Autor: Tomasz Poboży

Polish version: Kołnierz trzpienia a ryzyko złamania okołoprotezowego po bezcementowej endoprotezie biodra

An analysis of the Swiss National Joint Registry, published in The Journal of Arthroplasty on 24 August 2026, examined periprosthetic fracture risk after uncemented hip arthroplasty in older women. Its most notable finding concerned the presence of a stem collar.

Why this study matters

Uncemented stems are widely used in older women, a group in whom periprosthetic femoral fracture is a particular concern. The relevant question is therefore not only whether to use cemented or uncemented fixation, but whether a specific stem design feature affects the safety of uncemented implantation.

Study design

The authors analysed Swiss National Joint Registry (SIRIS) data from 2012–2024 for women aged at least 70 undergoing total hip arthroplasty (THA) for osteoarthritis. Nine uncemented stem models, each with more than 1,000 implantations, were included. The cohort comprised 32,874 women, with a mean age of 76 years and mean BMI of 26.5.

Design variables included collared versus collarless stems, standard versus increased offset, neck–shaft angle and relative stem length. The endpoint was revision for periprosthetic femoral fracture (PFF). THAs with cemented stem fixation provided an additional reference population. Multivariable analysis adjusted for patient and implant characteristics.

Main results

• Revision for PFF: 0.5% after uncemented THA versus 0.2% with cemented fixation (P < 0.001).
• Variation between uncemented models: revision for PFF ranged from 0.1% to 1.1%.
• Collared stems: 0.1% underwent revision for PFF, compared with 0.6% of collarless stems.
• Adjusted odds ratio for a collared stem: OR 0.08 (95% CI 0.03–0.27; P < 0.001).
• Offset, neck–shaft angle and relative stem length were not associated with PFF risk in this analysis.

Clinical interpretation for an orthopaedic surgeon

Among women aged ≥70 receiving uncemented THA, a stem collar was strongly associated with a lower risk of revision for PFF. The absolute difference was small, but relevant given the severity of this complication and the substantial revision surgery it often requires.

The crude comparison still favoured cemented fixation over uncemented fixation for this endpoint. The study mainly helps inform stem selection when uncemented fixation has been chosen for an older woman.

Limitations

• This registry study was observational, so it cannot establish causation.
• Residual confounding may involve bone quality, surgical technique, implant selection and patient selection.
• The endpoint was revision for PFF, rather than every periprosthetic fracture.
• The results concern women aged ≥70 treated for osteoarthritis and should not automatically be extrapolated to younger patients, men or other indications.
• The analysis included specific models in the Swiss registry; a collar is not the only difference between implants on the market.

Implications for practice

The findings encourage caution when choosing a collarless uncemented stem for an older woman and support considering a collared design if uncemented fixation is selected. They do not prove that a collared stem is superior to a cemented stem or that a collar eliminates fracture risk. Other outcomes, including aseptic loosening, patient-reported outcomes and long-term implant survival, remain unresolved.

References

Ladurner A, Kramer M, Giesinger K, Zdravkovic V. Collared, Uncemented Stems Markedly Reduce Periprosthetic Femoral Fracture Risk in Women ≥ 70 Years: A Swiss National Registry Study. The Journal of Arthroplasty. Published online 24 August 2026. DOI: 10.1016/j.arth.2026.08.037. PMID: 42637028. Article in The Journal of Arthroplasty.

This summary is based on the publicly available abstract and metadata from PubMed and the publisher.

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Content prepared by: Tomasz Poboży - orthopaedic surgeon.

Polish version: MIPO czy tylne ORIF w złamaniach dalszej części trzonu kości ramiennej?

A small randomized trial in the Journal of Orthopaedic Trauma compared two operations for extra-articular distal-third humeral shaft fractures: anterior minimally invasive plate osteosynthesis (MIPO) using a reversed PHILOS plate and posterior open reduction and internal fixation (ORIF) using an extra-articular locking compression plate (EA-LCP).

Why this study matters

Fixation in this region must balance stability with protection of soft tissues and the radial nerve. MIPO may reduce dissection and blood loss, but requires fluoroscopy and provides less direct visual control of fracture fragments. The trial examined whether these technical differences affect union and limb function.

