Aug 2026· Archives of Orthopaedic and Trauma Surgery· Vol 146· 0 citations· 83 references
Medicine
TL;DR
There remains a trend suggesting that higher-volume surgeons experience fewer revisions, complications, readmissions, and mortality after primary total hip arthroplasty; although these differences were largely not statistically significant.
Abstract
To synthesize, critically appraise and systematically review studies comparing outcomes after primary total hip arthroplasty (THA) performed by low- vs. high-volume surgeons, and to propose evidence-based threshold definitions for these categories. This review followed the PRISMA guidelines and was registered in PROSPERO. Medline and Embase were searched on March 24, 2025. Prospective and retrospective clinical studies were included if they reported THA thresholds for low- and high-volume surgeons. Articles not written in English or German were excluded. Outcomes were pooled and presented in forest plots. Methodological quality was assessed. Of 872 identified articles, 18 were included, reporting on 796,061 patients undergoing THA. Methodological quality was high in all studies (>6 of 7 points). Thresholds used to define high- vs. low-volume were determined using arbitrary values (n = 11), tertiles (n = 1), quartiles (n = 3), percentiles (n = 2), or receiver operating characteristic curves (n = 1). High-volume surgeons had significantly lower 1-month readmission rates [odds ratio (OR) = 1.6; p = 0.033] and 3-month mortality rates (OR = 1.8; p = 0.008). In contrast, there were no significant differences between high- and low-volume surgeons for 3-month revision rates (OR = 2.0; p = 0.228), 12-month revision rates (OR = 1.8; p = 0.228), and 3-month readmission rates (OR = 1.3; p = 0.337). The included studies demonstrated considerable variability in the definitions of surgeon volume. However, there remains a trend suggesting that higher-volume surgeons experience fewer revisions, complications, readmissions, and mortality; although these differences were largely not statistically significant. Nonetheless, surgeon volume may not be the only factor influencing outcomes, as hospital and patient characteristics may influence short- to long-term outcomes following primary THA.
Robotic-assisted total knee arthroplasty (rTKA) has been suggested as a potential advancement over conventional total knee arthroplasty (cTKA) to improve surgical precision, functional recovery, and patient satisfaction. This review aimed to compare clinical and functional results of robotic-assisted versus conventional TKA in randomized controlled trials (RCTs), subgroup analysis according to short- and long-term follow-up. Systematic review and meta-analysis were conducted according to PRISMA guidelines. The following electronic databases were utilized to search for qualified studies: MEDLINE/PubMed, Cochrane CENTRAL, Web of Science, ProQuest, ClinicalTrials.gov, grey literature, and Scopus. Only randomized controlled trials were included. Outcomes assessed were functional scores (KOOS, KSS), range of motion (ROM), pain (VAS), operation time, blood loss/transfusion, complications, length of stay in hospital, and readmission. Subgroup analysis was conducted according to short-term (≤1 year) and long-term (>1 year) follow-up. Robotic TKA demonstrated a significant improvement in functional score (MD 2.14; 95% CI 0.80 to 3.48; p≤ 0.002) and decrease in pain in long-term follow-up (MD-1.12; 95% CI-1.90 to-0.34; p≤0.005), but showed no differences in range of motion, blood loss, complication, or hospitalization length of stay. Operative times were significantly longer with Robotic TKA (MD 20.15 minutes; 95% CI 12.49-27.82; p<0.00001). The robotic-assisted TKA offered minimal improvements in pain and function in the immediate postoperative and long-term follow-up relative to conventional TKA at a higher operative time. There was no significant improvement in ROM, blood loss, complications, or length of hospital stay for the robotic-assisted TKA.
