Search Results (1,039)

Background and Objectives: Total femoral replacement (TFR) was originally developed for limb salvage following the resection of malignant tumors. Over time, its indications have expanded, now serving as a reconstructive option for failed endoprosthetic replacements and severe trauma cases. Despite its advantages, TFR is a highly complex surgical procedure associated with significant complication rates. This study aims to analyze the management of complications and propose strategies to mitigate associated risks. Materials and Methods: This is a retrospective study conducted on patients from two independent hospitals who underwent TFR for different reasons. Results: Nineteen patients were included: eight underwent TFR for oncological indications, while 11 had the procedure as a revision following failed endoprosthetic arthroplasty or trauma. Postoperative complications were observed in 10 patients (53%), including hip dislocation (21%), mechanical implant failure (11%), infection (21%), wound healing complications (26%), and metal allergy symptoms (5%). Revision surgery was required in six patients (32%), but no cases necessitated amputation. Conclusions: TFR is associated with a high risk of complications, with infection and wound healing issues being the most prevalent. In our experience effective complication management strategies should include early intervention, considering TFR at an earlier stage in non-oncological patients to minimize multiple revision surgeries; allergy screening, assessing for potential metal hypersensitivity preoperatively; dislocation prevention, implementing dual mobility bearings to reduce instability; infection control, utilizing intraoperative local antibiotic therapy in revision cases; and wound management, applying vacuum-assisted closure (VAC) therapy postoperatively to enhance wound healing. Implementing these strategies may improve patient outcomes and reduce the burden of complications associated with TFR. Full article

Background: Frail patients undergoing hip and knee revision surgery represent a major anesthetic challenge because of advanced age and multiple comorbidities. Continuous spinal anesthesia (CSA) with titrated low-dose levobupivacaine may offer a potentially useful alternative to general anesthesia or single-shot spinal anesthesia in this high-risk population. Methods: A retrospective review was conducted of ASA II-III patients who underwent complex hip and knee revision surgeries between February and October 2024 under CSA. The technique was performed using a 25-gauge spinal catheter with incremental boluses of 0.25% levobupivacaine (2.5 mg). Hemodynamic parameters, including mean arterial pressure (MAP), stroke volume index (SVI), and cardiac index (CI), were continuously monitored using the EV1000 hemodynamic monitoring system. Postoperative complications were recorded. Results: 37 high-risk patients were included in the study. Catheter placement was successful in all patients, with no conversions to general anesthesia. MAP decreased by a mean of 14.6% after boluses (p < 0.05); 9 patients (24.3%) experienced reductions ≥ 20%, but all remained >65 mmHg and responded to fluid therapy. CI and SVI decreased by 10.1% and 10.5%, respectively (p < 0.05), without clinical instability. No major complications (neurological injury, infection, post-dural puncture headache) were observed. Conclusions: In this retrospective single-center experience, CSA with titrated low-dose levobupivacaine was feasible and associated with stable hemodynamic profiles and a low rate of complications in frail patients undergoing complex lower-limb revision surgery. However, given the absence of a control group and the limited sample size, these findings should be interpreted cautiously. Further prospective comparative studies are needed to better define the role of CSA in high-risk orthopedic patients. Full article

Background: Dual mobility (DM) total hip arthroplasty (THA) was introduced to reduce postoperative instability, one of the most frequent causes of revision after hip replacement. Its use has progressively expanded beyond revision surgery to selected high-risk primary cases; however, comparative data integrating both clinical and radiographic outcomes from real-world tertiary centers remain limited. Methods: A retrospective comparative study was conducted including 78 patients who underwent THA with a DM acetabular component between January 2019 and December 2024, and 78 matched controls who received conventional fixed-bearing THA during the same period. Matching criteria were age, sex, and procedure type (primary versus revision). Clinical outcomes were assessed using the Harris Hip Score (HHS) and visual analogue scale (VAS) for pain. Radiographic evaluation focused on component positioning, radiolucent lines, and signs of loosening. Complications and revision rates were compared between groups. Results: The mean age was 71 ± 9 years, and 62% of patients were female. Mean follow-up was 38 months. HHS improved from 54 ± 10 preoperatively to 89 ± 8 postoperatively in the DM group (p < 0.001), with similar final functional outcomes in the conventional THA group (90 ± 9, p = 0.48), and comparable improvement between groups (p = 0.62). Radiographic parameters demonstrated stable fixation and appropriate component positioning in both groups, with no significant intergroup differences. The dislocation rate was numerically lower in the DM group (1.3% vs. 5.1%), although this difference did not reach statistical significance (p = 0.37). No cases of intraprosthetic dislocation occurred. Overall implant survival free from revision at five years was 96.5% for DM and 94.7% for conventional THA (p = 0.47). Conclusions: DM THA achieved excellent clinical and radiographic outcomes, with a numerically lower dislocation rate than conventional THA. Mid-term implant survivorship was comparable between groups, supporting DM as a reliable option for improving stability in appropriately selected patients. Full article

