30-Second Takeaway
- PSI in primary rTSA improves screw accuracy but not baseplate positioning versus free-hand using a standardized system.
- Supervised municipal rehabilitation after nonoperative displaced PHF did not outperform a single structured advice session.
- Denosumab showed promise as a synovitis‑targeting, disease‑modifying therapy in knee OA in translational models and a small trial.
- Patient frailty, cognition, and social support strongly influence rTSA outcomes for complex proximal humerus fractures in the elderly.
- Bisphosphonates offer only modest, short‑term pain relief in CRPS and increase adverse events, tempering off‑label enthusiasm.
Week ending December 20, 2025
Recent evidence with practice implications for shoulder, elbow, fragility fracture, and pain management
PSI improves peripheral screw but not baseplate accuracy in primary rTSA
In this multicenter RCT of 106 patients ≥65 years undergoing primary rTSA with a single implant system, PSI did not improve baseplate positioning versus free-hand placement. Version, inclination, and positional offset errors were similar between PSI and free-hand groups on postoperative CT relative to preoperative plans. PSI significantly improved peripheral screw accuracy, reducing anteroposterior and superoinferior gap deviations and improving superior screw length matching. Clinically relevant (>5°) screw placement errors were less frequent with PSI, but no clear benefit in baseplate accuracy was demonstrated.
Supervised rehab adds no benefit over single advice session after nonoperative displaced PHF
This pragmatic RCT randomized 60 adults ≥60 years with displaced proximal humerus fractures treated nonoperatively to supervised rehabilitation versus a single advice session only. At 6 months, Oxford Shoulder Scores were virtually identical between groups, with a negligible mean difference and confidence interval excluding a 10‑point benefit. Secondary outcomes, including 12‑month function, quality of life, surgery conversion, and adverse events, mirrored the primary result. Findings question routine referral to structured supervised rehabilitation for this population when competent early advice and follow-up are provided.
Denosumab targets synovitis and slows OA progression in translational knee OA models
This translational study showed that RANKL is highly expressed in knee synovium of OA mice and human patients. Systemic denosumab accumulated in synovium and reduced synovitis across post‑traumatic, inflammatory, and aged murine OA models, delaying structural disease progression. A beagle dog OA model similarly demonstrated attenuated progression with denosumab treatment. In a single‑arm clinical trial in knee OA patients, denosumab improved VAS pain, Oxford Knee Score, and WOMAC, with reported synovitis reduction.
References
Numbered in order of appearance. Click any reference to view details.
Additional Reads
Optional additional studies from this edition.