If reconstruction of the radial head using osteosynthesis is not possible, radial head arthroplasty (RHA) is performed. Despite the increasing use of RHA, little reliable data is available on the functional and clinical outcomes following removal of RHA in a mid- to long-term follow-up.

This study included 27 patients who underwent removal of RHA between 2010 and 2021. The mean follow-up period was 8.8 years (2.0 to 14.2 years). The time to removal, as well as functional elbow scores (Mayo Elbow Performance Score (MEPS), Oxford Elbow Score (OES) and Disabilities of arm, shoulder, and hand (DASH)) established during the follow-up period, were recorded for all patients. Furthermore, the pre- and post-operative range of motion (ROM), level of pain, and radiological images were analysed.

Across the entire cohort (46.4 ± 14.3 years; 40.7% female), moderate functional outcomes were observed during the follow-up period (MEPS: 66.7 ± 22.1; OES: 35 ± 9; DASH score: 32.6 ± 17.7). The most common reasons for revision were loosening (n = 15, 55.6%) and painful movement restrictions with anterolateral forearm pain (n = 15, 55.6%). Despite arthrolysis, there was no improvement in ROM in the long-term follow-up. The incidence of moderate to severe OA increased significantly (44.4% to 70.4%, p = 0.031).

Complications following RHA result in impaired functional outcomes that persist even after the prosthesis is removed. These findings support the importance of careful primary implantation and avoidance of overstuffing; however, removal of a failed RHA should be regarded as a salvage procedure with limited potential to restore long-term elbow function.

Limited information is available about revision after lateral unicompartmental knee arthroplasty (UKA) due to infrequency of this procedure. The purpose of this study is to examine reason for failure, time to failure, patient characteristics, type of revision and re-revision surgeries after failed mobile- and fixed-bearing lateral UKA.

In this single centre study, a total of 43 patients who underwent a revision surgery between 2010 and 2024 after mobile- and fixed-bearing lateral UKA implantation were analyzed. Demographic information, time to revision surgery, reason for failure, type of revision and re-revision surgery of these patients were evaluated.

In revision after mobile-bearing lateral UKA group with 20 patients, progression of osteoarthritis (OA) and bearing dislocation were the leading reasons for revision. In 13 cases, conversion to total knee arthroplasty (TKA), in four cases conversion to fixed-bearing component and in three cases bearing exchange were performed after a failed mobile-bearing lateral UKA. After revision, five patients underwent a re-revision surgery. In revision after fixed-bearing lateral UKA group with 23 patients, progression of OA was the leading reason for revision. In 20 cases, conversion to TKA, in two cases conversion to TKA with augments and in one case conversion to Vanguard 360 knee revision system with augments were performed. After revision to TKA, one patient underwent a re-revision surgery.

TKA without augments could be used in 94% of cases, if revision to TKA is performed. Bearing exchange or revision to fixed-bearing lateral UKA resulted in a high re-revision rate of 57%, so alternative revision strategies should be considered after a failed mobile-bearing lateral UKA.

Additive manufacturing (3D printing) is increasingly used in unicompartmental knee arthroplasty (UKA), including patient-specific instrumentation (PSI)/cutting guides, additively manufactured cementless implants, and fully patient-specific implant workflows. However, these applications differ substantially in purpose, evidence level, cost structure, and implementation burden; therefore, their clinical value should not be inferred from technical feasibility alone.

This narrative review was updated through December 2025 and was informed by a structured search of PubMed/MEDLINE, Embase, and the Cochrane Library, supplemented by reference screening. Search concepts combined UKA with 3D printing, additive manufacturing, PSI, patient-specific implants, custom implants, porous cementless fixation, osseointegration, navigation/robotics comparators, cost, and implementation. Study selection, eligibility criteria, evidence domains, outcomes, and anticipated sources of bias were predefined to improve reproducibility.

