Surgeries

Background/Objectives: Robot-assisted gastrointestinal (GI) cancer surgery has expanded in Japan since national reimbursement in 2018, yet hospital profitability remains uncertain because of capital, maintenance, and consumable costs. We examined whether a program-level volume threshold for profitability exists under Japan’s fee schedule and quantified actionable improvement targets. Methods: We developed a hospital-perspective, model-based economic evaluation (index admission to 30 days; 2025 Japanese yen (JPY)) comparing robot-assisted surgery (RAS) with conventional laparoscopic surgery (CLS) under Japan’s fee schedule (one point = ¥10) for gastrectomy, colectomy, rectal resection, and pancreatoduodenectomy. Case-level contribution margin differentials (ΔCM) were defined as the revenue differential minus the consumables differential and additional operating room (OR) time costs, plus savings from reduced length of stay (LOS), and were aggregated to annual program profit (Π) after fixed costs and platform sharing. Primary outputs were allowable consumables, required cut (%), and isoprofit contours. Uncertainty was assessed using 50,000-iteration probabilistic sensitivity analysis (PSA), one-way sensitivity analysis (OWSA), and learning-curve scenarios in line with Consolidated Health Economic Evaluation Reporting Standards (CHEERS) 2022. Results: In the base case, ΔCM was predominantly ≤0 for colon, rectum, and pancreatoduodenectomy; therefore, when the case-mix-weighted mean ΔCM was ≤0, increasing volume could not achieve breakeven and instead increased losses. Each 10 min reduction in OR time increased allowable consumables by ¥15,000, and each bed-day reduction increased it by ¥30,000. These required-cut and isoprofit maps provide actionable targets for cost negotiation, operational improvement, and platform sharing. Conclusions: Volume expansion alone rarely yields profitability; coordinated reductions in consumables, OR time, and LOS, together with platform sharing, are required. Full article

Background: Compromised left ventricular function presents unique challenges during mitral valve surgery. Recent evidence suggests that subvalvular apparatus preservation might enhance postoperative recovery in high-risk populations. Methods: This prospective observational investigation (Hue Central Hospital, March 2015–September 2016) evaluated 87 patients undergoing mechanical mitral valve replacement with posterior leaflet preservation. Participants were stratified into two groups: reduced ejection fraction (EF ≤ 50%, n = 38) and preserved EF (>50%, n = 49). Comprehensive clinical and echocardiographic assessments were conducted at 1, 3, 6, and 12 months postoperatively. Statistical analysis employed parametric and non-parametric methodologies, with survival analyzed via Kaplan–Meier techniques. Results: The reduced EF cohort demonstrated significant improvement in contractile performance from 48.8 ± 5.2% preoperatively to 61.6 ± 7.2% at 12 months (p < 0.05). Ventricular dimensions decreased notably from 59.2 ± 6.6 mm to 47.6 ± 4.0 mm (p < 0.05). Hospital mortality was 2.3% (2 patients). Twelve-month survival rates reached 94.66% and 97.96% for reduced and preserved EF groups, respectively, without significant inter-group differences (p = 0.42). All surviving participants achieved functional status in NYHA class I or II. Conclusions: Mechanical mitral valve replacement with posterior leaflet preservation represents an effective approach for patients with reduced ventricular performance, promoting substantial improvement in cardiac function and excellent clinical outcomes. Full article

The aim of this research was to identify the 50 articles most frequently referenced concerning patellofemoral instability (PFI) and to analyze their features. A search was performed in the Thomson ISI Web of Science using keywords such as “patellofemoral instability,” “patellar instability,” “patellar dislocation,” and “patella luxation.” This research included all publications related to PFI, covering aspects such as diagnostic and both nonoperative and operative treatment. The citation counts for the 50 articles ranged from 165 to 1024 citations. Notably, the top ten articles received a minimum of 348 citations each. In total, 84% (n = 42) of the studies were clinical, while the remainder consisted of basic science investigations (including three anatomical and five biomechanical studies). The predominant level of evidence was IV, accounting for 32%. The American Journal of Sport Medicine was responsible for publishing 34% of these articles. Most of the research took place in the United States and twelve additional countries. The years when the most-referenced papers were published spanned from 1985 to 2020, with the 2000s representing the highest share of articles (74%), and the years between 2006 and 2010 showing the peak quantity of articles (n = 15). This article provides a building block in the PFI management. The selection of these articles is useful for learning more about current trends on PFI and anticipating future developments. Full article

