrics require a detailed understanding of the methods to calculate them and their context of use. (10.1186/s13018-014-0144-x)
  • [L2] Females have more symptoms compared to males after surgery both at 6 and 12 months but this difference is not found when treated non-surgically. (10.1177/2325967114s00055)
  • [Case_report] The condition should be treated conservatively by immobilization or even without it, as the prognosis is good and the condition resolves spontaneously. (10.2106/00004623-198466070-00025)
  • [L5] Definitive answers regarding whether minimally invasive approaches are better or should be generally adopted are not yet known and will require many years of follow-up and large patient studies. (10.2106/00004623-200311000-00001)
  • [L5] Utilization of the direct anterior approach as a one-size-fits-all approach is not in the best interest of the patient; both anterior and posterior approaches have justification for specific indications. (10.2106/jbjs.24.01070)
  • [L5] The authors acknowledge that pooling data from retrospective studies was necessary due to the scarcity of RCTs and that future analyses should focus on the ideal time interval between staged procedures to allow for accurate comparisons. (10.1016/j.arth.2016.10.024)
  • [L5] There remains a paucity of data regarding long-term outcomes associated with newer systems such as Mako and TSolution One. (10.1302/2058-5241.5.200037)
  • [L1] No improvement in clinical outcome in terms of fracture reduction and functional outcome has been established so far. (10.3390/jpm11090930)
  • [L4] Attention must be paid to the highly demanding technical aspects of this procedure to reduce the risk of significant complications. (10.1302/2058-5241.4.180047)
  • [L5] Nonsurgical management is often successful but can take a protracted amount of time and requires patient compliance. (10.5435/00124635-201312000-00005)
  • [L5] Alignment guides are designed for operative definitions, and surgeons must convert these to radiographic definitions to determine safe zones. (10.1016/j.arth.2011.08.001)
  • [L4] While early results are encouraging, long-term follow-up is necessary to determine if increased bone turnover will cause prosthetic loosening. (10.2106/00004623-197658040-00007)
  • [Paper] This document is a collection of French abstracts covering various aspects of spinal trauma management, including surgical approaches, decompression timing, instrumentation techniques, and imaging, without presenting a single unified study with specific results. (10.1016/j.injury.2005.06.025)
  • [L4] The technique is rapid, simple, and offers unparalleled accuracy in identifying the involved vertebral area without introducing a substance that cannot be readily removed. (10.2106/00004623-195739030-00022)
  • [L4] Experience in orthopaedic management is scanty as none of the reported patients were followed beyond the age of twelve years. (10.2106/00004623-197557040-00018)
  • [L5] Diagnosis relies on a combination of physical examination, urinalysis, and imaging, with retrograde urethrogram and cystography serving as benchmarks. (10.5435/jaaos-d-25-01053)
  • [L4] Early diagnosis is valuable as it may reduce soft-tissue tightness and improve outcomes. (10.2106/00004623-197557050-00011)
  • [L5] Ultrasonography is an effective alternative to MRI for diagnosing musculoskeletal pathology, offering real-time imaging, excellent soft-tissue contrast, and high spatial resolution without radiation exposure, though its utility remains underutilized in orthopaedic surgery compared to other modalities. (10.5435/jaaos-d-16-00221)
  • [L5] The routine use of PROMs reflects a growing recognition of the importance of patient perspectives in improving treatments, and it will only be a matter of time before patient-reported experiences (PREMs) play a greater role in research, strategies, and clinical practice. (10.1302/0301-620x.97b7.36546)
  • [L4] The case represents a definite clinical syndrome associated with a specific anatomical lesion that is amenable to surgical repair. (10.2106/00004623-197355060-00016)
  • [L5] Diagnosis of deep infection can be established through clinical history, physical examination, and advanced imaging like indium111-labeled leukocyte scintigraphy. (10.5435/00124635-199509000-00001)