Background and Objectives: Postoperative delirium and postoperative cognitive dysfunction are common complications in older adults undergoing elective non-cardiac surgery, associated with increased morbidity and mortality, functional decline, and prolonged hospital stay. Prolonged preoperative fasting may intensify inflammatory responses and insulin resistance. Preoperative oral carbohydrate loading within ERAS protocols may modulate this response and reduce cognitive risk. Materials and Methods: A scoping review was conducted following the methodological recommendations of Arksey and O’Malley, the Joanna Briggs Institute, and PRISMA-ScR. A systematic search was performed in PubMed and Scopus for studies published up to September 2025. Randomized controlled trials and observational studies including adults ≥ 65 years undergoing elective non-cardiac surgery were included if they evaluated fasting modifications or preoperative carbohydrate loading and reported postoperative delirium or cognitive dysfunction. Results: A total of eight publications were included: four randomized controlled trials, one prospective cohort study, two cross-sectional studies, and one descriptive/correlational study. Populations included older adults undergoing elective abdominal, orthopedic, colorectal, or hip surgery, as well as hospitalized elderly surgical patients. Interventions included oral carbohydrate loading, assessment of preoperative nutritional status, and enteral versus parenteral nutrition. Only four of the eight included studies directly evaluated neurocognitive outcomes. Postoperative delirium was assessed in three studies, using the Confusion Assessment Method in two studies and the Delirium Rating Scale in one study. Postoperative cognitive dysfunction was evaluated in one study using a Mini-Mental State Examination-based cognitive assessment, while the remaining four studies did not assess neurocognitive outcomes and instead focused on metabolic, inflammatory, or perioperative well-being outcomes. Conclusions: Available evidence suggests that perioperative fasting protocols and preoperative carbohydrate loading may influence metabolic and inflammatory responses related to postoperative neurocognitive outcomes in older adults. However, evidence remains limited and heterogeneous. Findings are exploratory and hypothesis-generating, highlighting the need for well-designed trials assessing neurocognitive outcomes in geriatric surgical populations. Full article

Introduction: Periprosthetic joint infections (PJI) are among the most serious and costly complications in orthopedic surgery, significantly affecting patient prognosis and healthcare systems. Despite rigorous aseptic measures, intraoperative contamination of sterile fields, instruments, and air remains a persistent source of potential infection. This study investigates the relationship between the microbial contamination of sterile fields during arthroplasty and postoperative inflammatory markers, with the objective of determining whether the contamination of sterile fields correlates with the presence of periprosthetic joint infection (PJI). Material and Methods: This prospective observational study included 33 patients undergoing total hip or knee arthroplasty in a university-affiliated orthopedic center. Intraoperative samples were collected from sterile fields and equipment to detect microbial contamination, while postoperative monitoring involved the C-reactive protein (CRP); erythrocyte sedimentation rate (ESR); leukocyte count; temperature; and wound assessment on days 1, 3 and 7. All patients received 48 h of prophylactic cefuroxime. Statistical analysis was conducted using the International Business Machines (IBM) Statistical Product and Service Solutions (SPSS) software for Windows, version 30.0 (IBM Corporation, Armonk, New York, United States of America) with significance set at p ≤ 0.05. Results: Postoperative inflammatory markers showed distinct patterns depending on the isolated microorganism, with Proteus vulgaris and Staphylococcus hominis ssp. consistently associated with higher CRP and leukocyte values, indicating a more intense systemic response. Staphylococcus epidermidis was the most frequently isolated species but showed moderate inflammatory profiles, suggesting its potential role in subclinical colonization. A strong correlation between CRP on day 3 and leukocyte count (r = 0.81) confirms their combined utility in the early detection of infectious complications, while ESR appeared less dynamic and more complementary in nature. Discussion: This study highlights the significant role of intraoperative contamination and microbial virulence in shaping the postoperative inflammatory response after arthroplasty. Elevated CRP and leukocyte levels, particularly on day 3, were closely associated with pathogens known for biofilm formation and chronic infections. Despite prophylactic antibiotic use, confirmed infections still occurred, suggesting the need to reassess current protocols and enhance intraoperative contamination control. Conclusions: Pathogen presence in sterile fields during arthroplasty increases the risk of periprosthetic joint infections, often without early clinical symptoms. CRP on day 3 and leukocyte count were the most reliable early indicators of persistent inflammation. Full article

