Orthopedic Surgery

Exercise offers small, short-term benefits for OA and underperforms surgery in select patients

This overview combined five systematic reviews and 28 supplementary RCTs on exercise for knee, hip, hand, and ankle osteoarthritis. For knee OA, exercise yielded small short-term pain reductions versus placebo and no-treatment, with very low certainty and diminishing benefit in larger or longer trials. Hip OA showed negligible effects and hand OA small effects on pain, with at best moderate-certainty evidence. Outcomes were broadly comparable to education, manual therapy, analgesics, injections, and arthroscopy, but exercise was less effective than osteotomy and arthroplasty in single trials. 1

Rotator cuff MRI abnormalities are nearly universal and weakly linked to symptoms

In a Finnish population-based cohort of 602 adults aged 41 to 76 years, bilateral 3-T MRI found rotator cuff abnormalities in 98.7%. Tendinopathy, partial-thickness tears, and full-thickness tears increased with age but showed similar prevalence in men and women. Abnormalities were present in 96% of asymptomatic shoulders and 98% of symptomatic shoulders, showing poor concordance with recent shoulder pain. Full-thickness tears were somewhat more common in symptomatic shoulders, but this difference largely disappeared after adjustment. 2

Metagenomic sequencing outperforms culture for detecting hip periprosthetic joint infection pathogens

This retrospective cohort included 15 patients with periprosthetic hip infection after total hip arthroplasty undergoing both joint fluid culture and metagenomic next-generation sequencing. Standard culture was positive in two-thirds of cases, whereas mNGS was positive in all cases and identified more total pathogen types. Turnaround time was shorter with mNGS than culture, reducing reporting from just over three days to under two days on average. Antibiotics were adjusted based on these microbiologic results, and infection was controlled in 14 of 15 patients at follow-up beyond one year. 3

Prior shoulder surgery worsens survival and PROMs after primary shoulder arthroplasty

Using the Dutch Arthroplasty Register, investigators analyzed 25,188 primary shoulder arthroplasties performed between 2014 and 2022. About 17% of patients had previous non-arthroplasty shoulder surgery, including osteosynthesis, stabilization, rotator cuff repair, and subacromial decompression. Prior surgery increased revision risk and reduced 12-month improvements in shoulder function and pain compared with surgery-naïve shoulders. Previous osteosynthesis and rotator cuff repair were particularly associated with lower prosthesis survival versus no prior surgery. 4