Background/Objectives: Total knee arthroplasty (TKA) is a common procedure for knee osteoarthritis. While conventional TKA (C-TKA) remains standard, robot-assisted TKA (RA-TKA) has been introduced to enhance implant positioning and clinical outcomes. However, its comparative benefits remain unclear. This systematic review and meta-analysis compared RA-TKA with C-TKA, examining the influence of robotic system, surgeon experience, and follow-up duration. Methods: A systematic search was conducted across the PubMed, Scopus, Web of Science, and Cochrane Library databases. Randomized controlled trials (RCTs) comparing RA-TKA with C-TKA were included. Outcomes were categorized into clinical, radiographic, and safety endpoints. Subgroup and meta-regression analyses explored factors influencing outcome variability, including robotic system, number of surgeons, and follow-up duration. Results: Twenty-five RCTs (5614 patients) were analyzed. RA-TKA showed modest improvements in clinical outcomes, such as KSS and VAS pain scores, but results varied across subgroups. RA-TKA demonstrated a significantly better flexion range of motion (ROM) in certain countries (e.g., Russia, MD = 10; 95%CI: 5.44, 14.56) and with specific robotic systems (e.g., NAVIO). No significant differences were found in OKS and HSS scores. Radiographic outcomes, including the HKA Angle, varied by robotic system, with NAVIO and YUANHUA showing better alignment than C-TKA. Complication rates were comparable, though RA-TKA had a higher risk of conversion to open surgery (10% vs. 2%). Meta-regression identified robotic system and surgeon experience as key predictors of outcome variability. Conclusions: RA-TKA offers advantages in implant alignment and postoperative pain reduction. However, benefits are inconsistent across settings, and some robotic systems may not provide improvements over C-TKA.

Medication-related osteonecrosis of the jaw (MRONJ) is a relatively common pathology occurring in around 5% of patients taking bisphosphate and other antiresorptive or anti-angiogenic medications. Despite the efforts, as of today there is still no consensus on its management. In this case report, the successful management of stage II MRONJ was performed for an eighty-three-year-old female patient suffering from pain and alteration in her normal oral functions (swallowing and phonation). The treatment consisted of three sessions of photobiomodulation therapy (PBM), followed by minimal surgical intervention and three other sessions of PBM. PBM was applied on the sites of osteonecrosis with the follow parameters: 4 J/cm²; a power of 50 mW; 8 mm applicator diameter; a continuous contact mode. Irradiation was performed on three points, including the vestibular, occlusal and lingual parts of each of the bone exposure areas. Each point was irradiated for 40 s, and, in total, nine points were made per session, and nine sessions were conducted. To assess the pain, a visual analogue scale was used in which zero represented no pain at all and ten represented the greatest pain. At the first session and before any intervention, the patient stated that her pain was 8 out of 10. At the end of the treatment, a significant reduction in VAS was noted (2/10) and, clinically, a healing of the soft tissue in the previously exposed bone was observed. This case report suggests that the combination of PBM with surgical intervention is promising in the management of MRONJ.

Background: We conducted this systematic review to provide comprehensive evidence on the prevalence, clinical features and outcomes of young extraosseous Ewing sarcoma (EES) cases. Methods: PubMed, Scopus, Web of Science, and Google Scholar were searched for articles reporting the occurrence of EES among children and adolescents (<21 years). The primary outcome included the rate of occurrence of EES among children and adolescents, while the secondary outcomes included the descriptive analyses of the demographic characteristics, tumor characteristics, and clinical outcomes of the affected cases. The data are reported as the effect size (ES) and its corresponding 95% confidence interval (CI). Results: A total of 29 studies were included. Twenty-four reported instances of childhood disease among all the EES cases [ES = 30%; 95%CI: 29–31%], while five studies reported extraosseous cases among the pediatric EES cases [ES = 22%; 95%CI: 13–31%]. The thorax is the most common location of childhood EES [33%; 95%CI: 20–46%] followed by the extremities [31%; 95%CI: 22–40%]. Concurrent chemotherapy and radiotherapy [57%; 95%CI: 25–84%] was the most commonly implemented management protocol in the pediatric EES cases. The rate of no evidence of disease and 5-year overall survival was 69% for both outcomes. Mortality occurred in 29% of cases, while recurrence and secondary metastasis occurred in 35% and 16% of cases, respectively. Conclusions: Our findings provide insight into the clinical features and outcomes of EES among children and adolescents.

Background/Aim: The pattern of lower-limb amputation, indications, complications, and revision in pediatric cases differs globally. Therefore, we conducted this study to describe the patterns of lower-limb amputation at our institution. Methods: During a set period between 2010 and 2020, adolescent patients undergoing lower-limb amputation within the orthopedic department of Heidelberg University Hospital were retrospectively collected and analyzed. The retrieved dataset included two parts: data on lower-limb amputations and data on subsequent complications and revision surgeries at the same time. Besides patients’ general information (age, gender), the dataset included data regarding amputation patterns (number, indications, and level of amputation, complications, and revision surgeries and their indications). Results: Twenty-two patients undergoing lower-limb amputation were examined, of which the majority were males (63.6%) with a mean age of 12 (5.1) years. Tumor was the most common indication for amputation (72.7%), and transfemoral amputation was the most frequent level (68.2%). Complications occurred in 10 patients, mostly due to stump impalement or bony overgrowth. Of all recorded patients requiring revision, nine were regarding bone and one case regarding soft tissue. Conclusions: Lower-limb amputation in adolescents is a rare encounter and it is commonly indicated due to bone tumors. The thigh is the most common level of amputation. Postoperative complications are frequent, mainly secondary to bony overgrowth, and often require revision surgery.

Background: Equinus foot is the deformity most frequently observed in patients with cerebral palsy (CP). While there is widespread agreement on the treatment of equinus foot, a clear clinical definition has been lacking. Therefore, we conducted this study to evaluate functional changes in gait analysis in relation to maximum possible dorsiflexion (0°, 5°, 10° and 15°) and in two subgroups of CP patients (unilateral and bilateral). Methods: In this retrospective study, CP patients with different degrees of clinically measured maximum dorsiflexion were included. We further subdivided patients into unilaterally and bilaterally affected individuals and also included a healthy control group. All participants underwent a 3D gait analysis. Our goal was to determine the degree of maximum clinical dorsiflexion where the functional changes in range of motion (ROM) and ankle moment and power during gait were most evident. Then, a subgroup analysis was performed according to the affected side. Results: In all, 71 and 84 limbs were analyzed in unilaterally and bilaterally affected subgroups. The clinically 0° dorsiflexion group barely reached a plantigrade position in the 3D gait analysis. