Recent orthopedic cohort studies

New cohort and registry evidence from the weekly pipeline — hottest first.

Global Spine Journal IF 2.6 Aug 7 2026 LoE III Full text read

Incidence of Tetraplegia After Cervical Laminectomy Versus Laminoplasty: A Propensity Score Matched Analysis Using US Collaborative Network Database in TriNetX

This retrospective database study used TriNetX to compare rates of postoperative tetraplegia between cervical laminectomy and laminoplasty in about 3,950 propensity-matched patients per group with degenerative cervical stenosis/spondylosis. Tetraplegia (almost always incomplete) was rare in both groups but occurred more often after laminectomy, especially at the C1-C4 level, where 12-month risk was 2.2% versus 1.1% with laminoplasty (OR 2.0, 95% CI 1.4-2.9); 12-month mortality was also higher after laminectomy (2.7% vs 1.6%, p=0.0004).

AI summary · from the full text

Why it mattersTetraplegia after posterior cervical decompression is a rare but catastrophic complication, and these real-world incidence estimates and procedure comparisons can inform how surgeons counsel patients when choosing between laminectomy and laminoplasty.

CohortSpinen = 7,856DOI ↗

Presenting this at rounds? Start here

?If laminectomy carries roughly double the risk of incomplete tetraplegia at C1-C4 compared to laminoplasty, should laminoplasty be preferentially considered for patients needing decompression at these upper cervical levels?
?Given the higher 12-month mortality seen with laminectomy in this cohort, how should surgeons weigh unmeasured confounding by indication (e.g., patients selected for laminectomy with fusion, frailty, or more severe disease) when counseling patients about procedure choice?

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Global Spine Journal IF 2.6 Jul 30 2026 LoE III Full text read

Elective Lumbar Decompression With Fusion Is Associated With Increased Mortality Compared With Decompression Alone: A National Propensity-Matched Analysis of Aging Cohorts

This retrospective database study used TriNetX to compare adults with degenerative lumbar disease (no instability) who had decompression alone versus decompression plus fusion, matching by age decade and frailty. Fusion was linked to much higher mortality at every time point studied, most strikingly a 30-day mortality of 4.19% versus 0.68% in octogenarians (OR 6.34), with the gap persisting out to two years (13.24% vs 4.61% in the 80s group).

AI summary · from the full text

Why it mattersThis raises a real concern for how surgeons counsel elderly patients about adding fusion to decompression when there is no clear structural indication like instability or deformity.

CohortSpineDOI ↗

Presenting this at rounds? Start here

?In an octogenarian with degenerative stenosis but no radiographic instability, how should this absolute mortality gap change the way you counsel about adding fusion versus doing decompression alone?
?If a patient has significant mechanical back pain suggesting possible occult instability not captured on imaging, how should surgeons balance the theoretical benefit of fusion against this study's mortality signal?

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Journal of Hand Surgery Global Online IF 2.1 Aug 11 2026 LoE III Full text read

The Impact of Opioid-Related Disorder on Healthcare Resource Utilization Following Distal Radius Fracture Repair Surgery

This retrospective TriNetX database study compared 789 propensity-matched adults with a prior diagnosis of opioid-related disorder (ORD) to 789 without it, all having undergone distal radius fracture repair. Within 90 days, ORD patients had significantly higher rates of ED visits (21.8% vs 11.2%), hospitalizations (13.6% vs 8.5%), and physical therapy evaluations (18.8% vs 12.0%), and they received more opioid prescriptions per patient (8.3 vs 4.7) between 30 days and 1 year postoperatively, with no significant difference in outpatient visits or antidepressant prescriptions.

AI summary · from the full text

Why it mattersDistal radius fracture is one of the most common orthopedic procedures, so identifying patients with opioid-related disorder as a high-utilization, high-risk subgroup could help hand surgeons target perioperative counseling and opioid stewardship.

CohortTrauman = 1,578DOI ↗

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Spine IF 2.6 Jul 20 2026 LoE III Full text read

Cognitive Impairment as an Effect Modifier of Perioperative Risk in Elderly Patients Undergoing Lumbar Fusion Surgery

This retrospective cohort study looked at 243 patients aged 75 or older who had lumbar fusion surgery, comparing those with preoperative cognitive impairment (CI, n=57, defined by education-adjusted MMSE) to those without (n=186). Patients with CI had more major complications (42.1% vs 33.9%), longer hospital stays, more readmissions, and worse functional recovery, and interaction analyses suggested that diabetes, frailty, and intraoperative transfusion volume had a stronger effect on complications specifically in the CI group.

AI summary · from the full text

Why it mattersSpine surgeons increasingly operate on elderly patients, and this suggests cognitive screening could help identify who needs tighter glycemic, frailty, and blood management optimization before lumbar fusion.

CohortSpinen = 243DOI ↗

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?This is a single-center retrospective study with only 57 patients in the cognitive impairment subgroup; how much can we trust the stability of the interaction odds ratios (e.g., diabetes AOR 3.62, CI 1.18-11.07) given such small subgroup event counts?
?If a patient screens positive for cognitive impairment preoperatively, how should that concretely change your perioperative plan for glycemic control, frailty prehabilitation, and blood management before lumbar fusion?

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Arthroscopy The Journal of Arthroscopic and Related Surgery IF 4.4 Jul 22 2026 LoE III Full text read

Suture‐Only Fixation of Meniscal Allograft Is Associated With a Higher Reoperation Rate Than Bone Plug or Bone Bridge‐in‐Slot Fixation Techniques

This retrospective single-institution cohort study of 139 patients who underwent meniscal allograft transplantation (MAT) compared reoperation rates among three graft fixation techniques: suture-only, bone plug, and bone bridge-in-slot. Over a mean follow-up of 6.6 years, patients with suture-only fixation had a much higher meniscus-specific reoperation rate (15/48, 31.3%) than those with bone bridge-in-slot (4/45, 8.9%) or bone plug (5/46, 10.9%) fixation (P = .006), and on multivariable analysis suture-only fixation carried roughly 10-fold higher odds of reoperation versus bone bridge-in-slot fixation (OR 10.05, 95% CI 2.46-40.98).

AI summary · from the full text

Why it mattersFor surgeons performing meniscal allograft transplantation, this study suggests that fixation technique choice may meaningfully affect long-term graft durability and reoperation risk, a key consideration in patient counseling and surgical planning.

