Surgeries, Volume 7, Issue 3 (September 2026) – 35 articles

IgG4-related disease (IgG4-RD) is a systemic fibroinflammatory disorder that can affect multiple organs, while sinonasal involvement remains uncommon and poorly characterized. Its clinical and radiological resemblance to malignancy may delay diagnosis. We report the case of a 41-year-old man presenting with unilateral left exophthalmos, facial pain, ptosis and paraesthesia. Imaging revealed a destructive maxillary sinus mass extending into the pterygopalatine fossa and orbit, raising strong suspicion of malignancy. Endoscopic biopsy demonstrated dense lymphoplasmacytic infiltration, storiform fibrosis, obliterative phlebitis and numerous IgG4-positive plasma cells, suggestive of IgG4-associated chronic rhinosinusitis. Although the lesion fulfilled key histopathological features of IgG4-RD, its isolated maxillary sinus location potentially represents an atypical site of the disease, not included in the current ACR/EULAR classification criteria. Following surgery and corticosteroid therapy, symptoms initially resolved; however, possible local recurrence was detected four months later on PET imaging. Haematological evaluation subsequently recommended clinical surveillance without systemic immunosuppressive therapy. This case highlights the diagnostic challenges of unilateral rhinosinusitis presenting as an isolated tumour-like lesion and displaying dense IgG4 plasma cell infiltrate. IgG4-RD should be considered in the differential diagnosis of destructive sinonasal masses, even without involvement of typical organs. Histopathological evaluation is essential to guide diagnosis and management and avoid unnecessary aggressive surgery. Full article

Introduction: Posterior tibial slope (PTS) influences sagittal knee mechanics, affecting flexion–extension, ligament tension, and implant stability in total knee arthroplasty (TKA). Robotic-assisted (RA) TKA with functional alignment (FA) allows precise control of PTS, but the clinical relevance of small variations in achieved postoperative PTS remains unclear. This study evaluated whether achieved postoperative PTS is associated with differences in knee mechanics and patient-reported outcomes after RA-TKA with a FA workflow. Methods: In this single-center observational study, consecutive patients undergoing primary RA-TKA with FA were included. Patients were stratified according to achieved postoperative PTS into a near-3° group (2.5–3.5°) and a predominantly lower-PTS comparator group. Clinical outcomes included flexion, extension, and range of motion (ROM). Patient-reported outcomes were assessed using KOOS, KOOS-JR, Forgotten Joint Score (FJS), and PASS thresholds. Statistical comparisons were adjusted for false discovery rate, with multivariable regression analyses performed. Results: A total of 100 patients were analyzed. Mean postoperative PTS was 3.00° ± 0.25° in the near-3° group and 1.82° ± 1.10° in the predominantly lower-PTS comparator group. The predominantly lower-PTS comparator group showed greater ROM (129.5° vs. 122.2°), mainly due to increased hyperextension (−1.7° vs. 0.8°; adjusted p = 0.04). A moderately achieved postoperative PTS was associated with less terminal hyperextension. Patient-reported outcomes were largely comparable between groups. Multivariable analyses confirmed an association between increasing achieved postoperative PTS and reduced terminal hyperextension, whereas no significant associations with global patient-reported outcomes remained after FDR correction. Conclusions: In this implant-specific robotic functional-alignment cohort, a moderately achieved postoperative PTS was associated with less terminal hyperextension, without clinically meaningful differences in global patient-reported outcomes or PASS achievement. Full article

Background: The Meek micrografting technique remains an important option in burn reconstruction, particularly when donor sites are limited. By expanding a small split-thickness skin graft into a regularly spaced micrograft array, the method can achieve expansion ratios well beyond those of conventional meshed grafting. This systematic review aims to synthesize the clinical evidence on the Meek technique, its technical evolution since 1958, and its performance relative to mesh grafting across the full spectrum of burn severity. Methods: A systematic review of the surgical literature was conducted according to PRISMA 2020 recommendations. Searches were performed in PubMed, Scopus, and Web of Science from 1958 to 2026, using combinations of the terms Meek technique, Meek micrografting, microdermagrafting, burns, wound coverage, and skin graft expansion. Eligible studies included clinical outcome reports, comparative analyses with mesh grafting, randomized controlled trials, and technical modifications of the Meek method. Results: The search yielded 412 records, of which 15 unique publications met inclusion criteria and were synthesized, including a 2025 intra-patient randomized controlled trial conducted in a mixed wound population. Reports documented the evolution of the Meek technique from its original description in 1958 to contemporary refinements, while clinical studies reported expansion ratios of 1:2 to 1:9 and variable graft-take estimates, often around or above 80% in extensive burns. At the 1:2–1:3 expansion ratios studied, however, the only completed randomized controlled trial found mesh grafting superior to Meek micrografting for graft take and short-term scar quality, indicating that the relative advantage of Meek is most consistent in donor-site-limited injuries requiring high expansion ratios rather than a universal benefit. Conclusions: The Meek technique remains a reproducible and valuable strategy for burn reconstruction when donor sites are critically limited, but current randomized evidence does not support its routine use over mesh grafting within the population and expansion ratios studied, and the available evidence does not establish a universal TBSA threshold for selecting between the two techniques. Future research should prioritize randomized comparisons across a wider range of burn sizes and standardized long-term scar outcome reporting. Full article

Background/Objectives: Trapeziometacarpal (TM) joint involvement is common in inflammatory rheumatic disease and may result in pain, instability, and functional impairment. Although TM arthroplasty is widely performed for primary osteoarthritis, evidence in patients with inflammatory arthropathy remains limited. This multicenter study evaluated clinical outcomes, complications, and revision rates of TM arthroplasty in patients with inflammatory rheumatic disease. Methods: We conducted a retrospective multicenter cohort study including patients with inflammatory rheumatic disease who underwent primary TM arthroplasty at tertiary referral centers. Demographic, clinical, radiographic, and surgical data were collected. Standard radiographs obtained at 1, 6, and 12 months postoperatively were reviewed to assess implant stability, radiolucent lines, and implant-related complications. Primary outcomes included revision rate and complications; secondary outcomes included functional recovery. Results: Fourteen patients undergoing 15 TM arthroplasties were included; one patient underwent bilateral surgery. The cohort was predominantly female (64%), with a mean age of 63 years. Mean clinical follow-up was 12.8 months (range, 12–18). Functional outcomes improved significantly following surgery, with substantial reductions in QuickDASH disability scores. One complication (1/15 procedures; 6.7%) occurred, consisting of a postoperative hematoma managed nonoperatively. No revision surgeries were required among 15 procedures during the available follow-up, corresponding to a revision rate of 0%. Conclusions: TM arthroplasty in inflammatory rheumatic disease was associated with satisfactory functional outcomes, a low complication rate, and no revision procedures during short-term follow-up, suggesting that TM arthroplasty may represent a potential option in carefully selected patients. Full article