Study design

This prospective randomized trial at a single Level 1 trauma centre in New Delhi enrolled 30 adults aged 18–55 years with extra-articular distal-third humeral shaft fractures (AO/OTA 12A–C), presenting within 2 weeks of injury. Fourteen underwent anterior MIPO and 16 posterior ORIF. Radiographic union, Mayo Elbow Performance Score (MEPS), UCLA shoulder score, elbow range of motion, operating time, blood loss, radiation exposure, pain and complications were assessed through 6 months.

Main results

• Radiographic union: 16.3 ± 1.3 weeks after MIPO versus 18.1 ± 1.2 weeks after ORIF (P = 0.001).
• Operating time: 78.9 ± 24.4 versus 112.6 ± 42.0 minutes (P = 0.013).
• Blood loss: 182.1 ± 137.4 versus 328.1 ± 96.8 mL (P = 0.002).
• Pain on postoperative day 2: VAS 7 ± 0.5 versus 8 ± 0.6 (P < 0.001).
• Function at 6 months: no significant differences; MEPS 100 versus 100, UCLA 33.8 ± 0.3 versus 33.7 ± 0.4, and elbow range of motion 137.8 ± 2.5° versus 135.4 ± 3.0°.
• Fluoroscopy: greater exposure with MIPO, 1.5 ± 1.0 versus 0.3 ± 0.5 mGy (P = 0.003).
• Radial nerve palsy: 1 case after MIPO and 3 after ORIF; all resolved.
• Nonunion: 1 case in each group, both requiring revision.

Clinical interpretation for an orthopaedic surgeon

MIPO offered perioperative advantages and slightly earlier radiographic union in this small sample, while function at 6 months was essentially the same. These findings support anterior MIPO as a reasonable alternative, rather than proving clear overall superiority.

The approximately 1.8-week difference in union time was statistically significant, but its functional importance for individual patients was not established. The number of radial nerve palsies was also too small for a reliable comparison of complication risk.

Limitations

• Only 30 patients were included at a single centre.
• Follow-up was limited to 6 months.
• The sample was too small to compare rare complications reliably.
• Operating time and blood loss may depend on the team’s experience with each technique.
• The findings concern selected younger adults with extra-articular distal-third shaft fractures.

Implications for practice

Anterior MIPO with a reversed PHILOS plate may be an alternative to posterior ORIF for appropriately selected fractures. The study does not establish MIPO as the preferred treatment for every patient, demonstrate a lower risk of radial nerve injury, or prove better long-term outcomes.

References

Garika SS, Yadav P, Jyoti NJ et al. Comparative Efficacy of Anterior MIPO With PHILOS Versus Posterior ORIF With EA-LCP in Distal-Third Humerus Fractures: A Randomized Controlled Trial. J Orthop Trauma. 2026;40(9):482–491. DOI: 10.1097/BOT.0000000000003200. PMID: 42048119.

This summary is based solely on the publicly available abstract and PubMed metadata.

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Content prepared by: Tomasz Poboży - orthopaedic surgeon.

Polish version: Robotyczna rehabilitacja barku zamrożonego — obiecujący sygnał z małego badania

Robot-assisted rehabilitation could improve the consistency and control of exercises for frozen shoulder. A pilot randomized trial published on 21 August 2026 suggests possible benefits for pain and selected patient-reported outcomes, while also illustrating why small trials require cautious interpretation.

Why this study matters

Adhesive capsulitis causes pain and progressive loss of range of motion. Robotic assistance may improve exercise repeatability, movement control and treatment standardisation, but clinical evidence for this approach in frozen shoulder has been limited.

Study design

This prospective randomized controlled trial enrolled patients aged 20–60 years with adhesive capsulitis and assigned them to robot-assisted rehabilitation therapy (RART) or a control group. Assessments took place before treatment and at 1 and 3 months. Twenty-three patients in the RART group and 22 controls completed the study. Outcomes included patient-reported measures and objective clinical assessments, including range of motion.

Main results

• At 3 months, the RART group had a greater improvement in numerical rating scale pain scores than controls (P = 0.028).
• ASES scores also improved more with RART at 3 months (P = 0.046).
• External rotation improved significantly over time within the RART group (P = 0.042).
• Overall objective functional outcomes did not differ significantly between groups.