CohortArthroplastyn = 139DOI ↗

Presenting this at rounds? Start here

?Given that fixation technique was chosen by surgeon preference rather than randomized, how might confounding by indication (e.g., compartment, graft morphology, surgeon skill) explain part of the observed difference in reoperation rates?
?If you were counseling a young patient with lateral meniscal deficiency, would this single-institution retrospective study be enough to steer you away from suture-only fixation, or would you want prospective confirmation first?

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Journal of Neurosurgery Spine IF 2.9 Aug 12 2026 LoE III Full text read

Risk factors for mechanical failure involving the cervicothoracic junction following posterior cervical instrumentation

This retrospective single-center study of 485 patients undergoing posterior cervical decompression and fusion (PCDF) with the lowest instrumented vertebra (LIV) at C7, T1, or T2 examined which construct-specific factors predict mechanical hardware failure. Only 19 patients (3.9%) had mechanical failure overall, but failure rates were much higher when the construct stopped at C7 (11.5%) versus extending into the thoracic spine (2.8%), and having a C7 pedicle screw or a more cranial UIV (like C2) was independently protective against failure on multivariate analysis.

AI summary · from the full text

Why it mattersThis helps spine surgeons decide how far to extend cervical fusion constructs and whether to use pedicle versus lateral mass screws at C7 to reduce revision risk at the cervicothoracic junction.

CohortSpinen = 485DOI ↗

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Arthritis Care & Research IF 3.7 Aug 10 2026 LoE III Full text read

Osteoporotic fracture, diagnostic activity, and treatment in patients with gout

This retrospective cohort study used a US rheumatology registry linked to Medicare claims to compare gout patients with osteoarthritis (OA) and soft tissue rheumatism (STR) patients regarding osteoporosis screening, treatment, and fracture rates. Gout patients had higher rates of nonvertebral osteoporotic fracture than OA (incidence rate ratio 1.4, 95% CI 1.1-1.8) and STR (IRR 2.0, 95% CI 1.3-3.1) patients, despite having more risk factors like chronic kidney disease and higher glucocorticoid exposure, yet they were less likely to undergo DXA screening or receive bone-protective medications.

AI summary · from the full text

Why it mattersIt highlights that gout patients, who are frequently exposed to glucocorticoids and have comorbid CKD, are being under-screened and undertreated for osteoporosis despite bearing a higher fracture burden, a gap relevant to any clinician managing bone health in this population.

CohortSpineDOI ↗

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Journal of the American Academy of Orthopaedic Surgeons IF 2.9 Aug 13 2026 LoE III Full text read

Robotic-Assisted Total Hip Arthroplasty Is Associated With Lower Prosthetic Complications in Patients With Lumbar Fusion or Stiff Spine: A Propensity-Matched Cohort Study

This retrospective database study used TriNetX records to compare robotic-assisted versus manual total hip arthroplasty in patients with lumbar fusion or a stiff spine, a group known to have higher dislocation risk. After propensity matching 2,147 patients per group, robotic THA was associated with fewer prosthetic complications at 3 months (1.4% vs 2.7%, OR 1.86, P=0.01), fewer dislocations at 1 year (0.9% vs 1.8%, OR 2.07, P=0.01), and lower revision rates at 2 years (2.0% vs 3.7%, OR 1.86, P<0.001). Benefits were driven mainly by the larger nonfusion 'stiff spine' subgroup, while the smaller spinal fusion subgroup showed no significant differences.

AI summary · from the full text

Why it mattersThis adds observational support for using robotic assistance in a high dislocation-risk THA population, a decision point residents will face increasingly often as spinopelvic considerations become standard in preoperative planning.

CohortArthroplastyn = 4,294DOI ↗

Presenting this at rounds? Start here

?Should surgeons preferentially offer robotic-assisted THA to patients with degenerative spinal stiffness even when they lack a formal fusion, given this study's finding that nonfused stiff-spine patients had similar risk reduction?
?How should the absence of a significant benefit in the spinal fusion subgroup change counseling and technique selection for patients who have already undergone lumbar fusion before THA?

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Neurosurgery IF 3.9 Jul 21 2026 LoE III Full text read

Is rhBMP-2 Worth the Risk? A Data-Driven Look at Fusion Outcomes and rhBMP-2–Related Complication Burden in High-Risk Adult Spinal Deformity Patients

This single-center retrospective cohort followed 288 adults with adult spinal deformity who underwent ≥5-level fusion, comparing those who received rhBMP-2 (41%) versus those who did not. Patients given rhBMP-2 had a much lower rate of pseudarthrosis/rod fracture than those without it (16.1% vs 38.2%), and this held up after adjustment (OR 0.14, 95% CI 0.02-0.78). The benefit was clearest in patients with osteoporosis/osteopenia and, for mechanical complications specifically, in obese patients, while diabetic patients showed no statistically significant benefit, and rhBMP-2 was not independently linked to its classically feared complications (radiculitis, wound problems, seroma).

AI summary · from the full text

Why it mattersrhBMP-2 use in adult spinal deformity surgery remains controversial and often surgeon-dependent, so data suggesting it may reduce nonunion risk in high-risk bone-quality patients without added complications could influence how residents and attendings think about biologic augmentation in complex fusions.

CohortSpinen = 288DOI ↗

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?Given that rhBMP-2 use was not randomized and was more common in revision cases and longer constructs, how much of the observed pseudarthrosis benefit could reflect unmeasured surgeon selection (confounding by indication) rather than a true biologic effect?
?If you were counseling a patient with osteoporosis undergoing a long deformity fusion, would this single-center, retrospective, explicitly 'hypothesis-generating' study be enough to justify off-label rhBMP-2 use given its cost and regulatory status?

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Spine IF 2.6 Aug 26 2026 LoE III Full text read

Reoperation in Long Lumbar Constructs with and Without Iliac Fixation

This retrospective registry study compared 483 patients who got iliac screws with 818 who did not during long (>4 level) lumbosacral fusions for degenerative spine disease, following them for a mean of 6.3 years (up to 10 years). After one year, patients with iliac fixation had a lower risk of any reoperation (HR 0.58, 95% CI 0.40-0.85) and a much lower risk of reoperation for nonunion (HR 0.30, 95% CI 0.13-0.67), but there was no difference in reoperation within the first year, for adjacent segment disease, or for hardware failure/removal.