Objectives: Reconstruction of complex midfacial defects remains challenging due to the need to restore three-dimensional anatomy, functional integrity, and facial symmetry. This study aimed to evaluate the clinical effectiveness, safety, and functional and aesthetic outcomes of patient-specific custom implants (PSCIs) in complex midfacial reconstruction. Additionally, we assessed whether virtual surgical planning (VSP) combined with PSCIs reduces operative time and improves postoperative symmetry and patient-reported outcomes. Materials and Methods: A retrospective comparative cohort study was conducted using prospectively recorded clinical data from patients treated with PSCI/VSP between January 2021 and June 2025 and a historical control cohort treated with standard pre-shaped implants. Eighty-seven consecutive patients undergoing reconstruction of acquired or post-oncologic midfacial defects using titanium or PEEK patient-specific implants were enrolled. Preoperative VSP was performed in all cases. The principal endpoint was postoperative facial symmetry assessed by three-dimensional photogrammetry. Secondary functional outcomes included ocular position and nasal airway patency. Secondary outcomes included operative time, complication rates, implant-related morbidity, and patient-reported outcome measures (FACE-Q) at 12 months. Outcomes were compared with a historical cohort reconstructed with standard pre-shaped implants. Results: Eighty-two patients completed at least 12 months of follow-up. PSCI reconstruction demonstrated significantly improved postoperative symmetry (mean deviation 1.8 ± 0.6 mm vs. 3.4 ± 1.1 mm in controls, p < 0.001) and higher patient satisfaction scores at 12 months (FACE-Q overall satisfaction score 82.8 ± 9.3 vs. 69.7 ± 11.2, p < 0.001). Mean operative time was reduced by approximately 24.7%, and intraoperative implant modification was required in only 6% of cases compared with 48% in the control group. The overall complication rate was 11%, with implant removal required in 2.4% of patients. Functional outcomes showed significant improvements in orbital positioning and nasal airway patency. Conclusions: Patient-specific custom implants combined with virtual surgical planning provide reliable and reproducible reconstruction of complex midfacial defects. This approach significantly improves facial symmetry, patient satisfaction, and operative efficiency while maintaining low complication rates. PSCIs should be considered a preferred reconstructive option in selected patients requiring complex maxillofacial reconstruction. Full article

Background/Objectives: Peripheral nerve injuries of the median and ulnar nerves frequently cause significant functional impairment in young patients. When primary repair is not possible, autologous sural nerve grafting remains the gold-standard reconstructive technique, although functional outcomes remain variable and often unpredictable. This study aimed to evaluate functional outcomes after sural nerve autografting for median and/or ulnar nerve defects and to identify factors associated with sensory and motor recovery. Methods: A retrospective case series was conducted on all patients who underwent autologous sural nerve grafting for median and/or ulnar nerve defects between 2016 and 2025, with a minimum follow-up of 12 months. Vascularized and partial nerve grafts, as well as brachial plexus or terminal branch injuries, were excluded. Functional recovery was assessed using the British Medical Research Council (BMRC) sensory and motor scales, and outcomes were classified as good, fair, or bad. Univariate analysis was performed to identify factors associated with functional outcomes. Results: Forty-three patients received 50 nerve grafts (mean follow-up: 30 months). Good sensory recovery (≥S3) was achieved in 80% of median and 52% of ulnar nerve grafts, while good motor recovery (≥M3) was observed in 48% and 32% of cases, respectively. Motor recovery was significantly better for median than ulnar nerve injuries. Factors significantly associated with recovery included patient age, injury type (isolated vs. combined), associated vascular injury, time to surgery, defect length, and number of cable grafts. Conclusions: Sural nerve autografting provides satisfactory functional outcomes, particularly for sensory recovery and median nerve defects, while motor recovery remains limited in ulnar and combined injuries. Early surgery, shorter defects, and adequate cable grafting may improve prognosis. Full article

Background/Objectives: To evaluate the clinical effects of alveolar ridge preservation using a hyaluronic acid-based product combined with a resorbable collagen cone compared with spontaneous healing. Methods: In this prospective pilot comparative clinical study, extraction sockets were treated either with hyaluronic acid and a collagen cone (test group) or left to heal spontaneously (control group). Mesial and distal ridge height changes (ΔHm, ΔHd), ridge width reduction (ΔW), buccal mucosal thickness changes (ΔTmb), and occlusal mucosal thickness at 3 months (TmoT3) were assessed. Early wound healing was appreciated at 14 days follow-up, and postoperative complications after 7 and 14 days. Results: Complete 3-month follow-up data were available for 18 test and 14 control patients. Mesial bone loss was significantly lower in the test group than in controls [test ΔHm = 1.0 (1.0–1.0) vs. control ΔHm = 2.0 (1.0–2.0); p < 0.001]. Horizontal ridge width reduction was significantly lower in the test group [ΔW = 1.0 (1.0–1.0) vs. 2.0 (1.0–2.0); p = 0.021]. Buccal mucosal thickness was better maintained in the test group [ΔTmb = 0.0 (0.0–0.5) vs. 1.0 (0.5–1.0); p < 0.001], while TmoT3 was greater in the test group, in an exploratory analysis (p = 0.049). A statistically significant difference in early wound-healing scores favoring the test group was observed [4.0 (4.0–5.0) vs. 4.0 (3.0–4.0); p = 0.032]. No statistically detectable difference in postoperative complications was observed between groups. Conclusions: Alveolar ridge preservation was associated with reduced mesial vertical and horizontal dimensional changes and more favorable soft tissue outcomes compared with spontaneous healing. These preliminary findings should be considered hypothesis-generating. Full article