Background/Objectives: While hip arthroscopy outcomes for femoroacetabular impingement syndrome (FAIS) are well-documented, there is limited research comparing revision hip arthroscopy for FAIS to primary procedures. This study aimed to compare clinical outcome scores, revision hip arthroscopy, and conversion to total hip arthroplasty (THA) between patients undergoing revision hip arthroscopy for residual FAIS and those undergoing primary hip arthroscopy. Methods: This retrospective study matched 47 patients who underwent revision hip arthroscopy 1:2 by age, sex, body mass index, and smoking status to 94 patients who underwent primary surgery. Patient-reported outcomes (PROs) were assessed using the modified Harris Hip Score (mHHS) and Non-Arthritic Hip Score (NAHS) preoperatively and at 1-year follow-up. Long-term follow-up was performed to determine repeat surgical interventions at a minimum 5-year follow-up. Differences in postoperative outcomes were assessed using Mann–Whitney U tests and rate of subsequent surgery were compared using chi-squared analyses. Results: Both cohorts showed significant improvement in PROs at 1 year (p < 0.001). However, the revision cohort had lower preoperative scores (mHHS, p < 0.001; NAHS, p = 0.003) and lower postoperative scores (mHHS, p = 0.037; NAHS, p = 0.032) compared to the primary cohort. Despite these differences, the magnitude of improvement was similar between groups for the mHHS and NAHS (p > 0.05). Long-term follow-up revealed a significantly higher conversion rate to THA in the revision cohort compared to the primary group (p < 0.001). Conclusions: Patients undergoing revision hip arthroscopy start with lower baseline function but achieve similar improvements to those undergoing primary surgery. However, revision patients had a significantly higher rate of conversion to THA. Full article

Background: In head and neck reconstructive surgery, flap loss remains a major complication and continues to represent a significant challenge in perioperative management. Although free tissue transfer is widely used, unsatisfactory outcomes are still reported across different flap procedures. Anaesthetic management plays an important role in influencing flap perfusion through its effects on systemic haemodynamics, regional blood flow, and microcirculation. However, there is currently no consensus on universally acceptable haemodynamic targets, and the impact of intraoperative strategies appears to be highly application-specific. Materials and Methods: This narrative review was conducted in accordance with the 2019 SANRA guidelines. PubMed^® was used as the primary database for literature selection. Relevant studies addressing anaesthetic management in head and neck free flap surgery were reviewed, with a particular focus on intraoperative haemodynamic control, ischemia–reperfusion injury, fluid and transfusion management, vasoactive agents, and advanced monitoring techniques. Results: Ischemia–reperfusion injury represents a major mechanism of vascular compromise in free flap surgery and has a significant impact on microcirculatory perfusion. The literature suggests that several anaesthetic strategies—including goal-directed fluid therapy, cautious use of vasopressors, and advanced haemodynamic monitoring—may support intraoperative haemodynamic stability and improve flap perfusion. Nevertheless, the magnitude of haemodynamic improvement achievable with these strategies and their effect on graft survival vary according to patient characteristics, surgical factors, and flap type. Conclusions: Current evidence indicates that anaesthetic management has the potential to contribute to improved intraoperative haemodynamic control in head and neck free flap reconstruction, thereby supporting graft viability. However, haemodynamic targets and management strategies cannot be generalised and should be interpreted within specific clinical contexts. Rather than aiming for optimisation, future research should focus on defining acceptable clinical outcomes for individual applications and on evaluating whether achievable haemodynamic improvements are sufficient to reduce flap-related complications to clinically acceptable levels. Full article

