This Week in Orthopedics — Oct 29, 2026
Generated Oct 29, 2026 · 10:18
The week's practice-changing Orthopedics research, summarized for clinicians.
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Comparative effectiveness of three splints for rehabilitation after finger flexor tendon repair (FIRST): randomised controlled trial.
In a 430-patient multicentre randomised trial, long, short, and relative motion mini splints after zone 1 and 2 flexor tendon repair produced no significant differences in patient-rated hand function.
BMJ · 2026 · PubMed
This week’s papers
- 01
Association between cemented and uncemented cups and risk of revision in patients aged 65 years or older following primary total hip arthroplasty: a study of 310,515 patients from the Nordic Arthroplasty Register Association.
Among over 310,000 older hip arthroplasty patients, cemented cups roughly halved first-year revision risk but roughly doubled it at 6 to 26 years, with no difference beyond year one after age 80.
Latifi R, Kornvig S, Mohaddes M, et al. · Acta Orthopaedica · 2026
From the briefingWriting in Acta Orthopaedica, Latifi and colleagues used the Nordic Arthroplasty Register Association to study more than 310,000 patients aged 65 or older undergoing primary total hip arthroplasty [1]. Cemented cups were associated with roughly half the risk of cup revision in the first year compared with uncemented cups, but that advantage reversed over the long run, with roughly double the risk of cup revision between six and twenty-six years. In patients aged 80 or older, the authors found no evidence that fixation method mattered after the first year. This is registry data, so selection and confounding remain possible, but the pattern suggests the cemented versus uncemented cup debate may depend largely on how long a patient is expected to live with the implant.
Written by AI from the published abstract, for healthcare professionals. Not medical advice; check the paper before acting on it.
- 02
Arthroplasty versus internal fixation for displaced femoral neck fractures in older patients with dementia: a target trial emulation study.
In Danish patients with dementia and displaced femoral neck fracture, internal fixation was associated with fewer recorded reoperations and slightly lower mortality than arthroplasty, though residual confounding limits causal interpretation.
Jensen SS, Gundtoft PH, Nelissen RGHH, et al. · Acta Orthopaedica · 2026
From the briefingAlso in Acta Orthopaedica, Jensen and colleagues applied a target trial emulation to Danish registry data on 3,161 patients aged 70 or older with dementia and a displaced femoral neck fracture [2]. Arthroplasty was associated with more recorded reoperations than internal fixation, around 13 percent versus just under 8 percent at one year, while major reoperations were similar. Mortality was high in both groups, close to half of patients dying within a year, and slightly lower after internal fixation. Mobility outcomes were similar, and length of stay was modestly longer after arthroplasty. The authors are candid that residual confounding and differential outcome recording limit causal interpretation, so this is a signal worth testing rather than a settled answer for this frail population.
Written by AI from the published abstract, for healthcare professionals. Not medical advice; check the paper before acting on it.
- 03
What Is the 40-year Survivorship of Periacetabular Osteotomy Free From Conversion to THA?
In the original Bern periacetabular osteotomy cohort, about 27 percent of hips avoided conversion to total hip arthroplasty at 40 years, with higher preoperative Tönnis arthritis grade predicting conversion.
Hirt J, Roshardt J, Siebenrock KA, et al. · Clinical Orthopedics and Related Research · 2026
From the briefingAt the other end of the age spectrum, Hirt and colleagues in Clinical Orthopedics and Related Research report the first 40-year follow-up of periacetabular osteotomy, drawn from the original Bern cohort of 75 hips operated on by the originator of the procedure [3]. At 40 years, about 27 percent of hips remained free of conversion to total hip arthroplasty, and hip scores among surviving hips stayed above preoperative levels throughout. A higher preoperative Tönnis osteoarthritis grade was independently associated with conversion. This is a small, early-era, single-surgeon series with patients lost to follow-up, so the absolute figures may not reflect modern practice, but it supports the view that preexisting arthritis is a key predictor of how long the native joint lasts.
Written by AI from the published abstract, for healthcare professionals. Not medical advice; check the paper before acting on it.
