The edition · Orthopaedics
Revision arthroplasty set to climb, and a motor-sparing shoulder block
Plus a negative trial of tranexamic acid for endoscopic spine visualisation, where shockwave therapy earns its place in tendinopathy, and closing the fragility-fracture care gap.
The edition in brief
Today's orthopaedics edition opens on the coming revision burden. A 17-country registry projection estimates annual revision hip replacements rising about 31% and revision knee replacements about 41% by 2060, with the United States and China driving growth while mature European systems plateau — a planning signal for revision training and infection-prevention programmes. A randomised trial found a superior trunk block matched the interscalene block for analgesia after shoulder arthroscopy while sparing upper-limb motor function, fitting enhanced-recovery goals. A negative randomised trial found prophylactic tranexamic acid did not improve visualisation during single-level endoscopic lumbar discectomy, which already has good views. A network meta-analysis places extracorporeal shockwave therapy as a reasonable option for lateral epicondylitis, Achilles and rotator cuff tendinopathy but not patellar tendinopathy. A clinic pearl reaffirms antibiotics within the hour for open fractures. The practice-changer: a global review restates that the evidence for fragility-fracture care — timely surgery, orthogeriatric comanagement, early mobilisation, unrestricted weight-bearing and secondary fracture prevention — is strong and the gap is implementation, putting orthopaedic surgeons at the centre of closing it.
Revision hip and knee replacement volumes projected to climb by 2060
Plan revision-surgery capacity, infection-prevention programmes and registries now, because revision hip and knee volumes are projected to rise by about a third by 2060.
Superior trunk block matched the interscalene block but spared motor function
Consider a superior trunk block for shoulder arthroscopy where motor-sparing matters: it matched the interscalene block for pain while preserving more arm movement.
Tranexamic acid did not improve the view in endoscopic lumbar discectomy
Do not add tranexamic acid specifically to improve visualisation in single-level endoscopic lumbar discectomy; the view is already good without it.
Shockwave therapy helps some tendinopathies, not patellar
Consider shockwave therapy for lateral epicondylitis, Achilles and rotator cuff tendinopathy, but not for patellar tendinopathy, where it was no better than placebo.
Antibiotics within the hour for every open fracture
Give antibiotics within the hour for every open fracture, before theatre, and document the time.
The fragility-fracture gap is implementation, not evidence
Treat every fragility fracture as a trigger for prompt surgery, orthogeriatric care, early mobilisation and secondary fracture prevention — the evidence is settled; the work is delivery.
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