Background/Objectives: Patients aged ≥65 years undergoing colorectal cancer surgery are at increased risk of postoperative complications and mortality due to advanced age, comorbidity burden, frailty, and reduced physiological reserve. The aim of this study was to evaluate perioperative predictors associated with early in-hospital mortality in patients aged ≥65 years undergoing colorectal cancer surgery. Methods: This single-center retrospective cohort study included 438 patients aged ≥65 years who underwent colorectal cancer surgery at a tertiary referral center between January 2017 and December 2018. Demographic characteristics, comorbidities, American Society of Anesthesiologists (ASA) classification, surgical urgency, perioperative laboratory parameters, and transfusion requirements were analyzed. The primary endpoint was early in-hospital mortality. Survival analysis was performed using Kaplan–Meier curves and Cox proportional hazards regression analysis. Results: The overall in-hospital mortality rate was 9.4% (41/438). Emergency surgery was associated with significantly reduced in-hospital survival compared with elective procedures (log-rank p < 0.001). Non-survivors more frequently presented with emergency surgical indications, higher ASA scores, greater comorbidity burden, anemia, nutritional impairment, elevated inflammatory markers, renal dysfunction, and increased transfusion requirements. In univariate Cox regression analysis, emergency surgery, ASA score ≥ 3, elevated creatinine, leukocyte count, and C-reactive protein levels, lower hemoglobin, albumin and total protein levels, and red blood cell transfusion were significantly associated with mortality. In multivariate analysis, elevated creatinine (HR 1.004, p = 0.030), leukocyte count (HR 1.064, p = 0.004), C-reactive protein (HR 1.009, p < 0.001), and lower hemoglobin concentration (HR 0.938, p < 0.001) remained independent predictors of in-hospital mortality. Conclusions: Early in-hospital mortality after colorectal cancer surgery in patients aged ≥65 years is associated with systemic inflammation, anemia, and renal dysfunction. Routinely available clinical and laboratory parameters may assist in identifying high-risk patients and improving perioperative risk assessment and postoperative management. Full article

Background/Objectives: Maxillary sinus floor augmentation (MSFA) is a predictable procedure for the rehabilitation of the atrophic posterior maxilla. The prolonged healing time associated with particulate bone grafts poses a clinical challenge. This review aimed to evaluate the clinical, radiographic, and histomorphometric efficacy of autologous platelet-rich fibrin (PRF) combined with bone grafts versus bone grafts alone in MSFA. Methods: A search of databases was conducted until May 2026. We included randomized controlled trials, controlled clinical trials, and cohort studies. Random-effects meta-analyses were performed for new bone formation (NFB%), residual graft (RG%), implant stability quotient (ISQ), and vertical bone height gain. The certainty of the evidence was appraised using the GRADE framework. Results: Thirty-two studies encompassing 728 augmented sinuses in 563 patients met the inclusion criteria. The adjunctive use of PRF significantly increased NFB% (MD = 4.10%; 95% CI: 1.59–6.61; p = 0.005; 10 studies; 204 sinuses; I² = 20.9%; moderate certainty of evidence), with a 95% prediction interval that excluded the null. No statistically significant difference was demonstrated for RG% (MD = −2.71%; 95% CI: −6.08–0.67; p = 0.103; 10 studies; 204 sinuses; I² = 45.2%; very low certainty of evidence), the latter estimate being sensitive to the omission of individual studies. Exploratory subgroup analyses are reported as hypothesis-generating only; the significant between-subgroup contrasts for residual graft were generated by strata containing a single study each. There were no statistically significant differences in ISQ (MD = 1.74; 95% CI: −4.38–7.86; p = 0.432; 4 studies; 140 implants; I² = 92.1%) or vertical bone height gain (MD = −0.35 mm; 95% CI: −2.82–2.13; p = 0.687); both outcomes exhibited substantial heterogeneity and very low certainty of evidence, and their CIs remain compatible with a clinically relevant benefit. Conclusions: The incorporation of PRF into particulate bone grafts during MSFA enhances histological graft maturation by increasing NFB, without a demonstrable effect on RG. This histomorphometric benefit did not translate to improvements in radiographic bone height, bone density, or early implant stability, although the evidence for these outcomes remains imprecise. Therefore, PRF may be regarded as a low-cost autologous adjunct where accelerated histological graft maturation is the specific objective, but the present evidence does not justify a general recommendation for its routine use. Full article

Liver transplantation (LT) has evolved from a contraindicated procedure for malignancy into an established oncologic therapy for selected primary and secondary hepatic cancers. Advances in tumor biology, molecular profiling, immunotherapy, and peri-transplant management have expanded transplant indications beyond hepatocellular carcinoma (HCC) to include perihilar cholangiocarcinoma, intrahepatic cholangiocarcinoma, colorectal liver metastasis (CRLM), neuroendocrine liver metastasis (NELM), and rare hepatic malignancies. The 2024 TransMet randomized controlled trial, demonstrating a 5-year overall survival (OS) of 73% with LT plus chemotherapy versus 9% with chemotherapy alone for unresectable CRLM, established the first Level 1 evidence supporting transplantation as a curative oncologic intervention in metastatic disease. These advances necessitate a modern framework for clinical trial design and research prioritization in transplant oncology. This manuscript proposes a comprehensive framework for future transplant oncology trials addressing endpoint selection, biomarker-driven patient selection, trial methodology, immunosuppression optimization, surveillance strategies, and ethical organ allocation. OS and transplant benefit are emphasized as the preferred primary endpoints for CRLM and NELM, whereas recurrence-free survival is recognized as retaining distinct clinical and prognostic value in HCC, underscoring that endpoint selection should be disease-specific rather than universally standardized. Emerging biomarkers—including circulating tumor DNA, AFP dynamics, and molecular and functional imaging profiling—are stratified into established, prospectively validated, and investigational categories to clarify their current clinical applicability. Randomized controlled trials, adaptive platform and enrichment designs, biomarker-stratified randomization, registry-based trials, and prospective registries are presented as complementary strategies tailored to disease prevalence and feasibility, alongside explicit consideration of how graft source—particularly the predominance of living donor liver transplantation in Asia versus deceased donor systems elsewhere—shapes trial design and interpretation. The manuscript further examines tumor biology-based immunosuppression, immune checkpoint inhibitor integration, and management of post-transplant recurrence. A precision medicine vision is proposed in which transplant candidacy is determined by biologic behavior and molecular signatures rather than morphology alone, with proposed trial frameworks offering an actionable research agenda for the next decade of transplant oncology. Full article

