BackgroundThe rising prevalence of obesity and type 2 diabetes mellitus (T2DM) among patients undergoing total joint arthroplasty (TJA) presents a significant clinical challenge, increasing the risk of postoperative complications. Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) have emerged as a potential perioperative optimization strategy, but their impact on TJA outcomes remains debated. This systematic review was conducted to synthesize the evidence on the risks and benefits of GLP-1 RA use in adult patients undergoing primary TJA—specifically, total hip arthroplasty (THA), total knee arthroplasty (TKA), and total shoulder arthroplasty (TSA).MethodsA systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The PubMed, Scopus, and Web of Science databases were searched from their inception to June 16, 2025, for studies comparing postoperative outcomes in adult patients undergoing primary total joint arthroplasty (TJA) and using GLP-1 RAs versus a control group. Data on study characteristics, patient demographics, and postoperative outcomes were extracted. Due to significant heterogeneity and overlap in data sources, a narrative synthesis rather than meta-analysis of the findings was conducted. Study quality was assessed using the Newcastle–Ottawa Scale (NOS).ResultsFifteen retrospective cohort studies involving an aggregate total of 318,143 patients (114,365 THA, 125,505 TKA, 78,273 TSA) were included, with 56,132 receiving GLP-1 RAs. In THA and TKA, GLP-1 RAs use was associated with a reduced risk of periprosthetic joint infection (PJI) (e.g., 1.6% vs. 2.9% at 2 years for THA) and lower 90-day readmission rates (e.g., 1.1% vs. 2.0% for TKA and 1.6% vs. 2.0% for THA). When analyzed by exposure timing, the reduced PJI risk was most consistent in studies that defined GLP-1 RA use in the immediate perioperative period. Reported mean length of stay (LOS) was generally similar or slightly shorter among GLP-1 RA users compared to controls. Multiple studies reported either a reduction or no significant difference in the risk of 90-day emergency department visits. The short-term revision rates and dislocations were infrequent and did not differ significantly between groups in most of the included studies. In the TSA, evidence was inconsistent, with reduced odds of 90-day surgical site infection (SSI) (OR 0.25) in one study; however, no clear trend was observed. Gastrointestinal side effects and conflicting systemic risks were noted across procedures.ConclusionCurrent observational data suggest that perioperative GLP-1 RA use in patients undergoing total hip or knee arthroplasty is not associated with a consistent increase in short-term revision rates and may be associated with a reduced risk of postoperative infection. Evidence regarding TSA remains inconclusive. However, given the retrospective nature of the evidence, substantial overlap in data sources, heterogeneity in exposure definitions, and short-term follow-up, these findings should be considered hypothesis-generating. Future prospective, randomized controlled trials with standardized exposure definitions and longer follow-up are required to confirm these associations and establish causality.Supplementary InformationThe online version contains supplementary material available at 10.1186/s42836-026-00375-w.

BackgroundHemophilia A (HA) arthropathy poses a significant clinical challenge, particularly in achieving perioperative hemostasis and surgical precision. Accounting for the majority of hemophilia cases, HA frequently leads to severe secondary joint damage. Although gene therapy holds promise, its clinical application in HA remains limited by challenges to durable efficacy. Crucially, the transient efficacy and unpredictable pharmacokinetics of gene therapy have not been evaluated in major orthopedic surgeries with a high potential for bleeding, such as total hip arthroplasty (THA).Case presentationTo our knowledge, this is the first documented case of robot-assisted (RA)-THA performed after gene therapy for severe HA-associated hip arthropathy, including a detailed surgical protocol and a postoperative follow-up of over six months. The patient received hemophilia gene therapy 56 weeks prior to surgery. Crucially, no exogenous FVIII supplementation was required preoperatively or intraoperatively. A minimal amount of FVIII was administered postoperatively. No abnormal bleeding events occurred throughout the perioperative period. The patient maintained normal coagulation status, achieved excellent wound healing, and demonstrated excellent functional recovery.ConclusionThis pioneering case demonstrates the potential safety and efficacy of combining gene therapy with minimally invasive RA-THA for HA hip arthropathy. The integrated approach significantly reduced dependence on exogenous FVIII and enabled precise anatomical reconstruction.Supplementary InformationThe online version contains supplementary material available at 10.1186/s42836-025-00348-5.