Randomized trials and meta-analyses show that PSI in UKA does not consistently reduce alignment outliers or improve patient-reported outcome measures (PROMs), with recurrent technical vulnerability at tibial registration, slope, and rotation. Cadaveric studies support feasibility but mainly report surrogate technical endpoints. For additively manufactured cementless UKA implants, implant-specific long-term cohort data suggest acceptable survivorship and clinically meaningful PROM improvement, but evidence remains implant-specific. Patient-specific implants may improve anatomic fit in selected morphologies, yet comparative studies have not demonstrated consistent short-term clinical or gait advantages over well-executed standard UKA.

Current evidence supports selective, indication-driven adoption rather than routine use of 3D-enabled UKA technologies. PSI is best viewed as an execution aid for specific workflows or training contexts, porous cementless 3D-printed implants require implant-specific survivorship surveillance, and patient-specific implants should be reserved for carefully justified morphology-driven indications. Future research should prioritize standardized reporting, surgeon-volume stratification, long-term failure mechanisms, registry linkage, and cost-effectiveness across the complete care pathway.

To assess the feasibility of a new technique for antegrade insertion of LC-II screws, guided solely by the obturator-outlet view.

From September 2020 to September 2025, patients with pelvic and/or acetabular fractures involving disruption of the supra-acetabular corridor treated with antegrade insertion of a LC-II screw in our hospital were included in this study. The procedure of LC-II screw insertion was performed solely guided by the obturator-outlet view, referencing with two anatomical points, namely the anterior inferior iliac spine and a virtual anatomical point. Postoperative CT scans were carried out to assess whether the LC-II screws were placed correctly within the bony corridor. Peri- and postoperative complications were documented.

Thirty-seven long, large-diameter (≥ 7 mm) LC-II screws were inserted in a total of 20 consecutive patients. The average length of these 37 screws was 115.8 mm. The procedure was performed without any noted wound infections or related vascular, neurological, and visceral complications. Postoperative CT images confirmed that all 37 LC-II screws were correctly placed within the bony corridors, with no instances of screw penetration. All patients were followed up for an average of 19.1 months (range, 6.1- 37 months). No cases of screw loosening, breakage, or bone union failure were observed.

The technique for antegrade insertion of LC-II screws, guided solely by the obturator-outlet view is a feasible surgical procedure. The virtual anatomical point has been shown to be a reliable anatomical landmark in our surgical procedure.

The purpose of this study was to compare knee range of motion and 2011 Knee Society Score (2011KSS) after unicompartmental knee arthroplasty (UKA) and total knee arthroplasty (TKA) in background–matched cohort.

UKA and TKA for medial knee osteoarthritis were included, and preoperative patient backgrounds, knee alignment, osteoarthritis severity, knee range of motion, 2011KSS symptoms, satisfaction and functional activities were matched using a propensity score. Knee range of motion and 2011KSS were evaluated two year postoperatively.

Among 116 UKAs and 656 TKAs, 98 each arthroplasty were matched (mean 75 years). UKA showed greater knee flexion (mean: 136.6° vs 122.4°, p < 0.001) and 2011KSS functional activities (median: 78 vs 68, p = 0.04) at 2-year. There were no differences in knee extension or other 2011KSS domains.

UKA showed greater knee flexion and subjective functional score than TKA. UKA may be beneficial for populations with high flexion demands.

To compare the clinical efficacy and radiological outcomes of the far lateral approach of uni-portal non-coaxial spinal endoscopic surgery versus traditional percutaneous endoscopic transforaminal discectomy (PETD) for the treatment of L5/S1 foraminal stenosis with a high iliac crest.

A retrospective analysis was conducted on 82 patients with L5/S1 foraminal stenosis and a high iliac crest treated at our hospital from June 2023 to June 2025. Patients were divided into a uni-portal non-coaxial spinal endoscopic surgery group (n = 42) and a PETD group (n = 40) based on the surgical procedure. Operative time, the fluoroscopy time estimated blood loss, length of hospital stay, and complication rates were recorded and compared between the two groups. Clinical outcomes were evaluated using the Visual Analogue Scale (VAS) for leg pain, the Oswestry Disability Index (ODI), and the modified MacNab criteria. Radiological assessments included postoperative foraminal area, facet joint preservation rate, and segmental stability.

