Which implant, which injection, and one block you can stop doing

The edition in brief

A US closed-system registry applied International Society of Arthroplasty Registries benchmarking standards to 288,584 primary total knee arthroplasties for osteoarthritis performed between 2001 and 2024 across 45 implant systems. At two years, 42 of 45 systems met the benchmark, covering 99% of implantations; at five years, 37 of 42. At ten years 13 of 25 systems were superior and four non-inferior, with eight failing to reach any benchmark - though those eight accounted for only 3% of eligible knees. The same systems failed consistently across age and gender strata. A 24-member international Delphi panel produced 62 statements on orthobiologics, reaching consensus on 60; platelet-rich plasma for knee, hip and glenohumeral osteoarthritis, Achilles tendinopathy, lateral epicondylitis and rotator cuff tendinitis achieved consensus, while platelet-rich plasma for rotator cuff repair augmentation and autologous cell-based therapies did not, and the panel flagged dosing, preparation and quality control as unresolved. A meta-analysis of 38 studies found psychiatric diagnoses in 24.6% (95% CI 17.3-33.8) of adults presenting for hip arthroscopy and prior opioid use in 14.8% (5.7-33.4), with validated screeners finding substantially more than administrative codes. In 182 patients having secondary patella resurfacing after total knee arthroplasty, Oxford Knee Score improved by 8.1 points (95% CI 5.9-10.2) at two years with 85.7% satisfied, and satisfaction was higher when more than 2.5 years had elapsed since the primary. A double-blind trial in 100 ACL reconstructions found adding an adductor canal block to local infiltration analgesia did not reduce 24-hour opioid use (P=0.109).