Background/Objectives: Enhanced Recovery After Surgery (ERAS) has substantially advanced perioperative care across multiple surgical disciplines. Research in colorectal surgery has clearly demonstrated the effectiveness of ERAS programs; however, evidence regarding the application of these protocols in elderly patients undergoing upper gastrointestinal (GI) surgery remains limited. This population has a high prevalence of multimorbidity, frailty, and diminished physiological reserve, factors that collectively increase vulnerability to postoperative complications and may influence adherence to ERAS pathways. Methods: This narrative review is based on a structured literature search of PubMed, Scopus, and Web of Science for studies published between 2000 and 2025. The search identified randomized controlled trials (RCTs), observational studies, meta-analyses, and clinical guidelines evaluating ERAS protocols in elderly patients undergoing upper GI surgery. Results: Available evidence indicates that ERAS protocols are feasible and safe in elderly patients undergoing upper GI surgery, including gastrectomy and esophagectomy. Studies consistently associate their implementation with shorter hospital stays, faster gastrointestinal recovery, and no significant increase in postoperative complications or readmission rates. However, heterogeneity in study designs, ERAS components, and definitions of ‘elderly’ limits comparability across studies. Conclusions: ERAS protocols represent a promising perioperative strategy for elderly patients undergoing upper GI surgery. When implemented within a multidisciplinary framework and tailored to patients’ frailty and comorbidities, these protocols may improve postoperative recovery while maintaining safety. Future research should prioritize multicenter RCTs to identify the most effective ERAS components and evaluate long-term clinical and functional outcomes in this population. Full article

Background/Objectives: Caesarean section (CS) is the most frequently performed abdominal operation worldwide, and surgical technique continues to evolve to reduce peri-operative morbidity. Electrosurgery is now used in the majority of surgical procedures because it allows simultaneous tissue dissection and haemostasis, yet its systematic use during the abdominal-wall phase of CS remains debated, mainly because of concerns about neonatal safety and uncertain benefit in reducing maternal blood loss. This retrospective study aimed to compare the use of an electrosurgical unit with the conventional cold scalpel in women undergoing elective CS. The primary endpoint was maternal blood loss before hysterotomy; the secondary endpoint was the short-term neonatal effect assessed through umbilical cord blood gas analysis. Methods: We retrospectively reviewed 40 elective caesarean sections performed at a tertiary referral centre between September 2024 and May 2025. In 24 procedures (cold scalpel group), the abdominal wall was opened with a cold scalpel, whereas in 16 procedures (ESU group) an electrosurgical unit was used to dissect the subcutaneous abdominal tissues and the muscle fascia and to achieve subcutaneous haemostasis. Blood loss was quantified by weighing laparotomy gauze and by graduated suction. Continuous variables were compared with Student’s t-test for independent samples. Results: The distribution of pre-hysterotomy blood loss departed from normality in both groups (Shapiro–Wilk p < 0.001 and p = 0.003), and the comparison was therefore performed with the Mann–Whitney U test. Pre-hysterotomy blood loss was significantly lower in the ESU group (median 32.5 mL, IQR 25–50) than in the cold scalpel group (median 60 mL, IQR 50–75; Hodges–Lehmann difference −25 mL, 95% CI −45 to 0; p = 0.025; rank-biserial r = 0.42). Differences in haemoglobin, red blood cell and platelet counts measured 24 h after CS did not reach statistical significance (p = 0.27, 0.70 and 0.66, respectively), nor did total blood loss (p = 0.23). Umbilical cord blood gas analysis showed a mean pH of 7.29 ± 0.06 in the ESU group and 7.26 ± 0.08 in the cold scalpel group (p = 0.55), with comparable Apgar scores. Conclusions: In this retrospective series, the use of an electrosurgical unit during the abdominal-wall phase of elective CS was associated with a significant reduction in blood loss up to hysterotomy, with no detectable short-term effect on the neonate. Given the retrospective, non-randomised design and the limited sample size, these findings are hypothesis-generating and require confirmation in adequately powered randomised or prospective studies. Full article

Background: Management of high-grade carotid artery stenosis with concomitant ipsilateral parotid gland tumor presents a rare and challenging surgical condition. Due to the rarity of this dual pathology, standardized guidelines are lacking. Material and Methods: A retrospective study was conducted between January 2020 and May 2025. Six asymptomatic patients with significant carotid stenosis and coexisting ipsilateral Warthin’s tumor underwent simultaneous eversion CEA (carotid endarterectomy) and partial superficial parotidectomy/extracapsular enucleation via a single modified Blair’s incision. Results: Median follow-up was 43 months (range: 12–60 months). Postoperative and long-term survival at median follow-up was 100%, with a 5-year survival rate of 83.3% (one death at 50 months due to myocardial infarction). Disease-free survival at 5 years was 100% for Warthin’s tumor and 83.3% for carotid stenosis. No perioperative transient ischemic attacks (TIA), strokes, hematomas, salivary fistula or iatrogenic cranial nerve injuries occurred. Conclusions: In patients presenting with high-grade carotid stenosis and concomitant ipsilateral Warthin’s tumor, a simultaneous surgical approach is a feasible strategy. This approach eliminates the need for staged interventions, significantly reducing overall anesthetic risk, surgical burden, and healthcare resource utilization. Full article

Background: This study evaluated temporal changes in stage distribution, registry-recorded primary-site surgery, survival outcomes, and exploratory short-term mortality prediction among patients with early-onset testicular germ cell tumors, defined in this study as tumors diagnosed in patients aged 15–49 years, across the study periods. Materials and Methods: This retrospective cohort study used Incidence-SEER Research Data, 17 Registries, November 2025 Submission. Male patients aged 15–49 years diagnosed with malignant testicular germ cell tumors between 2018 and 2023 were included. Diagnosis periods were categorized as the pre-COVID-19 period (2018–2019), COVID-19 period (2020–2021), and 2022–2023 period. Logistic Regression was used to assess factors associated with regional or distant-stage disease. Overall survival was evaluated using Cox regression, while testicular cancer-specific death was additionally evaluated using Aalen–Johansen cumulative incidence estimates and Fine–Gray competing-risk regression. Follow-up was also restricted to 12 months in sensitivity analyses. Machine learning models were developed as an exploratory secondary analysis of 12-month all-cause mortality. Results: A total of 13,303 patients were included. Among patients with known stage, regional or distant-stage disease increased from 31.2% before the pandemic to 33.5% during the COVID-19 period and 34.4% during the 2022–2023 period. In adjusted analysis, COVID-19 (OR = 1.11, 95% CI: 1.02–1.22) and diagnoses during the 2022–2023 period (OR = 1.16, 95% CI: 1.06–1.28) were associated with higher odds of regional or distant-stage disease. In full follow-up analyses, diagnosis during the 2022–2023 period was associated with higher all-cause mortality (HR = 1.29, 95% CI: 1.01–1.65) and testicular cancer-specific death in both cause-specific Cox (HR = 1.49, 95% CI: 1.12–2.00) and Fine–Gray models (sHR = 1.45, 95% CI: 1.09–1.93). In 12-month analyses, the overall survival association was attenuated, whereas the association with testicular cancer-specific death remained significant in the Fine–Gray model (sHR = 1.46, 95% CI: 1.03–2.07). Conclusions: Early-onset testicular germ cell tumors diagnosed during the COVID-19 period and in 2022–2023 showed a modest shift toward regional or distant-stage presentation, while diagnosis in 2022–2023 was associated with higher testicular cancer-specific mortality in competing-risk analyses. Full article