All patients were followed up for at least 12 months. The uni-portal non-coaxial spinal endoscopic surgery group had a significantly shorter operative time (68.5 ± 12.3 min vs. 92.6 ± 18.4 min, P < 0.001) and significantly fewer fluoroscopy time (5.4 ± 1.5 vs. 15.8 ± 4.2, P < 0.001) compared to the PETD group. There were no significant differences between the two groups in estimated blood loss (42.5 ± 15.3 mL vs. 40.2 ± 16.1 mL, P 0.05) or length of hospital stay (3.2 ± 1.1 days vs. 3.6 ± 1.4 days, P 0.05). Both groups showed significant improvement in VAS and ODI scores at all postoperative time points compared to preoperative values (P < 0.05). At one week postoperatively, the uni-portal non-coaxial spinal endoscopic surgery group had noticeably better leg pain VAS scores than the PETD group (2.2 ± 0.7 vs. 3.3 ± 1.3, P < 0.01), while clinical outcomes were comparable between the two groups at three, six and 12 months postoperatively (P 0.05). The excellent-to-good rate according to the modified MacNab criteria was 90.5% in the uni-portal non-coaxial spinal endoscopic surgery group and 87.5% in the PETD group (P 0.05). Radiologically, the uni-portal non-coaxial spinal endoscopic surgery group demonstrated a noticeably larger postoperative foraminal area (79.8 ± 13.2 mm² vs. 63.5 ± 12.1 mm², P < 0.001) and a noticeably higher facet joint preservation rate (93.5% vs. 75.8%, P < 0.01) compared to the PETD group. The complication rate was 7.1% in the uni-portal non-coaxial spinal endoscopic surgery group and 17.5% in the PETD group (P 0.05).

Both the far lateral approach of uni-portal non-coaxial spinal endoscopic surgery and PETD are effective treatments for L5/S1 foraminal stenosis with a high iliac crest, yielding satisfactory clinical outcomes. Compared to PETD, uni-portal non-coaxial spinal endoscopic surgery offers advantages including shorter operative time, less fluoroscopy, more thorough foraminal decompression, and better preservation of the facet joint, making it a valuable and comparable alternative with additional perioperative benefits for managing pathologies in the L5/S1 region with a high iliac crest.

Antibiotic-loaded polymethylmethacrylate (PMMA) cement spacers are widely used in periprosthetic joint infection and chronic osteomyelitis. Manual prefabrication and sterilisation of non-commercial antibiotic-loaded cement may reduce operative time and cost; however, the effects of sterilisation and storage on antimicrobial efficacy remain unclear.

Manually prefabricated PMMA cement containing vancomycin (2 g or 4 g) underwent formaldehyde gas sterilisation (FO) and storage for one, four or seven days. Antibiotic elution was evaluated over 28 days. Antimicrobial activity against Staphylococcus aureus ATCC 25923 was assessed using minimum inhibitory dilution (MID) testing at predefined time points. Given the small number of specimens per subgroup, all comparisons should be interpreted as preliminary and hypothesis-generating.

FO sterilisation significantly reduced antimicrobial activity during the early elution phase. In the 4—g vancomycin group, Day 1 MID values were significantly higher in one day storage sterilised specimens than in specimens stored for four or seven days (1024 µg/mL vs. 213 µg/mL and 213 µg/mL, respectively; P < 0.001). Differences persisted at early time points but were no longer significant during the sustained elution phase (Days 14–28; P > 0.05). Overall, sterilised cement containing 4 g of vancomycin demonstrated higher MID values than 2 g cement during the early and mid-elution phases (Days 1–14; P < 0.01). MID values in all sterilised specimens remained several-fold above inhibitory thresholds for S. aureus throughout the 28-day period.

FO sterilisation transiently reduces vancomycin antimicrobial activity during the early elution phase (Days 1–7) but does not affect sustained antimicrobial efficacy compared with non-sterilised cement. Based on these findings, vancomycin-loaded PMMA cement containing 4 g of antibiotic may be sterilised and stored for up to seven days while maintaining MIC values several-fold above inhibitory thresholds for Staphylococcus aureus throughout the 28-day elution period.