- 04
Does a Prior Unsuccessful DAIR Increase the Risk of Reinfection After a Two-stage Revision for Periprosthetic Joint Infection? Results of a Multicenter Case-control Study.
A failed debridement, antibiotics and implant retention procedure was associated with roughly three and a half times higher odds of reinfection after subsequent two-stage revision for periprosthetic joint infection.
Barbero Allende JM, Fernández E, Gómez-Junyent J, et al. · Clinical Orthopedics and Related Research · 2026
From the briefingStaying with joint replacement, a multicentre Spanish case-control study in Clinical Orthopedics and Related Research, led by Barbero Allende, asked whether a failed debridement, antibiotics and implant retention procedure compromises a later two-stage revision for periprosthetic joint infection [4]. Comparing 89 patients who were reinfected within two years of reimplantation with 171 matched controls, the authors found that a prior unsuccessful retention procedure was associated with roughly three and a half times the odds of reinfection. The association looked stronger in chronic infection than in acute infection, though the test for a difference between those groups was not statistically significant. As a retrospective case-control analysis, it cannot prove causation, but it adds weight to the argument that patient selection for implant retention carries consequences beyond the first operation, and the authors call for prospective confirmation.
Written by AI from the published abstract, for healthcare professionals. Not medical advice; check the paper before acting on it.
- 05
Polyethylene glenospheres in reverse total shoulder arthroplasty have greater long-term implant survivorship than metallic glenospheres: A New Zealand Joint Registry Study.
In 8,601 New Zealand reverse shoulder arthroplasties, polyethylene glenospheres had about 43 percent lower adjusted revision rates than metal glenospheres, with similar Oxford Shoulder Scores up to ten years.
Bayley S, Boyle AB, Frampton C, et al. · Journal of Shoulder and Elbow Surgery · 2026
From the briefingIn the Journal of Shoulder and Elbow Surgery, Bayley and colleagues analysed 8,601 reverse shoulder arthroplasties from the New Zealand Joint Registry [5]. Polyethylene glenospheres, articulating against a metal or ceramic humeral liner, were associated with about a 43 percent lower revision rate than conventional metal glenospheres after adjustment for age, sex and diagnosis. Unadjusted analyses also suggested fewer revisions for deep infection and dislocation, while Oxford Shoulder Scores were similar out to ten years. A caveat is that the polyethylene group largely reflects a single manufacturer's system, so implant-specific and surgeon-specific factors are hard to separate from the bearing itself.
Written by AI from the published abstract, for healthcare professionals. Not medical advice; check the paper before acting on it.
- 06
Latarjet Offers Lower 2-Year Reoperation Rate With Similar Rates of Nerve Injury Compared With Anterior Free Bone Block Procedure in a Large Insurance Claims Database.
In claims data, anterior free bone block had higher two-year reoperation than Latarjet, about 13 versus 9 percent, with similar revision stabilization and nerve injury rates, though baseline groups differed.
Kucirek NK, Trotter MV, Feeley BT, et al. · Arthroscopy · 2026
From the briefingIn Arthroscopy, Kucirek and colleagues used a large insurance claims database to compare about 2,500 Latarjet procedures with roughly 450 anterior free bone block procedures [6]. Two-year reoperation was higher after free bone block, about 13 percent versus about 9 percent, but revision stabilization rates did not differ significantly, and nerve injury rates were low and similar, around one to two percent in each group. Free bone block patients were older and somewhat more comorbid, and claims coding offers limited clinical detail, so this comparison is suggestive rather than definitive.
Written by AI from the published abstract, for healthcare professionals. Not medical advice; check the paper before acting on it.
- 07
Lack of Evidence for Improved Outcomes With Dermal Allograft Augmentation of Revision Arthroscopic Rotator Cuff Repair: A Systematic Review.
A systematic review of mostly low-level studies found dermal allograft augmentation of revision rotator cuff repair produced outcomes and retear rates similar to unaugmented revision, leaving routine use unsupported.