Background: The growing awareness of breast cancer’s molecular diversity has not changed the technical foundations of surgery itself, but it has profoundly reshaped how surgeons think about surgery. Rather than molecular biology prescribing specific surgery, it is the surgeon’s interpretation of biological behavior—tumor subtype, genomic risk, treatment responsiveness—that influences surgical timing, extent, and feasibility. This is particularly important in the developing world, where mastectomy continues to be the default surgery, not always because it is required, but because biological nuance is underutilized in surgical planning. This review integrates existing evidence, guidelines, and real-world clinical experience to show how a surgeon who understands tumor biology can meaningfully expand safe breast conservation, de-escalate axillary surgery, and align operative choices with systemic therapy. In essence, molecular biology becomes a lens through which surgeons can practice more personalized, precise, and less invasive surgery, without compromising oncologic safety. Recent findings: We present evidence-based algorithms focusing on Luminal A, Luminal B, HER2-positive, and triple-negative subtypes, while discussing the nuances of multifocal and multicentric disease, metaplastic histologies, and discordant lesion management. The review addresses axillary management in the molecular era, specifying the appropriateness of sentinel lymph node biopsy, targeted axillary dissection, or completion axillary dissection, and how subtype-specific nodal responses to neoadjuvant therapy can guide de-escalation strategies. Through clinical vignettes, we exemplify how molecular integration into surgical planning can modify clinical courses, enabling oncoplastic conservation in downstaged tumors and justifying definitive resection in chemo-resistant cases. We examine the implications of germline and somatic genetic testing on surgical decision-making, particularly in relation to BRCA1/2 and PALB2 mutation carriers, alongside ethical and practical counseling considerations. Additionally, we review emerging biomarkers—such as circulating tumor DNA and immune and radiomic signatures—and propose research priorities for their incorporation into surgical trials. Conclusions: Effective implementation necessitates enhanced surgeon education, standardized assays, and multidisciplinary coordination to promote equitable access, consistent utilization of biology-driven algorithms, and rigorous quality oversight. This review furnishes breast surgeons with a pragmatic framework for translating molecular knowledge into multidisciplinary, patient-centered care pathways that optimize oncological safety, aesthetic outcomes, and overall quality of life. Full article

Background: Acute appendicitis is the leading pediatric surgical emergency. Identifying drivers of disease severity and laparoscopic-to-open conversion remains critical for surgical planning. We evaluated the discriminative performance of clinical scores and inflammatory biomarkers for both peritonitis and surgical conversion, and explored combined clinical–laboratory models among children with acute appendicitis undergoing an initially attempted laparoscopic appendectomy. Methods: A retrospective study was conducted, including pediatric patients with acute appendicitis who underwent surgical treatment. Clinical scores (Alvarado score and Pediatric Appendicitis Score) and laboratory parameters (C-reactive protein, neutrophil count, and neutrophil-to-lymphocyte ratio) were analyzed. Receiver operating characteristic (ROC) curve analysis was used to assess discriminative ability, with calculation of the area under the curve (AUC). Combined models based on standardized variables were constructed and evaluated. Comparisons between AUCs were performed using DeLong’s test. Results: For prediction of peritonitis, clinical scores suggested good discriminative ability within the sample, with AUC values of 0.805 for the Alvarado score and 0.812 for the Pediatric Appendicitis Score, whereas C-reactive protein showed moderate performance (AUC = 0.735). Combined models achieved AUC values of 0.823 for both zPAS + zCRP and zAlvarado + zCRP, and 0.773 for zCRP + zNLR. For surgical conversion, higher within-sample AUC values were observed, reaching 0.879 for the Alvarado score and up to 0.932 for the combined models (zAlvarado + zCRP), followed by 0.926 for zPAS + zCRP and 0.874 for zCRP + zNLR. However, these results should be interpreted with caution due to the limited number of conversion events. Conclusions: Clinical scoring systems and inflammatory biomarkers suggested good ability to predict peritonitis in pediatric acute appendicitis, while their performance for predicting surgical conversion appeared higher but remains exploratory. Combined clinical–laboratory models showed promising within-sample discriminative ability; however, given the very small number of conversion events, these findings should be regarded as exploratory and hypothesis-generating only. Full article

Background: Combined bone and soft-tissue loss of the lower extremity requires complex reconstructive pathways. While acute post-traumatic infected defects and chronic osteomyelitis differ clinically, both present reconstructive challenges that demand radical debridement, infection-directed therapy, and radiology-guided soft-tissue coverage. Objective: To evaluate treatment options and functional recovery using a standardized orthoplastic workflow supported by radiological planning in patients with lower-extremity combined bone and soft-tissue loss of acute traumatic infectious etiology and chronic osteomyelitis. Methods: In this retrospective case series, 27 patients treated between May 2021 and December 2023 were included and divided into two groups: (A) acute post-traumatic bone and soft-tissue loss (n = 17) and (B) chronic osteomyelitis with fistula and soft-tissue loss (n = 10). Patients received multidisciplinary orthoplastic management with local and/or free flaps selected according to defect characteristics and radiology-guided vascular assessment (CT/MRI and angiographic CT; Doppler ultrasound for regional flap planning). Empirical broad-spectrum antibiotics were started after intraoperative biopsy sampling and later tailored to microbiological results. Healing was defined by bone union, infection/inflammation resolution, and flap healing. Functional outcomes were assessed using the Lower Limb Functional Index (LLFI). Due to baseline differences and a small sample size, within-group pre- vs. post-treatment changes in LLFI were analyzed separately. Results: Both groups demonstrated clinically relevant improvements in LLFI after treatment when assessed within each group. Flap selection and antibiotic strategy were implemented according to predefined multidisciplinary endpoints, achieving the study healing criteria in the included patients. Conclusions: A standardized orthoplastic reconstruction strategy supported by radiology-guided planning appears feasible in distinct clinical contexts of acute infected traumatic defects and chronic osteomyelitis, with improvement in lower-limb function assessed within groups. Full article