  • [L4] A brief knowledge of the syndrome may help the hand surgeon to appropriately diagnose, assess, and refer these patients to rheumatologists or bone metabolism specialists. (10.1016/j.jhsa.2020.02.012)
  • [L5] The clinical syndrome of patellar pain has several causes and should not be diagnosed as chondromalacia patellae; instead, the term should be reserved for a description of articular cartilage lesions. (10.2106/00004623-200104000-00038)
  • [L4] Better selection of patients and improvement in surgical technique should increase the percentage of good results. (10.2106/00004623-194830030-00012)
  • [L5] The authors endorse the need for randomized, multicenter, prospective trials regarding modern general anesthesia vs neuraxial anesthesia for primary total joint arthroplasty and state that enhanced recovery after surgery protocols can be associated with decreased length of stay even in the absence of neuraxial anesthesia in some surgical settings. (10.1016/j.arth.2020.01.059)
  • [Paper] Proper indication relies on identifying and simultaneously correcting malalignment and/or traumatic changes in affected joints. (10.1016/j.injury.2008.01.041)
  • [L3] The total length of stay is reduced by about one-half compared with two-stage replacements, with similar incidence of local and systemic complications. (10.2106/00004623-197860050-00008)
  • [L5] The authors emphasize that responder analysis showed no significant difference in the proportion of patients achieving minimum clinically important difference in any PROs between surgical approaches, and that the conclusion of no clinically meaningful between-group difference should be considered in light of HOOS JR ceiling effects at 6 months. (10.1016/j.arth.2020.05.023)
  • [L4] The rigorous decontamination protocol and generalized inspection criteria proved useful for efficiently screening a large volume of devices. (10.1016/j.injury.2011.02.006)
  • [L5] Surgeons who carry out procedures regularly get better outcomes, and teams used to dealing with complicated problems can deliver better, more cost-effective, and clinically excellent care. (10.1302/0301-620x.105b6.bjj-2023-0397)
  • [L5] The author states that there is no single best treatment for osteoarthritis of the hip; instead, the procedure must be selected based on the specific features of each patient, with arthrodesis, osteotomy, and arthroplasty each having their appropriate indications. (10.2106/00004623-195436030-00002)
  • [L5] Successful results following primary surgical treatment are expected in 51% to 85% of patients, with 70% having some limitations in shoe wear and up to 38% requiring activity restriction. (10.5435/00124635-200808000-00016)
  • [L5] Novel treatment strategies, including copper-coated implants, show promise as adjunct therapies but require further clinical validation. (10.1530/eor-2025-0093)
  • [L5] Classification and Management' by Mnaymneh WA, which provides a classification system and management strategies for bone stock deficiency in total hip replacement. (10.2106/00004623-199072020-00038)
  • [Letter] The author clarifies that while the submitted article focused on a surgical technique and used Anglo-Saxon classifications for didactic purposes, both the Utheza and Sanders classifications are used in their daily practice and were included in their referenced retrospective studies. (10.1016/j.otsr.2014.10.011)
  • [L5] This two-volume, 920-page text is thorough, easy to read, and beautifully illustrated, fulfilling its goals of emphasizing optimum radiographic examination and diagnostic interpretation based on injury mechanism. (10.2106/00004623-198365030-00036)
  • [L5] Optimization of blood management is as important today as it was a decade ago, despite the markedly improved safety of allogenic blood. (10.2106/00004623-199805000-00017)
  • [L5] Therefore, the functional results do not justify two separate approaches and a prolonged operation time. (10.1007/s00402-004-0713-2)
  • [L4] Radiation therapy aids in the prevention of massive ectopic bone formation when administered early after surgery, but is of doubtful value once ectopic bone is visible on radiography. (10.2106/00004623-198163020-00004)
