Orthopedic Surgery

Cement-augmented percutaneous screws rapidly improve sacral insufficiency fracture symptoms

In 68 elderly patients with osteoporotic sacral insufficiency fractures, percutaneous screw fixation plus cement led to rapid functional gains. Functional scores increased from an estimated 2.43 at baseline to 3.51 on Day 1 and over 4 by 6 weeks and 6 months. Pain scores decreased from 6.60 preoperatively to 2.48 on Day 1 and about 1 at 6 weeks and 6 months. Same-day discharge was achieved in 43% of patients, and complications were infrequent at 4.4%, without lasting sequelae. 1

Antibiotic-loaded cement does not lower PJI risk in primary TKA

This systematic review and meta-analysis included 21 observational studies with over 4 million primary TKAs. Antibiotic-loaded bone cement was not associated with reduced periprosthetic joint infection versus standard cement (HR 1.04, 95% CI 0.91–1.19). Substantial heterogeneity (I² 81.6%) reflected variable study design and risk of bias. Sensitivity analyses were consistent, and overall certainty was very low, suggesting at most a very small benefit, if any. 2

Delphi consensus defines clinical diagnosis of atraumatic hip instability

An international Delphi panel established consensus clinical criteria for atraumatic hip instability. Typical symptoms included anterior hip pain during daily activities, mechanical popping or clicking, and subjective looseness or giving way. Three physical tests reached consensus as useful: AB-HEER, prone instability, and anterior apprehension (HEER) tests. FABER and a hip flexion plus rotation arc of 200° did not achieve consensus as diagnostic tests. 3

Expert consensus standardizes imaging workup for hip instability

This Delphi study generated 27 statements on imaging modalities, parameters, and thresholds for hip instability, with consensus on 22. Experts endorsed AP pelvis, false-profile, and Dunn radiographs plus CT and MRI as foundational imaging modalities. Key parameters included lateral center-edge angle, anterior wall index, posterior wall index, and Tönnis angle as morphologic indicators. An LCEA < 20° was considered diagnostic for hip dysplasia, a morphology frequently associated with clinical instability. 4