Background/Objectives: Hypoalbuminemia is a marker of poor nutritional status and has been associated with increased postoperative complications following total joint arthroplasty. However, its long-term implications in the revision total hip arthroplasty (THA) population are poorly characterized, and the utility of prealbumin to further risk-stratify these patients remains unclear. We aimed to study the association between preoperative hypoalbuminemia and complications after rTHA. Methods: We identified patients who underwent rTHA with preoperative albumin levels obtained within one month of surgery. Patients were divided into hypoalbuminemia (<3.5 g/dL) and normal albumin (3.5–6.0 g/dL) cohorts. A second analysis was conducted stratifying hypoalbuminemia patients by prealbumin level (<16 mg/dL vs. ≥16 mg/dL), measured within two weeks of surgery. Each cohort was 1:1 propensity score matched with a 1:1 nearest-neighbor greedy matching approach with a 0.10 standard deviation (SD) caliper, following a logistic regression to calculate patient propensity scores. Outcomes were compared at 90-day, 2-year, and 5-year intervals. Results: The matched cohorts included 4137 patients in both the hypoalbuminemia and normal-albumin groups. Hypoalbuminemia was significantly associated with increased short-term rates of any adverse event (38.9% vs. 22.5%; OR 2.195), wound dehiscence (5.4% vs. 3.1%; OR 1.808), surgical site infection (10.7% vs. 5.0%; OR: 2.271), and periprosthetic fracture (13.9% vs. 10.2%; OR: 1.414). Repeat revision THA was significantly more common within 90 days (6.6% vs. 4.5%; OR: 1.490). Periprosthetic fracture and prosthetic loosening were also more common within 2 years and 5 years (q = 0.001). There were no differences in repeat rTHA within 2 years and 5 years. Among hypoalbuminemic patients with prealbumin data, stratification by prealbumin level did not demonstrate any statistically significant differences in 90-day, 2-year, and 5-year complications. Conclusions: Hypoalbuminemia is a strong indicator of increased complication risk after rTHA, with increased risk for complications lasting to at least 5 years postoperatively. However, prealbumin stratification among hypoalbuminemic patients did not differentiate complication risk. These findings support preoperative albumin as a practical biomarker for risk stratification in rTHA patients. Full article

Background and Objectives: Medial unicompartmental knee arthroplasty (UKA) has emerged as an effective surgical option for isolated medial compartment osteoarthritis (OA), offering advantages in bone preservation, knee kinematics, and postoperative recovery compared with total knee arthroplasty (TKA). Although numerous studies have evaluated the mid- to long-term outcomes of UKA, reports focusing on cohorts with follow-up periods exceeding 10 years remain relatively limited. The purpose of this study was to analyze the long-term clinical and radiological results of medial fixed-bearing UKA using the Miller-Galante prosthesis. Methods: Sixty-eight patients who underwent UKA at a single institution with at least 10 years of follow-up were retrospectively reviewed. Clinical outcomes were assessed using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score and knee range of motion (ROM). Radiological parameters including the hip-knee-ankle axis angle (HKA) and osteoarthritis (OA) grade using the Kellgren-Lawrence (K-L) grading system were evaluated. Implant survivorship was evaluated using Kaplan–Meier survival analysis. Results: A total of 68 patients were included with a mean age of 56.8 ± 7.5 years at surgery and a mean follow-up of 170.9 ± 37.3 months. Significant improvement in the WOMAC score was observed from 48.9 ± 17.2 preoperatively to 23.8 ± 27.7 at final follow-up (p = 0.002). The cumulative survival rates were 97.1% at 10 years and 84.8% at 15 years with conversion to total knee arthroplasty as the endpoint. Significant improvement in the HKA was observed from 172.5° ± 4.4° to 174.3° ± 4.8° postoperatively (p = 0.002), though residual varus alignment persisted. Progressive OA was observed in the lateral tibiofemoral and patellofemoral compartments (both p < 0.001) but showed no correlation with the WOMAC score. The failure group showed trends toward higher body mass index (BMI) and smaller preoperative HKA angle compared to the non-failure group. Conclusions: The long-term outcomes of medial fixed-bearing UKA using the Miller–Galante prosthesis were generally favorable, with significant functional improvement and acceptable implant survivorship. Although overall varus alignment was corrected, some residual varus deformity remained, and OA progression was observed in the lateral tibiofemoral and patellofemoral compartments over time. However, given the retrospective design and limited sample size, these findings should be interpreted with caution. Full article