Background/Objectives: Titanium fixation remains the gold standard for stabilizing mandibular fractures; however, associated complications often necessitate a second surgery for hardware removal. Consequently, biodegradable systems were introduced, though questions persist regarding their mechanical reliability and potential for tissue reactions. This systematic review and meta-analysis was conducted to compare the efficacy and morbidity of biodegradable versus titanium osteosynthesis systems for the treatment of mandibular fractures. Methods: Following PRISMA guidelines, a systematic literature search was conducted in MEDLINE, Embase, and CENTRAL. Comparative studies, such as randomized controlled trials (RCTs) and non-randomized studies, were included. The primary outcome was the rate of hardware removal; therefore, a random-effects meta-analysis was performed to calculate a pooled Odds Ratio (OR), while the risk of bias was assessed using the Cochrane RoB 2 and ROBINS-I tools. Results: Eight studies, including four RCTs, comprising a total of 369 patients, were included, with most studies judged to be at a high or serious risk of bias due to inadequate randomization, lack of blinding, and confounding co-interventions. The meta-analysis of four RCTs on hardware removal revealed no statistically significant difference between the biodegradable and titanium groups (pooled OR 0.28, 95% CI 0.04 to 1.90), with substantial and statistically significant heterogeneity observed (I² = 66.1%). Qualitative synthesis indicated that biodegradable systems were associated with higher rates of intraoperative screw breakage and longer operative times, while rates of successful bone union were comparable between the two groups. Conclusions: Biodegradable osteosynthesis systems represent a viable alternative to titanium for mandibular fracture fixation, demonstrating similar efficacy in achieving bone union, which is counterbalanced by higher rates of screw breakage and longer operative times. The decision to use a biodegradable system involves a critical trade-off that should be designed for the specific clinical scenario. The high risk of bias and significant heterogeneity limit the certainty of these findings, underscoring the imperative for future high-quality, long-term RCTs. Full article

Background/Objectives: Point-of-care ultrasound (POCUS) is an accessible and low-cost diagnostic tool that is seldom used by orthopedic residents. This study aims to assess the efficacy of a POCUS training program within an orthopedic surgery residency curriculum in terms of knowledge retention and clinical usage among the group of residents. Methods: This study included didactic and hands-on teaching sessions. The impact of the teaching sessions was evaluated through surveys (pre-course, immediate post-course, and 6 months post-course). The surveys were divided into three sections: participant’s interest in and usage of POCUS, ultrasound-related knowledge, and perceived limitations related to the usage of ultrasound. All orthopedic residents who attended the teaching sessions and completed all the surveys were included. Results: There were 14 participants. There was a significant increase in interest in POCUS (scale 1 to 5) from 3.36 ± 0.50 in the pre-course survey to 3.93 ± 0.83 in the final post-course survey (p = 0.04). However, there was no significant change in the amount of POCUS usage in clinical settings. Levels of comfort with ultrasound-related procedures significantly increased immediately following the teaching session but did not stay significantly higher after 6 months. When tested on knowledge, the residents’ scores were still significantly greater than they were at the time of the pre-course test at 6 months (p = 0.01). Lack of ultrasound-related knowledge, lack of time, and site culture were the two most prevalent perceived barriers. Conclusions: This study demonstrates that POCUS teaching for orthopedic residents yields long-term benefits in terms of interest and knowledge. However, recurrent teaching sessions and further efforts are required to address perceived obstacles to PoCUS usage and increase clinical implementation. Full article