Clinical interpretation for an orthopaedic surgeon

The results provide preliminary evidence of feasibility and possible efficacy. RART appeared feasible and well tolerated, and the pain and ASES findings justify further research. They do not yet establish that robotic therapy should replace standard management of frozen shoulder.

The discrepancy between some subjective improvements and the lack of a significant difference in overall objective function matters. A small sample may both miss real effects and overestimate individual positive outcomes.

Limitations

• This was a pilot trial with few participants.
• The final sample was underpowered: the authors reported post hoc statistical power of approximately 68–70%.
• Follow-up lasted only 3 months, leaving the durability of any differences uncertain.
• Positive results concerned selected outcomes; superiority in overall objective function was not demonstrated.

Implications for practice

The study supports larger, adequately powered trials comparing robotic assistance with standard programmes and assessing durability, costs and patient selection. It does not show that a robot outperforms every well-delivered rehabilitation programme, shortens the natural course of frozen shoulder for all patients, or should routinely replace other treatments.

References

• Konarski W, Poboży T, Hordowicz M, Poboży K, Domańska J. Current concepts of natural course and in management of frozen shoulder: A clinical overview. Orthopedic Reviews. 2020;12(4):8832. DOI.
• Ryu SM, Park JH, Choi W, et al. Robot-assisted rehabilitation therapy for adhesive capsulitis: A pilot randomized controlled trial on clinical and patient-reported outcomes. Medicine (Baltimore). 2026;105(34):e50120. PubMed · DOI.

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Content prepared by: Tomasz Poboży - orthopaedic surgeon.

Polish version: Mniej opioidów po endoprotezoplastyce kolana — różnica statystyczna bez wyraźnej korzyści klinicznej

A randomized trial in the Journal of Clinical Anesthesia illustrates an important distinction: opioid-sparing anaesthesia improved early Quality of Recovery-15 scores after total knee arthroplasty (TKA), but the difference did not reach the minimum clinically important difference (MCID).

Why this study matters

Reducing perioperative opioid exposure is part of modern enhanced recovery pathways after TKA. A statistically significant improvement in a recovery score does not necessarily represent a change that patients can meaningfully perceive. This trial helps distinguish statistical significance from clinical importance.

Study design

The randomized trial included 98 adults undergoing elective unilateral TKA. Patients, surgeons and outcome assessors were blinded. Opioid-sparing anaesthesia based on opioid-free principles (OSA) was compared with conventional opioid-based anaesthesia (OBA). Esketamine and dexmedetomidine formed the basis of the OSA regimen.

This was not completely opioid-free anaesthesia: both groups received oxycodone at skin incision and closure, a femoral nerve block, and the same postoperative multimodal analgesia and patient-controlled analgesia. The primary outcome was QoR-15 at 24 hours. Other outcomes included QoR-15 at 48 hours, Oxford Knee Score (OKS), EQ-5D-3L, postoperative nausea and vomiting, CRP, and selected outcomes at 1 and 3 months.

Main results

• Mean QoR-15 at 24 hours was 118.4 ± 11.5 with OSA and 113.3 ± 12.2 with OBA; adjusted difference 5.12 points (95% CI 0.51–9.74; P = 0.029).
• At 48 hours the adjusted difference remained statistically significant: 5.54 points (95% CI 1.57–9.52; P = 0.007).
• OSA was associated with less postoperative nausea and vomiting and lower CRP.
• At 1 month, OKS was statistically better with OSA by 2.31 points (95% CI 0.34–4.27; P = 0.022).
• No significant differences were found in the other secondary outcomes reported in the abstract.

Clinical interpretation for an orthopaedic surgeon

The authors’ central conclusion is that the QoR-15 difference did not reach the MCID. The trial supports reducing opioid exposure within a well-designed multimodal regimen, but does not demonstrate a large, clearly perceptible improvement in recovery. It favours judicious opioid reduction rather than adoption of one regimen for every patient undergoing TKA.

Limitations

• This was a single-centre trial with a relatively small sample of 98 patients.
• Two complex protocols were compared, so the effects cannot be attributed to an individual drug.
• The regimen based on opioid-free principles still included opioids in both arms.
• The main QoR-15 difference remained below the threshold for a minimally important clinical change.
• The public abstract does not allow the same assessment of protocol details and additional analyses as the full text.

