Lo Scalpello - Journal

Cemented vs uncemented hip hemiarthroplasty in medial femoral neck fractures in the elderly: the Association of Orthopaedic Traumatology of Italian Hospitals (OTODI) Multicenter Study

2026-06-12T12:47:04+02:00

Background. The choice between cemented and uncemented hip hemiarthroplasty for medial femoral neck fractures in the elderly remains debated. While international guidelines often recommend cementation, modern uncemented designs offer potential advantages in operative efficiency.

Methods. This OTODI (Orthopaedic Traumatology of Italian Hospitals)-coordinated, prospective multicenter study analyzed 1,417 patients over 75 years of age across 150 Italian centers. Clinical trends, operative parameters, and mid-term outcomes (up to 12 months) were compared between cemented and uncemented fixation.

Results. Uncemented fixation was predominant (65.6%). The uncemented group showed significantly shorter mean operative times (62.0 vs. 72.8 minutes; p < 0.0001) and better initial functional scores (Barthel Index; p = 0.046). No significant differences were found in intraoperative complications, 12-month mortality, or long-term functional recovery.

Conclusions. In Italian clinical practice, modern uncemented hip hemiarthroplasty are frequently utilized and provide comparable safety and efficacy to cemented stems. These findings support the use of modern uncemented designs as a reliable alternative that reduces operative time without compromising mid-term outcomes.

Arthroplasty of the hip and knee in athletes: risk, functional outcomes and return to sport

2026-06-12T12:47:04+02:00

Introduction. The resumption of sports activity after total hip arthroplasty (THA) and total knee arthroplasty (TKA) is a topic of growing interest, given the decrease in the mean age of patients undergoing these surgical procedures and the higher functional expectations of younger individuals. However, no univocal guidelines are available, and contrasting opinions persist regarding which sports are safe after prosthetic implantation.

Methods. A comparative narrative review of the evidence on return to sport (RTS) after THA and TKA was conducted. A literature search was performed on PubMed, analyzing studies published on the topic up to December 2024. Data were extracted on RTS rates, physical activity levels (UCLA and Tegner scores), mean recovery times, and the main predictive or limiting factors for RTS.

Results. The vast majority of patients return to at least one sport after THA or TKA. Patients with THA show slightly higher average RTS rates (up to ~80-90% for low-impact activities) and faster initial recovery compared with TKA patients (RTS ~70-80%). Physical activity levels (UCLA, Tegner scores) improve in a clinically significant way after surgery in both groups. Younger age, male sex, normal BMI, high preoperative activity level, and strong personal motivation emerge as factors favoring successful RTS, whereas fear, residual pain, and stiffness may limit it. Low-impact sports are generally well tolerated and may be resumed within 3-6 months after surgery; high-impact sports carry greater risks, but recent evidence indicates that regular physical activity does not increase complication or revision rates in the medium term, thanks to advances in materials and implant design.

Conclusions. RTS after hip or knee arthroplasty is a realistic and safe goal for most patients, contributing to improved quality of life. It is essential to personalize recommendations: prioritize low-impact activities and carefully evaluate return to more demanding sports, informing patients about potential risks. Further long-term studies are needed to better define recommendations, particularly for high-impact sports.

Risk Factors for Infection in Total Knee Arthroplasty: A Narrative Review according of the ICM Istanbul 2025

2026-06-12T12:47:05+02:00

Periprosthetic joint infection (PJI) after total knee arthroplasty (TKA) remains one of the most serious complications in modern orthopedics. Despite technological and surgical advances, its incidence remains stable, suggesting that prevention cannot rely exclusively on the surgical act.

The 2025 International Consensus on Musculoskeletal Infections (ICM) held in Istanbul devoted extensive space to the analysis of preoperative risk factors, emphasizing the central role of the host and preoperative optimization.

This narrative review systematically analyzes the main risk factors for infection in patients undergoing TKA, distinguishing between modifiable and non-modifiable factors, and discusses the practical implications for daily clinical management in light of the most recent ICM recommendations.

Different generations of dual mobility cup: from beginning to contemporary systems

2026-06-12T12:47:05+02:00

Dual mobility cups (DMCs) were introduced in the 1970s to combine the low-friction concept of small femoral heads with the increased stability provided by larger articulations. Over the past five decades, DMCs have undergone substantial evolution in terms of design, materials, fixation methods, and polyethylene technology. This review analyzes the historical development of DMCs through three generations, focusing on the major complications encountered during their clinical use, including iliopsoas impingement, cup loosening, dislocation, intraprosthetic dislocation, accelerated wear, and infection. For each complication, the design modifications and technological advances introduced to improve implant performance are discussed. Contemporary third-generation systems have demonstrated excellent survivorship and low complication rates, while recent highly porous 3D-printed titanium designs may represent the beginning of a new generation of dual mobility implants. The continuous evolution of DMC technology has contributed to improved stability, fixation, and longevity, making these implants a valuable option in both primary and revision total hip arthroplasty.

Positioning strategies in surgical management of trimalleolar ankle fractures

2026-06-12T12:47:06+02:00

Objective. Trimalleolar ankle fractures are complex injuries typically managed via open reduction and internal fixation (ORIF). While prone positioning is traditional for posterior malleolus access, floppy lateral positioning may improve the workflow for combined approaches. This study compared perioperative and radiographic outcomes between these two techniques.