Background: This study aims to evaluate the effect of postoperative posturing on graft detachment and rebubbling rates following Descemet Membrane Endothelial Keratoplasty (DMEK). Methods: This was an interventional comparative cohort study, assessing patients with and without posturing. All consecutive eyes requiring DMEK or phaco-DMEK were included in two chronological cohorts. The first cohort received strict 48 h postoperative posturing instructions, while the subsequent cohort received no posturing advice. Primary outcomes were graft detachment and rebubbling rates. Secondary outcomes were other adverse events and 6 months functionality. Results: A total of 119 eyes were included: 29 eyes in the posturing cohort (PC) and 90 eyes in the no-posturing cohort (no-PC). Forty-five eyes developed a graft detachment and rebubbling was performed in 38 eyes (37.8% resp. 31.9%). There was no significant difference in detachments (37.9% PC vs. 37.8% no-PC, p = 0.99) or rebubbling (31.0% PC vs. 32.2% no-PC, p = 0.91) between cohorts. Graft failure occurred twice in both cohorts (6.9% PC vs. 2.2% no-PC, p = 0.23). Conclusions: Abstaining from postoperative posturing did not impact the clinical outcomes of DMEK surgery. Eliminating posturing could reduce patient discomfort, health risks, and broaden eligibility for endothelial keratoplasty. Full article

Laser technology has recently gained renewed interest in hysteroscopic surgery due to advances in fiber-optic delivery systems, device miniaturization, and the growing adoption of office-based procedures. In this context, laser energy represents a potential alternative to conventional mechanical and electrosurgical techniques, particularly in settings where precision and tissue preservation are clinically relevant. This narrative review provides a comprehensive and clinically oriented overview of the role of laser technology in modern hysteroscopy. A literature search was conducted in PubMed, Scopus, and Web of Science up to December 2025, focusing on studies addressing technical aspects, clinical applications, safety, and outpatient feasibility of laser-assisted hysteroscopy. Different laser systems, including Nd:YAG, diode, CO₂, Ho:YAG, and KTP lasers, are discussed in terms of physical properties and tissue interaction. Current clinical applications include the management of intrauterine adhesions, submucous myomas, endometrial polyps, septate uterus, and selected cases of endometrial ablation. Available evidence suggests that modern diode laser platforms are particularly suited for office-based procedures due to their combined cutting and coagulative effects and compatibility with small-caliber hysteroscopes. However, most of the current literature is based on small, heterogeneous studies, and robust comparative data with standard hysteroscopic techniques remain limited. As a result, laser hysteroscopy cannot yet be considered a standard approach across indications. To move beyond a purely technical appraisal, this review also frames laser hysteroscopy as a potential translational platform in which laser–tissue interaction, biomarker-informed patient selection, endometrial repair biology, fertility outcomes, and adhesion-formation mechanisms may be integrated into future functional precision medicine pathways. In conclusion, laser technology represents a promising and evolving tool in operative hysteroscopy, with potential advantages in selected clinical scenarios. Further prospective and comparative studies are required to better define its role and to support its broader integration into routine clinical practice. Full article

Objective: Traumatic dislocation and fracture–dislocation of the hip are rare and severe injuries often associated with high-energy trauma. Early recognition and rapid, stable reduction are essential for successful treatment; otherwise, this type of injury is associated with poor functional outcomes and high rates of complications such as avascular necrosis. This retrospective study aims to describe and analyze long-term outcomes and survival rates after a hip dislocation. Methods: Between 2008 and 2021, all patients with traumatic hip dislocation who were treated in a Level I Trauma Center were retrospectively assessed and analyzed. During the follow-up examination, two experienced surgeons carried out a clinical follow-up examination and evaluated the available X-ray images. Anterior and posterior fracture–dislocations and femoral head fractures were classified according to Stewart and Milford’s and Pipkin’s classification system, respectively. All patients were followed up using the Harris Hip Score (HHS) and Lequesne score. Results: Forty-four (38 male and 6 female) patients with a mean age of 46.02 (±19.48) years were included. The average follow-up period was 45.69 (±45.69) months. Traffic accidents were the main cause of traumatic dislocation in this series, accounting for 75% of all cases. Associated injuries were noted in 28 cases. Twenty-three and 21 patients were treated with closed and open reduction, respectively. Isolated hip dislocations without bony involvement according to Stewart and Milford type 1 occurred in five cases. Type 3 injuries were most common, followed by type 4 injuries. This study found that the type of reduction and the trauma mechanism are not significant factors in long-term prognosis (p = 0.463). Thirteen patients had subjective excellent or good results in the HHS and Lequesne score. Late post-traumatic osteoarthritis of the hip developed in 10 patients (22.7%). Patients received a hip replacement at 20.7 months (1–102) months. Thus, after 2 years, implantation of a hip prosthesis due to post-traumatic coxarthrosis was necessary in 22.7% of all cases. The type of hip dislocation classified according to Stewart and Milford had no significant influence on the implantation of a hip prosthesis. Conclusions: Excellent or good results in HHS were obtained in patients with early, stable, and accurate reduction by closed or open methods. After 2 years, 22.7% of the patients needed a total hip replacement. Full article

Background/Objectives: This paper synthesizes and evaluates the potential origins of ectopic salivary gland pathologies in the human nasopharynx. By combining historical reports with an original comparative analysis, this study aims to clarify the precise anatomical and functional status of the proposed tubarial salivary-type glands. Methods: A literature search through December 2025 across major electronic databases identified 84 relevant publications on nasopharyngeal glandular pathologies. The methodological quality in the histomorphological literature was evaluated using the AQUA tool. Concurrently, histological samples were harvested from the inner Eustachian tube opening/torus tubarius region of human, canine, and rodent cadavers and analyzed using histomorphological and immunohistochemical protocols. Results: Most of the literature addressing histologically indicated nasopharyngeal glandular pathology described these findings as controversial, largely overlooking salivary gland origins. The AQUA appraisal identified significant vulnerabilities, showing a high risk of bias in the Study Design domain and yielding moderate inter-rater agreement (κ = 0.435). The empirical morphological study revealed mixed glands with strong mucous predominance in the torus tubarius region of humans and dogs, whereas rodents displayed exclusive PAS positivity within a trabecular stroma. Human samples uniquely demonstrated distinct compartmentalization, duct- and capsule-like formations, and negative α-amylase immunoreactivity. Conclusions: Our pilot empirical evidence, combined with the literature data, suggests a possible pathogenetic link between specific nasopharyngeal neoplasms and the baseline glandular structures of the human torus tubarius. Exhibiting traits of both major and minor salivary systems, the tubarial glands may represent an intermediate structural entity. Furthermore, the animal models utilized do not provide a completely reliable translational framework, highlighting the need for standardized research using fresh human biopsies. Full article