Background/Objectives: Prepectoral direct-to-implant reconstruction is widely used, but implant rippling often necessitates lipofilling. This study aimed to identify preoperative and perioperative factors associated with delayed lipofilling. Methods: A retrospective cohort of consecutive patients who underwent immediate prepectoral implant reconstruction (April 2023–September 2024) was analyzed. Demographic data, BMI, smoking, comorbidities, oncologic treatments, surgical factors, and tumor location were recorded. Patients were divided according to whether delayed lipofilling was required. Univariate analysis was performed using Mann–Whitney U and Fisher’s exact tests. Results: Fifty-eight patients were included; approximately one-third required lipofilling. Patients who underwent lipofilling were younger and had lower BMI than those who did not. Tumor location was strongly associated with the outcome: upper inner quadrant tumors were consistently linked to delayed lipofilling, whereas upper outer quadrant tumors were more frequently observed in the group not requiring revision. Smoking history and planned radiotherapy showed nonsignificant trends toward higher lipofilling rates. No differences were found for diabetes or corticosteroid therapy. Conclusions: Younger age, low BMI, and tumor location, particularly in the upper inner quadrant, were key factors associated with delayed lipofilling after prepectoral reconstruction. These variables may support preoperative counseling and follow-up planning to better anticipate secondary procedures and optimize aesthetic outcomes. Full article

Background and objectives: Anterior cruciate ligament reconstruction (ACLR) is often associated with significant postoperative pain. Effective pain control is vital for early mobilization and reducing opioid use. While femoral nerve block (FNB) and adductor canal block (ACB) are common, they can cause motor weakness and incomplete analgesia. The genicular nerve block (GNB), typically used for chronic knee pain and arthroplasty, may offer a motor-sparing alternative for ACLR pain management. This review evaluates the evidence on GNB’s effectiveness for pain control, opioid reduction, and recovery after ACLR. Materials and Methods: A literature search (January 2014–May 2025) identified five studies involving adult ACLR patients receiving GNB. Data on demographics, techniques, pain scores, opioid use, and complications were analyzed. Results: Among 115 patients, GNB provided effective analgesia and reduced opioid needs. Randomized trials showed GNB was comparable to ACB and more effective when combined. Ultrasound, especially with Doppler, enhances precision and safety. No major motor deficits or adverse events were noted. Landmark-based approaches also showed utility in low-resource settings. Conclusions: GNB is a promising, motor-sparing option for postoperative pain in ACLR. Further high-quality trials are needed to confirm the benefits and standardize its use. The findings should be interpreted with caution, as the current evidence is of limited quality and lacks generalizability. Full article

Background/Objectives: Over the last decade, the role and timing of lymph node dissection (LND) in stage III melanoma has shifted from completion LND after a positive sentinel node to a mainly therapeutic procedure for clinically evident nodal disease, driven by randomized evidence showing no survival benefit for routine completion dissection. In this evolving landscape, real-world data on postoperative morbidity—by nodal basin—and on whether complications may influence melanoma-specific survival (MSS) and disease-free survival (DFS) remain limited. We evaluated 90-day postoperative complications after cervical, axillary, and inguino–iliac–obturator LND and explored their association with survival outcomes and treatment era. Methods: We retrospectively analyzed 185 consecutive stage III melanoma patients undergoing LND at a single tertiary center (January 2004–August 2025). Postoperative morbidity was recorded up to 90 days and graded by Clavien–Dindo; given the very low rate of grade > II events, the primary endpoint was a composite of loco-regional surgical field–related complications (persistent seroma, wound dehiscence, surgical-site infection, limb lymphedema). Risk factors were assessed using logistic regression; Firth’s penalized models were applied when appropriate. MSS and DFS were estimated by Kaplan–Meier and explored with Cox models. Results: Median follow-up was 105 months. Surgical field–related complications occurred in 16.8% (31/185), and postoperative mortality was 1.0% (2/185). In multivariable analyses, inguino–iliac–obturator LND was associated with higher odds of overall complications (OR 4.03) and specifically wound dehiscence (OR 4.79) and infection (OR 7.18) versus axillary LND. MSS (n = 179) was 82% at 1 year, 55% at 5 years, and 49% at 10 years; DFS (n = 171) was 63%, 42%, and 41%, respectively. In era-based comparisons, nodal yield decreased in the post–MSLT-II period without clear separation of MSS/DFS curves; exploratory models did not show a consistent independent signal linking postoperative complications to MSS/DFS. Conclusions: In stage III melanoma, LND was associated with low major morbidity, but clinically meaningful locoregional complications persisted—most notably after inguino–iliac–obturator dissection. These data support careful patient selection and basin-tailored strategies to reduce groin morbidity within modern multidisciplinary management. Full article