Methods. A retrospective cohort study of 87 adult patients (prone: n = 45; floppy lateral: n = 42) was conducted at a Level I trauma center (2020-2024). Outcomes included operative time, fluoroscopic exposure, reduction quality, and postoperative complications.

Results. No significant differences were found in mean operative time (111.9 vs. 108.6 minutes; p = 0.235) or fluoroscopic exposure (39.0 vs. 38.4 seconds; p = 0.761). Both groups achieved high rates of anatomical reduction (92.77% vs. 92.42%; p = 0.561) with comparable complication rates and clinical outcomes.

Conclusion. Floppy lateral positioning provides equivalent surgical efficiency and radiographic outcomes to prone positioning. The choice of position can be safely guided by surgeon preference and patient-specific safety considerations.

Chevron olecranon osteotomy and fixation with kirschner wires and tension band in the surgical treatment of distal humeral fractures in adults: clinical evaluation of 32 cases

2026-06-12T12:47:06+02:00

Objective. This study aimed to evaluate long-term outcomes and complications after olecranon osteotomy for complex distal humerus fractures.

Methods. We retrospectively reviewed adult patients with AO/OTA 13-C fractures treated by open reduction and internal fixation via olecranon osteotomy from 2005 to 2015. Thirty-two patients were assessed clinically and radiographically, and functional outcomes were measured using the Mayo Elbow Performance Score (MEPS) at a mean follow-up of 10 years.

Results. Olecranon osteotomy for complex distal humerus fractures produced mostly positive outcomes: 84% of patients had excellent or good MEPS results. Mean flexion-extension was 100° (range 10°-130°). By fracture type, 100% of C1, 69% of C2, and 90% of C3 had excellent/good results. Complications included nonunion (1), implant prominence (10), heterotopic ossification (2), and ulnar nerve entrapment (2). The purpose of our study is to evaluate the long-term outcomes of patients with type C fractures treated surgically with Chevron olecranon osteotomy.

Conclusions. Olecranon osteotomy provides adequate exposure and, with stable fixation and early rehabilitation, yields good long-term results with manageable complications. The retrospective design and small sample size are limitations of the study.

Medial malleolar fractures: hook plates versus lag screws fixation. A prospective multicenter observational study

2026-06-12T12:47:06+02:00

Objective. This prospective multicenter observational study compares clinical, functional, and radiological outcomes of hook plate versus lag screw fixation for medial malleolar fractures.

Methods. Between June 1, 2019, and June 1, 2021, a prospective observational study was conducted across 5 hospitals. Sixty-one patients with isolated medial malleolar fractures or bimalleolar fractures were enrolled and assigned to two groups based on the treatment received: lag screw fixation (n = 30) or hook plate fixation (n = 31). Outcomes included AOFAS, OMAS, VAS scores and radiographic evaluations.

Results. Hook plate fixation yielded higher AOFAS (90.2 ± 9.7 vs 74.3 ± 13.8; p = 0.001), OMAS (85.7 ± 9.5 vs 71.0 ± 13.6; p = 0.002), healing rate (100% vs 86.6%; p = 0.050), and shorter time to union (9.7 vs 13.3 weeks; p = 0.044).

Conclusion. Hook plate fixation provides superior functional outcomes and higher healing rates compared to lag screws, particularly in osteoporotic or comminuted fractures. Careful patient selection and surgical technique are essential.

Scapular asymmetry in tennis players: differential diagnosis and biomechanical insights

2026-06-12T12:47:07+02:00

Objectives. To analyze the clinical significance of scapular asymmetry in tennis players and its differential diagnosis with scoliosis.

Methods. Narrative review of biomechanical and clinical literature on overhead athletes, focusing on rotator cuff adaptations and inertial loading mechanisms.

Results. Evidence indicates that scapular asymmetry in tennis players is associated with predominance of internal rotators, reduced external-to-internal rotator strength ratio, and repeated exposure to high inertial forces during overhead movements.

Conclusions. Scapular asymmetry is more likely to represent a functional neuromuscular adaptation rather than a structural spinal deformity. Correct interpretation is essential to avoid misdiagnosis and to guide appropriate orthopedic evaluation.

Femoral Neck System versus Cannulated Screws for Medial Proximal Femoral Fractures: A State-of-the-Art Review of Early Complications and Functional Outcomes

2026-06-12T12:47:07+02:00

Abstract

Objectives

Displaced femoral neck fractures remain a challenging injury, particularly regarding implant selection for internal fixation. The Femoral Neck System (FNS) was developed to improve angular and axial stability compared with traditional cannulated screw fixation.

Methods

A focused literature review comparing FNS and cannulated screws for femoral neck fracture fixation was performed using the Consensus platform, enabling analysis across millions of indexed scientific articles, and complemented by a targeted manual search. Based on relevance, methodological quality, and scientific impact, the 50 most influential studies were included. Early clinical and radiographic outcomes and implant-related complications within the first six months were analyzed.

Results

The available evidence suggests that FNS fixation is associated with lower rates of early mechanical and biological complications and improved early functional recovery compared with cannulated screws, particularly in unstable fracture patterns.

Conclusions

Current evidence indicates that the Femoral Neck System offers a more favorable short-term clinical profile than cannulated screw fixation for medial proximal femoral fractures. While both techniques achieve high union rates when adequate reduction is obtained, the biomechanical advantages of FNS appear clinically relevant within the first six months following surgery