Background: In children with cerebral palsy, bony acetabular deficiencies are common and may be associated with progressive hip subluxation, abnormal joint loading, and ultimately hip dislocation. Hip reconstruction surgery is typically performed to prevent dislocation, and this includes acetabular reshaping using acetabuloplasty. The location of acetabular deficiency may vary among individuals; however, only radiographs are used for planning and intraoperative correction in many centers. Precise reconstruction and preop planning are necessary for the accurate correction of acetabular coverage. This study compares conventional hip reconstruction with a 3D-guided technique using individual preop 3D planning and 3D-printed guides during surgery to determine which method allows for a more accurate correction. We hypothesize that the patient-specific 3D planning leads to more precise anatomical correction of acetabular coverage compared to conventional freehand osteotomy. Methods: This study was registered in the German Clinical Trial Register (DRKS-ID: DRKS00031356) on 14 July 2023. In a randomized controlled trial, various imaging-based parameters were used to assess the bony anatomy preoperatively and postoperatively. Preoperative and 6-week postoperative computed tomography (CT) scans are part of routine clinical care. Additionally, an immediate postoperative CT scan was performed. One hip was operated on using individualized 3D preoperative planning, while the other hip was corrected using a conventional surgical approach. A standardized subtrochanteric osteotomy was performed for the varisation, derotation, and shortening of the proximal femur. This osteotomy was followed by acetabuloplasty under fluoroscopic control. For the 3D-planned operation, patient-specific cutting and repositioning guides were produced based on preoperative CT imaging. Patients with bilateral cerebral palsy (GMFCS levels I–V), aged 4–18 years, with an open triradiate growth plate and a migration index ≥ 40% in at least one hip were included. In a preliminary retrospective part, this project reproduces the existing three-dimensional acetabular index (3-DAI) and compares it with established radiographic methods to determine the utility and reliability of a reconstructed 3D CT measurement technique. A further component of the retrospective part is the creation of an age-adjusted database of typically developed hips and the development of a 3D head coverage index (3D-HCI) as a new 3D parameter to express acetabular coverage; therefore, it will be used as a secondary parameter and correlated to the 3DAI in the prospective part. Conclusions: Improved precision may have meaningful clinical implications for long-term joint congruency, load distribution, pain, and mobility outcomes. Full article

Background and Objectives: Hip fracture surgery is considered a major operation due to the risk of complications and increased mortality. COVID-19 is a newly recognized risk factor for increased mortality in regard to various diseases. Materials and Methods: The aim of this retrospective observational study, conducted from January 2018 to April 2022, was to analyze mortality among rehabilitation ward patients after surgical treatment of acetabular or femoral fractures in both the COVID-19 and pre-COVID-19 periods. The association between mortality and age, gender, comorbidity status, and number of complications during hospital stay was also examined. Results: Higher mortality was observed in the COVID-19-period group during all analyzed periods: cumulative three-year mortality was 2.3 times higher (14.2% vs. 6.2%, p = 0.013); two-year mortality was 3.7 times higher (9.2% vs. 2.5%, p = 0.005); and first-year mortality was 8.3 times higher (5.0% vs. 0.6%, p = 0.006). The Charlson Comorbidity Index (CCI) and admission during the COVID-19 period were strong predictors of mortality, while the number of complications, age, and gender did not significantly influence the mortality rate. An increase of one point in CCI resulted in a 42% increase in the likelihood of mortality, while hospitalization during the COVID-19 period was associated with an odds ratio of 2.44 for death compared to the pre-COVID-19 period (p = 0.013, 95% CI [1.19, 4.94]). Conclusions: The excess mortality may be attributed to the COVID-19 pandemic because the groups were comparable in all other aspects (Barthel index, CCI, complications, age, and gender). Additional five-year mortality data will be useful for analyzing mortality dynamics, as pre-COVID-19 patients will enter the COVID-19 period and COVID-19 patients will enter the post-COVID-19 period. Full article

