Kategoria: Updates for Doctors (EN)

Polish version

An ultrasound-guided radial nerve block may be a useful alternative to a hematoma block during closed reduction of a distal radius fracture. In a small randomised trial, more patients achieved a clinically meaningful reduction in pain from admission to the reduction manoeuvre, but the result is not strong enough to establish a new standard of care.

Why might an orthopaedic surgeon find this study interesting?

Closed reduction of a displaced distal radius fracture can be very painful. Emergency departments use several analgesic strategies, including hematoma block, sedation, regional anaesthesia or combinations of these approaches. A hematoma block is simple and does not require advanced equipment, but injecting local anaesthetic around the fracture does not always provide sufficient comfort. An ultrasound-guided nerve block, by contrast, allows local anaesthetic to be placed away from the fracture itself while the needle and surrounding anatomy are directly visualised.

The study, conducted at Hospital Universitario San Ignacio and Pontificia Universidad Javeriana in Bogotá and published online on 7 August 2026 in Journal of Hand Surgery Global Online, compared an ultrasound-guided supracondylar radial nerve block with a conventional hematoma block in patients requiring fracture reduction in the emergency department.

Question and methodology

Adults with an acute distal radius fracture diagnosed within the first week after injury were enrolled in the randomised trial. Patients and clinicians performing the procedure could not be blinded, whereas outcome analysis was blinded.

Fifty patients were included in the final analysis: 28 received the ultrasound-guided radial nerve block and 22 received a hematoma block. Median age was 62 years, and most participants were women. Pain was measured on a numerical rating scale at admission, 10 minutes after anaesthesia and during the reduction manoeuvre. The investigators also assessed radiographic reduction quality and recorded complications during the emergency-department stay and at a telephone follow-up after 2 weeks.

Results

There was no clinically meaningful between-group difference in the proportion of patients achieving at least a 2-point pain improvement either from admission to 10 minutes after the block or from the block to the reduction manoeuvre.

A difference emerged when pain at admission was compared with pain during reduction. A clinically meaningful improvement was more frequent after the ultrasound-guided radial nerve block: the relative probability of improvement was 2.10 (95% CI 1.06–5.04), with an absolute risk difference of 29.9 percentage points. The authors calculated an NNT of 4. This result should be interpreted cautiously because the confidence interval was wide and the p value was 0.047, close to the conventional threshold for statistical significance.

Radiographic measures of reduction quality did not differ significantly between groups. In other words, the signal for better pain control did not translate into measurably better fracture alignment in this trial.

How should the findings be interpreted clinically?

The most defensible conclusion is not that an ultrasound-guided nerve block is superior to a hematoma block. The evidence is too limited for that. Rather, the study suggests that a targeted regional block can be performed in the acute emergency setting and may increase the likelihood of a meaningful reduction in pain during fracture reduction.

This may be particularly relevant in departments with experience in ultrasound-guided regional anaesthesia and an interest in reducing the need for deeper sedation. Ultrasound availability alone, however, does not replace knowledge of anatomy, regional anaesthesia principles or appropriate patient monitoring. Choice of analgesia should still reflect fracture characteristics, the patient’s clinical condition, staff expertise and the local protocol.

Limitations

• The study was small, with only 50 patients in the final analysis.
• Patients and clinicians performing the block could not be fully blinded.
• The key positive result had a wide confidence interval and a p value close to 0.05.
• Safety follow-up lasted only 2 weeks.
• This was a single-centre study, so results may depend on operator experience with ultrasound and regional blocks.
• Radiographic quality of reduction was not improved.

What might this change in practice — and what does the study not prove?

The trial provides a reasonable signal that an ultrasound-guided supracondylar radial nerve block can be considered among the analgesic options for closed reduction of distal radius fractures. Before it replaces hematoma block in routine care, larger multicentre studies are needed, ideally with a clearly specified primary endpoint and assessment of rescue analgesia, procedure time, complications and patient satisfaction.

The study does not prove that the ultrasound-guided block produces a better reduction, is safer than a hematoma block or eliminates the need for sedation in every patient. It also did not show superiority at every pain-assessment time point. At present, the findings support further evaluation and selective use rather than a wholesale change in standard practice.

Back to: Research Updates, Literature and Evidence-Based Medicine

Source

Olmos Muskus N, Botero Bermúdez M, Caro Hurtado D, Mejía Grueso A, Cadena De-Poortere V, García González LA. Ultrasound-Guided Supracondylar Radial Nerve Block Versus Hematoma Block for Closed Reductions of Distal Radius Fracture in the Emergency Department: A Randomized Controlled Clinical Trial. Journal of Hand Surgery Global Online. 2026;8(6):101095. DOI: 10.1016/j.jhsg.2026.101095. PubMed PMID: 42604104.

Educational material for healthcare professionals. It does not constitute an individual therapeutic recommendation.

Content prepared by: Tomasz Poboży - orthopaedic surgeon.

Polish version

A meta-analysis including more than 96,000 patients suggests that people treated with GLP-1 receptor agonists before total hip or knee arthroplasty had fewer selected complications and readmissions. This should be interpreted primarily as an observational signal: all included studies were cohort studies, and certainty of evidence was rated very low for almost every outcome. The analysis therefore does not show that starting a GLP-1 receptor agonist itself reduces perioperative risk.

Why might an orthopaedic surgeon find this study interesting?