AI summary · from the full text

Why it mattersThis informs whether spine surgeons should extend fixation to the pelvis in long degenerative lumbar fusions to reduce late nonunion-related reoperation.

CohortSpinen = 1,301DOI ↗

Presenting this at rounds? Start here

?Given that the benefit of iliac fixation appears driven almost entirely by reduced nonunion, should surgeons reserve iliac screws for patients at highest risk of pseudarthrosis rather than using them routinely in all long constructs?
?Does the finding that unilateral iliac fixation performed as well as bilateral fixation (with fewer implants) support de-escalating to a single iliac screw in appropriate patients?

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The Bone & Joint Journal IF 4.6 Aug 1 2026 LoE III Full text read

Use of neurolytic nerve blocks and mortality in nonoperative management of hip fracture patients

This Dutch nationwide registry study looked at 1,415 elderly hip fracture patients (mean age 86) who were managed nonoperatively, comparing the 633 (45%) who received a neurolytic phenol nerve block for pain control with those who did not. Nerve block patients had lower mortality at 7 days (24.9% vs 39.0%) but higher mortality at 90 days (74.9% vs 68.1%) and 180 days (79.7% vs 72.9%), while an adjusted Cox model showed a lower 30-day hazard of death with blocks (adjusted HR 0.73, 95% CI 0.61-0.88, p<0.001); the authors conclude the blocks were not associated with prolonged survival overall.

AI summary · from the full text

Why it mattersNonoperative, palliative management of frail hip fracture patients is a growing pathway, and this paper raises the possibility that widely-adopted neurolytic nerve blocks may not extend meaningful survival despite short-term mortality benefits, which matters for end-of-life counseling and hospital policy.

CohortTrauman = 2,267DOI ↗

Presenting this at rounds? Start here

?If neurolytic nerve blocks reduce early mortality but are linked to higher mortality by three to six months, how should this change what you tell families about expected survival when choosing nonoperative management?
?Given the wide hospital-to-hospital variation in nerve block use (4% to 100%), how should patient selection criteria for these blocks be standardized in your own practice?

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Journal of the American Academy of Orthopaedic Surgeons IF 2.9 Jul 23 2026 LoE III Full text read

Predictive Factors for Manipulations Under Anesthesia After Total Knee Arthroplasty: An Analysis of 15,139 Cases

This retrospective cohort study used a national database of over 975,000 total knee replacements to find which patients most often needed a later 'manipulation under anesthesia' (MUA) for postoperative stiffness. About 1.55% of patients (15,139) required MUA, and those patients were more likely to be younger, female, and Black (adjusted odds ratio for Black race 1.98, 95% CI 1.88-2.08), while use of perioperative dexamethasone, daily corticosteroids, and ARBs were linked to lower odds of needing MUA.

AI summary · from the full text

Why it mattersKnowing which patients are more likely to develop stiffness after knee replacement could help surgeons counsel patients and consider perioperative anti-inflammatory strategies, even though this is only association-level evidence.

CohortArthroplastyDOI ↗

Presenting this at rounds? Start here

?Because this is a retrospective administrative database study without data on intraoperative technique, implant alignment, or actual ROM measurements, how much of the observed 'protective' effect of medications like dexamethasone or ARBs could instead reflect unmeasured confounding (e.g., healthier patients being prescribed these drugs)?
?If a patient is young, female, and Black and therefore statistically at higher risk of MUA, how should that information actually change your preoperative counseling or perioperative medication plan, given the authors themselves call for more prospective research before changing practice?

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European Spine Journal IF 2.8 Aug 28 2026 LoE III Full text read

Associations between different sports and low back pain: a population-based study with a 15-year follow-up

Using the Northern Finland Birth Cohort 1966 (n=3352), researchers looked at whether the type and frequency of sport played in adulthood (age 31) predicted low back pain (LBP) status 15 years later (age 46). After adjusting for sex, BMI, smoking, education, occupational exposure, and comorbidities, only cross-country skiing remained associated with lower odds of repeatedly reported LBP (OR 0.77, 95% CI 0.60-0.98 for skiing up to once a week; OR 0.71, 95% CI 0.51-1.00 for at least twice a week), while running and gym training lost significance after adjustment, and no sport was associated with new-onset or resolved LBP.

AI summary · from the full text

Why it mattersIt's a commonly asked clinical question, whether recommending specific sports (rather than just 'more exercise') can help prevent recurrent low back pain, and this study offers population-level, though modest, evidence that not all physical activity is equal.

CohortSpinen = 7,146DOI ↗

Presenting this at rounds? Start here

?If a patient with recurrent low back pain asks which sport to take up, should cross-country skiing be specifically recommended over running or gym training based on this evidence?
?How should clinicians counsel patients about the limits of this data (borderline confidence intervals, self-reported pain, no dose-response causality) when discussing exercise choices for LBP prevention?

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Arthroplasty Today IF 1.5 Aug 24 2026 LoE III Full text read

Preoperative Platelet and International Normalized Ratio Thresholds and Their Impact on Complications Following Revision Total Joint Arthroplasty

This retrospective database study looked at patients undergoing revision total hip or knee arthroplasty and asked whether preoperative platelet counts and INR values below the traditional 'safe' thresholds (platelets ≥50,000/μL, INR <1.5) were linked to more complications. After propensity matching, patients with platelets 50,000-100,000/μL had nearly double the odds of needing a blood transfusion at 90 days (OR 1.88, 95% CI 1.45-2.44) along with higher odds of periprosthetic joint infection and 2-year mortality; mild INR elevation (1.1-1.5) and higher INR levels were also linked to more transfusions, thromboembolic events, infection, and in some groups mortality, though the risk did not rise in a clean stepwise fashion with higher INR.

AI summary · from the full text

Why it mattersSurgeons often use platelet and INR cutoffs to decide who is 'safe' for revision arthroplasty, and this study suggests those thresholds may be too lenient, particularly for infection and transfusion risk.

CohortArthroplastyn = 1,012DOI ↗

Presenting this at rounds? Start here

?Should surgeons delay or further optimize revision arthroplasty candidates with platelet counts between 100,000 and 150,000/μL, a range currently considered 'normal' but here linked to higher transfusion, PJI, and mortality risk?
?Given that INR elevations above 1.5 did not show a stepwise increase in complications, how should surgeons weigh the risks of interrupting anticoagulation for reversal versus proceeding with a mildly elevated INR in revision arthroplasty patients?