Background: The primary concern of hip surgeons is restoring the physiological biomechanics of the hip joint through arthroplasty, thereby enabling patients with osteoarthritis to engage better in daily activities. The modularity of the femoral stem-neck head allows surgeons to better restore the hip’s native biomechanics. However, concerns have been raised regarding the potential postoperative complications. This study aims to evaluate patients’ satisfaction and functional outcomes following primary Total Hip Arthroplasty (THA) with modular stem-neck, with a mean follow-up duration of eight years. Methods: We retrospectively reviewed 208 patients who underwent primary THA with modular stem-neck between February 2012 and July 2019. The follow-up period extended from November 2024 to April 2025. Patients who died from unrelated causes were excluded. Patients’ satisfaction was assessed using the SF-36 questionnaire, while functional outcomes were evaluated using the Harris Hip Score (HHS). Intraoperative and postoperative complications were meticulously documented. Results: The average follow-up duration was 95.6 months, with a range from 67.7 to 159.7 months. The mean SF-36 score was 91.2 out of 100, indicating high patient satisfaction. The mean HHS was 90 out of 100, reflecting excellent functional outcomes. Notably, some patients achieved the maximum score of 100 in both SF-36 and HHS assessments, while the lowest recorded scores were 54 and 50, respectively. The mean age of patients at the time of surgery was 67.1 years. One case of periprosthetic fracture was reported; however, no complications related to modular necks, such as trunnionosis or implant failure, were observed. Conclusions: The present study demonstrates that modular neck primary THA could achieve excellent functional and radiological outcomes, high patient satisfaction, and outstanding long-term survivorship, provided that implant selection and surgical technique follow biomechanical principles. Full article

Background: Extramedullary spinal tumors represent a significant challenge for spine surgeons. Currently, various techniques exist to perform tumor resection safely while optimizing patient outcomes. Historically, the standard of care has been open surgery; however, in the last two decades, Minimally Invasive Spine Surgery (MISS) techniques have gained importance due to superior postoperative recovery. Literature on Unilateral Biportal Endoscopy (UBE) for tumor resection is currently limited. We propose that UBE has the potential to become a standard approach for these lesions due to its distinct advantages. Methods: We performed a retrospective review of 11 patients who underwent UBE resection of lower thoracic and lumbar spinal extramedullary tumors. We analyzed clinical files and intraoperative endoscopic videos to describe our surgical technique step by step. We also evaluated the advantages of this approach in terms of resection rate, operative time, operative blood loss, and hospital stay. A representative case is also presented. Results: Clinical resolution and significant symptomatic improvement were achieved in all cases, as evidenced by functional and pain scales. In terms of tumor resection, we obtained results comparable to other MISS techniques and open surgery, with a low complication rate. Conclusions: UBE represents a safe, effective evolution in MISS for spinal tumors. Future studies with larger cohorts are needed to validate these findings as a standard of care. Full article

Replantation of an amputated finger is a complex microsurgical procedure that is rarely attempted in low-resource settings due to limited infrastructure and expertise. We report a case of complete amputation of a finger in rural Kenya that was successfully replanted during a humanitarian surgical mission. A 28-year-old man sustained a severe crush avulsion agricultural machine injury resulting in the amputation of all ten digits; only one digit was deemed suitable for replantation. The replantation was performed under loupe and microscope magnification by a visiting specialist team in collaboration with local staff. Intraoperatively, bony fixation with Kirschner wires, extensor and flexor digitorum profundus tendon repair, arterial and venous anastomoses, and neurorrhaphy of the digital nerve were achieved. Postoperatively, the finger survived with adequate perfusion. At one-month follow-up, the replanted finger was viable with progressing wound healing and early joint motion; further rehabilitation was arranged to maximize functional recovery. This case, which is, to our knowledge, one of the first documented digital replantations in East Africa, illustrates that successful microsurgical limb salvage is feasible in a non-specialized hospital setting. Our experience underscores that, with proper planning, training, and teamwork, advanced reconstructive procedures like finger replantation can be safely carried out even in resource-constrained hospitals, offering patients in low-income regions outcomes previously achievable only in high-resource centers. Full article

