30-Second Takeaway
- Adding intrawound tobramycin to vancomycin in high-risk tibial fractures did not reduce deep SSI rates.
- Reverse shoulder arthroplasty for glenohumeral OA with intact cuff has fewer complications than for cuff-deficient shoulders.
- Reverse shoulder arthroplasty is the most cost-effective option for complex geriatric proximal humerus fractures.
- Retained articulating antibiotic spacers can control infection but carry substantial long-term mechanical and functional tradeoffs.
- Machine learning can stratify post-TKA pain trajectories early, suggesting paths toward individualized analgesia plans.
Week ending April 18, 2026
Targeted updates in infection prophylaxis, upper-extremity arthroplasty, limb salvage, and arthroplasty pain phenotyping
Intrawound tobramycin adds no benefit over vancomycin alone in high-risk periarticular tibial fractures
In this 39-center randomized trial (n=1528), adults with high-risk periarticular tibial fractures received intrawound vancomycin with or without tobramycin at definitive fixation. Deep SSI at 182 days occurred in 7.4% with tobramycin plus vancomycin versus 6.6% with vancomycin alone (HR 1.11; 95% CrI 0.75-1.66). No superiority threshold was reached for any secondary infection endpoint, including gram-negative or polymicrobial infections. These results do not support routine intrawound tobramycin powder in addition to vancomycin for infection prophylaxis in this setting.
Reverse TSA for OA with intact cuff shows fewer complications than for cuff-deficient shoulders
This meta-analysis pooled 12 studies and 20,924 reverse shoulder arthroplasty patients, comparing glenohumeral OA with intact cuff versus cuff-deficient indications. Cuff-intact OA patients had lower revision risk (OR 0.53; 95% CI 0.41-0.68) and fewer overall complications (OR 0.57; 95% CI 0.46-0.71). Risks of aseptic stem failure, infection, and instability were all reduced in the cuff-intact group. ASES score gains and external rotation improvement were modestly better with intact cuff, but ASES differences did not exceed the MCID.
Reverse TSA is the most cost-effective strategy for complex proximal humerus fractures in older adults
This cost-utility analysis compared nonoperative care, IM nailing, ORIF, hemiarthroplasty, and reverse TSA for proximal humerus fractures in 65-year-old patients. Reverse TSA yielded the highest QALYs and was the most cost-effective strategy across 2-, 5-, and 10-year time horizons. At 2 years, reverse TSA provided 1.69 QALYs at a mean cost of $18,661, with an ICER of $24,112 per QALY. At 10 years, reverse TSA produced 7.16 QALYs at $23,311, with an ICER of $6,374 per QALY.
Retained articulating spacers after hip or knee PJI control infection but have important mechanical and functional limitations
This retrospective series examined patients with articulating spacers intentionally or unintentionally retained after first-stage revision for chronic hip or knee PJI. About one-fifth of 111 THA and 152 TKA patients ultimately retained their spacers long term, rather than undergoing planned reimplantation. Only a subset had at least 2 years of follow-up, with median follow-up 4 to 5 years for analyzed THA and TKA patients. The study evaluated spacer survivorship free from reoperation or removal, recurrent symptomatic infection, mechanical failure, and ambulatory status among retained-spacer patients.
References
Numbered in order of appearance. Click any reference to view details.
Additional Reads
Optional additional studies from this edition.