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Hand IF 1.6 Aug 13 2026 LoE III Full text read

Clinical Characteristics of Concomitant Versus Isolated Carpal and Cubital Tunnel Syndromes: A Prospective Cohort Study

This prospective cohort study compared 86 surgical patients with isolated carpal tunnel syndrome (CTS), isolated cubital tunnel syndrome (CuTS), or both conditions together to see if concomitant disease is a distinct, more severe entity. Sensory symptoms and provocative tests were similar across groups, but patients with concomitant disease had significantly weaker intrinsic hand muscles (abductor pollicis brevis strength P=.0308 vs isolated CTS; abductor digiti minimi strength P=.0319 vs isolated CuTS), and concomitant disease independently predicted lower APB strength on multivariable analysis (adjusted OR 3.55, 95% CI 1.02-12.38, P=.0471), though the analogous ADM finding did not reach significance (adjusted OR 2.45, P=.1550).

AI summary · from the full text

Why it mattersHand surgeons should have a lower threshold to examine for dual median/ulnar nerve compression when a patient presents with objective intrinsic motor weakness rather than isolated sensory complaints.

CohortSpinen = 86DOI ↗

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The American Journal of Sports Medicine IF 4.5 Jul 23 2026 LoE III Full text read

Minimum 5-Year Outcomes After Arthroscopic Subspine Decompression in Patients With Femoroacetabular Impingement: A Propensity-Matched Study

This retrospective, propensity-matched cohort study followed 94 patients who underwent arthroscopic subspine decompression (SSD) alongside FAI correction and compared them to 188 matched controls without subspine impingement, all with at least 5 years of follow-up. Both groups improved significantly from baseline on all patient-reported outcome scores (p<.0001), and rates of achieving clinically meaningful improvement (MCID/PASS) were similar between groups; the SSD group had a numerically lower but statistically similar conversion-to-arthroplasty rate (5.3% vs 17.4%, though p=.61 reported for that comparison) and a significantly longer time to revision arthroscopy (52.0 vs 32.8 months, p=.04).

AI summary · from the full text

Why it mattersHip arthroscopists often encounter subspine impingement alongside FAI, and this study offers reassurance that concurrent decompression does not compromise, and may even improve, midterm durability compared to FAI surgery alone.

CohortArthroplastyn = 111DOI ↗

Presenting this at rounds? Start here

?This is a single-surgeon retrospective cohort with propensity matching rather than randomization; how might unmeasured confounders like femoral version or activity level have influenced the comparable outcomes and the paradoxical p=.61 result reported for a rate that looks numerically quite different?
?Given that outcomes were 'comparable' rather than superior, how should a surgeon weigh the added operative time and risk of AIIS decompression against its uncertain independent benefit when SSI is identified intraoperatively?

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JAMA Network Open IF 10.5 Jul 30 2026 LoE III Full text read

Adiposity Excess and Vertebral Fractures in Patients With Breast Cancer Taking Aromatase Inhibitors

This single-center retrospective cohort of 769 postmenopausal women with early breast cancer on aromatase inhibitors used serial DXA to test whether high body fat percentage (>40.8%) predicts worsening or new vertebral fractures over a median follow-up of about 46 months. Fat mass excess was seen in nearly half the cohort at some point and was independently linked to a doubled risk of vertebral fracture progression (adjusted HR 2.00, 95% CI 1.44-2.82, p<.001), while higher muscle mass (ALMI) and higher bone density were protective; BMI itself was not a significant predictor.

AI summary · from the full text

Why it mattersIt suggests that BMI, the metric most oncologists use at the bedside, misses a substantial subset of AI-treated patients at high fracture risk, potentially changing how bone health is screened in breast cancer survivorship clinics.

CohortSpinen = 583DOI ↗

Presenting this at rounds? Start here

?Should oncologists routinely obtain DXA-based fat mass percentage rather than relying on BMI alone when risk-stratifying breast cancer patients starting aromatase inhibitor therapy?
?Given that appendicular lean mass was protective, should resistance training or muscle-preserving exercise programs be prioritized alongside bone-targeting agents in patients with excess adiposity on AI therapy?

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Sports Health A Multidisciplinary Approach IF 2.7 Sep 11 2026 LoE III Full text read

Functional and Psychological Predictors of Return to Sport and Reinjury Risk in Professional Athletes After ACL Reconstruction

This mixed prospective-retrospective cohort followed 127 professional athletes after ACL reconstruction, comparing 32 who suffered a noncontact graft rupture within 3 years against matched non-reinjured controls using 10 functional hop tests, limb symmetry index (LSI), and patient-reported outcome measures. Absolute hop performance (distance/time) differed significantly between reinjured and non-reinjured athletes on most tests (e.g., lateral hop for distance in males: 104.7 vs 160.0 cm, P<0.001), while LSI showed a significant difference in only one test (TCHD in females, P=0.03). The ACL-RSI psychological readiness score correlated moderately-to-strongly with hop performance (r=0.43-0.73) in both groups, whereas KOOS and IKDC did not correlate with hop tests.

AI summary · from the full text

Why it mattersThis challenges the common reliance on limb symmetry index for return-to-sport clearance, suggesting absolute performance benchmarks and psychological readiness scores may better flag athletes at risk of ACL graft reinjury.

CohortSportsn = 150DOI ↗

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Clinical Spine Surgery A Spine Publication IF 1.6 Jul 21 2026 LoE III Full text read

Predictors of Sacroiliac Joint Intervention Following Lumbar Spine Fusion

This retrospective database study looked at over 500,000 patients who underwent 1-5 level lumbar fusion and tracked how many later needed a sacroiliac (SI) joint fusion. Only 0.73% (3718 patients) went on to SI fusion, but among those, the strongest predictor by far was having had an SI joint injection after the index lumbar surgery (OR 15.48), followed by anterior/lateral approaches (OR 1.86), posterior approaches (OR 1.36), segmental instrumentation (OR 1.29), osteoarthritis (OR 1.14), and female sex (OR 1.09); risk of SI fusion also rose with more fused levels (HR up to 1.72 for 4-level fusion).

