Orthopedic Surgery

US registry benchmarking shows most TKA systems meet survivorship standards, but some lag at 10–15 years

A US integrated-system registry analyzed 288,584 primary TKAs for osteoarthritis from 2001–2024, using ISAR benchmarking at 2, 5, 10, and 15 years. Follow-up remained high, with at least 80% of patients retained at 15 years, supporting reliable revision-free survivorship estimates. Most contemporary implant systems met 2- and 5-year benchmarks, supporting their general suitability for routine primary TKA. Several systems failed to consistently meet 10- and 15-year benchmarks, indicating higher long-term revision risk and informing implant selection and counseling. 1

Genicular artery embolization provides no 12-month advantage over sham for mild–moderate knee OA

This randomized, sham-controlled trial enrolled 58 patients with mild–moderate knee osteoarthritis unresponsive to conservative treatment. Both genicular artery embolization and sham produced sustained KOOS pain improvement over 12 months. The between-group pain difference at 12 months was not significant, and synovitis on contrast-enhanced MRI was unchanged. These findings indicate a largely placebo-driven effect and do not support routine clinical use of genicular artery embolization for knee osteoarthritis. 2

Extended-release opioids after THA/TKA are frequent and mainly driven by institutional and surgeon practice

In a population-based Ontario cohort of 229,995 primary THA and TKA procedures, 12.1% of patients filled a new extended-release opioid within 7 days of discharge. Male sex, higher preoperative opioid exposure, and ASA 3 status modestly increased the odds of extended-release dispensing. Neuraxial anesthesia, peripheral nerve blocks, and acute pain service involvement reduced the odds of extended-release prescribing. Hospital and surgeon effects dominated variation (median odds ratios 9.3 and 5.3), highlighting stewardship and standardized discharge protocols as key interventions. 3

Hospital harms after hip fracture admission independently raise 1-year post-discharge mortality

This Ontario cohort included 131,472 adults aged ≥50 years hospitalized for acute hip fracture and discharged alive between 2008 and 2022. Hospital harm occurred in 17.5% of admissions, and overall 1-year mortality after discharge was 18.4%. After adjustment, hospital harm was associated with a 42% higher risk of 1-year all-cause mortality (adjusted HR 1.42, 95% CI 1.38–1.46). Results support aggressive prevention, early detection, and mitigation of in-hospital complications as core components of hip fracture care quality. 4