Background/Objectives: Osteoporosis and osteoarthritis are age-related musculoskeletal disorders with a high socio-health burden, affecting both healthcare systems and individuals’ quality of life. Both conditions are generally accompanied by a concomitant decline in muscle mass and strength, referred to as sarcopenia. In this context, tensiomyography emerges as a novel, non-invasive potential diagnostic strategy for assessing muscle quality, as this parameter influences the progression of both conditions. Methods: Histomorphometric and immunohistochemical analyses were performed on vastus lateralis muscle tissue obtained from patients undergoing surgery for femoral fracture affected by osteoporosis or osteopenia, patients operated for hip osteoarthritis, and patients undergoing hip arthroplasty for osteoarthritis, concomitantly affected by osteoporosis or osteopenia. In addition, muscle function was assessed in these patients using tensiomyographic analysis. Results: In osteoarthritic, osteoporotic, and osteopenic patients, a reduction in muscle quality and function was observed compared with the other two experimental groups, indicating an unfavorable effect of the coexistence of the two conditions on the muscular component. Furthermore, contraction time (Tc) measured by tensiomyography was negatively correlated with lumbar spine bone mineral density values and positively correlated with the percentage of type II muscle fibers. Conclusions: This study highlights how tensiomyography may represent a valuable non-invasive diagnostic strategy for assessing muscle status in osteoporotic and osteoarthritic patients, as it is able to detect muscle alterations that parallel the worsening of bone status and that cannot be inferred from simple biopsy analysis. Thus, tensiomyography could be considered a practical adjunct tool in the clinical assessment of musculoskeletal frailty. Full article

Osteoarthritis (OA) represents a degenerative joint disease which advances through cartilage breakdown, synovial inflammation, and subchondral bone transformation until it causes persistent pain and mobility loss. The scientific community lacks complete knowledge about OA disease mechanisms and post-operative healing processes despite arthroplasty surgery providing effective symptom relief. This study investigated plasma proteomic changes in OA patients before and after arthroplasty. The cohort included eight OA patients undergoing knee or hip arthroplasty and ten age-, sex-, and body mass index-matched healthy controls. Plasma proteins were analyzed using liquid chromatography–tandem mass spectrometry following enzymatic digestion and depletion of high-abundance components. The bioinformatic analysis together with quantitative methods showed that OA patients experienced changes in inflammatory pathways, extracellular matrix remodeling, immune system regulation and coagulation processes. A total of 93 proteins were differentially abundant in the pre-operative comparison. Among these, 63 proteins were consistently up-regulated and 23 were consistently down-regulated across both pre- and post-operative time points. In addition, 20 proteins exhibited post-operative-specific changes. These findings highlight both persistent disease-associated alterations and transient proteomic shifts linked to post-operative recovery. Overall, this study identifies candidate plasma proteomic signatures associated with OA and surgical intervention, providing exploratory insights into disease monitoring and potential personalized therapeutic strategies. Full article

Background: Work-related musculoskeletal disorders (WMSDs) are common among surgeons. The objective was to study how economic, demographic, and quality-of-life indicators influence the WMSD prevalence among European surgeons. Methods: A systematic review and meta-analysis was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Three open databases were scanned without a date limit to extract the overall WMSD prevalence and by body area. Results: Among the 11,814 articles, 25 were included, with a total of 5174 surgeons. The overall prevalence was pooled at 75.8% (95% CI: 68.6–83.1%). The most affected areas were lower back (52.1%, 95% CI: 43.1–61.0%), neck (51.2%, 95% CI: 43.7–58.9%), shoulder (43.1%, 95% CI: 36.4–49.8%) and upper back (34.2%, 95% CI: 24.2–44.1%). Surgeons aged over 45 with more than 10 years’ experience had a higher prevalence of WMSDs in the neck, hip, upper and lower back. The overall and lower back prevalence was higher among surgeons in countries where the surgery-by-surgeon ratio was greater than 125. A negative correlation was observed between the Human Development Index and the lower back prevalence. Conclusions: Further research is needed to strengthen ergonomics programs, knowledge, and organizational work strategies to effectively reduce WMSD prevalence among European surgeons. Full article