Implications for practice

The findings support multimodal analgesia and opioid reduction after TKA, particularly when nausea and vomiting can be reduced without compromising pain control. They do not establish the superiority of entirely opioid-free anaesthesia, justify routine esketamine plus dexmedetomidine for everyone, or warrant direct extrapolation to other ERAS pathways, regional blocks or high-risk populations.

References

Liu J, Liu J, Liu P, et al. Opioid-sparing anesthesia based on opioid-free principles for early recovery after total knee arthroplasty: A randomized controlled trial. Journal of Clinical Anesthesia. Published online 22 August 2026;114:112307. PMID: 42632160. DOI: 10.1016/j.jclinane.2026.112307. PubMed record.

This summary is based on the public abstract.

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Content prepared by: Tomasz Poboży - orthopaedic surgeon.

Polish version: Kwas traneksamowy w endoprotezoplastyce kolana — podanie dostawowe czy okołostawowe?

A randomized trial conducted in Thailand suggests that a fixed 3 g intra-articular dose of tranexamic acid (TXA) may improve some bleeding outcomes compared with 10 mg/kg administered peri-articularly during primary total knee arthroplasty. The findings concern two specific local regimens and do not establish the best TXA strategy overall.

Why this study matters

TXA is widely used in knee arthroplasty, but protocols vary in route, dose and timing. Comparing a high fixed intra-articular dose with a weight-based peri-articular dose addresses a practical question: both can be administered during surgery, and a difference in transfusion requirements could be clinically relevant.

Study design

This prospective, assessor-blinded randomized trial allocated 80 patients undergoing primary unilateral total knee arthroplasty 1:1 to 3 g intra-articular TXA or 10 mg/kg peri-articular TXA. The co-primary outcomes were transfusion-adjusted calculated blood loss at 72 hours and red blood cell transfusion. Analysis followed the intention-to-treat principle.

Main results

• Transfusion-adjusted calculated blood loss was lower with intra-articular administration: 537 ± 282 mL versus 754 ± 476 mL; mean difference 218 mL, 95% CI 43–393 mL; P = 0.019.
• Transfusion was required in 3/40 patients (7.5%) in the intra-articular group and 11/40 (27.5%) in the peri-articular group. The relative risk for peri-articular versus intra-articular administration was 3.67 (95% CI 1.11–12.16; P = 0.037).
• Unadjusted calculated blood loss, haematocrit decline and drain output were similar between groups.
• The abstract reported no symptomatic deep vein thrombosis or pulmonary embolism.

Clinical interpretation for an orthopaedic surgeon

The most practical finding is the lower transfusion rate with 3 g intra-articular TXA. Several other bleeding measures did not differ, however, so the results were not uniformly favourable. They support further standardisation of local protocols rather than a universal preference for one administration route.

Limitations

• With only 80 patients, the trial cannot reliably assess rare thromboembolic complications.
• Two specific doses and local administration techniques were compared. The findings cannot be directly extrapolated to intravenous TXA, combined regimens or other doses.
• The relatively high transfusion rate in the peri-articular group may also reflect local transfusion thresholds and population characteristics, which cannot be fully assessed from the public abstract.
• The full text was not freely and legally available when the original summary was prepared.

Implications for practice

Local administration technique and dose deserve consideration within the overall blood conservation protocol for knee arthroplasty. This study does not show that 3 g intra-articular TXA should replace every other strategy or that it is safer regarding thromboembolic events; the trial was too small to answer the latter question.

References

1. Konarski W, Derczyński M, Poboży K, Domańska-Poboża J, Poboży T. Tranexamic Acid Use in Total Hip Arthroplasty for Avascular Necrosis: A Single-Center Experience. Journal of Clinical Medicine. 2025;14(10):3399. DOI: 10.3390/jcm14103399. 2. Plangsiri K, Phimolthares S, Kasemkijwattana C, Kongmalai P. High-dose intra-articular versus weight-based peri-articular tranexamic acid in primary total knee arthroplasty: a randomized controlled trial. The Knee. Published online 18 August 2026. DOI: 10.1016/j.knee.2026.104605. PMID: 42617482.

This summary is based on the publicly available abstract and publication metadata.

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Content prepared by: Tomasz Poboży - orthopaedic surgeon.

Polish version: Blok kanału przywodzicieli po rekonstrukcji ACL — czy wnosi coś ponad infiltrację miejscową?

