Orthopedic Surgery Research Updates

In a single-center, randomized, participant- and assessor-blinded trial of 76 older adults (median age 77) undergoing hemiarthroplasty or total hip arthroplasty for hip fracture, investigators compared local incisional infiltration of liposomal bupivacaine (LB) versus no local infiltration as an adjunct to standardized multimodal analgesia. The prespecified primary outcome—resting VAS pain at 48 hours—did not differ between groups, but several secondary outcomes favored LB (lower resting pain at 24 hours, reduced activity pain at 8–48 hours, fewer oral rescue opioid administrations, and improved postoperative sleep duration/quality), while ambulation and length of stay were similar. The authors conclude that LB did not improve the primary endpoint and do not support routine clinical use pending further research.

This systematic review and meta-analysis of studies comparing unilateral unicompartmental knee arthroplasty (UKA) to a contralateral total knee arthroplasty (TKA) in the same patients found that UKA achieved greater postoperative range of motion and higher patient preference, with comparable joint 'forgettability' measures. However, UKA was associated with a higher revision risk and TKA showed greater improvement in Knee Society Score from baseline.

Retrospective review of 2,829 patients undergoing total hip arthroplasty or hemiarthroplasty for femoral neck fracture compared cemented (79%) versus cementless (21%) femoral fixation with propensity-matched analyses (346 pairs). Cemented fixation was associated with fewer periprosthetic fractures (4% vs 7%; P<0.04) but a higher rate of low-grade (Grade 1) bone‑cement implantation syndrome (43% vs 32%; P<0.01); a separate match of collared cemented versus collared/metaphyseal‑filling cementless stems (213 pairs) showed no differences in BCIS, periprosthetic fracture, mortality, DVT, or SSI (all P>0.05).