AI summary · from the full text

Why it mattersHelps spine surgeons identify which lumbar fusion patients (women, more levels fused, segmental instrumentation, osteoarthritis) are at higher risk of later SI joint pain requiring intervention, informing preoperative counseling.

CohortSpineDOI ↗

Presenting this at rounds? Start here

?This is a large administrative database study using ICD/CPT codes without radiographic, symptom, or surgical technique detail; how might coding inaccuracies and lack of clinical granularity (e.g., unknown levels fused, indication for SI injection) bias the identified risk factors?
?Given that only 0.73% of patients required SI fusion and the strongest predictor was a prior SI injection (which itself signals emerging symptoms rather than an independent risk factor), how should this information change preoperative counseling versus intraoperative decision-making about concurrent SI fixation?

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Hand IF 1.6 Aug 7 2026 LoE III Full text read

Socioeconomic and Demographic Influences on Trigger Finger Management: A Retrospective Cohort study

This retrospective cohort study looked at 2,639 adults with trigger finger treated at one academic hand practice from 2015-2020, asking whether age, race, insurance, and education predicted who ended up getting surgical release versus staying on conservative care. Only 16.2% ultimately had surgery, and after adjustment, older age, Asian/Pacific Islander race (adjusted OR 0.46 vs White patients), and having Medicare/Medicaid/uninsured status were all associated with lower odds of surgery, while patients with more than one insurance type had higher odds (adjusted OR 1.85). Insurance type was also linked to how long patients spent in conservative management before their last documented procedure, though not to how quickly they got to surgery once they had it.

AI summary · from the full text

Why it mattersIt highlights that even a routine, algorithm-driven hand condition like trigger finger shows measurable racial and insurance-based gaps in who reaches definitive surgical treatment, a pattern residents should recognize when counseling patients about escalation of care.

CohortHand & Wristn = 145DOI ↗

Presenting this at rounds? Start here

?If a patient's insurance type seems to be prolonging their conservative management, how should that change your counseling about the timing of offering surgical release?
?Given the lower observed odds of surgery in Asian/Pacific Islander and older patients even after adjustment, how should surgeons check whether they are under-offering surgery to certain groups versus those patients genuinely preferring to avoid it?

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Journal of Orthopaedics and Traumatology IF 3.5 Aug 13 2026 LoE III Full text read

One-year mortality of the anterior approach compared with other approaches in elderly patients with hip fracture treated with hemiarthroplasty: a national registry study

This Dutch registry study of over 40,000 patients aged 75+ who had hemiarthroplasty for hip fracture compared 1-year mortality by surgical approach (anterior, posterolateral, anterolateral, straight lateral). After propensity score matching about 21,393 patients, mortality was essentially identical across approaches (26% for DAA, PLA, and SLA, 27% for ALA), with no significant differences on Cox regression.

AI summary · from the full text

Why it mattersThe direct anterior approach is increasingly popular and marketed for faster recovery, so this large registry study helps temper expectations that it improves survival after hip fracture hemiarthroplasty.

CohortArthroplastyn = 40,981DOI ↗

Presenting this at rounds? Start here

?If DAA does not reduce mortality after hemiarthroplasty, should surgeons choose approach based on other factors like dislocation risk, mobilization speed, or surgeon familiarity instead?
?Given the fragility of hip fracture patients, is 1-year mortality even the right outcome to judge approach choice, or should function and complications weigh more heavily in decision-making?

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Journal of Orthopaedic Surgery and Research IF 2.8 Jul 31 2026 LoE III Full text read

Impact of neuromuscular and visuo-motor training on landing biomechanics, functional performance, and psychological factors in female athletes with unilateral anterior cruciate ligament reconstruction: a simple parallel-group randomized controlled trial

This small trial randomized 45 female athletes with prior unilateral ACL reconstruction into neuromuscular training (NMT), visuo-motor training (VMT), or a control group, then measured landing biomechanics (hip/knee/ankle angles, knee valgus, ground reaction force), functional hop/balance tests, and fear of reinjury (ACL-RSI). Both NMT and VMT groups showed significant improvements across nearly every measured variable (e.g., knee valgus p=0.03–0.04, ACL-RSI p=0.001) with large effect sizes, but the two active interventions did not differ significantly from each other on any outcome.

AI summary · from the full text

Why it mattersLanding mechanics like knee valgus and reduced knee flexion are linked to reinjury risk after ACL reconstruction, so trials comparing rehab strategies targeting these mechanics are directly relevant to return-to-sport planning.

CohortSportsn = 45DOI ↗

Presenting this at rounds? Start here

?If NMT and VMT produce statistically indistinguishable improvements in landing mechanics and psychological readiness, how should a clinician choose between them for a given athlete returning to sport after ACLR?
?Given that fear of reinjury (kinesiophobia) improved substantially with both interventions, should psychological readiness be assessed as routinely as biomechanical metrics before clearing athletes for return to sport?

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Acta Orthopaedica IF 2.9 Aug 13 2026 LoE III Full text read

Single versus dual antibiotic-loaded bone cement in hip fracture arthroplasty: a cohort study of 56,434 hip arthroplasties from the Dutch Arthroplasty Register

This Dutch registry study of 56,434 cemented hip fracture arthroplasties compared single versus dual antibiotic-loaded bone cement (ALBC) for preventing periprosthetic joint infection. After adjustment, dual ALBC was not associated with lower all-cause revision (HR 1.2, CI 0.9-1.5), but was associated with a slightly higher rate of revision for infection (HR 1.6, CI 1.0-2.5) and mortality (HR 1.2, CI 1.1-1.2) compared with single ALBC. The authors attribute the mortality signal to residual confounding (dual ALBC likely used in frailer patients) rather than a true causal effect of the cement.

AI summary · from the full text

Why it mattersThis is one of the largest real-world datasets addressing whether dual ALBC reduces infection after hip fracture arthroplasty, a question with major cost and antibiotic-stewardship implications for a very common procedure.

CohortArthroplastyn = 56,434DOI ↗

Presenting this at rounds? Start here

?Given the lack of demonstrated infection-prevention benefit and higher cost, should surgeons who currently use dual ALBC routinely in hip fracture arthroplasty reconsider switching to single ALBC?
?How should indication bias and unmeasured frailty be factored into decisions about cement selection for high-risk hip fracture patients while awaiting trial data like DAICY?