Background and Objectives: Hip and knee replacement joint surgeries are experiencing constant growth, and anticipating future needs allows decision-makers and stakeholders involved in the healthcare system to allocate the necessary resources for safe and effective services. The objective of this study is to estimate the volumes of primary and revision hip and knee surgeries expected to be performed in Romania by 2060. Materials and Methods: We used data from the Romanian Arthroplasty Register regarding the total volume of primary hip replacement surgery (cumulative n = 51,252 across five years), hip revision surgery (cumulative n = 3579), primary knee replacement surgery (cumulative n = 32,283), and knee revision surgery (cumulative n = 943) performed in 2017–2019, 2023 and 2024—the last five years of complete registrations, excluding the pandemic period. We projected future numbers of hip and knee primary and revision surgeries using the arithmetic mean of annual procedure rates observed during the study period, combined with the average annual trend in these rates. Projections were stratified by age group (0–39, 40–49, 50–59, 60–69, 70–79, and ≥80 years) and sex and were applied to population forecasts from the National Institute of Statistics of Romania up to 2060. Results: By 2060, primary hip replacement surgery volumes will increase by 40.14% relative to 2024 levels (from 13,526 in 2024 to 18,965 in 2060), and primary knee replacement surgery volumes will increase by 79.78% (from 9003 in 2024 to 16,186 in 2060). Revision hip surgery volumes will increase by 42.02% (from 759 in 2024 to 1078 in 2060), and revision knee surgery volumes will increase by 109.25% (from 227 in 2024 to 475 in 2060). The largest relative increases are concentrated in patients aged ≥80 years, with projected growth substantially exceeding those in younger age groups across all procedure types and both sexes. These percentages represent the projected growth in procedure volumes for this age group compared with 2024 baseline volumes. Conclusions: By 2060, we project substantial increases in all arthroplasty procedure types in Romania, with the most pronounced growth among patients aged ≥80 years. Given that resource utilization and morbidity are higher in this population, the increased demand for medical interventions requires advance planning, which will have significant implications for the healthcare system. Full article

Background/Objectives: Blood loss is a major concern in elderly patients undergoing hip fracture surgery. Tranexamic acid (TXA) is used to improve bleeding outcomes; however, randomized clinical trials (RCTs) report mixed findings, with some studies finding no improvements. This meta-analysis was conducted to evaluate the effectiveness of intravenous TXA in patients with extracapsular proximal femur fractures undergoing surgery. Methods: A systematic literature review was performed to identify relevant RCTs. Evaluated outcomes were total blood loss (TBL), hidden blood loss (HBL), change in hemoglobin (Hb), change in hematocrit (Hct), risk for transfusion and number of transfused units per patient. Review Manager 5.3 was used. Results: Twenty-five RCTs were included. TXA administration was associated with significant reductions in TBL (MD = −255.59 mL, 95% CI −306.50 to −204.68) and HBL (MD = −219.28 mL, 95% CI −286.93 to −151.62) compared with control. Patients receiving TXA had significantly smaller changes in Hb (MD = 0.65 g/dL, 95% CI 0.39–0.90) and Hct (MD = 4.22%, 95% CI 2.04–6.40). TXA significantly reduced the risk of transfusion (RR = 0.55, 95% CI 0.43–0.70) and number of transfused units per patient (SMD = −0.66, 95% CI −1.15 to −0.17). Subgroup analyses showed consistent effects. Sensitivity analyses confirmed robustness of results, except for the significance in reducing the number of transfused units when studies with ‘liberal’ transfusion thresholds were excluded. Conclusions: These findings show statistically significant improvements in bleeding outcomes with the use of intravenous TXA in patients with extracapsular proximal femur fractures undergoing surgery. Further high-quality RCTs are needed to standardize TXA timing and dosing. Full article

Background/Objectives: While sarcopenia has been implicated, we hypothesize that a distinct body composition phenotype, characterized by elevated visceral adiposity and reduced abdominal muscle mass, plays a more critical role in T2DM-related fracture pathogenesis. Methods: In a cross-sectional study of 99 female patients aged ≥65 years who underwent surgery for hip fracture, we compared body composition parameters derived from DXA scans between those with (n = 40) and without (n = 59) T2DM. Key measures included appendicular lean mass index (ALMI), visceral adipose tissue (VAT) mass, android-to-gynoid (A/G) fat ratio, and a derived measure of relative core lean mass (RCLM). Results: There were no significant differences in ALMI between T2DM and non-DM groups. In contrast, T2DM showed significantly higher central adiposity—A/G ratio (1.13 ± 0.15 vs. 1.05 ± 0.17; p = 0.0298) and TL fat ratio (1.31 ± 0.22 vs. 1.19 ± 0.23; p = 0.0071)—with VAT estimate numerically higher. Conclusions: In older hip-fracture patients, T2DM was characterized not by appendicular sarcopenia but by central adiposity without significant differences in LMI or RCLM—a phenotype that may contribute to fracture risk through bone-quality and fall-related pathways independent of ALMI. Full article