Background and Clinical Significance: With increasing demand for total knee arthroplasty (TKA), the incidence of post-operative instability has also risen. Although fracture of the polyethylene tibial post in posterior-stabilized (PS) prostheses is relatively uncommon, it should not be overlooked because delayed recognition may lead to severe late sequelae. Case Presentation: Between April 2008 and January 2020, 132 revision TKAs were performed at our institution due to suspected instability with or without component loosening. Among these, three patients were identified as having instability associated with fracture of the polyethylene tibial post in PS implants. All three patients presented late, with a mean interval of 49.66 months (range 34–74) after the index TKA. At presentation, all demonstrated multiplanar global instability, and two showed recurvatum deformity. Pre-operatively, revision surgery was indicated due to progressive global instability. Although tibial post fracture was suspected as a possible underlying cause, the diagnosis could not be definitively established until intraoperative inspection, which confirmed polyethylene tibial post fracture in all cases. Each patient underwent revision TKA using a semi-constrained prosthesis with an increased polyethylene insert height. At final follow-up (12–18 months), all patients achieved complete resolution of clinical instability and demonstrated meaningful improvement in the Hospital for Special Surgery (HSS) and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores. Conclusions: Although rare, polyethylene tibial post fracture should be considered in the differential diagnosis of post-operative knee instability following PS TKA. Early recognition may allow management with isolated polyethylene exchange, whereas delayed diagnosis can result in progressive ligamentous insufficiency and global multiplanar instability, ultimately necessitating revision using a semi-constrained implant. Full article

Background: The prognostic trends for adults who undergo fracture surgery for metastatic long bones remain unclear, even as survival among individuals with bone metastasis has improved. Because prognoses after fracture surgery may shift over time, this chronological study aimed to evaluate outcomes in individuals who received surgical treatment for femoral metastasis. Methods: This multicenter retrospective study included 186 adults who underwent fracture surgery for metastatic femoral disease between 2008 and 2023. Individuals were categorized into period 1 (2008–2016) and period 2 (2017–2023). The primary outcome was 1-year overall survival. Prognostic variables included fracture type (impending pathological fracture (IF) or completed pathological fracture (CF)), recovery of ambulation, and receipt of chemotherapy. Results: Individuals in period 2 were older and had a higher rate of solitary bone metastasis; however, period 2 did not demonstrate a higher proportion of IF relative to CF. Multivariate analysis showed that the hazard ratio for period 2 compared with period 1 was 0.57 (95% confidence interval: 0.35 to 0.94, p = 0.02). Conclusions: This chronological assessment demonstrated that the later period was associated with improved 1-year overall survival after fracture surgery for metastatic long bone disease. Because prophylactic fixation for IF is linked to more favorable outcomes, increasing the proportion of IF cases relative to CF should be prioritized. Full article

Although occult breast carcinomas and lesions with uncertain malignant potential are rare, their incidental discovery during symmetrizing mammoplasty can significantly alter the treatment approaches and cancer staging. In the context of oncoplastic surgery, the systematic evaluation of the contralateral breast is a clinical priority that has been underexplored in Eastern Europe. Background/Objectives: This study aimed to assess the incidence and histological characteristics of incidental carcinomas and B 3 lesions detected during contralateral symmetry mammoplasty in patients with breast cancer. Methods: This retrospective study was conducted at the Plastic and Reconstructive Surgery Clinic of the “Pius Brînzeu” County Emergency Clinical Hospital in Timisoara, Romania, over six years (2018–2024), and included 180 of 256 patients who underwent contralateral breast symmetrization. Results: Among the 180 patients, 21 (11.66%) had incidental findings: eight (4.44%) had contralateral carcinomas, and 13 (7.22%) had B3 lesions. The histopathological types identified were invasive ductal carcinoma NST (one case), ductal carcinoma in situ (one case), invasive lobular carcinoma (five cases), and mucinous/papillary carcinoma (one case). Compared to the reported international range of 2–10%, our observed incidence of 11.66% reflects the unique aspects of our patient cohort and the thoroughness of our histological analyses. Conclusions: Detection of contralateral carcinomas and B3 lesions during symmetry mammoplasties underscores the importance of a multidisciplinary approach, comprehensive bilateral screening, and detailed histopathological examination of specimens. Full article

