Latest Orthopedics and Sports Medicine research

Top 8 this week

Week of 1 November 2026

1. 1

   Restricted Kinematic Alignment Improves Function, But Does Not Reduce Kinesiophobia After Total Knee Arthroplasty: A 3-Year Follow-Up Study

   The Journal of arthroplasty · Q1 journal · RCT · Evidence level 1 (High) · 29 October 2026

   In a randomized trial of 183 knee replacement patients, restricted kinematic alignment was linked to better functional scores over three years, but did not reduce fear of movement. The functional gains were modest, with individual score differences at six months and one year. Fear reduction tracked with functional recovery in both groups, leaving open how best to address it.

2. 2

   Opioid-sparing anesthesia based on opioid-free principles for early recovery after total knee arthroplasty: A randomized controlled trial

   Journal of clinical anesthesia · Q1 journal · RCT · Evidence level 1 (High) · 22 August 2026

   Opioid‑sparing anesthesia improves early recovery after TKA

3. 3

   Effects of Internet-Based Neuromuscular Versus Quadriceps Exercise on Pain and Function in Patients With Knee Osteoarthritis: A Single-Blind Randomized Controlled Trial

   Journal of evidence-based medicine · Q1 journal · RCT · Evidence level 1 (High) · 7 September 2026

   Internet‑based neuromuscular vs quadriceps exercise for KOA

4. 4

   Physical activity levels two years after total knee arthroplasty and preoperative patient characteristics: a secondary analysis of the MOVE randomized controlled trial

   The Journal of arthroplasty · Q1 journal · RCT · Evidence level 1 (High) · 23 October 2026

   Two years after knee replacement, 53% to 56% of patients had returned to their preoperative levels of light activity, moderate-to-vigorous activity, or daily steps, even as average steps rose 8%. Those who were more active before surgery were less likely to match their baseline levels afterward, suggesting rehabilitation may need more tailored support to address activity goals.

5. 5

   Comparison of analgesic efficacy of pericapsular group of nerve block versus anterior quadratus lumborum block in adult patients undergoing unilateral hip arthroplasty: A comparative randomized controlled trial

   Journal of clinical anesthesia · Q1 journal · RCT · Evidence level 1 (High) · 8 August 2026

   In a randomized trial of 92 adults undergoing unilateral total hip arthroplasty, total fentanyl use in the first 24 hours was similar for the pericapsular nerve group block (median 237 µg) and the anterior quadratus lumborum block (median 250 µg). Pain scores, time to first rescue analgesia, and side-effect rates were also comparable, suggesting either technique can be chosen without expecting opioid-sparing differences.

6. 6

   Efficacy and Safety of Intraosseous Regional Versus Intravenous Tranexamic Acid in Total Knee Arthroplasty: A Randomized Controlled Trial

   JB & JS open access · Q1 journal · RCT · Evidence level 1 (High) · 15 October 2026

   In this 98-patient randomized trial, intraosseous tranexamic acid reduced calculated blood loss by about 143 mL compared with intravenous dosing and preserved hemoglobin better on postoperative days 2 and 3; no patient needed a transfusion. Deep vein thrombosis was detected in 10% versus none, a possible safety signal that larger trials must clarify.

7. 7

   Natural history of sleep before and after total joint arthroplasty is poor and unimproved by melatonin: A randomized controlled study

   SICOT-J · Q1 journal · RCT · Evidence level 1 (High) · 15 September 2026

   In a randomized trial of 48 total hip and knee arthroplasty patients, peri-operative melatonin increased nightly sleep hours for hip patients but did not raise overall sleep quality scores, opioid use, or recovery measures. Knee patients showed no sleep benefit. The findings highlight persistent sleep disruption after joint surgery and limited impact of melatonin.