Rigor × clinical importance

Rigor53Clinical45

Limited35

Journal of Neurosurgery Spine IF 2.9 Aug 12 2026 LoE III Full text read

The utility of the Risk Assessment and Prediction Tool in predicting discharge disposition, length of stay, and readmissions in patients undergoing transforaminal lumbar interbody fusion

This retrospective cohort study of 116 patients undergoing open TLIF looked at whether the preoperative RAPT score (a tool originally designed for joint replacement) predicts discharge destination, length of stay, and 30-day readmission. Higher RAPT scores were associated with greater odds of home discharge (adjusted OR 2.17) and shorter length of stay (adjusted β −0.39 days), but RAPT was not associated with 30-day readmission, and its discrimination for facility discharge was only moderate (AUC 0.709).

AI summary · from the full text

Why it mattersSpine surgeons are increasingly asked to predict discharge needs preoperatively for bundled-payment and value-based care purposes, and this paper tests whether a tool borrowed from arthroplasty actually works for TLIF patients.

CohortArthroplastyn = 116DOI ↗

Presenting this at rounds? Start here

?If RAPT modestly predicts home discharge after TLIF but not readmission, how should surgeons weigh its score against other clinical judgment when counseling patients preoperatively?
?Given the wide, imprecise cutoffs found here (9.5 vs 8.5 vs 10.5), should institutions adopt RAPT for TLIF discharge planning now, or wait for validation in larger multicenter cohorts?

Rigor × clinical importance

Rigor28Clinical54

Limited33

Bone & Joint Open IF 2.8 Aug 13 2026 LoE III Full text read

Fracture laterality as an independent prognostic factor for clinical outcomes after hip fracture surgery

This Japanese administrative-database study followed 72,008 patients age 65+ who had surgery for hip fracture, asking whether the side of the fracture (left vs right) predicts outcomes. Overall in-hospital mortality did not differ significantly by side (adjusted OR 1.10, 95% CI 0.99-1.22, p=0.075), but right-sided fractures were associated with slightly worse independence at discharge (Barthel Index <60; adjusted OR 1.09, 95% CI 1.05-1.13, p<0.001), and among patients with high comorbidity burden (CCI \u2265 2), right-sided fracture carried a higher mortality risk (aOR 1.29, 95% CI 1.09-1.53).

AI summary · from the full text

Why it mattersFracture laterality is a free, already-recorded data point that could add modest prognostic information for discharge planning and rehabilitation intensity in frail hip fracture patients, if the association is confirmed prospectively.

CohortTrauman = 78,224DOI ↗

Rigor × clinical importance

Rigor45Clinical45

Limited33

Global Spine Journal IF 2.6 Aug 28 2026 LoE III Full text read

Association of Postoperative Slip Reduction With Patient-Reported Outcomes at Two Years After Fusion Surgery for Low-Grade Degenerative Spondylolisthesis: A Single-Center Study

This single-center retrospective study followed 160 patients who underwent lumbar fusion with an attempted intraoperative reduction for low-grade degenerative spondylolisthesis, and asked whether the amount of slip correction achieved (not just whether reduction was attempted) predicted patient-reported outcomes at 2 years. Each additional percentage-point of postoperative slip reduction was associated with a 4.51-point greater relative improvement in ODI and a 3.76-point greater relative improvement in low back pain (both p<0.001), while changes in lumbar lordosis, PI-LL, and other spinopelvic parameters correlated with slip reduction but were not independently linked to clinical outcomes.

AI summary · from the full text

Why it mattersThis addresses an unresolved question in spine surgery, namely whether the degree of slip correction achieved during fusion for low-grade spondylolisthesis matters clinically, which could inform intraoperative reduction targets.

CohortSpinen = 40DOI ↗

Presenting this at rounds? Start here

?If greater slip reduction is associated with better patient-reported outcomes, should surgeons more aggressively pursue reduction intraoperatively even at the cost of longer operative time or added risk?
?Given that sagittal alignment changes did not independently predict outcomes, should surgical planning for low-grade DLS fusion prioritize slip correction over alignment restoration?

Rigor × clinical importance

Rigor41Clinical48Editorial59

Limited32

Journal of the American Academy of Orthopaedic Surgeons IF 2.9 Jul 31 2026 LoE III Full text read

Implant-Related Complications After Robotic-Assisted Versus Manual Revision Knee Arthroplasty: A Propensity-Matched Cohort Study

This retrospective database study compared complication rates after robotic-assisted versus manual revision total knee arthroplasty using propensity-matched cohorts of about 2,010-2,210 patients per group. Robotic-assisted revision was associated with lower odds of mechanical implant-related complications (instability, loosening, periprosthetic fracture) at 3 months (OR 1.67) and 6 months (OR 1.66), lower early VTE and opioid use, and a lower revision rate by 3 years (13.5% vs 11.4%, OR 1.22), while infection, readmission, and early revision rates did not differ significantly between groups.

AI summary · from the full text

Why it mattersAs robotic platforms expand into the technically demanding revision knee arthroplasty space, surgeons need to know whether the touted precision benefits translate into fewer mechanical failures and reoperations, not just better alignment on imaging.

CohortArthroplastyn = 4,420DOI ↗

Presenting this at rounds? Start here

?If robotic assistance in revision TKA truly lowers rates of aseptic loosening and instability, should surgeons prioritize robotic platforms specifically for revisions where bone loss or component malalignment is the indication?
?Given that PJI, readmission, and early revision rates were similar between robotic and manual revision TKA, should patient counseling emphasize long-term mechanical durability rather than short-term safety as the main selling point of robotic revision surgery?

Rigor × clinical importance

Rigor27Clinical52

Limited32

Journal of the American Academy of Orthopaedic Surgeons IF 2.9 Jul 31 2026 LoE III Full text read

Risk and Timing of Total Knee Arthroplasty After High Tibial Osteotomy: A Cohort Study With 10-Year Follow-Up

This retrospective cohort study followed 207 patients who underwent high tibial osteotomy (HTO) for medial compartment knee osteoarthritis, using a synthetic deidentified data platform, for a mean of 17.8 years. About 10% (20/207) eventually converted to total knee arthroplasty (TKA), with conversion rising from 5.9% at 10 years to 22.0% at 20 years; patients who converted were older and had higher BMI at the time of HTO, and higher BMI independently predicted TKA conversion (RR 1.13, 95% CI 1.04-1.23, p=0.004).