Total hip arthroplasty (THA) is the standard treatment for hip osteoarthritis, yet its effects on lower limb alignment remain unclear. The coronal plane alignment of the knee (CPAK) classification system, widely used in knee surgery, has not been explored in THA. We investigated CPAK classifications in patients with hip osteoarthritis and examined alignment changes following THA.

This retrospective cohort study analyzed 110 patients (113 hips) who underwent primary THA between January 2017 and July 2019. Full-length standing radiographs were obtained preoperatively and one year postoperatively. Measured parameters included the mechanical medial proximal tibial angle (MPTA), mechanical lateral distal femoral angle (LDFA), arithmetic hip-knee-ankle angle (aHKA), and joint line obliquity for CPAK classification. Horizontal and vertical alignments were assessed to determine hip centre position.

Type II was the predominant CPAK type (47.8%) preoperatively, while types I and III were equally distributed (22.1% each). One year postoperatively, types I and II were equally prevalent (34.5% each), whereas type III decreased to 15%. LDFA and aHKA changed from 86.4 ± 2.2° to 87.9 ± 2.2° and from -0.2 ± 3.2° to -1.2 ± 3.2°, respectively, while MPTA remained unchanged. Hip center medialization was observed, with horizontal and vertical alignments changing from 43.6 ± 6.4 mm to 34.7 ± 4.9 mm and 30.2 ± 8.8 mm to 24.5 ± 6.0 mm.

Japanese patients exhibit distinct CPAK patterns, with type II predominance. Post-THA alignment changes were characterized by increased LDFA and decreased aHKA due to hip center medialization, highlighting the importance of considering alignment changes during THA planning.

To clarify differences in hip-specific function, satisfaction, and patient preference between transposition osteotomy of the acetabulum (TOA) and contralateral total hip arthroplasty (THA) in the same patients with bilateral hip dysplasia.

Among 689 patients who underwent TOA between 1998 and 2019, 32 patients who also underwent contralateral THA were included. Median age at surgery was 46 years for TOA and 50 years for THA (p = 0.008), and median follow-up was 14 and 12 years, respectively (p = 0.049). Postoperative patient-reported outcome measures included pain and satisfaction visual analogue scales (VAS), the Forgotten Joint Score-12 (FJS-12), and the Hip disability and Osteoarthritis Outcome Score (HOOS). Patients were also asked which hip they preferred.

Preoperative modified Harris Hip Score (mHHS) was higher in TOA hips than in THA hips (64 vs. 43; p < 0.001), whereas the latest mHHS was lower in TOA hips (92 vs. 96; p = 0.007). Although pain VAS, FJS-12, and all HOOS subscales were comparable between TOA and THA, satisfaction VAS was higher in THA hips (98 vs. 93; p = 0.029). Fifteen patients (47%) preferred THA, nine (28%) reported no difference, and eight (25%) preferred TOA. The most common reason for preferring THA was less pain (10 of 15 patients, 67%).

In middle-aged patients with bilateral hip dysplasia, TOA and contralateral THA yielded comparable functional outcomes; however, satisfaction was higher after THA, and 47% preferred THA. These findings may inform shared decision-making regarding joint-preserving surgery and arthroplasty.

Operating rooms contribute disproportionately to healthcare-related greenhouse gas emissions and waste generation. Total Hip Arthroplasty (THA) and Total Knee Arthroplasty (TKA) are high-volume procedures with increasing global incidence, yet pooled data on their environmental impact are lacking.

A systematic review and pooled analysis were conducted in accordance with PRISMA guidelines (PROSPERO: CRD420261297449). PubMed, Embase, and Scopus were searched through October 31, 2025, for studies reporting total waste, recyclable waste, and carbon dioxide equivalent (CO₂e) emissions associated with primary THA and TKA. Seventeen studies, including 394 procedures, were included. Data extraction covered waste quantity, recyclable proportion, and carbon footprint. Random-effects models with inverse variance weighting were used to calculate pooled mean estimates. Standard deviations were estimated from reported ranges when not provided. Heterogeneity was assessed using I² statistics.