8. 8

   How prior beliefs shape the interpretation of a randomized trial: a Bayesian re-examination of the CROSSFIRE trial

   The Journal of hand surgery, European volume · Q1 journal · RCT · Evidence level 1 (High) · 21 October 2026

   Re-reading the CROSSFIRE trial with five evidence-based prior beliefs produced estimates ranging from 0% to 47% for a clinically meaningful benefit at 3 months. By 12 months, all approaches pointed to no meaningful difference. The analysis shows why readers can reach different conclusions from the same trial, and why making assumptions explicit matters when discussing evidence with patients.

Paper of the day, last two weeks

• Comparison of analgesic therapies in traumatic vertebral compression fractures: Vertebroplasty and kyphoplasty versus thermal facet ablation-a prospective randomized trial

  North American Spine Society journal · Q1 journal · RCT · Evidence level 1 (High) · 2 October 2026

  In a single-center randomized trial, radiofrequency facet ablation and vertebral augmentation reduced pain by about 5 points on a 10-point scale at six months. No complications were reported among 245 ablation patients, who were discharged the same day; augmentation caused cement leakage in 8% of patients. The results support ablation as an alternative, but broader safety evidence is still needed.

• Comparative efficacy and safety of locking intramedullary nails versus locking plates for displaced proximal humeral fractures : a meta-analysis and trial sequential analysis of randomized controlled trial

  Bone & joint open · Q1 journal · SR/MA of RCTs · Evidence level 1 (High) · 5 November 2026

  Randomized evidence compares fixation options for proximal humeral fractures

• Does scapular muscle training program preoperatively improve the functional outcomes and decrease coracoid pain?: A randomized controlled trial

  Journal of ISAKOS : joint disorders & orthopaedic sports medicine · Q1 journal · RCT · Evidence level 1 (High) · 3 November 2026

  In this randomized trial of 50 patients, 4 to 6 weeks of scapular-focused training before rotator cuff repair did not improve pain, function, or coracoid tenderness compared with standard care. More patients improved lower trapezius strength with training, but the difference was not statistically significant; whether targeted prehabilitation can improve muscle recovery remains uncertain.

• Tibiotalocalcaneal Fusion Using Hindfoot Nailing Versus Open Reduction and Internal Fixation for Fragility Ankle Fractures in Older Adults: A Prospective Randomized Comparative Study

  Orthopaedics & traumatology, surgery & research : OTSR · Q1 journal · RCT · Evidence level 1 (High) · 3 November 2026

  In a 60-patient randomized trial, older adults treated with a hindfoot nail began weight bearing at about 2 weeks, compared with 9 weeks after open reduction and internal fixation, and had better ankle function at 12 months. Bone union was also faster, but the rate of union and complications did not differ significantly; permanent loss of ankle and subtalar motion and limited follow-up matter when weighing the trade-offs.

• A Randomized Controlled Trial Examining the Effects of Extended Oral Tranexamic Acid on Postoperative Pain and Range of Motion Following Total Knee Arthroplasty

  The Journal of arthroplasty · Q1 journal · RCT · Evidence level 1 (High) · 2 November 2026

  In this randomized trial of 86 patients, adding oral tranexamic acid for three days after knee replacement did not improve pain, knee motion, opioid use, or walking compared with placebo through 12 weeks. All patients received intravenous tranexamic acid, so the findings address the added oral course; its routine use after primary knee replacement may not be warranted.

• Closed reduction in distal radius fractures: manual manipulation vs. finger trap traction-a prospective randomized controlled clinical trial

  Archives of orthopaedic and trauma surgery · Q1 journal · RCT · Evidence level 1 (High) · 31 October 2026

  Randomized trial compares reduction techniques for distal radius fractures

• Collared cemented femoral stems are associated with lower periprosthetic femoral fracture rates: A systematic review and subgroup meta-analysis

  Journal of experimental orthopaedics · Q1 journal · SR of cohorts · Evidence level 2 (Moderate) · 28 October 2026