GLP-1 receptor agonists are increasingly used in people with type 2 diabetes and obesity—two groups that are common among patients undergoing joint replacement. From an orthopaedic perspective, the question is not only whether these drugs reduce body weight and improve glycaemic control, but whether their use is associated with a different risk profile after surgery.

The study by Rudran and colleagues, published on 1 August 2026 in The Bone & Joint Journal, is notable because it combines data from almost 100,000 arthroplasties. At the same time, it illustrates the difference between a large sample and strong causal evidence: the numbers are impressive, but the underlying studies remain observational.

Question and methodology

The authors performed a PRISMA-based systematic review and meta-analysis. Ten matched cohort studies were included, covering a total of 96,356 patients: 30,350 after total hip arthroplasty and 66,606 after total knee arthroplasty. Mean age was 61.9 years, and 60.1% of participants were women.

GLP-1 receptor agonists had been prescribed for type 2 diabetes or obesity. The primary outcome was 90-day surgical complications, including periprosthetic joint infection, wound dehiscence, periprosthetic fracture, haematoma, nerve injury and surgical-site infection. The authors also assessed medical complications, readmissions, revisions, length of stay and treatment costs.

Results

Across the overall cohort, GLP-1 receptor agonist use was associated with a lower rate of 90-day surgical complications, with a pooled risk ratio of 0.73. Medical complications were also lower (RR 0.78), as were hospital readmissions (RR 0.79).

The signal was stronger in the total hip arthroplasty subgroup. GLP-1 therapy was associated with lower surgical complications (RR 0.63), medical complications (RR 0.55) and readmissions (RR 0.82). After total knee arthroplasty, the only statistically significant association that remained was a lower risk of readmission (RR 0.77).

Two-year revision rates ranged from 1.7–3.3% in GLP-1 users and 1.7–4.5% in control groups. These ranges should not be interpreted as proof that GLP-1 therapy improves implant survival.

How should the findings be interpreted clinically?

The most defensible conclusion is that preoperative GLP-1 receptor agonist use was not associated with worse outcomes in the available studies, and some analyses suggested lower early complication rates. That is relevant in populations with obesity and diabetes, where metabolic optimisation is part of preparation for arthroplasty.

However, the study cannot determine how much of the observed difference comes from the pharmacological effect of the drugs, weight loss, improved glycaemic control or characteristics of the patients who receive this treatment. GLP-1 users may differ from controls in healthcare access, adherence, intensity of treatment for comorbidities and other factors that matching cannot fully remove.

Limitations

• All 10 included studies were observational; there was no randomised trial comparing initiation of GLP-1 treatment with non-use before arthroplasty.
• Two studies were judged to have a serious risk of bias and eight a moderate risk.
• GRADE certainty was very low for all analysed outcomes except costs, for which certainty was moderate.
• Indications for treatment, patient characteristics and probably the duration and type of therapy differed between studies.
• Some endpoints were composite outcomes, so a single risk ratio does not reveal which individual complication accounted for the observed difference.
• The difference between hip and knee findings may reflect a true effect, but could also reflect study heterogeneity and residual confounding.

What might this change in practice?

The study supports the view that GLP-1 receptor agonist use should not itself be treated as an automatic adverse prognostic factor before joint replacement. In a patient with obesity or diabetes, the medication may be one part of broader metabolic optimisation before surgery.

Decisions about continuing or temporarily withholding a GLP-1 receptor agonist around the time of surgery should nevertheless follow the current anaesthetic and diabetes-care protocol for the individual patient. This meta-analysis was not designed to establish perioperative medication-withholding rules.

What does the study not prove?

The analysis does not prove that GLP-1 treatment should be started solely to reduce arthroplasty complications. It also cannot establish an optimal drug, dose or treatment duration before surgery, or determine whether any potential benefit is mediated by the medication itself, weight reduction, improved glycaemia or other mechanisms. Prospective studies, ideally randomised, would be needed to answer those questions.

Back to: For Doctors and Physiotherapists

Source

Rudran B, Little CDJ, Palmer AJR, Judge A, Carli A, Price AJ, Alvand A. Glucagon-like peptide-1 receptor agonists are associated with improved 90-day outcomes after total hip and knee arthroplasty: a systematic review and meta-analysis. Bone Joint J. 2026;108-B(8):986–994. DOI: 10.1302/0301-620X.108B8.BJJ-2025-1486.R2. PMID: 42538001.

Educational material for healthcare professionals. It does not constitute an individual therapeutic recommendation.

Content prepared by: Tomasz Poboży - orthopaedic surgeon.

Polish version

Key message: regular exercise can help limit age-related loss of bone mineral density, but different forms of activity are not equally effective and the evidence does not support one universal programme for everyone. A new network meta-analysis suggests the strongest signals for brisk walking or jogging and for programmes combining aerobic and resistance exercise.

Why is this study interesting?

Advice to “be more active” is broadly correct but not very specific. In a paper published in BMJ on 9 September 2026, the authors asked two practical questions: which forms of exercise best preserve bone mineral density after the age of 40, and what weekly exercise dose may be needed to produce a measurable effect?

Question and methodology

The investigators performed a hierarchical Bayesian network meta-analysis together with a dose-response analysis. The review included 124 randomised trials involving 18,429 participants aged at least 40 years. Structured exercise programmes were compared with no exercise or with other forms of activity.

The main outcomes were changes in bone mineral density at the lumbar spine, femoral neck and total hip. Fractures were assessed as an additional outcome. The authors also modelled the relationship between weekly exercise dose, expressed as MET-minutes, and bone-density effects.