Intravascular papillary endothelial hyperplasia (IPEH), also known as Masson’s tumor, is a rare benign vascular lesion first described in 1923. Its pathogenesis involves thrombus formation influenced by stasis, trauma, hormones, or radiation, followed by endothelial proliferation and papillary formation. IPEH occurs in various anatomical locations, including the hand and wrist, with a predilection for the skin and subcutaneous tissues. Clinical presentation varies according to the site, ranging from asymptomatic slow-growing masses to syndromes caused by the compression of surrounding structures. Diagnosis relies on histopathology, supported by immunohistochemistry. Complete surgical excision remains the treatment of choice, with excellent prognosis and low recurrence rates. Full article

Background and Objectives: A number of published studies comparing transanal haemorrhoidal dearterialization (THD) and conventional haemorrhoidectomy (CH) have primarily focused on short-term outcomes, while data on long-term results remains scarce. This study aimed to compare Doppler-guided THD and CH with emphasis on both early and long-term postoperative results. Methods: This retrospective study included 336 patients who underwent CH (Group 1, n = 189) or Doppler-guided THD (Group 2, n = 147). The groups were compared according to demographic data, HD stage, symptoms, complications, duration of hospital stay, postoperative pain, patient satisfaction, and recurrence rates after 18 months of surgery. Results: There was no difference between groups regarding gender, although there were statistically significant distinctions in terms of disease stage and age (p < 0.001), with the emphasis that in CH group patients had advanced stage of disease and were older. THD was associated with significantly lower postoperative pain, with median visual analogue scale (VAS) scores on postoperative days 1, 2, and 7 of 5, 3, and 1, compared with 7, 5, and 3 after CH (p < 0.001). There was no difference in VAS on POD 30 between groups. Median hospital stay was significantly shorter after THD (1 vs. 3 days; p < 0.001). Patients undergoing CH required more analgesics, laxatives, and follow-up visits within the first postoperative month (p ≤ 0.008). Postoperative complications occurred in nine patients, without significant differences between groups. During the 18-month follow-up period, HD recurrence occurred in seven patients and was more frequent after THD. Additionally, two THD patients developed anal fissures. Conclusions: Doppler-guided THD is a safe and effective treatment for HD, providing reduced postoperative pain, faster recovery, and shorter hospitalization. Long-term outcomes were favourable in both groups, with a trend of lower recurrence rate in the CH group. Full article

Background: Chronic distal radioulnar joint (DRUJ) instability secondary to triangular fibrocartilage complex (TFCC) injury remains challenging to treat. This study describes a novel mini-open dorsal technique for TFCC reconstruction and reports preliminary clinical outcomes. Methods: Six patients with chronic symptomatic DRUJ instability underwent mini-open dorsal TFCC reconstruction using a dorsal capsular flap fixed to the ulnar fovea with a 2 mm suture anchor. Clinical outcomes included DRUJ stability, forearm range of motion, pain (VAS), QuickDASH, and PRWHE scores. Results: At final follow-up, clinical DRUJ stability was restored in all patients, with full forearm rotation. Mean QuickDASH improved from 61.0 to 6.5, mean PRWHE improved from 58.7 to 8.0, and mean VAS pain score improved from 7.5 to 0.83. No complications or recurrences were observed. Conclusions: This mini-open dorsal technique was feasible in this small case series and was associated with encouraging early clinical outcomes and restoration of clinical DRUJ stability. Larger prospective studies with longer follow-up are required before definitive conclusions can be drawn. Full article

Background/Objectives: Frontal sinus surgery remains one of the most challenging procedures in endoscopic sinus surgery due to the complex and variable anatomy of the frontal recess. While several radiological parameters have been proposed to guide surgical planning, there is no standardized anatomical classification that informs both approachability and techniques. This study aimed to develop a reproducible CT-based classification of the nasofrontal beak (NFB) and frontal ostium clearance (FOC), and to validate its surgical applicability through a two-phase design. Methods: A combined retrospective–prospective cohort study was conducted. In Phase 1, CT scans from 1383 patients (2595 sinuses) were analyzed to measure NFB and FOC lengths via a novel technique. The cutoff points were defined through histograms, kernel density estimation, and K-means clustering. In Phase 2, 100 patients (191 sinuses) who underwent frontal sinus surgery were prospectively assessed. Radiological classifications were compared with intraoperative findings, and instruments were selected on the basis of anatomical classes. Agreement between radiological and surgical classifications was analyzed, and surgical outcomes were recorded. Results: NFB and FOC were each classified into three groups: Class A (≤6 mm), Class B (6–12 mm), and Class C (≥12 mm) for NFB, and Class A (≥12 mm), Class B (6–12 mm), and Class C (≤6 mm) for FOC. There was excellent agreement between radiological and intraoperative NFB classes. Class-specific techniques included no modifications for Class A NFB, frontal sinus punches for Class B, and straight/curved drill for Class C. Only one intraoperative lamina papyracea injury and two cases of postoperative neo-ostium narrowing were reported. Significant sex-based anatomical differences and minor side-to-side asymmetries were also observed. Conclusions: This novel classification provides a reproducible, internally validated system for stratifying frontal sinus anatomy preoperatively, with good radiological–surgical concordance for the nasofrontal beak. By mapping the anatomical class onto instrument selection, it offers a practical planning adjunct. As a single-center derivation without an external cohort or comparator arm, it demonstrates anatomical–surgical concordance and feasibility rather than clinical superiority, and warrants multicenter external validation. Full article

A 52-year-old man presented with an unrepaired common canalicular laceration resulting from a traffic accident 1.5 months prior to referral. Cutaneous and conjunctival scars were identified medial to the right lower lacrimal punctum. During surgery, the skin, subcutaneous tissue, and conjunctiva were incised along the existing scar, and the plane under the orbicularis oculi muscle was dissected to expose the lacrimal sac. The anterior wall of the lacrimal sac was incised, and a pigtail probe was inserted through the internal common canalicular orifice via the lacrimal sac lumen to identify the distal end of the common canaliculus. A bicanalicular lacrimal tube was inserted into the identified distal end, followed by suturing of the Horner’s muscle surrounding the lacerated canaliculus and skin closure. At 6-month follow-up, the patient was free of epiphora, with a normal tear meniscus height. Full article

