Orthopedic Surgery

Selective subscapularis repair in reverse TSA for GHOA yields early IR benefits but no 1-year PROM gain

In 80 rTSA patients with GHOA and intact cuffs using a lateralized system, subscapularis was repaired when it did not restrict intraoperative passive external rotation. At ≥1 year, global PROMs were similar between repair and no-repair groups despite better scores in the repair group at 3 and 6 months. The repair group had greater internal rotation range and strength at all time points and more often reached PASS for IR ROM. The no-repair group gained more active external rotation and more frequently achieved substantial clinical benefit for external rotation. There were no instability events, highlighting functional trade-offs rather than clear safety or long-term outcome differences with repair. 1

Short and stemless humeral components in aTSA match standard stems with fewer radiolucencies and shorter OR time

This multicenter series included 825 aTSAs with standard, short, or stemless humeral components and minimum 2-year follow-up. Final forward elevation and internal rotation were similar, and external rotation differences did not reach the minimal clinically important difference. PROMs and patient satisfaction were equivalent across stem lengths, with no difference in complication or revision rates. Operative time was shorter for short and stemless components compared with standard stems, supporting potential efficiency gains. Standard stems showed markedly higher humeral radiolucent line rates than short or stemless implants, favoring bone-preserving designs radiographically. 2

PENG, QLB, and periarticular injection improve early movement-evoked pain after THA

This network meta-analysis pooled 18 RCTs with 1424 THA patients comparing nine ultrasound-guided regional techniques and saline control. Periarticular injection, PENG block, and quadratus lumborum block significantly reduced movement-evoked pain at 12 and 24 hours versus control. Rest pain at 12 and 24 hours did not differ significantly among techniques, suggesting benefits are mainly with mobilization. Quadratus lumborum block reduced 24-hour and in-hospital morphine consumption, and regional blocks overall reduced postoperative nausea and vomiting versus placebo. No single technique was consistently superior for all outcomes, underscoring the need to tailor blocks to institutional expertise and goals. 3

App-based ankle rehab after modified Brostrom is noninferior to in-person physiotherapy and more cost-effective

This single-blind noninferiority RCT randomized 84 chronic ankle instability patients after modified Brostrom surgery to 12 weeks of digital or face-to-face physiotherapy. By 24 weeks, FAAM-ADL and FAAM-S improvements were similar, with adjusted differences well within prespecified noninferiority margins. Balance, functional hop tests, and quality-of-life outcomes were comparable between groups over follow-up. Cost analysis favored the digital program, which achieved similar clinical gains at lower intervention cost. These data support structured, individualized app-based rehabilitation as a viable alternative where in-person ankle-specific therapy is constrained. 4