Does routinely adding an adductor canal block (ACB) to effective local infiltration analgesia (LIA) provide additional pain relief after anterior cruciate ligament (ACL) reconstruction? A double-blind randomised trial in The American Journal of Sports Medicine found no significant advantage over LIA alone during the first postoperative day.

Why does this study matter?

ACB is widely used after ACL reconstruction because it aims to reduce pain while relatively preserving quadriceps function. LIA is simpler to organise and can be performed by the surgical team without a separate block procedure. If combining the methods adds little benefit, this may matter for day-case care, anaesthetist time and costs. The findings nevertheless need to be interpreted within the trial’s design.

Research question and methods

Ojaghi and colleagues conducted a double-blind randomised controlled trial of 100 patients undergoing ACL reconstruction under general anaesthesia. Fifty patients were assigned to each group:

• LIA plus sham procedure: local infiltration and a saline injection instead of an active ACB.
• LIA plus ACB: local infiltration combined with an adductor canal block.

The primary outcome was opioid consumption during the first 24 postoperative hours. Other outcomes were pain on a visual analogue scale (VAS), ability to perform a straight-leg raise (SLR) at three hours, Quality of Recovery-15 (QoR-15) on the first day and Knee injury and Osteoarthritis Outcome Score (KOOS) at one week.

Main findings

• No significant difference in opioid consumption over the first 24 hours: p = 0.109.
• No significant difference in VAS pain at 24 hours: p = 0.0804.
• No difference in SLR performance at three hours: p = 0.6711.
• No difference in QoR-15 on the first day: p = 0.6486.
• No difference in KOOS at one week: p = 0.9054.
• Intraoperative opioid use also did not differ significantly: p = 0.127.

The public abstract does not provide effect sizes or confidence intervals for the primary outcome. Lack of statistical significance alone cannot establish how large or small the true clinical difference might be.

Clinical interpretation for an orthopaedic surgeon

Within the protocol studied, no measurable additional benefit from routinely adding ACB to LIA was demonstrated. This supports examining whether well-planned local infiltration may be sufficient as part of multimodal analgesia for some patients after standard ACL reconstruction.

However, failure to detect a difference is not proof of equivalence. The public abstract does not indicate a formal non-inferiority or equivalence design. A non-significant result in 100 patients does not exclude a small benefit that might matter in a particular subgroup.

Limitations

• The study included 100 patients and one specific perioperative protocol.
• The main analgesic assessment covered only the first 24 hours.
• The public abstract does not report absolute opioid consumption, mean differences or confidence intervals, preventing precise assessment of effect size.
• Patients underwent general anaesthesia; the findings should not automatically be generalised to every anaesthetic regimen, graft type or more complex combined procedure.
• Individual postoperative pain risk, opioid tolerance and the rehabilitation plan may still influence regional analgesia choices.

Implications for practice and remaining uncertainty

The trial may encourage reconsideration of automatic ACB for every patient when effective LIA and multimodal analgesia are already used. This is particularly relevant to outpatient surgery, where simplicity and predictability of care matter.

It does not show that ACB is ineffective or should be removed from all ACL reconstruction protocols. The specific comparison was LIA plus ACB versus LIA without an active block. It does not resolve questions about patients at high risk of pain, other block techniques, different drug volumes or concentrations, or situations where LIA is not used.

References

Ojaghi R, Locke E, Elmi P, Pickell M. Adductor Canal Block and Local Anesthetic Versus Local Anesthetic Alone in ACL Reconstruction: A Double-Blind Randomized Controlled Trial. Am J Sports Med. Published online August 3, 2026. DOI: 10.1177/03635465261464409. PMID: 42544937. Trial registration: NCT04721119.

This summary is based solely on the public abstract and publication metadata.

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Content prepared by: Tomasz Poboży - orthopaedic surgeon.

Polish version: Czy po endoprotezie biodra potrzebne są rutynowe ograniczenia ruchu?

After primary posterior-approach total hip arthroplasty, should patients routinely avoid flexion beyond 90°, adduction across the midline and internal rotation for six weeks? A large randomised trial in The Journal of Arthroplasty found no detectable reduction in dislocation risk from this set of precautions when the posterior capsule and soft tissues were repaired.

Why does this study matter?