  • [Letter] The authors are convinced a corrigendum is not necessary, citing manufacturer documentation, biomechanical studies, and registry data to support the classification of the GTS stem and its performance relative to the CLS stem. (10.1530/eor-23-0177)
  • [L4] A complete implant library containing characteristics of 32,500 orthopaedic implants was developed, covering about 85 different hip and 85 different knee implants. (10.1302/2058-5241.4.180063)
  • [Paper] It meets the basic principles of computer-assisted surgery, minimizing X-ray dose, invasiveness and morbidity. (10.1016/j.otsr.2013.03.002)
  • [L3] It was more responsive than the SF-36 and more efficient in measuring changes in function between baseline and follow-up values. (10.2106/00004623-199709000-00006)
  • [Case_report] The patient was successfully managed nonoperatively with a locked knee brace and returned to full activity in 5 months without complication. (10.1155/2021/9776362)
  • [Case_report] Despite the severity of the injury to the hip, roentgenograms and a technetium scan showed the fracture to be united, with no evidence of avascular necrosis. (10.2106/00004623-197961080-00018)
  • [L4] Conservative management is indicated for patients without neural involvement, while immediate exploration followed by fusion is indicated for those with progressive neural involvement or instability. (10.2106/00004623-196749020-00012)
  • [L5] This book serves as a succinct and complete summary of the state of the art nuclear medicine that is relevant to orthopaedic practice, significantly enhancing the diagnostic armamentarium of both clinical and research orthopaedists. (10.2106/00004623-198567030-00033)
  • [L4] Secondary reconstruction with other prosthesis types resulted in better outcomes, though long-term follow-up was inadequate. (10.2106/00004623-195436060-00006)
  • [L5] Surgical management is indicated for progressive, painful, unilateral deformity or leg-length discrepancy, while moderate nonprogressive deformity often does not require surgery. (10.5435/00124635-199803000-00003)
  • [L5] In non-elite patients, persistent grade 2 or 3 laxity beyond 12 weeks should prompt combined anterior cruciate ligament reconstruction with MCL repair and reconstruction. (10.1002/arj.70105)
  • [L4] However, magnetic resonance imaging indicates that the donor site is resurfaced with fibrous tissue. (10.1177/0363546507306465)
  • [L5] A heightened awareness and serial roentgenographic studies are necessary to demonstrate the evolution of these fractures. (10.2106/00004623-196749070-00017)
  • [L3] All techniques resulted in excellent clinical improvement based upon PROMs from a global registry. (10.1016/j.arthro.2023.01.038)
  • [L4] The study shows that the procedure is efficient in restoring a satisfactory stability for most patients and stabilises the evolution of the degenerative lesions as shown by standing X-ray. (10.1007/s001670050076)
  • [L3] Aspiration should be performed in selected patients rather than routinely, specifically when a detailed clinical history suggests infection or if radiographs demonstrate focal lysis, aggressive non-focal lysis, or periostitis. (10.2106/00004623-199301000-00010)
  • [L4] Simultaneous biplane radiography can accurately assess the motion of total joint replacements in vivo and may become an important adjunct in postoperative management to detect early changes before clinical or radiographic evidence of loosening is apparent. (10.2106/00004623-198466040-00028)
  • [L5] Treatment options range from non-operative measures to various surgical procedures including cheilectomy, arthroplasty, and arthrodesis, with selection depending on disease stage and patient factors. (10.2106/00004623-199806000-00015)
  • [L4] The author states that in their statistics, curative purpose was achieved in all cases, with only four out of ninety-one cases experiencing complications, all of which were ultimately healed by repeated operations and additional therapy. (10.2106/00004623-197759020-00034)
  • [Case_report] This case highlights that excellent functional outcomes can be achieved with a conservative approach even after extensive soft tissue damage from minor injury. (10.1186/1471-2474-3-1)
  • [L4] Despite major primary complications and high incidence of radiographic signs of degenerative changes after 8.8 years, mainly good clinical results were achieved with Judet's bipolar prosthesis. (10.1016/j.jse.2010.05.022)