Hurley ET, Villarreal-Espinosa JB, Levin JM, et al. · Arthroscopy · 2026
From the briefingAlso in Arthroscopy, a systematic review by Hurley and colleagues examined dermal allograft augmentation for revision arthroscopic rotator cuff repair [7]. Across 27 mostly low-level studies, only 136 augmented shoulders were identified, and their patient-reported outcomes and retear rates, ranging from about 17 to 57 percent, overlapped with those of unaugmented revisions. The authors conclude there is insufficient evidence to support routine augmentation, which in practice means the question remains open rather than answered in the negative.
Written by AI from the published abstract, for healthcare professionals. Not medical advice; check the paper before acting on it.
- 08
Comparative effectiveness of three splints for rehabilitation after finger flexor tendon repair (FIRST): randomised controlled trial.
In a 430-patient multicentre randomised trial, long, short, and relative motion mini splints after zone 1 and 2 flexor tendon repair produced no significant differences in patient-rated hand function.
Bamford E, Berntsson H, Beale S, et al. · BMJ · 2026
From the briefingThe FIRST trial in the BMJ, led by Bamford, randomised 430 adults across 26 hospitals in the United Kingdom after zone 1 and 2 flexor tendon repair to a long forearm-based splint, the Manchester short splint, or a relative motion flexion mini splint [8]. Patient-rated wrist and hand scores over a year showed no statistically significant difference between any of the three splints, and serious adverse events occurred in about one in ten patients in each group. Adherence was imperfect in all arms, at roughly three quarters to four fifths of patients, and participants could not be masked, but as a large pragmatic trial it provides firm evidence that splint design alone does not appear to drive outcomes.
If you only have time for one paper this week, make it the FIRST trial in the BMJ [8]. It is a large, multicentre randomised trial addressing a question hand therapists and surgeons face daily, and it largely settles that splint size and design make little difference to patient-reported recovery after flexor tendon repair.
Written by AI from the published abstract, for healthcare professionals. Not medical advice; check the paper before acting on it.
- 09
Clinical Pathway Management for Platelet-Rich Plasma Therapy in Kellgren-Lawrence Grade I and II Knee Osteoarthritis: A Prospective, Multicenter, Double-Blind Randomized Controlled Trial.
A standardized platelet-rich plasma pathway improved 12-month pain and function and halved adverse events versus conventional care in early knee osteoarthritis, but without placebo cannot establish platelet-rich plasma efficacy.
Yang S, Wang H, Liu Y, et al. · American Journal of Sports Medicine · 2026
From the briefingIn the American Journal of Sports Medicine, Yang and colleagues randomised 240 patients with early knee osteoarthritis, Kellgren-Lawrence grade one or two, to either a standardized platelet-rich plasma pathway or physician-directed conventional platelet-rich plasma care [9]. The pathway bundled patient selection, quality-controlled leukocyte-poor preparation, ultrasound-guided injection, staged rehabilitation, and structured follow-up. At twelve months, pain improved by about three additional points on a ten-point scale, function scores also favoured the pathway, and adverse events were roughly halved, at about 15 percent versus 32 percent, with similar costs. Importantly, the authors stress that without a placebo arm and with bundled components, the trial does not establish that platelet-rich plasma itself works, only that a structured pathway outperformed variable usual care.
Written by AI from the published abstract, for healthcare professionals. Not medical advice; check the paper before acting on it.
- 10
Editorial Commentary: High Failure Rate of All-Inside Hamstring Anterior Cruciate Ligament Reconstruction at Long-Term Follow-Up: It's the Graft Not the Construct, but the Future Keeps Complicating the Past.
Expert commentary argues high failure after all-inside hamstring ACL reconstruction reflects the hamstring graft rather than the fixation construct, favouring quadriceps or patellar tendon autograft in higher-risk patients.
Laporte C, Gilmer BB · Arthroscopy · 2026
From the briefingFinally, an editorial commentary in Arthroscopy by Laporte and Gilmer weighs reports of high long-term failure after all-inside hamstring anterior cruciate ligament reconstruction [10]. They argue that because higher revision rates with hamstring autograft predate modern all-inside fixation, and because all-inside quadriceps constructs have not shown the same concern, the graft rather than the construct is the most likely culprit in higher-risk patients. This is expert opinion rather than new data, but it frames an active debate over graft selection.