Pooled mean total waste per arthroplasty was 12.27 kg (95% CI, 10.88–13.66). Recyclable waste averaged 1.97 kg per procedure (95% CI, 1.64–2.31), representing 14.5% of total waste (95% CI, 11.99–17.02), and indicating substantial unrealized recycling potential. Carbon footprint estimates varied substantially by accounting methodology. Studies measuring waste-disposal emissions alone reported a pooled mean of 13.7 kg CO₂e per case (95% CI, 11.32–16.08), whereas comprehensive life-cycle assessment (LCA) studies reported a pooled mean of 135.37 kg CO₂e per case (95% CI, 74.91–195.83). Considerable inter-study heterogeneity reflected differences in waste segregation, recycling infrastructure, and carbon accounting methodologies.

Primary THA and TKA generate substantial waste and carbon emissions, with low recycling rates across institutions. These findings provide benchmark data to inform sustainability initiatives, optimize resource use, and guide standardized environmental assessment frameworks in arthroplasty.

The optimal management of AO/OTA 33-C3 distal femoral fractures combined with symptomatic medial compartment knee osteoarthritis remains uncertain. This preliminary feasibility series explored whether metaphyseal comminution could be used as a “natural osteotomy” window to permit intentional valgus alignment correction during dual-plate fixation, while maintaining anatomical articular reconstruction and fracture stability.

This retrospective preliminary feasibility series included 17 patients with AO/OTA 33-C3 distal femoral fractures complicated by Kellgren-Lawrence grade 3 or 4 medial compartment knee osteoarthritis. All patients underwent anatomical reconstruction of the articular surface, intentional mild valgus alignment correction using the metaphyseal comminuted zone as a “natural osteotomy,” and medial–lateral dual-plate fixation. The primary feasibility outcomes included successful articular reconstruction, achievement and maintenance of planned valgus alignment, fracture union, and absence of early mechanical failure or reoperation. Operative time, intraoperative blood loss, articular step-off and gap, healing time, complications, mLDFA, and HKA angle were assessed. Pain, range of motion, Knee Society Score, and ambulatory status were evaluated as exploratory clinical outcomes.

Mean operative time was 148.18 ± 10.01 min and blood loss 351.18 ± 30.18 mL. Anatomical articular reduction (step-off ≤ 2 mm) was achieved in all patients, with mean step-off 0.97 ± 0.20 mm and gap 0.98 ± 0.16 mm. All fractures united (mean healing time 29.76 ± 3.42 weeks), with no nonunion, implant failure, or reoperation within years. mLDFA changed from contralateral baseline 93.09° ± 0.65°to postoperative 85.03° ± 0.50°(P < 0.001); HKA changed from varus –9.12° ± 1.41°to valgus 2.47° ± 0.80°(P < 0.001). At final follow‑up, VAS pain score decreased from 7.47 ± 0.87 to 1.18 ± 0.39 (P < 0.001). KSS knee score increased from 34.12 ± 3.64 to 89.76 ± 3.21 (P < 0.001), and KSS function score from 43.82 ± 4.85 to 81.65 ± 2.80 (P < 0.001). Mean maximum knee flexion was 99.29° ± 4.22°at final follow‑up. Independent ambulation was achieved in 16 patients (94.1%).

In this small single-center preliminary feasibility series, intentional valgus alignment correction using the metaphyseal comminuted zone as a “natural osteotomy” during dual-plate fixation was technically feasible in selected patients with AO/OTA 33-C3 distal femoral fractures and medial compartment knee osteoarthritis. This approach achieved fracture union, maintained coronal alignment, and showed favorable exploratory pain and functional outcomes at mid-term follow-up. These preliminary findings support this joint-preserving concept and warrant further validation in prospective comparative studies with longer follow-up.

This study aimed to evaluate the accuracy of two imageless navigation systems for restoring leg length change (LLC) and global offset change (GOC) in total hip arthroplasty (THA) using two-dimensional (2D) radiographic and three-dimensional computed tomography (3D CT)-based assessment methods.

Patients undergoing primary cementless THA were divided into two groups based on the imageless navigation system used: a large-console group (n = 120) and a portable handheld group (n = 83). Intraoperative navigation measurements of the LLC and GOC were compared with values derived from preoperative and postoperative assessments, and absolute measurement errors were calculated. Accuracy was evaluated using 2D radiographic and 3D CT-based measurements. Between-system differences and discrepancies between 2 and 3D assessment methods were analyzed.