  • [L5] The cause for poor results in managing arthritic contractures lies in the failure to recognize beginning contractures and take them seriously during their development; the solution lies in the refinement of conservative indications and treatment rather than further development of operative methods. (10.2106/00004623-195133040-00004)
  • [L4] The aim of this study was to review the current literature regarding persistent wound drainage (PWD) and consolidate the risk factors and management strategies available. (10.1302/2058-5241.6.200054)
  • [Case_report] In patients with risk factors such as altered biomechanics from knee procedures, hip pain or stiffness may indicate a stress fracture of the ipsilateral femoral neck, as early radiographs may be negative. (10.2106/00004623-198264020-00030)
  • [L4] The procedure restores normal mechanics of the hip joint by producing a normal angular thrust and eliminates hazards of dislocation. (10.2106/00004623-195133020-00017)
  • [L5] The PPS injury produces alterations in GH kinematics with implications for GH joint instability, increased GH joint loading, and potential joint damage. (10.1016/j.jse.2024.12.023)
  • [L3] Variations in lumbosacral alignment may continue to impact patient outcomes despite addressing FAI deformities. (10.1177/2325967124s00007)
  • [L5] The ALL demonstrated a role in controlling anterolateral laxity. (10.1177/2325967116s00027)
  • [Paper] Cervical spine surgery in ankylosing spondylitis involves specific challenges due to stiff kyphosis and unstable fractures that differ from common cervical surgery; management requires tailored strategies for trauma and deformity correction that rely on principles distinct from standard protocols. (10.1016/j.otsr.2015.02.005)
  • [L1] Spine robots demonstrate clear advantages in screw implantation accuracy and different robots may achieve optimal results under specific surgical requirements. (10.1186/s13018-025-06005-6)
  • [L3] This procedure can improve patients' pain, neurological function and kyphotic deformity and achieve effects similar to traditional methods, making it an ideal surgical treatment for thoracolumbar fractures in AS patients. (10.1186/s13018-022-03378-w)
  • [L1] The two designs functioned equivalently at the time of early follow-up in this low-to-moderate-demand patient group. (10.2106/jbjs.j.00157)
  • [L4] Patients with a preoperative duration of symptomatic medial knee overload/arthritis of two years or greater do not experience inferior PRO or clinical outcomes than patients with a symptom duration of less than 2 years at mid-term follow-up. (10.1016/j.jisako.2022.03.003)
  • [L3] The Delta Angle (DA) can be reliably measured and serves as a valuable supportive parameter in the assessment of hip microinstability. (10.1186/s12891-025-09267-7)
  • [L5] This review summarizes clinically relevant developments and advancements in orthopaedic trauma published or presented in 2019 or 2020 to aid practicing orthopaedic surgeons. (10.2106/jbjs.20.00425)
  • [L5] Developing a robotic spine surgery program faces challenges including obtaining technology, training, and managing the learning curve. (10.2106/jbjs.22.00022)
  • [L3] Measurement of TK with T2 on standing whole spinal radiographs resulted in a greater measurement error of up to 6.6°. (10.1186/s12891-021-04786-5)
  • [L4] The best visualization of the pathological anatomy and most direct means of reduction of the dislocation is provided through a plantar approach. (10.2106/00004623-197456050-00022)
  • [L4] Preoperative planning to accurately select and insert pedicle screws in adolescent idiopathic scoliosis should be based on anatomical limitations in the apical vertebra region, apical vertebra level, and apical vertebral rotation degree. (10.1186/s12891-022-05799-4)
  • [L4] Eight of the twelve patients were alive and well with no evidence of active infection an average of eleven years after onset. (10.2106/00004623-197860020-00018)
  • [L4] The experience suggests that direct exchange can yield a rate of success comparable with that of delayed exchange if antibiotic-loaded cement and appropriate postoperative antibiotics are used. (10.2106/00004623-199807000-00004)