Routine hip precautions are a longstanding component of care after posterior-approach total hip arthroplasty (THA). They can make everyday activities harder, increase fear of movement and delay recovery of confidence, while their effect on dislocation has remained uncertain. The trial by Yadav and colleagues is valuable particularly because of its randomised design and large sample: 1,133 patients were analysed.

Research question and methods

This prospective randomised trial was conducted at Rush University Medical Center and affiliated surgical centres in the United States. All patients underwent a posterior approach with posterior soft-tissue repair. After surgery, they were allocated to one of two groups:

• No routine restrictions: 567 patients, with no prohibitions on specific movements or activities.
• Standard precautions: 566 patients, instructed to avoid hip flexion >90°, adduction across the midline and internal rotation for six weeks.

The primary outcome was dislocation. Complications, revisions, Hip disability and Osteoarthritis Outcome Score for Joint Replacement (HOOS JR) and return to work were also assessed. Mean follow-up was 1.3 years. Adherence to precautions at six weeks was 92.9% in the restricted group.

Main findings

• There were 10 dislocations overall (0.88%): four without restrictions and six with precautions.
• The difference was not statistically significant: OR 0.60; 95% CI 0.17–2.17; p = 0.547.
• There were no differences in 90-day complications or revisions.
• HOOS JR was statistically higher without restrictions at six weeks (76.78 versus 74.48; p = 0.028) and at 3–6 months (84.60 versus 81.54; p = 0.015).
• At one year, the HOOS JR difference was not significant (87.74 versus 85.64; p = 0.107).
• Return-to-work rates did not differ significantly.

Clinical interpretation for an orthopaedic surgeon

The result is specific: after primary posterior-approach THA with capsular repair and standard soft-tissue reconstruction, six weeks of routine conventional precautions did not produce a detectable reduction in dislocation risk. It is not a statement that movement never needs to be restricted after THA.

Early HOOS JR differences favoured unrestricted movement and were statistically significant, but their magnitude was small. They should not automatically be interpreted as a large clinical functional advantage. The more notable finding was the absence of an observed protective effect of precautions, with a very low overall dislocation rate.

Limitations

• The trial was conducted within one specialist clinical system.
• Dislocations were uncommon, resulting in a wide confidence interval for the effect.
• The findings concern primary posterior-approach THA with capsular repair. They should not automatically be applied to revision surgery, absent soft-tissue repair or other high-risk situations.
• Anatomy, muscle control, the indication for surgery, implant characteristics and neurological factors may still affect instability risk.

Implications for practice and remaining uncertainty

The study strengthens the argument against prescribing the same automatic set of restrictions to every patient after uncomplicated primary posterior-approach THA with appropriate soft-tissue repair. It may support more individualised postoperative care.

It does not establish that all movement-related advice can be abandoned for every patient. Intraoperative instability, revision surgery, particular implant designs, neurological disorders and other risk factors may require different recommendations.

References

Yadav AS, Potluri AS, Dandamudi S, Singh H, DeBenedetti A, Behery OA, Levine BR. Do Hip Precautions Matter After Posterior Approach Total Hip Arthroplasty With Capsular Repair? A Randomized Control Trial. J Arthroplasty. 2026;41(9 Suppl 1):S324-S328. Published online 27 April 2026; issue publication September 2026. DOI: 10.1016/j.arth.2026.04.080. PMID: 42055222. The full text is openly available from The Journal of Arthroplasty.

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Content prepared by: Tomasz Poboży - orthopaedic surgeon.

Polish version: Czy warto naprawiać ścięgno podłopatkowe podczas odwróconej endoprotezoplastyki barku?

Should the subscapularis insertion be restored by repairing a lesser tuberosity osteotomy during primary reverse shoulder arthroplasty? A randomised trial in The Journal of Bone and Joint Surgery supports repair, at least when the tendon is of sufficient quality for reattachment.

Why does this study matter?

Management of the subscapularis during reverse total shoulder arthroplasty remains debated. Earlier evidence was heterogeneous, and some recommendations relied on observational studies using different implant designs. This study was prospective and randomised, with at least two years of follow-up.

Research question and methods

The study was conducted at Washington University in St. Louis. Patients undergoing primary reverse total shoulder arthroplasty (rTSA) with a sufficiently preserved subscapularis tendon were randomised to repair or no repair of the lesser tuberosity osteotomy (LTO), to which the tendon remained attached.