Main results

• At the lumbar spine, brisk walking or jogging and programmes combining aerobic with resistance exercise were associated with an average improvement in bone mineral density of about 0.013 g/cm² compared with control.
• At the femoral neck, favourable signals were seen for brisk walking or jogging and for exercise combining movement, balance and concentration, such as tai chi.
• For total hip bone mineral density, brisk walking or jogging ranked highest, but certainty in that estimate was low.
• The dose-response relationship was not linear. The threshold for a potentially clinically meaningful benefit was estimated at about 400 MET-minutes per week for the lumbar spine and about 600 MET-minutes for the femoral neck and total hip.
• The fracture analysis included 26 trials and 11,132 participants. Mixed aerobic exercise and mind-body exercise were associated with lower fracture risk, but certainty in these data was low.

Clinical interpretation for an orthopaedic surgeon

The most useful conclusion is not that everyone should start running. The findings support programmes that include skeletal loading, aerobic activity and strength training, adapted to age, physical capacity, fall risk and fracture risk. Around 600 MET-minutes per week corresponds roughly to 2–3 hours of brisk walking or jogging, but this is an average signal derived from a statistical model, not a ready-made prescription for an individual patient.

Jogging may be inappropriate for someone with advanced osteoporosis, a recent fracture, impaired balance or substantial joint disease. In such situations, safe resistance training, balance work and graded loading may matter more than mechanically trying to achieve one numerical exercise target.

Limitations

• The included trials differed in population, duration, exercise intensity and monitoring of adherence.
• A substantial proportion of comparisons between exercise methods were indirect, as is typical in network meta-analysis.
• Certainty for many estimates was low or moderate, and rankings of interventions may be less stable than individual numbers suggest.
• Bone mineral density is an important surrogate outcome but is not equivalent to a demonstrated reduction in fractures.
• Fracture data were less abundant than densitometry data and therefore provide less certain evidence about actual fracture prevention.

What could this change in practice?

The study strengthens the case for making exercise advice for prevention of bone loss more specific. Recommendations should address the type of exercise, its weekly dose and safety. A sensible programme will often combine weight-bearing lower-limb activity with resistance training and balance work.

What does the study not prove?

The meta-analysis does not prove that walking or jogging alone prevents fractures in every patient. It also does not show that exercise replaces osteoporosis assessment or pharmacological treatment in people at high fracture risk. Nor does it justify naming a single form of activity as best regardless of age, comorbidity and functional capacity.

Back to: For Doctors and Physiotherapists

Source

Lu C, Li L, Zhang L, et al. Effect of exercise on bone health in middle aged and older adults: hierarchical network meta-analysis of randomised trials. BMJ. 2026;394:e100561. DOI: 10.1136/bmj-2026-100561. PubMed.

Educational material for healthcare professionals. It does not constitute an individual therapeutic recommendation.

Content prepared by: Tomasz Poboży - orthopaedic surgeon.

Polska wersja

Key finding: an extensive ultrasound-guided combination of eight sensory nerve blocks did not reduce pain after total knee arthroplasty compared with local infiltration analgesia. Lower opioid consumption and a shorter hospital stay were secondary findings, so they should be treated as signals for further research rather than proof that the entire protocol is superior.

Why is this study interesting?

Early mobilisation after total knee arthroplasty requires analgesia that controls pain while preserving muscle function as much as possible. This is why motor-sparing approaches such as adductor canal block, IPACK block and genicular nerve blocks have been developed. In a paper published electronically on 8 September 2026, the investigators asked whether a broader block of the knee’s sensory innervation could outperform local infiltration analgesia.

Question and methodology

The randomized trial included 217 patients undergoing total knee arthroplasty. The intervention group received an ultrasound-guided combination of eight sensory nerve blocks using 40 mL ropivacaine 5 mg/mL with 75 µg clonidine. In addition to the adductor canal, IPACK and genicular nerve blocks, the protocol also targeted nerves supplying the vastus medialis and vastus intermedius muscles and the anterior femoral cutaneous nerve.

The control group received local infiltration analgesia with 150 mL ropivacaine 2 mg/mL plus 0.5 mg epinephrine. The primary endpoint was resting pain intensity, assessed repeatedly from admission to the post-anaesthesia care unit until 2:00 p.m. on the first postoperative day. Secondary outcomes included opioid consumption expressed as oral morphine equivalents over 48 hours and length of hospital stay.

Results

There was no statistically significant difference in pain intensity between the groups at any of the prespecified time points. The trial therefore did not demonstrate superiority of the extensive block combination for its primary endpoint.

• Median 48-hour opioid consumption was 70 mg oral morphine equivalents after the nerve blocks and 96 mg after local infiltration analgesia; p = 0.008.
• Median length of stay was 1 day and 2 days, respectively; p < 0.001.
• Both findings were secondary and exploratory.

Clinical interpretation for an orthopaedic surgeon

No difference in pain combined with lower opioid use may appear encouraging: similar symptom control was achieved with less opioid exposure. However, the hierarchy of endpoints matters. The protocol was not superior for the primary outcome, and the differences in opioid consumption and length of stay require confirmation in a trial specifically designed around those outcomes.

The study also cannot identify which component of the combination produced the observed signal. Two complete and substantially different perioperative protocols were compared, rather than a single additional block. Total ropivacaine dose, the use of clonidine or epinephrine, mobilisation pathways and discharge criteria may all influence the results.