The combination of anatomical inaccessibility, less-than-optimal blood supply, tightly closed anal sphincters below a low anastomosis, and an infected haematoma is likely to be contributory to anastomotic leakage following low anterior resection of the rectum for rectal cancer. Although under-reported, chronic pelvic sepsis complicating low anterior resection of the rectum is still a major problem associated with impaired quality of life. It should be avoided as much as possible, in addition to the fact that it is more difficult to manage surgically than acute sepsis. Primary preventive measures are well established. Secondary prevention of chronic pelvic sepsis is achieved by early diagnosis and active management of the anastomotic leak. However, optimal postoperative management cannot fully eliminate chronic sinuses or delayed reactivation leaks. With chronic leakage, major restorative redo-anastomosis or ablative abdominal perineal resection is required and 20% of patients will require a permanent stoma. Full article

Scapholunate (SL) ligament injuries, if not properly treated, can compromise wrist biomechanics, leading to instability, scapholunate advanced collapse (SLAC) and progressive osteoarthritis. Depending on the severity of the injury, current repair techniques include either arthroscopic or open surgical approaches; however, the limited vascularization of the region often represents an obstacle to optimal ligament healing. This study aims to assess the feasibility of using a vascularized fascial flap based on the 1,2 intercompartmental supraretinacular artery (1,2 ICSRA) for biological augmentation of the scapholunate ligament. Five previously injected cadaveric upper limbs were dissected and flap dimensions, including length, width, and pedicle length, were measured using a millimeter-calibrated ruler by two independent operators. All flaps provided sufficient coverage, and the vascular pedicle length allowed tension-free positioning without vascular kinking. These findings demonstrate that a 1,2 ICSRA-based fascial flap is anatomically feasible for scapholunate ligament augmentation. It should be noted that this is a purely cadaveric study, and the technique has not yet been tested in vivo. The results suggest potential surgical applications, providing a vascularized biological option that may enhance ligament healing in future clinical studies. Full article

Total hip arthroplasty (THA) is a transformative procedure for managing severe hip disorders, yet implant longevity remains a critical challenge, particularly for younger, active patients. Wear-related complications are a leading cause of revision surgery, emphasizing the need for optimized design and material performance. This systematic review aims to synthesize evidence on the wear behavior, material properties, and design parameters of hip implants with a focus on finite element analysis (FEA)-based predictive approaches. A comprehensive literature search was conducted across Scopus, PubMed, ScienceDirect, MDPI, and Cochrane databases following PRISMA guidelines. Studies published between 2010 and 2025 were included if they addressed THA biomechanics, wear analysis, or material optimization using FEA, hip simulators, or radiostereometric techniques. Key findings reveal that larger femoral heads, while reducing contact pressure, increase wear due to greater sliding distance. Gravimetric wear rates ranged from 3.15 ± 0.27 mg/Mc to 2.18 ± 0.31 mg/Mc, while linear and volumetric wear reached 0.0375 mm/Mc and 33.6 mm³/Mc, respectively. Stress analysis showed custom stems exhibited markedly lower von Mises stress (194.9 MPa) compared to standard designs (664.3 MPa), and fatigue assessments confirmed a factor of safety > 1 across profiles. Patient-specific factors, such as body weight, significantly influenced wear with a 26% increase in metal wear observed between 100 kg and 140 kg. This systematic review synthesizes current research on total hip arthroplasty, emphasizing biomechanical and material factors critical for implant longevity and patient care. It uniquely integrates FEA-based wear prediction with clinical implications, bridging computational modeling, geometry optimization, and material performance to provide actionable insights for next-generation, patient-specific hip implant design. Full article