The analysis at a minimum of two years included 85 shoulders in 81 patients; 43 shoulders were assigned to repair. The primary outcome was the American Shoulder and Elbow Surgeons (ASES) score. Range of motion, imaging and functional internal rotation were also assessed.

Main findings

• At two years, the mean ASES score was higher after repair: 90.4 versus 82.3 (p = 0.01).
• Repair was associated with approximately sevenfold greater odds of improved internal rotation.
• No significant differences were found in other active ranges of motion or the other outcome scores assessed.

Clinical interpretation for an orthopaedic surgeon

In patients undergoing primary rTSA with a repairable subscapularis, LTO repair may improve overall function and internal rotation without a clear adverse effect on movement in other planes. This is particularly relevant to activities requiring the hand to reach behind the back.

Limitations

• This was a single-centre study.
• The sample was relatively small.
• Only patients with a subscapularis suitable for reattachment were included.
• The findings should not automatically be generalised to every implant design or clinical setting.

Implications for practice

The trial strengthens the case for preserving and repairing the subscapularis during primary reverse shoulder arthroplasty when anatomy and operative conditions allow. It does not establish that repair is necessary for every patient or that it has the same effect with all implants.

References

Aleem AW, Zmistowski BM, Sefko J, Chen L, Keener JD. The Impact of Lesser Tuberosity Osteotomy Repair After Reverse Total Shoulder Arthroplasty: A Randomized Controlled Trial. J Bone Joint Surg Am. 2026; online ahead of print. DOI: 10.2106/JBJS.25.01330. PMID: 42550892.

This summary is based on the publicly available abstract and publication metadata.

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Content prepared by: Tomasz Poboży - orthopaedic surgeon.

Polish version: Synowektomia przy naprawie stożka rotatorów — brak dodatkowej korzyści po 3 miesiącach

Should inflamed synovium routinely be removed during arthroscopic rotator cuff repair? A randomised trial published on 20 August 2026 in Orthopaedic Journal of Sports Medicine found no improvement in early postoperative outcomes from adding synovectomy.

Why does this study matter to an orthopaedic surgeon?

Synovitis is common in patients with rotator cuff tears and may be associated with greater pain. This raises a practical question: does removing the synovium during cuff repair help pain settle sooner and improve shoulder function?

Study design

This prospective randomised controlled trial included 60 patients with full-thickness rotator cuff tears. Thirty underwent arthroscopic repair with synovectomy and 30 underwent repair alone. Outcomes were assessed before surgery and at three months, with assessors blinded to group allocation.

The primary outcome was worst pain at three months, measured on a 10-cm visual analogue scale (VAS). Other pain measures, range of motion, rotator cuff strength, functional scores and patient satisfaction were also assessed.

Main findings

Pain decreased substantially in both groups, but the difference between repair with and without synovectomy was not significant. The between-group comparison of the change in worst VAS pain yielded P = 0.79.

At three months, there were also no significant between-group differences in other pain measures, range of motion, rotator cuff strength, functional outcomes or overall satisfaction. Supraspinatus strength decreased significantly from baseline only in the control group; however, the difference in strength change between the groups was still not statistically significant.

Implications for practice

The findings do not support routine synovectomy solely to improve early pain or function after rotator cuff repair. An additional operative step should offer a demonstrable benefit, particularly when it extends the procedure.

This does not exclude synovectomy for other indications, such as primary synovial disease or diagnostic and technical reasons. The trial assessed synovectomy specifically as a routine addition to full-thickness cuff repair.

Limitations

• Only 60 patients were included.
• The principal assessment was at three months, so the study does not establish long-term effects.
• The findings cannot be extrapolated to other synovial disorders or other shoulder operations.

What the study does not establish

It does not show that synovectomy has no value in any setting. It shows that, in this population and for this indication, it provided no additional short-term improvement over rotator cuff repair alone.

References

Kim DM, Cho JW, Oh S, Jo CH. The Efficacy of Synovectomy in Rotator Cuff Repair: A Randomized Controlled Trial. Orthop J Sports Med. 2026;14(8):23259671261474635. DOI: 10.1177/23259671261474635. PMID: 42630550.

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Content prepared by: Tomasz Poboży - orthopaedic surgeon.