Absolute LLC error in the large-console group was 2.7 ± 3.3 mm on 2D radiographic evaluation and 2.5 ± 3.3 mm on 3D CT-based evaluation, compared with 2.9 ± 2.7 mm and 3.0 ± 2.8 mm, respectively, in the portable handheld group. LLC error was significantly lower in the large-console group on 3D evaluation (p = 0.004). Absolute GOC error did not differ significantly between groups. No differences were observed between 2 and 3D evaluations for LLC, whereas most GOC-related parameters differed significantly between methods.

Imageless navigation systems achieved favorable accuracy for LLC and GOC in THA. While radiographic assessment is sufficient for evaluating leg length, 3D CT-based evaluation provides a more consistent and less position-dependent assessment of global offset.

Osteoarthritis (OA) is now understood as a heterogeneous syndrome driven by diverse biological, biomechanical, metabolic, genetic, and molecular mechanisms. This variability explains differences in disease progression and treatment response, challenging the traditional “one-size-fits-all” approach. This review highlights OA phenotyping as a key step toward precision medicine, focusing on clinical, structural, and molecular classifications that inform individualized care.

A narrative review was conducted using a non-systematic search of major databases and Osteoarthritis Research Society International sources (2010–2026). Evidence was thematically synthesized across clinical, imaging, and molecular domains to characterize OA phenotypes and their potential relevance to precision medicine.

Multiple OA phenotypes were identified: inflammatory, metabolic, biomechanical, cartilage–subchondral, pain-sensitization, and aging/senescence. These exhibit distinct clinical features, risk factors, and therapeutic responses. Imaging-based phenotypes (e.g., inflammatory, meniscus–cartilage, subchondral bone, atrophic, hypertrophic) and molecular endotypes (low turnover, structural damage, systemic inflammation) further refine stratification. Pain–structure discordance is notable in sensitization phenotypes and may predict poorer surgical outcomes. Joint-specific variations and emerging genomic and epigenetic insights underscore disease complexity. Advances in imaging, biomarkers, and machine learning may enable earlier detection and patient clustering, though clinical application remains limited.

Phenotype- and endotype-based classification represents a critical advancement toward precision OA management. Tailored interventions based on stratification hold promise for improving outcomes; however, clinical translation remains limited by overlapping phenotypes, lack of validated biomarkers, and inconsistent results from phenotype-driven trials. Wider clinical adoption requires standardized definitions, validation across joints, and integration of multimodal diagnostic tools into routine practice.

Septic arthritis (SA) of the native knee is a severe and increasingly prevalent condition, particularly among elderly and comorbid patients. When associated with end-stage degenerative joint disease, a two-stage total knee arthroplasty (TKA) with an antibiotic-loaded articulating spacer is commonly adopted. However, evidence directly comparing different spacer designs is limited. The aim of this study was to compare the clinical and functional outcomes of two two-stage strategies: a preformed cement articulating spacer and a Hofmann-type metal-on-polyethylene articulating spacer.

We retrospectively reviewed 15 consecutive patients treated between June 2022 and December 2024 at a tertiary referralcentre. Inclusion criteria were native knee SA with end-stage arthritis managed with planned two-stage TKA and minimum 12-month follow-up. Seven patients received a Hofmann spacer and eight a preformed cement spacer. The primary endpoint was septic failure, defined as recurrent infection requiring surgical intervention; secondary endpoints included functional outcomes (Knee Society Score [KSS], Oxford Knee Score [OKS], Forgotten Joint Score [FJS]), pain (VAS), and range of motion (ROM) during the interstage period and after reimplantation.

Mean follow-up was 24.2 months. Infection eradication was comparable between groups, with one reinfection (6.7%) occurring in the cement spacer group (p = 1). During the interstage period, the Hofmann group demonstrated significantly superior KSS, OKS, FJS, VAS, and ROM (p = 0.001). After reimplantation, functional outcomes remained significantly better in the Hofmann group, with greater ROM and higher patient-reported scores. Two patients in the Hofmann group elected spacer retention due to satisfactory function.