Limitations

• The primary endpoint was negative, while the favourable differences concerned secondary outcomes.
• The extensive procedure involves multiple needle placements and requires experience with ultrasound-guided nerve blocks.
• The study cannot isolate the effect of individual blocks or the contribution of clonidine.
• Length of stay depends not only on analgesia but also on local care pathways and discharge criteria.
• The abstract does not show whether the difference in opioid consumption translated into fewer episodes of nausea, delirium, falls or other clinical benefits.

What could this change in practice?

The study supports further work on analgesic strategies that reduce opioid exposure without worsening pain control or muscle function. At this stage, it argues more strongly for comparing and simplifying individual components of the protocol than for routinely implementing all eight blocks.

What does the study not prove?

It does not show that blocking eight sensory nerves provides better analgesia than local infiltration analgesia. It also does not show that the same effect would occur in a different perioperative pathway or that the shorter hospital stay was caused directly by the nerve-block protocol itself.

Back to: For Doctors and Physiotherapists

Source

Fellert F, Sjövall F, Flivik G, Ekman A. A Novel Multiple Sensory Nerve Block Combination Using Ultrasound Guidance in Knee Arthroplasty: A Randomized Clinical Trial. A&A Practice. 2026;20(9):e02274. DOI: 10.1213/XAA.0000000000002274. PubMed.

Educational material for healthcare professionals. It does not constitute an individual therapeutic recommendation.

Content prepared by: Tomasz Poboży - orthopaedic surgeon.

Polish version · Trauma — Literature for Clinicians

Key finding: at approximately 7.5 years, patients treated with reverse shoulder arthroplasty had a better Constant score than those treated nonoperatively. There was no advantage in pain or overall quality of life, however, and the long-term analysis included only 29 of the original 62 participants. This is an important clinical signal, but not a decisive argument for routine surgery.

Why is this study interesting?

In very elderly patients with displaced three- or four-part proximal humerus fractures, choosing between nonoperative treatment and reverse shoulder arthroplasty remains difficult. Early results do not necessarily reflect shoulder function several years later. The authors therefore returned to participants from a previous randomised trial and assessed them after a mean follow-up of more than seven years.

Question and methods

The original trial included 62 patients aged at least 80 years with displaced three- or four-part fractures. Reverse shoulder arthroplasty was compared with nonoperative treatment. Twenty-nine patients were available for long-term analysis: 17 after arthroplasty and 12 after nonoperative treatment. Mean follow-up was 7.6 and 7.4 years, respectively.

Outcomes included the Constant score for shoulder function, DASH for upper-limb disability, pain on a visual analogue scale, SF-12 quality of life and radiographic findings. In the long-term subgroup, patients in the arthroplasty group were older on average: 92 versus 88 years.

Results

• The mean Constant score was 62 after reverse shoulder arthroplasty and 51 after nonoperative treatment; p=0.039.
• DASH scores were 16 and 25, respectively; the difference did not reach statistical significance, p=0.069.
• Pain was similar in the two groups: 1.5 versus 1.4 points.
• No differences were found in either the physical or mental components of SF-12.
• All fractures treated nonoperatively healed in malunion, but none of those patients later required reverse shoulder arthroplasty.
• In the operative group, one patient required revision because of prosthetic dislocation.

Clinical interpretation for an orthopaedic surgeon

The advantage in Constant score suggests that in some relatively fit patients aged 80 years or older, reverse shoulder arthroplasty may preserve useful shoulder function better over the long term. At the same time, similar pain scores and the absence of a difference in SF-12 show that an improvement in a shoulder-specific measure does not necessarily translate into an equally large difference in overall wellbeing.

Malunion after nonoperative treatment was not automatically equivalent to later surgical failure. In very elderly patients, the decision should still take into account pre-injury independence, functional expectations, deltoid function, perioperative risk, ability to participate in rehabilitation and patient preference.

Limitations

• Only 29 of the 62 originally enrolled patients remained in the long-term analysis. This substantial attrition can introduce survival and follow-up bias.
• The small sample limits precision and the ability to assess uncommon complications.
• After years of attrition, the original randomisation no longer fully protects against differences between the groups.
• The groups differed in age at long-term follow-up.
• A statistically significant difference was found in the Constant score, but not in DASH, pain or SF-12.
• The findings should not be extrapolated to younger patients or to simpler fracture patterns.

What might this change in practice?

The study strengthens the case for discussing a possible long-term functional benefit of reverse shoulder arthroplasty with selected active patients of very advanced age rather than judging treatment only by the first few months. It does not justify automatic selection for surgery based on the fracture image alone.

What does the study not prove?

It does not prove that reverse shoulder arthroplasty is the best treatment for every patient over 80. It does not show an advantage in pain or overall quality of life, and the sample is too small for a precise comparison of complication risk. It also does not mean that every malunion after nonoperative care requires later reconstruction.

Reference

Lopiz Y, Alcobía-Díaz B, Coderch J, et al. Long-term outcomes of reverse shoulder arthroplasty versus nonoperative treatment for 3- or 4-part proximal humerus fractures in elderly patients: results from a prior randomized clinical trial. Journal of Shoulder and Elbow Surgery. 2026;35(9S):S32–S38. DOI: 10.1016/j.jse.2026.05.029. PubMed.

Content prepared by: Tomasz Poboży - orthopaedic surgeon.

Polish version · Joint Replacement — Literature for Clinicians

Changes in posterior tibial slope after total knee arthroplasty raise concern because they can influence flexion geometry and soft-tissue tension. A new analysis of 370 patients suggests, however, that in posterior-stabilised TKA, relatively small deviations within the range typically encountered in surgery do not translate into meaningfully worse functional outcomes.