H. Awaji, Awatif Hazazi, K. Alharbi et al.· International Journal of Med...· 0 citations
Objectives: Fast-track or enhanced recovery after surgery (ERAS) pathways have been increasingly adopted in total knee arthroplasty (TKA) to optimize perioperative care, yet their comparative effectiveness and safety relative to routine pathways remain incompletely defined. This systematic review and meta-analysis compared the effects of fast-track versus routine perioperative care on length of hospital stay (LOS), postoperative pain, complications, and readmissions in patients undergoing primary TKA. Methods: A systematic search of PubMed, Embase, Cochrane Library, Scopus, and Web of Science was performed from inception to January 2025 using MeSH terms. Primary outcomes were LOS and postoperative pain, with complications and readmissions assessed as secondary outcomes. Risk of bias was assessed using Cochrane RoB 2 for RCTs and ROBINS-I for non-randomized studies. A random-effects meta-analysis was conducted due to anticipated heterogeneity. Results: Nine studies (total 2607 patients) met inclusion criteria. Fast-track care significantly reduced LOS (WMD: -2.41 days, 95% CI: -3.18 to -1.64). Postoperative pain was slightly higher in the fast-track group at 24h (MD: 0.98, 95% CI: -0.1 to 2.05) and at 2 weeks (MD: 0.33, 95% CI: -0.04 to 0.7), neither reaching statistical significance. Methodological quality was limited, with moderate to serious risk of bias in non-randomized studies and high risk of bias in all randomized trials. Conclusion: Overall, the available evidence suggests that fast-track rehabilitation following TKA substantially reduces hospitalization without clinically meaningful or sustained increases in postoperative pain. These findings support the use of fast-track pathways to enhance perioperative efficiency in TKA, while highlighting the need for higher-quality randomized studies to better define their effects on pain and safety outcomes.
Abdul Qadim Esehaqzai, M. H. Ebrahimzadeh, M. Sadeghi et al.· The Archives of Bone & Joint...· 0 citations
Background
Reverse total shoulder arthroplasty (RTSA) is increasingly performed in younger patients, yet prior studies frequently include heterogeneous cohorts and revision cases. This systematic review evaluated outcomes of primary RTSA in patients <65 years.
Methods
Embase, PubMed, and CENTRAL were queried through October 2025. Methodological quality was assessed using the Newcastle-Ottawa Scale (level III) and NIH Quality Assessment Tool for Case Series (level IV). Random-effects meta-analysis generated pooled estimates for range-of-motion (ROM), patient-reported outcome measures (PROMs), and complication/revision rates.
Results
Thirteen studies (nine level III, four level IV; fair-to-good quality) were included. Weighted mean age was 55.4 years (60.9% female; follow-up 2-7.8 years). Forward flexion = 133.2° (95% CI 126-140.4); external rotation = 38.1° (95% CI 32-44.2); abduction = 118.2° (95% CI 111.2-125.2); internal rotation = 3.7 (95% CI 2.7-4.7, 0-7 scale). ASES = 69.5 (95% CI 64.7-74.4); VAS = 2.6 (95% CI 1.3-3.9); Constant-Murley = 62.9 (95% CI 60.3-65.5); SST = 7.5 (95% CI 5.9-9.1); SPADI = 38 (95% CI 33.3-42.7); UCLA = 27.9 (95% CI 26.9-28.8). Complication rate was 13% (95% CI 6%-23%) and revision rate 8% (95% CI 5%-14%), most commonly for instability. Sensitivity analyses demonstrated significant pre-to-postoperative improvements in forward flexion (+46.6°; 95% CI 34.9-58.3) and external rotation (+16.6°; 95% CI 13.6-19.5).
Discussion
Primary RTSA in patients <65 years improves ROM and PROMs. Although complication/revision risk increases over time, these findings support RTSA in appropriately selected younger patients and provide benchmarks for outcome counseling.
Mohini Johri, Nouri Bouzid, Josh W. Thibeault et al.· Shoulder & Elbow· 0 citations
Background Total hip arthroplasty (THA) and resurfacing hip arthroplasty (RHA) are widely used for treating hip joint disorders. While THA is the gold standard for hip replacement, RHA is increasingly used in younger, active patients due to bone preservation. This systematic review and meta‐analysis compare functional outcomes, metal ions, complications, revision rates, survivorship and satisfaction between THA and RHA. Methods A systematic search of EMBASE, Cochrane Library and PubMed was conducted (inception–August 2024) to identify primary research articles for THA and RHA. Risk of bias was assessed using the Newcastle–Ottawa Quality Assessment Scale. A meta‐analysis using MATLAB applied a random‐effects model to calculate pooled effect sizes for functional scores, revision rates, complications and metal ions. Results Initial search collated 2265 studies, of which 11 met inclusion criteria (2013–2021). Most frequently reported outcomes included complications, revision rates and UCLA. RHA showed better UCLA, HHS and chromium levels, while THA had better WOMAC and cobalt levels, although differences were nonsignificant. Total complications were higher with THA, though nonsignificant. The most common complications were aseptic loosening and dislocation for RHA and THA, respectively. Notably, when the dislocation rate was analysed in isolation, a statistically significant higher dislocation rate was demonstrated with THA. Revision rates were higher for THA, and survivorship was 85.5% compared to 89.5% (RHA), however, with no statistical difference. Statistically significant higher preference for RHA (66.1%) was reported in one study. Satisfaction was greater for RHA (87.8% vs 83.9%) and more patients perceived their hip as natural. One study reported significantly higher quality of life with THA. Conclusion Patient‐reported outcomes, metal ions, complications, revision rates and survivorship were broadly similar between RHA and THA. However, dislocations were more frequent with THA, a key consideration when treating athletic patients. Greater satisfaction and preference with RHA suggest that it may be preferable when outcomes are otherwise comparable. Christoforos Demosthenous and Christos Pittalis are joined‐first authors.
