🧠 Key Points:

CT-based evaluation shows that intra-articular gaps up to 4 mm and step-offs up to 2 mm can be safely managed nonoperatively, achieving excellent 10-year functional outcomes. The traditional 2 mm rule for surgical indication, derived from plain radiographs, may be overly restrictive in modern CT-guided fracture assessment.

🧠 Key Points

• AKA patients had better quality of life scores (higher SF-36 general health and role-physical scores) compared to spacers.

• Pain relief was superior in AKA (lower VAS and DN4) than both spacer and arthrodesis.

• Complication and reoperation rates were highest with spacers (53% and 42%) vs. lowest with AKA (14% each).

• Functional mobility: AKA patients more often walked >1 mile (26% vs. 5% with spacer) and were more frequently able to drive (42% vs. 23%).

• Mortality and reinfection rates were similar across groups at 2 years.

• Conclusion: AKA should not only be a last resort—it offers better pain control, fewer complications, and improved QoL in selected patients.

🧠 Key Points:

Staged amputation (SA) was compared with primary amputation (PA) in diabetic foot patients with severe infections.
• SA showed lower 30-day readmission (17% vs 27%) and 30-day unplanned reoperation (11% vs 13%).
• Length of stay and major adverse cardiovascular events were similar.
•  SA may provide better short-term quality outcomes in selected patients.

🧠 Key Points

• Study Population: 94 hips with ONFH treated with core decompression (20 converted to THA within 26 months, 74 did not).

• Edema Zone vs JIC: Edema Zone classification correlated with THA conversion, while JIC did not (P < 0.001 vs P = 0.83).

• Predictive accuracy: AUC 0.71 for Edema Zone vs 0.52 for JIC → better prognostic tool.

• Reliability: Excellent inter-rater reliability for Edema Zone (κ = 0.87), outperforming JIC and other systems.

• Risk association: Higher Edema Zone grades (≥3) had significantly greater THA conversion rates (e.g., 67% for grade 4).

• Clinical implication: The Edema Zone classification provides a simple, MRI-based, reliable system to guide surgical decision-making and avoid ineffective core decompressions in high-risk patients.

🧠 Key Points

• Syndesmotic suture button placement 0.5–1.5 cm from the joint line provides the most rotationally stable fixation.

• Medial and posterior trajectories are more stable than anterior placements.

• Proximal placements beyond 1.5 cm increase fibular motion and reduce stability.

• Ankle width changes were minimal but increased slightly with anterior or proximal placement.

• Biomechanical cadaveric testing simulates in vivo weightbearing and rotational loads.

🧠 Key Points:

• Mirels score was originally proposed for metastatic lesions in the lower extremities; its applicability to the upper extremity has been questioned.

• A score of ≥7 may be sufficient to consider prophylactic fixation in upper extremity metastases.

• This was a retrospective study analyzing 138 cases.

🧠 Key Points

• Complication rates at 24h and 1–90 days were not significantly different across BMI groups, including BMI ≥40.

• Operative and pre-op times were longer in higher BMI patients, but PACU discharge was earlier.

• Pain scores before discharge were higher in obesity groups, but without increased adverse events.

• Estimated blood loss was similar across BMI groups.

• Conclusion: With proper preoperative optimization, BMI ≥40 should not be an exclusion criterion for outpatient TJA; outcomes are comparable to lower BMI patients.

🧠 Key Points:

• Mechanical alignment remains standard in TKA but doesn’t consider individual pre-arthritic alignment.
• Newer techniques (kinematic, restricted, inverse, modified, functional alignment) aim to restore native joint line and improve satisfaction.
• Most RCTs show comparable or better short-term outcomes with novel techniques.
• Long-term survivorship data are still lacking; alignment “safe zones” remain debated.
• Robotic and navigation systems are key tools in implementing newer alignment methods.