Why is this study interesting?

Posterior tibial slope (PTS) is one parameter of tibial component alignment in the sagittal plane. Biomechanically, it can influence knee flexion, the flexion space and ligament behaviour. In practice, radiographic deviation from the planned slope is therefore sometimes treated as a possible explanation for a mediocre result after surgery. The authors examined whether this association could actually be detected in medium-term patient outcomes.

Question and methods

This was a single-centre retrospective cohort study of 370 patients who underwent primary cemented total knee arthroplasty using one posterior-stabilised implant design. Mean age was 71 years and mean follow-up was 64.6 months, with a minimum follow-up of 48 months.

PTS was measured on standardised lateral radiographs before and after surgery. Two observers performed the measurements independently and were blinded to each other’s results. Change in slope was analysed by direction, magnitude (up to 3°, 4–9°, and at least 10°) and a 5.47° cut-off corresponding to the mean absolute change across the cohort. Outcomes included pain, WOMAC, Knee Society Score, Oxford Knee Score, Forgotten Joint Score-12 and range of motion. Multivariable analysis was also performed.

Results

• All patient-reported outcome measures improved significantly after surgery.
• Neither the direction nor the magnitude of PTS change was associated with pain, function or overall clinical improvement; p was greater than 0.05 for all of these analyses.
• A greater PTS was associated with statistically greater flexion: the coefficient was 0.53° of additional flexion for each 1° increase in PTS (p<0.001).
• This difference in range of motion did not translate into better patient-reported outcomes.
• Preoperative function remained the strongest predictor of postoperative outcome.

Clinical interpretation for an orthopaedic surgeon

The important distinction is between a measurable difference and one that matters to the patient. The association between PTS and flexion was statistically clear but small, and it was not reflected in any of the functional scores. The findings challenge the simple assumption that every few-degree sagittal-plane deviation must be the reason for a poor TKA result.

The study supports a broader assessment of the dissatisfied patient. Baseline function, pain, stiffness, instability, alignment in other planes, component rotation, soft-tissue condition, infection and expectations all need to be considered. PTS measured on a lateral radiograph is rarely a complete explanation on its own.

Limitations

• The study was retrospective and single-centre, so it cannot establish causation.
• It included only cemented TKA using one posterior-stabilised implant design; the findings should not automatically be extrapolated to cruciate-retaining, medially stabilised or other implant systems.
• PTS was measured on conventional lateral radiographs, which do not fully represent three-dimensional component position and are sensitive to limb positioning.
• The analysis does not answer questions about extreme malalignment, implant survivorship, aseptic loosening or outcomes beyond a decade.
• Unmeasured confounding remains possible despite multivariable analysis.

What might this change in practice — and what does it not prove?

The findings may reduce the tendency to overinterpret a modest PTS deviation as the sole cause of an unsatisfactory result after posterior-stabilised TKA. They are not an argument for arbitrary tibial component positioning or for disregarding surgical planning. Nor do they prove equivalence between different PTS angles, because this was not a randomised study designed to demonstrate no difference.

Reference

Altun O, Ergişi Y, Özdemir E, Özihtiyar AA, Altıntaş M, Daşar U. The Effect of Posterior Tibial Slope Change on Functional Outcomes After Posterior-Stabilized Total Knee Arthroplasty: An Analysis of 370 Patients Who Had A Minimum 4-Year Follow-Up. Journal of Arthroplasty. Published online 9 September 2026. PMID 42716147. DOI: 10.1016/j.arth.2026.09.001. PubMed abstract.

Content prepared by: Tomasz Poboży - orthopaedic surgeon.

Polish version · Research Updates, Literature and Evidence-Based Medicine

In older adults who had been mobile before injury, primary total hip arthroplasty did not accelerate functional recovery after a pertrochanteric fracture compared with a modern intramedullary nail. This was the finding of a small randomised trial published on 9 September 2026. Importantly, immediate full weight bearing was allowed in both groups.

Why is this study interesting?

Intramedullary nailing remains the standard treatment for pertrochanteric fractures. Advocates of primary arthroplasty have argued that, in an older patient, it may avoid the risk of fixation failure and facilitate early mobilisation. The trade-off is a more extensive operation, the need to reconstruct the trochanteric region and the risks inherent to joint replacement.

French investigators compared these strategies in a group in whom the argument for arthroplasty might appear particularly persuasive: patients older than 70 years who had been able to walk outside the home before the fracture.

Question and methods

This was a prospective, single-centre, open-label randomised trial conducted from 2015 to 2017. Of 460 patients screened, 70 were randomly assigned to treatment and 69 were included in the analysis: 35 underwent intramedullary nailing and 34 underwent uncemented total hip arthroplasty with a dual-mobility cup and trochanteric stabilisation.

The mean age was 84.7 years and 82.6% of participants were women. Eligibility required a pre-injury Parker Mobility Score of at least 5, indicating the ability to walk outside the home with or without assistance. Patients with dementia, severe cognitive impairment and pathological fractures were among those excluded. Immediate full weight bearing was permitted in both groups, and both groups followed the same rehabilitation programme.

The primary endpoint was the Harris Hip Score at six months. The investigators also assessed function at six weeks and one year, pain, mobility, complications, operating time, mortality and subsequent reoperations. The analysis followed the original treatment allocation.