Written by AI from the published abstract, for healthcare professionals. Not medical advice; check the paper before acting on it.
The full briefing
This AudioScholar briefing is generated by artificial intelligence for healthcare professionals and trainees. It is not medical advice.
Welcome to This Week in Orthopedics. This week we're covering 10 notable papers spanning implant and fixation choices in hip and shoulder surgery, long-term durability and infection after joint procedures, and what really drives outcomes in soft tissue repair and sports medicine. Let's dive in.
We start with the hip, where three studies examine how fixation and treatment strategy play out over very different time horizons. Writing in Acta Orthopaedica, Latifi and colleagues used the Nordic Arthroplasty Register Association to study more than 310,000 patients aged 65 or older undergoing primary total hip arthroplasty [1]. Cemented cups were associated with roughly half the risk of cup revision in the first year compared with uncemented cups, but that advantage reversed over the long run, with roughly double the risk of cup revision between six and twenty-six years. In patients aged 80 or older, the authors found no evidence that fixation method mattered after the first year. This is registry data, so selection and confounding remain possible, but the pattern suggests the cemented versus uncemented cup debate may depend largely on how long a patient is expected to live with the implant. Also in Acta Orthopaedica, Jensen and colleagues applied a target trial emulation to Danish registry data on 3,161 patients aged 70 or older with dementia and a displaced femoral neck fracture [2]. Arthroplasty was associated with more recorded reoperations than internal fixation, around 13 percent versus just under 8 percent at one year, while major reoperations were similar. Mortality was high in both groups, close to half of patients dying within a year, and slightly lower after internal fixation. Mobility outcomes were similar, and length of stay was modestly longer after arthroplasty. The authors are candid that residual confounding and differential outcome recording limit causal interpretation, so this is a signal worth testing rather than a settled answer for this frail population. At the other end of the age spectrum, Hirt and colleagues in Clinical Orthopedics and Related Research report the first 40-year follow-up of periacetabular osteotomy, drawn from the original Bern cohort of 75 hips operated on by the originator of the procedure [3]. At 40 years, about 27 percent of hips remained free of conversion to total hip arthroplasty, and hip scores among surviving hips stayed above preoperative levels throughout. A higher preoperative Tönnis osteoarthritis grade was independently associated with conversion. This is a small, early-era, single-surgeon series with patients lost to follow-up, so the absolute figures may not reflect modern practice, but it supports the view that preexisting arthritis is a key predictor of how long the native joint lasts.
Staying with joint replacement, a multicentre Spanish case-control study in Clinical Orthopedics and Related Research, led by Barbero Allende, asked whether a failed debridement, antibiotics and implant retention procedure compromises a later two-stage revision for periprosthetic joint infection [4]. Comparing 89 patients who were reinfected within two years of reimplantation with 171 matched controls, the authors found that a prior unsuccessful retention procedure was associated with roughly three and a half times the odds of reinfection. The association looked stronger in chronic infection than in acute infection, though the test for a difference between those groups was not statistically significant. As a retrospective case-control analysis, it cannot prove causation, but it adds weight to the argument that patient selection for implant retention carries consequences beyond the first operation, and the authors call for prospective confirmation.