Both strategies achieved effective infection control. However, the Hofmann articulating spacer provided superior functional recovery without compromising septic eradication, supporting its use in selected patients with native septic knee arthritis and advanced degeneration.

To evaluate fracture table availability and functional usability in Nigerian orthopaedic practice and their influence on surgical decision-making, including referral practices, to inform strategies for improving access within existing surgical infrastructure.

A nationwide cross-sectional survey was conducted among 77 orthopaedic surgeons across 46 hospitals in 25 Nigerian states, representing all six geopolitical zones and the Federal Capital Territory. Participants were recruited via a national WhatsApp group of practising orthopaedic surgeons, enabling broad geographic representation, although the sample was non-probability. A structured questionnaire captured respondent demographics, institutional characteristics, fracture table availability and functional usability, barriers to use, and qualitative suggestions for improving access. Quantitative data were analysed descriptively, with associations assessed using chi-square tests, interpreted cautiously in the context of potential structural dependencies. Open-ended responses underwent thematic qualitative analysis.

Sixty-one per cent of respondents reported the presence of fracture tables at their primary workplaces, with private hospitals showing the highest availability (85.7%). However, consistent usability was limited; only 19.1% of surgeons with access reported ‘always’ using the equipment when indicated, highlighting a gap between availability and functional readiness. Reported barriers included malfunction (34.0%), lack of perceived need (21.3%), and insufficient training (12.8%). While higher utilisation was associated with reported availability (p < 0.001), this relationship likely reflects underlying differences in institutional resources. Formal training was associated with increased self-reported confidence (p < 0.001). Notably, the availability of fracture tables alone was not clearly associated with reported changes in surgical planning, suggesting that broader contextual constraints may influence decision-making. Respondents proposed financing strategies, training initiatives, maintenance systems, and policy measures to improve access.

In Nigeria, the presence of fracture tables does not necessarily translate to functional usability. Constraints related to maintenance, training, and institutional capacity limit effective use and may attenuate their influence on surgical decision-making. Strengthening orthopaedic care will require coordinated system-level interventions that prioritise not only the provision of equipment but also sustainability, workforce capacity, and context-appropriate surgical planning.

Third-generation alumina is being replaced with fourth-generation alumina matrix composite (AMC) in ceramic-on-ceramic total hip arthroplasty (THA), however, comparative clinical studies at a long-term are lacking. We aimed to compare third- and fourth-generation ceramic-on-ceramic THA at a minimum follow-up of ten years.

A total of 332 third-generation ceramic-on-ceramic THAs (302 patients) performed between 2010 and 2015 were compared with 185 fourth-generation (165 patients) during the same time period. Changes in the Harris Hip Score (HHS), Euro Qol-5D (EQ-5D), Visual Analogue Scale (VAS) satisfaction instruments, complications, survival rates for reoperation and the radiographic results were compared.

At the latest follow-up, the mean HHS, EQ-5D and VAS scores were similar between the groups. There were four dislocations (1.2%) in the alumina group (one with a 28—mm and three with a 32—mm femoral head), and two (1.1%) in the AMC group (all with a 36—mm). Four (1.2%) patients in the alumina group and eight (2.1%) in the AMC group reported occasional noises but no squeaking. One 28—mm femoral head fractured in the alumina group. The 15-year survival rate for any reoperation was 95.8% (95% confidence interval [CI]: 93.6% to 97.9%) for alumina-on-alumina THAs, and 96.3% (95% CI: 93.5—99.0) for the AMC group (p = 0.8).

Both third- and fourth-generation ceramic-on-ceramic THA can provide excellent results in most patients. Although no ceramic-related complications occurred in the AMC group, fourth-generation bearings were not found to be superior to third-generation alumina bearings overall. A thorough understanding of implant characteristics and surgical technique is essential for an accurate clinical interpretation when assessing different brands in THA.

Combined anteversion (CA), integrating acetabular (AA) and femoral anteversion (FA), is crucial for total hip arthroplasty (THA) stability. We evaluated CA distribution in natural Asian hips, AA and FA contributions to CA variance, and sex and age effects.

