Orthopedic Surgery

Robotic pedicle screws outperform freehand and navigation in accuracy with added perioperative benefits

This umbrella review pooled 38 meta-analyses including 414 primary studies comparing robot-assisted, freehand, and navigation-guided pedicle screw placement. Robotic systems had convincing (class I) evidence for higher rates of acceptable screw placement versus freehand and navigation, and perfect placement versus navigation. Highly suggestive evidence indicated improved perfect placement versus freehand and shorter hospital stays with robotic techniques. Suggestive evidence also supported reductions in intraoperative blood loss and radiation exposure with robotics. Overall, the evidence base supports robot-assisted pedicle screw placement as more accurate and at least as safe as conventional approaches. 1

CAST provides durable pain relief and stability in complex osteoporotic vertebral compression fractures

This retrospective series evaluated 147 patients (155 levels, mean age 80.1 years) with predominantly osteoporotic complex vertebral compression fractures treated using CAST. CAST combined percutaneous pedicle screw fixation with targeted cement augmentation and was technically feasible in all cases without major complications. Mean NRS pain scores fell from 7.7 preprocedure to 3.6 at 1 month and 2.7 at 6 months, with most patients reporting marked improvement. Radiographically, only one asymptomatic refracture of a treated vertebra occurred by 1 month and none at 6 months, with low new-fracture incidence. These findings support CAST as a minimally invasive option offering durable stabilization and pain relief in complex VCFs unsuitable for standard vertebroplasty or kyphoplasty. 2

Valgus knees require laxity-driven, personalized alignment strategies in TKA

This narrative review emphasizes that valgus knees, about 18.5% of TKA cases, are biomechanically distinct and poorly served by strict mechanical alignment. Conventional MA-TKA can over-distalize and posteriorize the lateral femoral condyle, worsening patellar tracking and flexion instability. The authors advocate assessing medial collateral ligament status and generalized laxity to tailor tibial cuts, soft-tissue releases, and implant constraint. They recommend techniques prioritizing patellar tracking and avoiding medial gap over-release, with adjunctive patellofemoral procedures when indicated. Restricted kinematic alignment in valgus TKA shows long-term satisfaction and survivorship comparable to varus knees when anatomy and laxity are respected. 3

IV tranexamic acid offers no clear benefit in arthroscopic shoulder surgery

This systematic review and meta-analysis included 11 randomized trials with 904 patients undergoing arthroscopic shoulder surgery with or without IV tranexamic acid. TXA did not significantly improve arthroscopic visual clarity, pain scores, operative time, irrigation volume, blood loss, or mean arterial pressure versus controls. No complications were reported in either TXA or control groups in the six trials that documented adverse events. Current randomized evidence does not support routine IV TXA use to meaningfully improve perioperative outcomes in shoulder arthroscopy. Further high-quality RCTs under standardized protocols are needed before endorsing TXA for this indication. 4