Turning to the shoulder, three papers address implant design, bone block choice, and graft augmentation. In the Journal of Shoulder and Elbow Surgery, Bayley and colleagues analysed 8,601 reverse shoulder arthroplasties from the New Zealand Joint Registry [5]. Polyethylene glenospheres, articulating against a metal or ceramic humeral liner, were associated with about a 43 percent lower revision rate than conventional metal glenospheres after adjustment for age, sex and diagnosis. Unadjusted analyses also suggested fewer revisions for deep infection and dislocation, while Oxford Shoulder Scores were similar out to ten years. A caveat is that the polyethylene group largely reflects a single manufacturer's system, so implant-specific and surgeon-specific factors are hard to separate from the bearing itself. In Arthroscopy, Kucirek and colleagues used a large insurance claims database to compare about 2,500 Latarjet procedures with roughly 450 anterior free bone block procedures [6]. Two-year reoperation was higher after free bone block, about 13 percent versus about 9 percent, but revision stabilization rates did not differ significantly, and nerve injury rates were low and similar, around one to two percent in each group. Free bone block patients were older and somewhat more comorbid, and claims coding offers limited clinical detail, so this comparison is suggestive rather than definitive. Also in Arthroscopy, a systematic review by Hurley and colleagues examined dermal allograft augmentation for revision arthroscopic rotator cuff repair [7]. Across 27 mostly low-level studies, only 136 augmented shoulders were identified, and their patient-reported outcomes and retear rates, ranging from about 17 to 57 percent, overlapped with those of unaugmented revisions. The authors conclude there is insufficient evidence to support routine augmentation, which in practice means the question remains open rather than answered in the negative.
Our final theme concerns soft tissue rehabilitation and sports medicine, where several papers suggest the process around a treatment can matter as much as the device or biologic. The FIRST trial in the BMJ, led by Bamford, randomised 430 adults across 26 hospitals in the United Kingdom after zone 1 and 2 flexor tendon repair to a long forearm-based splint, the Manchester short splint, or a relative motion flexion mini splint [8]. Patient-rated wrist and hand scores over a year showed no statistically significant difference between any of the three splints, and serious adverse events occurred in about one in ten patients in each group. Adherence was imperfect in all arms, at roughly three quarters to four fifths of patients, and participants could not be masked, but as a large pragmatic trial it provides firm evidence that splint design alone does not appear to drive outcomes. In the American Journal of Sports Medicine, Yang and colleagues randomised 240 patients with early knee osteoarthritis, Kellgren-Lawrence grade one or two, to either a standardized platelet-rich plasma pathway or physician-directed conventional platelet-rich plasma care [9]. The pathway bundled patient selection, quality-controlled leukocyte-poor preparation, ultrasound-guided injection, staged rehabilitation, and structured follow-up. At twelve months, pain improved by about three additional points on a ten-point scale, function scores also favoured the pathway, and adverse events were roughly halved, at about 15 percent versus 32 percent, with similar costs. Importantly, the authors stress that without a placebo arm and with bundled components, the trial does not establish that platelet-rich plasma itself works, only that a structured pathway outperformed variable usual care. Finally, an editorial commentary in Arthroscopy by Laporte and Gilmer weighs reports of high long-term failure after all-inside hamstring anterior cruciate ligament reconstruction [10]. They argue that because higher revision rates with hamstring autograft predate modern all-inside fixation, and because all-inside quadriceps constructs have not shown the same concern, the graft rather than the construct is the most likely culprit in higher-risk patients. This is expert opinion rather than new data, but it frames an active debate over graft selection.
If you only have time for one paper this week, make it the FIRST trial in the BMJ [8]. It is a large, multicentre randomised trial addressing a question hand therapists and surgeons face daily, and it largely settles that splint size and design make little difference to patient-reported recovery after flexor tendon repair.
Here is what this week's evidence adds up to in Orthopedics. First, randomised evidence now shows comparable outcomes across long, short, and relative motion splints after flexor tendon repair, which opens the door to choosing on comfort and practicality. Second, Nordic registry data suggest cemented cups trade lower early revision for higher late revision in older hip patients, with fixation mattering little beyond the first year in those over 80, though this remains observational. Third, registry signals favour polyethylene glenospheres in reverse shoulder arthroplasty and Latarjet over free bone block for reoperation, but both comparisons are confounded by implant, patient, and coding factors. Fourth, a failed implant retention procedure is associated with substantially higher reinfection risk after two-stage revision, a case-control finding awaiting prospective confirmation. And fifth, the platelet-rich plasma pathway trial shows that standardized care delivery improved outcomes, while the efficacy of platelet-rich plasma itself remains unsettled.
That's your roundup for This Week in Orthopedics. The full transcript and references are available on the episode page. This is an AI-curated summary — for clinical decisions, always consult primary sources and current guidelines. See you next week.
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