AI summary · from the full text

Why it mattersHelps orthopedic surgeons counsel patients considering joint-preserving HTO about realistic long-term odds of eventually needing TKA, particularly regarding age and BMI as modifiable/nonmodifiable risk factors.

CohortArthroplastyn = 85DOI ↗

Rigor × clinical importance

Rigor42Clinical42

Weak30

Osteoporosis International IF 4 Sep 11 2026 LoE III Full text read

Systemic glucocorticoid use increases fracture risk similarly in individuals with and without type 2 diabetes: a Danish nationwide cohort study

This Danish nationwide cohort study used registry data on nearly 478,000 people who started systemic glucocorticoids (about 28,000 with type 2 diabetes) to see whether diabetes makes glucocorticoid-related fracture risk worse. Using a within-person before/after design with statistical weighting, glucocorticoids raised major osteoporotic fracture risk substantially (adjusted IRR 1.70, 95% CI 1.55-1.85), but this increase was essentially the same in people with and without type 2 diabetes (interaction/product term IRR 1.01, 95% CI 0.87-1.17), and this held across sex, age, fracture site, and multiple sensitivity analyses.

AI summary · from the full text

Why it mattersClinicians often assume diabetic patients face extra glucocorticoid-related fracture risk, but this large study suggests the relative risk increase is similar, meaning fracture prevention counseling should focus on glucocorticoid exposure itself rather than diabetes status as an added multiplier.

CohortTrauman = 449,663DOI ↗

Presenting this at rounds? Start here

?Should orthopedic surgeons and endocrinologists treat glucocorticoid-associated fracture risk the same way in diabetic and non-diabetic patients, given that the relative risk increase appears similar despite diabetics' higher baseline risk?
?Given that fracture risk from glucocorticoids was highest early in treatment and with higher doses, how should this inform timing of DXA screening or bone-protective therapy initiation after starting steroids?

Rigor × clinical importance

Rigor50Clinical45Editorial49

Weak29

Journal of Pediatric Orthopaedics IF 1.7 Jul 22 2026 LoE III Full text read

Serial Casting Before Relapse Surgery: Investigating the Challenges of Relapsed Clubfoot Care

This retrospective cohort study from a single pediatric tertiary center compared 65 children under 16 who needed surgery for relapsed clubfoot after initial Ponseti treatment, 14 of whom received presurgical serial casting versus 51 who went straight to surgery. The casting group had a larger drop in surgical complexity from waitlist to actual surgery (40.0% reduction) versus the non-casting group (1.9% reduction, P=0.001), and fewer high-complexity surgeries (53.3% vs 80.6%, P=0.004). The study also found Indigenous children were overrepresented among relapse cases and lived far from the treatment center, and orthosis noncompliance was common.

AI summary · from the full text

Why it mattersRelapse surgery for clubfoot is a common, burdensome pediatric orthopedic problem, and this hypothesis-generating cohort suggests presurgical casting might reduce surgical extent, but the small nonrandomized sample means it cannot yet change practice.

CohortPedsn = 123DOI ↗

Presenting this at rounds? Start here

?Given that casting group assignment was based on unstandardized surgeon preference and the two groups differed in waitlist complexity and physiotherapy involvement, how much of the observed complexity reduction could be due to selection or regression to the mean rather than a true casting effect?
?If you were setting up a relapsed clubfoot pathway, would this preliminary retrospective data be enough to justify adding presurgical serial casting for all patients, given the added time to surgery and resource burden?

Rigor × clinical importance

Rigor16Clinical54

Weak29

Arthroscopy The Journal of Arthroscopic and Related Surgery IF 4.4 Aug 27 2026 LoE III Full text read

Medial Meniscus Posterior Root Repair Is Associated With Better Function But Persistent Knee Varus Thrust and Reduced Knee Internal Rotation During Gait

This cross-sectional study used 3D motion capture to compare gait mechanics and patient-reported outcomes among 58 knees: patients with unrepaired medial meniscus posterior root (MMPR) tears, patients who had undergone MMPR repair (mean 19.7 months prior), and healthy age-matched controls. Both the tear and repair groups showed abnormal gait patterns compared with controls, including increased varus thrust range of motion (repair 5.2° vs control 3.3°, tear 5.0° vs control 3.3°, P<.01) and reduced tibial internal rotation at loading response, but the repair group had significantly better function, less pain, and higher rates of meeting patient-acceptable symptom thresholds than the tear group.

AI summary · from the full text

Why it mattersIt suggests that even after successful MMPR repair with good clinical outcomes, patients may retain biomechanical gait abnormalities linked to knee osteoarthritis progression, which could inform decisions about adjunct gait-modifying therapy or earlier surgical timing.

CohortSportsn = 58DOI ↗

Presenting this at rounds? Start here

?Should patients who show persistent varus thrust after MMPR repair be offered adjunct interventions like gait retraining, bracing, or targeted strengthening to reduce their risk of knee OA progression?
?Does the finding that repaired knees still show abnormal internal rotation and varus thrust argue for earlier repair timing in symptomatic root tears, before compensatory gait patterns become entrenched?

Rigor × clinical importance

Rigor34Clinical46Editorial53

Weak28

Journal of Bone and Joint Surgery IF 4.4 Aug 27 2026 LoE III Full text read

Distal Radial Fracture as an Early Marker of Bone Fragility

This Japanese claims-database cohort study asked whether a distal radial fracture (DRF) in adults 65-89 signals broader frailty and higher mortality risk, or instead occurs in relatively active older people with preserved reflexes. After matching over 23,000 DRF patients to controls with an upper-limb contusion, the crude mortality was lower in the DRF group, but this advantage disappeared once baseline long-term-care (frailty) status was accounted for (adjusted HR 0.98, 95% CI 0.93-1.02, p=0.284). DRF patients did have substantially higher rates of subsequent hip fracture (2.58 vs 2.00 per 100 person-years) and were more likely to start osteoporosis treatment within a year (17.6% vs 7.7%).

AI summary · from the full text

Why it mattersIt challenges the common teaching that a distal radius fracture is a red flag for frailty and mortality, suggesting instead it is mainly a marker of skeletal (not systemic) fragility, and reinforces that DRF is an underused trigger for osteoporosis workup.