See Also

References

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6. No endorsement. Nothing in this Public License constitutes or may be construed as permission to assert or imply that You are, or that Your use of the Licensed Material is, connected with, or sponsored, endorsed, or granted official status by, the Licensor or others designated to receive attribution as provided in Section 3(a)(1)(A)(i).

b. Other rights.

1. Moral rights, such as the right of integrity, are not licensed under this Public License, nor are publicity, privacy, and/or other similar personality rights; however, to the extent possible, the Licensor waives and/or agrees not to assert any such rights held by the Licensor to the limited extent necessary to allow You to exercise the Licensed Rights, but not otherwise.

2. Patent and trademark rights are not licensed under this Public License.

3. To the extent possible, the Licensor waives any right to collect royalties from You for the exercise of the Licensed Rights, whether directly or through a collecting society under any voluntary or waivable statutory or compulsory licensing scheme. In all other cases the Licensor expressly reserves any right to collect such royalties, including when the Licensed Material is used other than for NonCommercial purposes.

Section 3 -- License Conditions.

Your exercise of the Licensed Rights is expressly made subject to the following conditions.

a. Attribution.

1. If You Share the Licensed Material (including in modified form), You must:

a. retain the following if it is supplied by the Licensor with the Licensed Material:

i. identification of the creator(s) of the Licensed Material and any others designated to receive attribution, in any reasonable manner requested by the Licensor (including by pseudonym if designated);

ii. a copyright notice;

iii. a notice that refers to this Public License;

iv. a notice that refers to the disclaimer of warranties;

v. a URI or hyperlink to the Licensed Material to the extent reasonably practicable;

b. indicate if You modified the Licensed Material and retain an indication of any previous modifications; and

c. indicate the Licensed Material is licensed under this Public License, and include the text of, or the URI or hyperlink to, this Public License.

2. You may satisfy the conditions in Section 3(a)(1) in any reasonable manner based on the medium, means, and context in which You Share the Licensed Material. For example, it may be reasonable to satisfy the conditions by providing a URI or hyperlink to a resource that includes the required information.

3. If requested by the Licensor, You must remove any of the information required by Section 3(a)(1)(A) to the extent reasonably practicable.

4. If You Share Adapted Material You produce, the Adapter's License You apply must not prevent recipients of the Adapted Material from complying with this Public License.

Section 4 -- Sui Generis Database Rights.

Where the Licensed Rights include Sui Generis Database Rights that apply to Your use of the Licensed Material:

a. for the avoidance of doubt, Section 2(a)(1) grants You the right to extract, reuse, reproduce, and Share all or a substantial portion of the contents of the database for NonCommercial purposes only;

b. if You include all or a substantial portion of the database contents in a database in which You have Sui Generis Database Rights, then the database in which You have Sui Generis Database Rights (but not its individual contents) is Adapted Material; and

c. You must comply with the conditions in Section 3(a) if You Share all or a substantial portion of the contents of the database.

For the avoidance of doubt, this Section 4 supplements and does not replace Your obligations under this Public License where the Licensed Rights include other Copyright and Similar Rights.

Section 5 -- Disclaimer of Warranties and Limitation of Liability.

a. UNLESS OTHERWISE SEPARATELY UNDERTAKEN BY THE LICENSOR, TO THE EXTENT POSSIBLE, THE LICENSOR OFFERS THE LICENSED MATERIAL AS-IS AND AS-AVAILABLE, AND MAKES NO REPRESENTATIONS OR WARRANTIES OF ANY KIND CONCERNING THE LICENSED MATERIAL, WHETHER EXPRESS, IMPLIED, STATUTORY, OR OTHER. THIS INCLUDES, WITHOUT LIMITATION, WARRANTIES OF TITLE, MERCHANTABILITY, FITNESS FOR A PARTICULAR PURPOSE, NON-INFRINGEMENT, ABSENCE OF LATENT OR OTHER DEFECTS, ACCURACY, OR THE PRESENCE OR ABSENCE OF ERRORS, WHETHER OR NOT KNOWN OR DISCOVERABLE. WHERE DISCLAIMERS OF WARRANTIES ARE NOT ALLOWED IN FULL OR IN PART, THIS DISCLAIMER MAY NOT APPLY TO YOU.