BackgroundThis study aims to investigate whether individualized component positioning in robotic-assisted total hip arthroplasty (RTHA) using three-dimensional (3D) Functional Component Positioning Assessment (FCPA) reduces prosthetic and bone impingement and improves Patient-Reported Outcome Measures (PROMs).MethodsThis retrospective study includes 100 consecutive patients who underwent RTHA at a single center between May 2021 and March 2022 using the Mako THA system. Preoperative imaging and planning incorporated sacral slope (SS) measurements. SS values in standing and sitting positions were uploaded into the robotic software to simulate prosthetic hip motion during FCPA and guide component orientation. The primary outcome measures included intraoperative impingement analyses using FCPA and postoperative PROMs, including the Oxford Hip Score (OHS), Forgotten Joint Score (FJS-12), and Hip Disability and Osteoarthritis Outcome Score (HOOS).ResultsImpingement was detected in 46% of patients during daily living activities, with prosthesis-on-prosthesis being the most frequent impingement type. No statistically significant differences in PROMs were observed between patients with and without impingement. Nonetheless, overall PROMs were excellent, with a mean HOOS of 94.2 ± 8.3, mean FJS-12 of 87.8 ± 17.2, and mean OHS of 92.3 ± 10. Multivariate analysis revealed that higher BMI negatively impacted PROMs, and the SS difference correlated significantly with OHS and FJS-12 scores (P < 0.0001).ConclusionsIndividualized component positioning, even when aided by 3D FCPA, does not eliminate the risk of impingement. The concept of a universal “safe zone” may be inadequate to prevent impingement, emphasizing the need for patient-specific implant positioning strategies based on spinopelvic mobility. While impingement did not significantly impact PROMs, optimizing implant positioning through robotic-assisted techniques may contribute to improved long-term outcomes and reduced dislocation risk.

BackgroundIntraoperative measurement of component orientation represents a basis for optimizing outcomes after total hip arthroplasty (THA). Although the use of computer navigation systems in THA has improved the accuracy of component positioning, they have not gained widespread popularity due to their complexity, time demands, and time-consuming protocols.MethodsWe developed an Inertial Measurement Unit-based Hip Smart Trial system (IMUHST) to assist with intra-operative monitoring of hip posture. An in vitro validation experiment was conducted using a sawbones with a three-dimensional (3D) measurement model as the reference standard.ResultsThe absolute mean error, Bland–Altman analysis, and Intra-class Correlation Coefficient revealed that the accuracy and precision of this system meet the threshold for clinical application.ConclusionsIn conclusion, this in vitro validation demonstrates that the IMUHST system provides accurate component orientation measurements while eliminating the cost and complexity of optical navigation, offering a practical solution for widespread adoption.B8MSmaAh5KXs1DHK-LAAzjVideo

Background and purposePeriprosthetic joint infection (PJI) is a devastating but rare complication. Its incidence ranges between 1%–2% in primary arthroplasties. However, infection rates are much higher in megaprostheses (15%–43%). Revision of megaprostheses (MP) is a highly complex procedure associated with massive bone loss, so that implant retention occurs as a viable initial therapy option even in chronic infections. Unfortunately, literature regarding therapy strategies and outcome reports for PJI in MP is scarce. Reinfection rates are reported to be between 22 and 58%. We therefore proposed the following questions: What is the overall outcome of PJI in MP in our cohort, and are there significant differences in infection-free survival between various surgical strategies?MethodsIn this retrospective cohort study, 50 cases of PJI in MP treated from 2010 to 2022 were identified. The median (IQR) age was 70.5 (16.3) years. Mean follow-up was 19.0 months. Treatment outcome was categorized following international consensus criteria.ResultsOverall infection-free implant survival was 42.0%. 7 patients died in direct association with the ongoing PJI, and 7 had to undergo amputation. Two-stage revision had the highest success rate of 71.4% (5/7), followed by multi-stage surgery (57.1%; 4/7), DAIR (38.7%; 12/31), and single-stage revision (0%; 0/5) (P = 0.009). Overall, treatment success rates following DAIR were 55.6% (10/18) for acute and 15.4% (2/13) for chronic infections (P = 0.027).The most common pathogens were coagulase-negative Staphylococci (42.0%; 21/50) and Staphylococcus aureus (34.0%; 17/50). Gram-negative pathogens accounted for 16.0% (8/50).ConclusionsPJI in MP remains a devastating complication with low success rates. Two-stage revision is the most promising treatment option, but it requires patients to be able to cope with the burden of multiple surgeries. DAIR cannot be recommended as a definitive treatment for chronic cases (15% success rate) and should be questioned in acute cases (56% success rate), as infection eradication is rare. DAIR can be considered a low-impact surgery for infection control if more extensive surgery is not viable.DJJYxByMimjoQG8hmFEzikVideo