  Comparative evidence on stem design and hip arthroplasty fracture

• Arthroscopic Capsular Release Provides Greater Range-of-Motion Improvement Within the First 6 Months Postoperatively Than Nonoperative Management Modalities in Frozen Shoulder: A Systematic Review and Meta-analysis of Randomized Controlled Trials

  Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association · Q1 journal · SR/MA of RCTs · Evidence level 1 (High) · 28 October 2026

  Randomized evidence comparing capsular release with nonoperative frozen-shoulder care

• The 10-Year Revision Risk of Dual-Mobility Versus Standard Cups in Primary Total Hip Arthroplasty for Osteoarthritis: A Population-Based Study from the Danish Hip Arthroplasty Register

  The Journal of arthroplasty · Q1 journal · Cohort · Evidence level 3 (Low) · 27 October 2026

  In this Danish registry study of more than 55,000 people having hip replacement for osteoarthritis, 10-year revision risk was 6.6% with dual-mobility cups, versus 5.9% with standard 36 mm cups and 6.9% with 32 mm cups; overall differences were not significant. Dual-mobility cups had fewer revisions for dislocation but more for infection, leaving the trade-off between these causes important.

• Arthroscopic versus open reduction and internal fixation for tibial plateau fractures: a meta-analysis

  Journal of orthopaedic surgery and research · Q1 journal · SR/MA of RCTs · Evidence level 1 (High) · 31 July 2026

  Meta-analysis compares operative fixation approaches for tibial plateau fractures

• Impact of malnutrition and protein-enriched oral nutrition on early recovery after fragility fractures in older adults: the NuTra trial

  BMC geriatrics · Q1 journal · RCT · Evidence level 1 (High) · 17 October 2026

  In this single-center trial of 218 adults aged 70 and older with fragility fractures, 46% screened at nutritional risk; a protein-enriched diet did not reduce complications or improve mobility, hospital stay, or discharge destination versus a standard diet. Nutritional risk tracked with frailty and greater need for institutional care, while age-related comorbidity predicted discharge destination, leaving open whether longer-term nutritional support helps.

• Lower risk of postoperative complications with Hardinge approach in revision total hip replacement surgery

  SICOT-J · Q1 journal · Prospective cohort · Evidence level 2 (Moderate) · 21 October 2026

  In a matched analysis of 137 revision hip replacements, dislocations occurred in 1.8% of patients treated through a lateral approach versus 16.1% with a posterior approach. The lateral approach also involved less blood loss and higher satisfaction, but hip function scores were similar; the retrospective findings need confirmation in further comparative studies.

• Suture-Button Fixation Provides a Statistically But Not Clinically Important Improvement in Function for Syndesmotic Injuries in Unstable Ankle Fractures: A Systematic Review and Network Meta-Analysis of Randomized Controlled Trials

  JB & JS open access · Q1 journal · SR/MA of RCTs · Evidence level 1 (High) · 27 October 2026

  In 12 randomized trials involving 883 adults, suture-button fixation scored 5.2 points higher than a three-cortex screw on ankle function at one year, short of the 10-point threshold considered clinically important. Unplanned reoperations did not differ, and evidence certainty was low to very low; whether the small functional gain matters in practice remains unclear.

• How have management and outcomes of periprosthetic proximal femoral fractures changed? A comparison of two 8 year time periods in a high volume centre

  Injury · Q1 journal · Retrospective cohort · Evidence level 4 (Very Low) · 15 October 2026

  At one high-volume center, periprosthetic fractures increased from 189 to 320 across two eight-year periods, while fixation for B2 fractures rose from 9.5% to 59%. Surgery happened sooner, but 12-month mortality increased from 12.2% to 20%; the retrospective findings suggest fixation can suit selected frail patients, but do not establish which treatment is best.

Evidence summaries in Orthopedics and Sports Medicine

• Hip Fracture
• Radial Nerve
• Carpal Tunnel Syndrome
• Anterior Cruciate Ligament Tear