CohortTrauman = 23,589DOI ↗

Rigor × clinical importance

Rigor40Clinical45Editorial48

Weak27

Arthroscopy The Journal of Arthroscopic and Related Surgery IF 4.4 Aug 24 2026 LoE III Full text read

Losartan Is Not Associated With Decreased Postoperative Arthrofibrosis After Hip Arthroscopy

This retrospective database study used the TriNetX network to compare hip arthroscopy patients prescribed losartan (n=947 after matching) with a matched cohort not given ACE inhibitors or ARBs, looking at rates of capsulolabral adhesions, hip instability, conversion to THA, osteoarthritis, and medical complications up to 2 years. Lysis of adhesions and ankylosis rates were too low to even generate reportable patient counts in either group, and no orthopedic or medical complication differed significantly between losartan and non-losartan patients at any time point, including in subgroups by sex or age under 30.

AI summary · from the full text

Why it mattersLosartan has been promoted as a low-cost adjunct to reduce postoperative stiffness after hip arthroscopy, so a large database study finding no measurable benefit is relevant to whether surgeons should continue prescribing it for this indication.

CohortSportsn = 947DOI ↗

Presenting this at rounds? Start here

?If arthroscopic lysis of adhesions occurred too rarely in this database to even be counted, should surgeons continue prescribing losartan empirically, or wait for a study powered to detect a real difference?
?Given that osteoarthritis rates were transiently higher in the losartan group at 30 days but not later, how should surgeons interpret early postoperative radiographic or symptomatic findings in patients on antifibrotic agents?

Rigor × clinical importance

Rigor16Clinical57Editorial48

Weak27

PLoS Medicine IF 9.8 Aug 27 2026 LoE III Full text read

A clinical decision support tool for accurate hip fracture prediction: A nationwide cohort study

Researchers used Swedish national registry data on 3.5 million adults aged 50+ to build a machine-learning model (FRACTURE-ML) that predicts hip fracture risk using only routinely collected data, no patient interview or exam needed. In a held-out validation cohort, the model achieved an AUC of 0.89 at 1 year and 0.85 at 5 years, and identified about seven times more at-risk people than the current fracture liaison service (secondary prevention) approach at 2 years (sensitivity 0.84 vs 0.12), with only a modest drop in specificity (0.79 vs 0.98).

AI summary · from the full text

Why it mattersOrthopedic surgeons and osteoporosis clinics may eventually use registry-based screening tools like this to identify at-risk patients earlier for fracture prevention, changing how referrals into osteoporosis/fall-prevention pathways are triggered.

CohortTrauman = 3,542,647DOI ↗

Presenting this at rounds? Start here

?If a tool like FRACTURE-ML flagged many more patients as high-risk than current fracture liaison service criteria, how should orthopedic and primary care teams handle the resulting increase in referrals for DXA and osteoporosis workup?
?Given that the model has not been externally validated outside Sweden or tested in real clinical workflows, would you support using such a risk score to guide bone density testing or osteoporosis treatment decisions in your practice today?

Rigor × clinical importance

Rigor20Clinical45Editorial58

Weak25

The American Journal of Sports Medicine IF 4.5 Sep 9 2026 LoE III Full text read

Psychiatric Comorbidity Is Associated With Increased Failure Rates and Inferior Clinical Outcomes After Hip Arthroscopy for Femoroacetabular Impingement Syndrome at a Minimum 10-Year Follow-up

This retrospective cohort study followed 243 adults who had hip arthroscopy for femoroacetabular impingement syndrome (FAIS) for a minimum of 10 years, comparing those with a documented psychiatric diagnosis (30%) to those without. Patients with psychiatric comorbidity had a much higher failure rate (revision arthroscopy or conversion to THA) at 23.3% versus 5.3%, and this comorbidity independently predicted failure on adjusted Cox regression (HR 2.84, 95% CI 1.17-6.88). Both groups improved significantly on hip function scores after surgery, but patients with psychiatric comorbidity started lower, ended lower, and improved less than those without.

AI summary · from the full text

Why it mattersThis suggests surgeons should screen for and counsel patients about psychiatric comorbidity before hip arthroscopy, since it appears to meaningfully worsen long-term implant/procedure survival and patient-reported outcomes.

CohortArthroplastyn = 243DOI ↗

Presenting this at rounds? Start here

?Should a positive psychiatric history change how surgeons counsel FAIS patients about expected improvement and failure risk before hip arthroscopy?
?Would preoperative mental health optimization (therapy, medication review) before hip arthroscopy plausibly reduce the observed failure gap, or does this study only show association rather than a modifiable pathway?

Rigor × clinical importance

Rigor21Clinical50Editorial48

Weak23

The American Journal of Sports Medicine IF 4.5 Sep 9 2026 LoE III Full text read

Patella Alta and Trochlear Dysplasia as a Determinant of Patellar Tendon Lateralization and Inclination: A Cross-sectional MRI Study in Adolescents With Patellofemoral Instability

This retrospective case-control MRI study compared 142 adolescent knees with surgically treated patellofemoral instability (PFI) to 142 age/sex-matched controls, measuring two soft-tissue-based markers of patellar tendon alignment: the previously described patellar tendon-lateral trochlear ridge distance (PT-LTR) and a newly proposed patellar tendon inclination angle (PTIA). Both measures were markedly higher in PFI knees than controls (PT-LTR 9.76 vs 0.61 mm; PTIA 22.76° vs 11.09°, both P<.001), correlated with established risk factors like patella alta, trochlear dysplasia, and TT-TG distance, and showed good diagnostic accuracy (AUC 0.90 and 0.87, respectively) for distinguishing PFI from controls.

AI summary · from the full text

Why it mattersIntroduces a new, easily measured MRI angle (PTIA) that may add diagnostic information about patellar tendon malalignment beyond standard bony measurements like TT-TG in adolescents being worked up for patellofemoral instability.

CohortPedsn = 20DOI ↗

Presenting this at rounds? Start here

?If PTIA and PT-LTR are elevated in a patient with a normal TT-TG distance, should that change how aggressively you counsel about surgical stabilization versus bracing/physical therapy for patellofemoral instability?
?Given that patella alta and trochlear dysplasia both independently raise PT-LTR and PTIA, how might these tendon-based measurements influence your choice of concomitant procedures (e.g., tibial tubercle osteotomy, trochleoplasty) alongside MPFL reconstruction?

Rigor × clinical importance

Rigor22Clinical50Editorial48

Weak22