BackgroundThe hip dysfunction and osteoarthritis outcome score for joint replacement (HOOS JR) has been widely used to assess patient hip function. The subjective hip value (SHV) has become increasingly recognized as an efficient single-question survey for assessing hip joint function. This study aimed to determine the psychometric properties of the SHV in evaluating hip function in patients undergoing total hip arthroplasty (THA) in correlation with the traditional HOOS JR.MethodsThis was a retrospective review of 1,157 distinct patients who underwent primary THA between January 2021 and December 2023. Scores for SHV and HOOS JR were collected preoperatively, as well as 3 months and 1 year postoperatively. Validity was determined using Pearson’s correlation tests between the SHV and HOOS JR.ResultsOverall, the SHV was highly correlated with the HOOS JR at 3 months (R = 0.71, P < 0.001) and 1 year postoperatively (R = 0.79, P < 0.001). Additionally, changes in the SHV showed significant correlations with changes in the HOOS JR between the preoperative and postoperative periods. The SHV also had substantially fewer ceiling effects compared to the HOOS JR.ConclusionsThe SHV is a valid and responsive single-item assessment for hip joint function following primary THA. Despite its limitations, its efficiency and ease of use make it a feasible option for routine clinical assessments, providing clinicians with valuable insights into patients' recovery. Subsequently, the integration of the SHV into orthopedic practice holds promise for enhancing the management of postoperative care and improving patient outcomes.

The recently-completed special edition of Arthroplasty entitled 'Advances in Artificial Intelligence and Robotics in Joint Arthroplasty', brings together novel and innovative research from around the world in this cutting edge topic area. With robotics, artificial intelligence and technology-assistance (inside and out of the operating theatre) all becoming increasingly relevant to contemporary practice, we hope the readership will find this special edition an informative and thought-provoking read. Ultimately twelve individual papers were accepted for the edition, covering a range of exciting and novel applications. There clearly exists an ongoing need to provide further validation of new applications and, in many instances, replication of results away from designer sites is needed to provide robust generalizability of use. While several of the included papers show wide international collaboration, the prospect of future interactive work engaging leaders and think-tanks regionally and globally provides a tantalizing opportunity. With global health settings under increasing pressure and scrutiny to provide greater provision of joint replacement services – with the expectation of even more predictable (better) outcomes in a cost and resource efficacious manner – necessity will continue to drive further work exploring how technology-incorporation into arthroplasty care pathways might help address many of these considerations. There are undoubtedly exciting times ahead.

