Orthopedic Surgery

Acute and delayed TKA after tibial plateau fracture show similar 5-year reoperation risk

This Swedish Arthroplasty Register study compared acute TKA within 3 months of tibial plateau fracture (n=152) with delayed TKA for fracture sequelae (n=950). Acute TKA patients were older, more often women, and more frequently received constrained or hinged implants than delayed cases. Five-year cumulative reoperation and revision rates were low and similar between acute and delayed groups, with overall reoperation in 7% and revision in 5%. Adjusted analyses showed no meaningful differences in risk of any reoperation, infection-related procedures, or loosening-related procedures between strategies. These data support choosing acute versus delayed TKA based on fracture pattern, patient demands, and reconstructability rather than concern for higher revision risk. 1

Dermal allograft patch augmentation yields good results even with anterior cable disruption

This retrospective series evaluated 78 large-to-massive repairable rotator cuff tears treated arthroscopically with human dermal allograft augmentation and ≥24 months follow-up. Patients with intact versus disrupted anterior rotator cable had similar, significant improvements in VAS pain, ASES, UCLA scores, and range of motion. Over 85% of patients achieved the MCID for ASES and nearly all achieved the MCID for UCLA, with no between-group differences. MRI showed increased acromiohumeral interval and a decrease in combined tendon–graft thickness, consistent with graft remodeling over time. The overall retear rate was 7.7%, with no significant difference between intact and disrupted cable groups, supporting patch augmentation in difficult cuff patterns. 2

BMI thresholds alone are poor gatekeepers for hip and knee arthroplasty access

This PLoS Medicine article argues that BMI-based restrictions for joint replacement deny effective surgery to patients who can benefit safely. The authors summarize evidence that patients with higher BMI experience meaningful pain relief and functional gains after arthroplasty. Available data indicate that, while some complications increase with BMI, absolute risks are generally acceptable and often modifiable. The paper highlights that rigid BMI cutoffs may worsen stigma, inequity, and disease progression by delaying definitive treatment. Clinicians and systems are urged to adopt individualized, risk-based assessments rather than single-parameter BMI exclusion policies. 3