b. TO THE EXTENT POSSIBLE, IN NO EVENT WILL THE LICENSOR BE LIABLE TO YOU ON ANY LEGAL THEORY (INCLUDING, WITHOUT LIMITATION, NEGLIGENCE) OR OTHERWISE FOR ANY DIRECT, SPECIAL, INDIRECT, INCIDENTAL, CONSEQUENTIAL, PUNITIVE, EXEMPLARY, OR OTHER LOSSES, COSTS, EXPENSES, OR DAMAGES ARISING OUT OF THIS PUBLIC LICENSE OR USE OF THE LICENSED MATERIAL, EVEN IF THE LICENSOR HAS BEEN ADVISED OF THE POSSIBILITY OF SUCH LOSSES, COSTS, EXPENSES, OR DAMAGES. WHERE A LIMITATION OF LIABILITY IS NOT ALLOWED IN FULL OR IN PART, THIS LIMITATION MAY NOT APPLY TO YOU.

c. The disclaimer of warranties and limitation of liability provided above shall be interpreted in a manner that, to the extent possible, most closely approximates an absolute disclaimer and waiver of all liability.

Section 6 -- Term and Termination.

a. This Public License applies for the term of the Copyright and Similar Rights licensed here. However, if You fail to comply with this Public License, then Your rights under this Public License terminate automatically.

b. Where Your right to use the Licensed Material has terminated under Section 6(a), it reinstates:

1. automatically as of the date the violation is cured, provided it is cured within 30 days of Your discovery of the violation; or

2. upon express reinstatement by the Licensor.

For the avoidance of doubt, this Section 6(b) does not affect any right the Licensor may have to seek remedies for Your violations of this Public License.

c. For the avoidance of doubt, the Licensor may also offer the Licensed Material under separate terms or conditions or stop distributing the Licensed Material at any time; however, doing so will not terminate this Public License.

d. Sections 1, 5, 6, 7, and 8 survive termination of this Public License.

Section 7 -- Other Terms and Conditions.

a. The Licensor shall not be bound by any additional or different terms or conditions communicated by You unless expressly agreed.

b. Any arrangements, understandings, or agreements regarding the Licensed Material not stated herein are separate from and independent of the terms and conditions of this Public License.

Section 8 -- Interpretation.

a. For the avoidance of doubt, this Public License does not, and shall not be interpreted to, reduce, limit, restrict, or impose conditions on any use of the Licensed Material that could lawfully be made without permission under this Public License.

b. To the extent possible, if any provision of this Public License is deemed unenforceable, it shall be automatically reformed to the minimum extent necessary to make it enforceable. If the provision cannot be reformed, it shall be severed from this Public License without affecting the enforceability of the remaining terms and conditions.

c. No term or condition of this Public License will be waived and no failure to comply consented to unless expressly agreed to by the Licensor.

d. Nothing in this Public License constitutes or may be interpreted as a limitation upon, or waiver of, any privileges and immunities that apply to the Licensor or You, including from the legal processes of any jurisdiction or authority.

Creative Commons is not a party to its public licenses. Notwithstanding, Creative Commons may elect to apply one of its public licenses to material it publishes and in those instances will be considered the “Licensor.” The text of the Creative Commons public licenses is dedicated to the public domain under the CC0 Public Domain Dedication. Except for the limited purpose of indicating that material is shared under a Creative Commons public license or as otherwise permitted by the Creative Commons policies published at creativecommons.org/policies, Creative Commons does not authorize the use of the trademark "Creative Commons" or any other trademark or logo of Creative Commons without its prior written consent including, without limitation, in connection with any unauthorized modifications to any of its public licenses or any other arrangements, understandings, or agreements concerning use of licensed material. For the avoidance of doubt, this paragraph does not form part of the public licenses.

Creative Commons may be contacted at creativecommons.org.