Results

• At six months, the mean Harris Hip Score was 85.7 after intramedullary nailing and 82.5 after arthroplasty; the difference was not statistically significant (p=0.291).
• At six weeks, the scores were 70.4 and 69.7, respectively, and at 12 months 88.7 and 88.1, with no advantage for either strategy.
• Pain, autonomy and the other functional measures were similar through one year. Function improved over time in both groups, but average mobility at one year had not fully returned to the pre-fracture level.
• The median operating time was 30 minutes for nailing and 94 minutes for arthroplasty (p<0.001).
• There was one early mechanical failure in the fixation group. In the arthroplasty group, one patient sustained both a dislocation and a deep infection requiring reoperation.
• One-year mortality was 21.7% and did not differ between groups.
• At a median follow-up of 4.1 years, 80% of the original cohort had died; there was no difference in survival. No patient underwent secondary conversion from fixation to arthroplasty.

Clinical interpretation for an orthopaedic surgeon

The study does not support the proposition that the additional burden of primary THA provides a functional advantage in an older person who had been mobile before injury. Particularly relevant is the fact that full weight bearing was also permitted after intramedullary nailing. In this protocol, the argument that arthroplasty is necessary mainly to allow immediate weight bearing was therefore not supported.

The 3.2-point difference in Harris Hip Score at six months was not statistically significant and was also clearly below the closest available estimates of a minimal clinically important difference. Arthroplasty, meanwhile, required more than three times as long in the operating room.

Limitations

• The sample was small, and complete six-month functional data were available for 56 of 69 patients; missing results were mainly due to deaths.
• The trial was not designed as a formal equivalence study. It shows no large clinical superiority of arthroplasty, but it does not prove that the two strategies are identical.
• The population was highly selected: patients with dementia were excluded and pre-injury mobility had to be preserved. The result cannot be extrapolated to every patient with a hip fracture.
• The fractures were AO/OTA A1–A2 patterns; the study does not settle management for every extremely unstable or unreconstructable fracture.
• Uncemented femoral stems were used, reflecting the centre’s practice in 2015–2017. No cost analysis was performed.
• Assessments were performed by treating clinicians, and surgeon experience differed between groups: arthroplasties were more often performed by more senior surgeons.
• The long-term follow-up covered survival and major hip-related events, but not repeated functional measurements.

What might this change in practice — and what does the study not show?

The findings support retaining intramedullary nailing as a proportionate treatment for most pertrochanteric fractures in previously mobile older adults when stable fixation can be achieved and early weight bearing is possible. They do not provide a basis for routinely replacing nailing with primary THA solely because of age.

The study does not show that arthroplasty has no role. A different strategy may be justified in unreconstructable destruction of the proximal femur, advanced pre-existing joint disease, a pathological fracture or as salvage after failed fixation — situations that this trial did not assess.

Source

Piercecchi A, Bordet A, Labattut L, Maczynski A, Baulot E, Martz P. Intramedullary nailing compared with primary total hip arthroplasty for pertrochanteric fractures in autonomous elderly patients: a prospective randomized study. Bone & Joint Open. 2026;7(9):1178–1186. Published 9 September 2026. DOI: 10.1302/2633-1462.79.BJO-2026-0142.R1. PubMed | open full text.

Content prepared by: Tomasz Poboży - orthopaedic surgeon.

Polish version · Research Updates, Literature and Evidence-Based Medicine

A randomized trial published online on 8 September 2026 found substantially less quadratus femoris damage on MRI after total hip arthroplasty performed through the SuperPATH approach than through a conventional posterolateral approach. At one year, however, this did not translate into superior pain or functional outcomes. The distinction matters: better preservation of soft tissue on imaging does not automatically mean a benefit that patients can feel.

Why is this study interesting?

Debate about whether a surgical approach is “minimally invasive” often centres on incision length, early postoperative pain or speed of mobilisation. The authors of this study in The Journal of Arthroplasty asked a more objective question: does SuperPATH actually preserve the muscles and tendons around the hip better when assessed by MRI 12 months after surgery?

The study is particularly useful because it places an anatomical endpoint alongside clinical outcomes. That allows the MRI difference to be judged against what ultimately matters to the patient.

Research question and methods

Patients undergoing primary unilateral total hip arthroplasty were randomized to a SuperPATH approach — a superior capsular route with percutaneous introduction of part of the instrumentation — or to a posterolateral approach. The primary endpoint was the difference in quadratus femoris fatty infiltration on MRI at 12 months.

The investigators also assessed atrophy and tendon continuity in other periarticular muscles, perioperative parameters, pain on a visual analogue scale and function using the Harris Hip Score. Eighty-two patients completed the full follow-up. The public abstract does not state how many patients were initially randomized or provide detailed information on the handling of missing data.

Key results

• At 12 months, there were no significant differences in fatty infiltration or atrophy of the piriformis, obturator internus or gluteus minimus.
• Marked quadratus femoris fatty infiltration was reported in 7.3% of patients after SuperPATH versus 85.4% after the posterolateral approach; the difference was statistically significant.
• SuperPATH was also associated with less quadratus femoris atrophy and more frequent preservation of tendon continuity: 100% versus 56.1%.
• SuperPATH used a smaller incision but was associated with a longer operation and greater blood loss.
• At one month, pain and functional scores favoured SuperPATH; by 12 months the groups no longer differed clinically.
• Two early dislocations occurred in the posterolateral group.