Christoforos Demosthenous, Christos Pittalis, Gregoris A. Orphanides et al.· Advances in Orthopedics· 0 citations
This systematic review and meta-analysis evaluated preoperative patient factors associated with adverse outcomes after primary total knee arthroplasty (TKA). PubMed and Crossref were searched from 2010 to 2025 according to PRISMA guidance, and the protocol was registered in PROSPERO (CRD420261297849). Eligible studies included adults undergoing primary TKA and reported diabetes mellitus, hypertension, obesity, morbid obesity, or sex in relation to readmission, revision surgery, or deep infection. Random-effects generic inverse variance meta-analyses were performed using odds ratios from adjusted models when available; unadjusted or calculated estimates were used only when adjusted estimates were unavailable. Twelve cohort studies including 1,586,680 patients were included. Diabetes mellitus was associated with higher odds of readmission (OR 1.17, 95% CI 1.05-1.30) and revision surgery (OR 1.17, 95% CI 1.03-1.32). Morbid obesity (BMI ≥40 kg/m²) was associated with readmission, revision surgery, and deep infection. Male sex was associated with readmission and revision surgery, while non-morbid obesity and hypertension were not consistently associated with adverse outcomes. These findings support preoperative risk stratification and optimization for diabetes and morbid obesity before elective TKA. Interpretation should remain cautious because included studies were observational and heterogeneity was substantial in several analyses.
S. Almasoud, S. A. Alhassan, A. Alwusaibie et al.· Annals of Middle Eastern Med...· 0 citations
BACKGROUND
Aseptic loosening after total knee arthroplasty (TKA) is a challenging complication. Outcomes regarding an isolated versus full component revision TKA (rTKA) are not well summarized in the literature. To address this, we conducted a systematic review of the literature regarding this topic along with a meta-analysis to clarify inconsistent conclusions in the literature.
METHODS
We used Embase.com, Scopus, Web of Science, Cochrane Library, and ClinicalTrials.gov to search from their inception to September 17, 2025. A bias quality assessment was conducted for each study included. There were 11 studies that were included in the final analysis to assess for and compare complications, implant failures, and functional results between isolated versus full component rTKA. Across 11 studies (median cases: 164; mean age: 66 years; 65.8% women) RESULTS: Isolated and full component rTKA demonstrated comparable rates of re-revision for all indications (odds ratio (OR): 1.36, 95% confidence interval (CI) 0.96 to 1.95, P = 0.094, I2 = 23.5%), including aseptic loosening (OR: 0.76, 95% CI 0.40 to 1.47, P = 0.42, I2 = 7.0%) and periprosthetic joint infection (OR: 1.23, 95% CI 0.52 to 2.92, P = 0.64, I2 = 7.5%). The isolated component rTKA showed significantly reduced operative time (Standardized Mean Difference = 2.85, 95% CI 1.47 to 4.23, P < 0.001, I2 = 98.8%), and two studies reported lower intraoperative blood loss, while postoperative range of motion was similar between approaches without consistent differences.
CONCLUSIONS
In this systematic review and meta-analysis, isolated component revision demonstrated outcomes comparable to full component revision. These findings support the idea that when components are well-fixed and compatible, isolated component revision may serve as a less morbid option for rTKA. Additional prospective and longer-term studies are required to corroborate these findings.
LEVEL OF EVIDENCE
I.
N. Sheth, Max McCall, Bryce T. Hrudka et al.· Journal of Arthroplasty· 0 citations