Objective: Long-term data on ejaculation-sparing transurethral surgery for primary bladder neck obstruction (PBNO) in young men remain limited. We report the extended outcomes of the ZANCLE technique—a monopolar or bipolar unilateral “Z”-shaped transurethral incision of the prostate and bladder neck (TUIP) designed to relieve obstruction while anatomically preserving the ejaculatory pathway—in the largest single-surgeon cohort published to date, with follow-up extended to 24 months. Materials and Methods: We retrospectively analyzed prospectively collected data from 186 consecutive patients who underwent the ZANCLE procedure at a single institution between December 2018 and September 2025. Eligibility required prostate volume < 30 mL and failure of alpha-blocker therapy. Voiding parameters—Qmax, post-void residual (PVR), IPSS, and IPSS-QoL—were recorded at baseline and at 1, 6, 12, and 24 months postoperatively. Ejaculatory function was evaluated at each follow-up visit. Results: Median patient age was 43 years (IQR 37–58); median prostate volume was 27 mL (IQR 20–29). Mean Qmax improved from 10.2 ± 2.5 mL/s preoperatively to 22.8 ± 3.9 mL/s at 1 month and remained at 19.8 ± 4.2 mL/s at 24 months (p < 0.001). IPSS fell from 16 ± 2.7 to 6.9 ± 1.5 at 1 month and 6.5 ± 1.6 at 24 months; IPSS-QoL from 4.3 ± 0.9 to 1.9 ± 1.6 and 1.6 ± 1.2, respectively (all p < 0.001). Mean PVR decreased from 125.5 ± 16.1 mL to 31.2 ± 8.9 mL at 24 months (p < 0.001). Anterograde ejaculation was maintained in all 186 patients (100%) at every postoperative timepoint. Minor complications (Clavien 1–2) occurred in 5 patients (2.7%); no major adverse events were recorded. Conclusions: The ZANCLE technique achieves sustained improvements in voiding function and quality of life over 24 months, with a 100% ejaculation preservation rate and an excellent safety profile. These findings support the ZANCLE technique as a clinically promising surgical option for selected young men with PBNO refractory to medical therapy, pending comparative evidence; functional outcomes were numerically consistent with those reported for laser-based approaches, without the associated cost burden, although direct comparison was not possible in this non-comparative design. Full article

Background: Despite modern technology of energy instruments, secure arterial vessel sealing remains a surgical challenge. Particularly in cases of fragile vessel walls or limited visibility, additional reinforcement techniques are potentially desirable. TachoSil^®, a collagen-based, fibrin-coated fleece, is routinely employed in clinical practice for hemostasis and suture support. Whether its external use in terms of collagen augmentation improves the burst strength of bipolarly sealed arteries is to be examined. Objective: To investigate the influence of a TachoSil^® cuff on sealing quality and burst pressures after bipolar vessel sealing in a standardized ex vivo model. Materials and Methods: Porcine carotid arteries (outer diameter 5–7 mm) were examined in two groups: native vessels (group A, n = 12) and vessels with TachoSil^® cuffs (group B, n = 12). Sealing was performed with marSeal^® 5 plus and maXium^® sealer. Burst pressures were measured by continuously increasing intraluminal pressure. Histological analyses were performed. Results: Mean burst pressures were significantly reduced in group B (805 ± 78 mbar) as compared to group A (1452 ± 275 mbar; p < 0.001). Histologically, no structural fusion between vessel walls and collagen fleece was observed. Conclusions: External collagen augmentation using TachoSil^® leads to a significant reduction in the burst strength of bipolarly sealed arteries, despite unaltered sealing duration. The combination of collagen fleece and energy sealing does not have a synergistic effect and should not be used in planned vessel sealing. Further studies are needed to evaluate the underlying mechanisms and possible alternative augmentation strategies. Full article

Low-grade myofibroblastic sarcoma is a malignant mesenchymal tumor with myofibroblastic differentiation, characterized by a high rate of local recurrence but low metastatic potential. It is commonly identified in the head and neck region, and particularly in the oral cavity. We report the diagnostic and treatment steps of a fast-growing lesion of the lower left jaw in a 22-year-old otherwise healthy woman. Based on histological and immunohistochemical features, the diagnosis of low-grade myofibroblastic sarcoma was determined. After a careful evaluation and given the absence of established protocols, our multidisciplinary tumor board recommended segmental mandibulectomy combined with a selective neck dissection. Histopathological examination of the resected specimen confirmed a low-grade mesenchymal neoplasm with focal intermediate-grade areas, resected within oncologically safe margins. In view of the histopathological findings, the case was further discussed by the multidisciplinary tumor board, which recommended adjuvant radiotherapy. No evidence of local recurrence or metastatic disease has been observed during the 10-month postoperative follow-up. Given the rarity of this tumor and the limited number of reported cases, this case report provides further insight into its diagnosis and management and contributes to the existing evidence available for the treatment of this pathology. Full article

Background/Objectives: Preoperative patient education (PPE) has been increasingly recognized as an important component of perioperative care in patients undergoing total knee arthroplasty (TKA). This study aimed to evaluate the association between preoperative education and knowledge acquisition, functional outcomes, health-related quality of life, and anxiety levels following TKA. Methods: A prospective controlled longitudinal study included 120 patients undergoing primary TKA. Participants were allocated to an intervention group receiving structured preoperative education (n = 80) and a control group receiving standard perioperative care (n = 40). Outcomes were assessed preoperatively and at one and six months postoperatively using validated instruments, including WOMAC, KOOS, Lysholm score, RAND SF-36, and the Beck Anxiety Inventory. Knowledge levels were evaluated using a structured knowledge test. Between-group comparisons and correlation analyses were performed. Results: Patients in the intervention group demonstrated significantly higher knowledge scores following education. The intervention group demonstrated more favorable postoperative functional outcomes across follow-up assessments, reflected by lower WOMAC scores and higher KOOS and Lysholm scores. Significant improvements in health-related quality of life were observed across most RAND SF-36 domains. Anxiety levels decreased over time in both groups, with consistently lower scores observed in the intervention group. Significant correlations were identified between baseline knowledge levels and selected functional and quality-of-life outcomes. Conclusions: Structured preoperative patient education was associated with improved knowledge acquisition and more favorable postoperative functional and health-related quality-of-life outcomes following TKA. Anxiety scores decreased over time in both groups; however, anxiety-related findings should be interpreted with caution because baseline BAI scores differed between groups. These findings support the integration of structured patient education into routine perioperative care pathways for individuals undergoing total knee arthroplasty. Full article