Clinical interpretation for an orthopaedic surgeon

The trial provides a strong signal that the choice of approach can substantially affect the condition of a specific muscle as seen on MRI. At the same time, it demonstrates the limited value of a surrogate endpoint when considered in isolation: despite a striking imaging difference, patients had similar pain and function at one year.

The better one-month results may matter for early recovery, but they do not show that SuperPATH produces a lasting functional advantage. The longer operating time and greater blood loss also illustrate why “minimally invasive” should not be interpreted as “better in every respect”.

The two dislocations in one group are clinically relevant events, but this sample is far too small to establish a safety advantage. The trial was not presented as being powered to compare uncommon complications reliably.

Limitations

• The primary endpoint was an imaging outcome rather than an outcome directly experienced by the patient.
• No clinical superiority was shown at one year, so the practical importance of the large MRI difference remains uncertain.
• The public abstract does not provide the full participant flow, details of blinding for MRI assessment or the assumptions used for statistical power.
• The study was conducted at a single hospital in China, limiting generalisability to other surgical teams and learning curves.
• Twelve months is too short to assess the persistence of muscle differences, late dislocations, revision risk or implant survival.
• The findings apply to the specific comparison of SuperPATH with a posterolateral approach, not to every tissue-sparing hip approach.

What could this change in practice — and what does it not prove?

The study supports more precise counselling about SuperPATH: there is evidence of better quadratus femoris preservation on MRI and a possible early recovery advantage. It does not justify describing SuperPATH as clinically superior at one year, nor does it support changing surgical technique independently of surgeon experience, patient anatomy and the wider perioperative pathway.

Source

Gan F, Zhang Q, Luo H, Li L, Zheng F, Lin X, Qin H. Magnetic Resonance Imaging Assessment of Muscle Damage After Postero-lateral Versus Supercapsular Percutaneously-Assisted Total Hip Approaches: A Randomized Controlled Trial. J Arthroplasty. Published online 8 September 2026. PMID: 42710744. DOI: 10.1016/j.arth.2026.08.056. PubMed record.

Content prepared by: Tomasz Poboży - orthopaedic surgeon.

Hop tests after anterior cruciate ligament reconstruction can help describe functional readiness, but they should not be used on their own to decide whether an athlete is ready for a safe return to sport. A meta-analysis of 43 studies involving 17,350 participants found only modest associations between selected hop-test results and actual return to sport, with limited value for predicting reinjury.

Why is this study important?

Single-leg hop tests and the limb symmetry index (LSI) are widely used after ACL reconstruction. LSI expresses performance of the operated limb as a percentage of the opposite limb, and a threshold of 90% is often treated as an important marker of readiness. The problem is that symmetry does not necessarily mean full recovery: both limbs may be deconditioned, while jump distance alone says little about landing quality, fatigue, deceleration or performance in an unpredictable sporting situation.

The meta-analysis, published on 1 September 2026 in the Journal of Sports Science and Medicine, examined whether hop-test performance is actually associated with return to sport and subsequent ACL injury.

Question and methodology

The authors searched PubMed, MEDLINE, SPORTDiscus and Web of Science. Eligible studies included patients after primary unilateral ACL reconstruction who had undergone hop testing and for whom return-to-sport or reinjury outcomes were reported. Risk of bias was assessed with a modified Newcastle–Ottawa Scale and certainty of evidence with a modified GRADE approach.

Forty-three studies with 17,350 participants were included. Twenty-four analysed return to sport and 21 analysed reinjury; some studies reported both outcomes.

Key findings

• Achieving an LSI of at least 90% on the single-leg hop for distance was associated with a slightly greater likelihood of return to sport: OR 1.20; 95% CI 1.09–1.33.
• For the triple crossover hop, the association with return to sport was similarly modest: OR 1.18; 95% CI 1.02–1.36.
• For the triple hop for distance, an LSI of at least 90% was paradoxically associated with a slightly higher odds of reinjury: OR 1.05; 95% CI 1.01–1.09.
• The association between the single-leg hop and return to sport was stronger in studies in which more than 90% of reconstructions used hamstring-tendon grafts and in patients without meniscal injury.
• The overall certainty of evidence was rated as low.

Clinical interpretation for an orthopaedic surgeon

The main message is not that a 90% threshold has been validated as a universal cut-off, but that its limitations are substantial. Patients with good symmetry on selected hop tests were somewhat more likely to return to sport, but the effect was small. Returning to activity is also not the same as returning safely: the decision is influenced by the athlete’s goals, sport demands, access to training and advice from the treating team.

The apparently paradoxical association between a good triple-hop result and slightly greater reinjury odds does not show that better-performing patients are rehabilitated poorly. A more plausible explanation is that those who perform better are more likely to return to sporting exposure, creating more opportunities for another injury. These observational associations cannot establish causation.

Limitations

• Studies differed in the timing of testing, definitions of return to sport, activity levels and methods used to define reinjury.
• LSI compares the operated limb with the opposite leg, which may itself have become weaker after months of reduced activity.
• Hop distance does not describe lower-limb alignment, trunk control, deceleration quality or performance under fatigue.
• The analyses cannot separate physical readiness from the amount of subsequent exposure to training and competition.
• Low certainty of evidence limits the ability to define a universal decision threshold.

What could this change in practice?

Hop tests remain useful, but they should form part of a broader return-to-sport assessment that includes strength, movement and landing quality, fatigue tolerance, stability, psychological readiness, time from surgery and the demands of the specific sport. It is also useful to examine the absolute performance of both limbs rather than symmetry alone.