BackgroundWhile the role of chronic preoperative steroid use in orthopedic outcomes has been studied, particularly in hip, knee, and lumbar surgeries, its impact on total shoulder arthroplasty (TSA) outcomes is not well understood. This study aimed to evaluate the impact of chronic preoperative steroid use on early-onset postoperative infectious outcomes and readmission within 30 days following TSA compared to patients without chronic steroid use.MethodsA retrospective analysis was performed using data from the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) spanning from 2010–2018. Clinical data including preoperative demographics, operative variables, and 30-day post-TSA outcomes were collected. Groups were balanced using propensity score matching based on gender, age, race, ethnicity, BMI, functional status, ASA, smoking status, alcohol use, year of operation, and comorbidities. A conditional logistic regression model was used to calculate odds ratios for each outcome measure.ResultsA total of 3,445 identified cases were included in this analysis after propensity score matching, with 1,157 exhibiting chronic steroid use. The steroid group demonstrated significantly greater rates of readmission (OR: 1.86; 95% CI: 1.22–2.81; P = 0.004). No significant differences were observed between groups in all other adverse outcomes, including reoperation, specific infectious outcomes, and combined infectious outcomes.ConclusionsPreoperative chronic steroid use is an independent predictor of readmission but not infection following TSA. While the surgeon should be aware of the increased risk of readmission associated with chronic steroid use, the role of steroid use as a risk factor for postoperative infections following TSA may be less pronounced, particularly compared to surgeries of other joints. Further investigation of infectious outcomes and readmissions with longer follow-up is needed to clarify the specific role of chronic preoperative steroid use in adverse outcomes following TSA.

BackgroundThis study introduced an Augmented Reality (AR) navigation system to address limitations in conventional high tibial osteotomy (HTO). The objective was to enhance precision and efficiency in HTO procedures, overcoming challenges such as inconsistent postoperative alignment and potential neurovascular damage.MethodsThe AR-MR (Mixed Reality) navigation system, comprising HoloLens, Unity Engine, and Vuforia software, was employed for pre-clinical trials using tibial sawbone models. CT images generated 3D anatomical models, projected via HoloLens, allowing surgeons to interact through intuitive hand gestures. The critical procedure of target tracking, essential for aligning virtual and real objects, was facilitated by Vuforia’s feature detection algorithm.ResultsIn trials, the AR-MR system demonstrated significant reductions in both preoperative planning and intraoperative times compared to conventional navigation and metal 3D-printed surgical guides. The AR system, while exhibiting lower accuracy, exhibited efficiency, making it a promising option for HTO procedures. The preoperative planning time for the AR system was notably shorter (4 min) compared to conventional navigation (30.5 min) and metal guides (75.5 min). Intraoperative time for AR lasted 8.5 min, considerably faster than that of conventional navigation (31.5 min) and metal guides (10.5 min).ConclusionsThe AR navigation system presents a transformative approach to HTO, offering a trade-off between accuracy and efficiency. Ongoing improvements, such as the incorporation of two-stage registration and pointing devices, could further enhance precision. While the system may be less accurate, its efficiency renders it a potential breakthrough in orthopedic surgery, particularly for reducing unnecessary harm and streamlining surgical procedures.

BackgroundRevision total hip arthroplasties (RTHA) are associated with a higher complication rate than primary total hip arthroplasties (THA), and therefore it is important for patients to have realistic expectations regarding outcomes. The aim of this literature review was to gather and summarize the available evidence on patients’ expectations following RTHA.MethodsA literature search was conducted in PubMed, PsycINFO, Cochrane, Google Scholar, Web of Science and Embase from inception to November 2023. Articles assessing patient expectations for RTHA were included. Methodological quality was assessed by two independent reviewers using the National Heart, Lung and Blood Institute (NIH) study quality assessment tool for observational cohort and cross-sectional studies. A qualitative analysis was performed involving the summarization of study characteristics and outcomes.ResultsThe search strategy generated 7,450 references, of which 5 articles met the inclusion criteria. Methodological quality scores ranged from 7–10. Patients had high expectations concerning future walking ability, pain and implant longevity relative to actual postoperative outcomes. A significant positive correlation was found between fulfilled expectations of pain and walking ability and patient satisfaction (r = 0.46–0.47). Only two studies assessed the fulfillment of patient expectations. Great variability was seen in the measurement of expectations.ConclusionPatients undergoing RTHA appeared to have high expectations for pain and functionality compared to postoperative outcomes. However, there was a paucity of high-quality data in this area, limiting the accuracy of the conclusion. Further research is needed, that emphasizes developing a sound theoretical framework for expectations, allowing for the consistent implementation of valid measurement tools for patient expectations.