The edition · Orthopaedics
The robot did not win: RACER-Knee finds no patient benefit and higher cost
A masked, ten-centre randomised trial with sham incisions puts robotic-arm total knee replacement 1.5 points behind conventional instruments on the Forgotten Joint Score at a year; a UK cohort isolates capacity delay from medical delay in hip fracture and finds a 37 per cent higher one-year mortality; and pooled data support a bisphosphonate after stopping denosumab.
The edition in brief
RACER-Knee randomised 339 patients with advanced knee osteoarthritis across ten British hospitals and 33 surgeons to robotic-arm-assisted or conventional total knee replacement, masking participants with sham incisions, extra draping and masked operation notes. At 12 months the Forgotten Joint Score was 49.2 with the robot and 50.2 with conventional instruments, an adjusted difference of -1.5 (95 per cent CI -7.5 to 4.5, p = 0.62) against a prespecified target of 12 points, with equal serious adverse events and higher cost. A retrospective cohort of 2,358 patients aged 65 and over in a UK teaching hospital separated capacity-related delay beyond 36 hours from delay for medical optimisation, which previous studies conflated; 54 per cent were delayed for capacity, and after propensity matching those patients had a hazard ratio of 1.37 (1.15 to 1.63) for death at 365 days, rising to 1.71 (1.11 to 2.65) in the first 30 days, with frail patients on a Clinical Frailty Scale above 4 most affected. The FDA listed an ongoing, not yet classified recall of repackaged ibuprofen 20 mg per mL oral suspension unit-dose syringes for cross-contamination with other products. A JBJS international review argues that fragility fracture care in low- and middle-income countries is limited by health-system constraints rather than by absent evidence. A meta-analysis of six studies and 683 participants found alendronate or zoledronic acid after stopping denosumab reduced incident vertebral fractures (RR 0.29, 0.14 to 0.59) and multiple vertebral fractures (RR 0.08, 0.01 to 0.43), at low to very low certainty.
RACER-Knee: robotic assistance cost more and changed nothing at a year
In a masked ten-centre randomised trial, robotic-arm-assisted total knee replacement gave no patient-perceived benefit at 12 months (adjusted difference -1.5 points, 95 per cent CI -7.5 to 4.5) and cost more than conventional instruments.
Waiting for a theatre, not for a cardiologist, kills hip fracture patients
Hip fracture surgery delayed beyond 36 hours purely for lack of theatre capacity carried a 37 per cent higher one-year mortality, with the harm concentrated in the first 30 days and in frail patients - so give the frailest the earliest slot.
FDA recall of repackaged ibuprofen oral syringes for cross-contamination
An ongoing, unclassified FDA recall covers repackaged ibuprofen 20 mg per mL unit-dose oral syringes for cross-contamination with other products - check unit-dose stock sourcing with pharmacy, but note this is a US action with no stated Indian implication.
The fragility fracture gap is a health-system problem, not an evidence problem
What is missing in fragility fracture care outside high-income systems is implementation, not evidence - a written pathway, a named owner for secondary prevention, and two audited numbers are the realistic first moves.
"Partial weight-bearing" means nothing to a patient - give a number and a weighing scale
Give partial weight-bearing as a number in kilograms, train it against a bathroom scale before discharge, and write the date it changes - a fraction of body weight is an instruction no patient can follow.
Follow denosumab with a potent bisphosphonate - the vertebral fracture reduction is large
Anyone stopping denosumab needs alendronate or zoledronic acid to follow, which cut incident vertebral fractures by about 71 per cent and multiple vertebral fractures by 92 per cent in pooled data - and a missed injection counts as stopping.
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