The study does not show that hop tests are unnecessary. It shows that passing a single threshold is not an insurance policy against reinjury and should not automatically trigger unrestricted training.

Related resources

Full rehabilitation protocol after primary, isolated ACL reconstruction →

For broader clinical evidence appraisal and rehabilitation decision-making, see Research Updates, Literature and Evidence-Based Medicine.

Source

Liu Y, Sun Y, Cao M et al. Hop Test Performance is Associated with Return-to-Sport but Shows Limited Association with Reinjury after Anterior Cruciate Ligament Reconstruction: A Systematic Review and Meta-Analysis. J Sports Sci Med. 2026;25(3):772–806. Published 1 September 2026. PMID: 42713242. DOI: 10.52082/jssm.2026.772. PubMed. Full text.

Polish version

Content prepared by: Tomasz Poboży - orthopaedic surgeon.

Can ultrasound and elastography replace the calendar as the main guide for rehabilitation progression after rotator cuff repair? A recent systematic review found interesting associations between ultrasound-derived measures and tendon healing, function and return to activity. It also shows how far the field remains from validated decision thresholds that are ready for routine clinical use.

Polish version · For Doctors and Physiotherapists

Why is this study interesting?

Rehabilitation after rotator cuff repair has to balance protection of the repair with gradual restoration of motion and strength. Protocols based only on time do not account for tendon quality, tear size or individual healing rates. Ultrasound is repeatable, dynamic and widely accessible, while shear-wave elastography can describe mechanical properties of tissue. The clinically relevant question is not simply whether an imaging measure correlates with outcome, but whether changing rehabilitation according to that measure improves patient outcomes.

Question and methodology

Shi, Bao and Li conducted a PRISMA-compliant systematic review with a protocol registered in PROSPERO. They searched PubMed and two Chinese databases, CNKI and Wanfang, for studies published from January 2020 through April 2026. Eligible studies involved patients after surgical rotator cuff repair and related grayscale ultrasound, Doppler or elastographic findings to rehabilitation decisions or functional outcomes.

Eleven studies including 673 patients were synthesised: six prospective cohorts, three retrospective cohorts, one case series and one randomised trial. Individual studies included 39 to 95 patients. Nine of the eleven studies were therefore cohort studies, and most of the key inferences came from observed associations rather than direct comparisons of rehabilitation strategies.

Main findings

Shear-wave velocity in the tendon

In normally healing supraspinatus tendons, shear-wave velocity, used as an indirect measure of stiffness, was approximately 6.2–6.3 m/s at one week, about 7.5 m/s at six months and 7.7–7.8 m/s at one year. This represented an increase of roughly 22–25% over 12 months.

Higher early values were associated with a greater retear risk in one cohort. Tendon stiffness measured at 12 weeks was also correlated with later return to work or sport, with a reported correlation coefficient of 0.49. This is a moderate prognostic signal, not evidence that adjusting load according to that parameter improves outcomes.

Muscle cross-sectional area and echogenicity

Changes in muscle cross-sectional area and echogenicity were associated with shoulder function. In one study, correlations with the Constant score were 0.633 and 0.693 respectively. Confidence intervals were not reported, however, and these associations do not constitute validated criteria for starting active movement, increasing resistance or introducing electrical stimulation.

Clinical interpretation for an orthopaedic surgeon

The review supports the use of ultrasound as a tool for observing healing biology and for generating hypotheses about more individualised rehabilitation. It does not support a simple rule such as “the elastography value crossed a threshold, therefore loading can be increased”. The review itself acknowledges that quantitative thresholds remain limited and unvalidated.

A value around 7.5 m/s at six months was presented as a potential reference point, but it depends on the ultrasound system, probe, measurement angle, tendon tension, limb position and protocol. It cannot be treated as a universal safety threshold.

Limitations

• only one of the 11 studies was randomised;
• small samples, ranging from 39 to 95 patients, with 673 participants in total;
• substantial heterogeneity in ultrasound techniques, time points and measured parameters;
• no shared prospectively validated threshold for changing rehabilitation load;
• some correlations were reported without confidence intervals;
• the search was limited to three databases and English- and Chinese-language publications;
• two reports by Maloof and colleagues each included 50 patients and may represent sequential analyses of the same or partly overlapping cohort;
• the review did not directly compare imaging-guided rehabilitation with a well-conducted clinical rehabilitation protocol.

What could change practice?

At present, the most defensible use is systematic documentation of the repaired tendon and muscle parameters in centres with a reproducible protocol. An unusual appearance may prompt closer clinical review, reassessment of loading or additional imaging. It should not independently determine a return-to-sport date.

A practice-changing study would need to randomise patients to a rehabilitation protocol modified according to standardised ultrasound measurements versus a protocol based on time, operative findings and functional assessment. Patient-important outcomes should include retear, pain, function, stiffness, return to work or sport and adverse events.

What does the review not prove?

It does not prove that elastography improves rehabilitation outcomes, that one shear-wave velocity is safe for every repaired tendon, or that a normal ultrasound can replace clinical examination. It also does not show that time-based protocols should be abandoned. The review is a useful map of a developing field, not a ready-made rehabilitation algorithm.

Source

Shi Y, Bao Y, Li C. Application of musculoskeletal ultrasound in postoperative rehabilitation assessment and monitoring after rotator cuff repair: a systematic review. PLoS One. 2026;21(9):e0357622. Published 8 September 2026. DOI: 10.1371/journal.pone.0357622. PubMed. Full text.

Content prepared by: Tomasz Poboży - orthopaedic surgeon.