We retrospectively analysed 200 normal contralateral hips from patients with femoral neck fractures. Using CT-based 3D models, we calculated AA and FA. CA was determined using the Widmer equation (CA = AA + 0.7 × FA). We evaluated sex and age differences and used standardised regression coefficients to identify CA variance determinants.

Mean values were AA 16.3° ± 5.4°, FA 18.8° ± 11.2°, and CA 29.4° ± 9.6°. Standardised regression coefficients for CA variance were β = 0.822 for FA and β = 0.580 for AA. Women had significantly higher AA, FA, and CA than men (mean CA: 30.7° vs 24.4°). Sex-specific coefficients confirmed FA as the dominant determinant (men: FA β = 0.889, AA β = 0.595; women: FA β = 0.817, AA β = 0.587). With age, AA increased (0.12°/year, P = 0.006) and FA decreased (-0.30°/year, P = 0.001), but CA remained unchanged (P = 0.256).

Mean CA in natural Asian hips (29.4°) is lower than conventional THA targets. CA variance is predominantly determined by FA. While AA and FA change with age, CA remains stable. Optimising CA in THA requires individualised strategies emphasising sex differences.

This study aimed to evaluate the association of oxidized regenerated cellulose (ORC) powder in perioperative blood management during total knee arthroplasty (TKA) using a subvastus approach with limited tourniquet use.

We retrospectively analyzed 140 patients who underwent primary TKA using the subvastus approach at our institution between January 2023 and December 2025. The Patients were divided into ORC (n = 69) and non-ORC (n = 71) groups based on the intraoperative application of ORC powder. All patients received local tranexamic acid (TXA), and the tourniquets were inflated only during cementation. To account for potential confounding, multivariable linear regression analysis was performed. The primary outcomes were estimated total blood loss (eTBL) and hidden blood loss (HBL). Secondary outcomes included postoperative pain (numeric rating scale, NRS) and the incidence of postoperative complications.

The ORC group demonstrated significantly lower eTBL (599.2 ± 211.9 vs. 713.4 ± 273.3 mL, p = 0.007) and HBL (398.3 ± 207.6 vs. 485.8 ± 273.0 mL, p = 0.03) compared to the non-ORC group. Multivariable analysis confirmed that ORC use was independently associated with lower eTBL (β = -117.2; p = 0.009) and HBL (p = 0.02), though it was not an independent predictor for pain reduction on postoperative day seven (p = 0.15). There were no significant differences in operative time, or the incidence of postoperative complications.

The adjunctive use of ORC powder during TKA was associated with lower eTBL and HBL.

Spinal tuberculosis (TB) remains a major cause of morbidity in low- and middle-income countries. This study evaluated the epidemiological profile, management strategies, and neurological outcomes of spinal TB at a tertiary orthopaedic centre in Nigeria.

A retrospective review of patients treated between January 2021 and October 2025 was conducted. Diagnosis was based on clinical, radiological, microbiological, or histopathological criteria. Demographic and neurological data using the ASIA impairment scale were extracted. Changes in neurological status between presentation and final follow-up were analysed using the Wilcoxon signed-rank test, with significance set at p < 0.05.

A total of 223 patients were identified; 61% were male (n = 137) with a mean age of 45.2 years (range 4–81). All patients received anti-tuberculous therapy. Non-operative management was undertaken in 203 patients (91%), while 20 patients (9%) underwent adjunctive surgery for neurological deficit, instability, or deformity. Among conservatively managed patients with documented orthopaedic follow-up (n = 95), 75 presented with neurological deficits; 62 (82.7%) improved by at least one ASIA grade, including 51 (68.0%) who recovered to ASIA E (median improvement D to E; p < 0.001). Twelve surgical patients had neurological deficits; 83.3% improved postoperatively, with 33.3% achieving complete recovery (exact p = 0.002). Surgical complication rate was 15%, with no mortality.

Protocol-driven spinal TB management combining universal chemotherapy with selective surgery yields favourable neurological outcomes in endemic resource-limited settings.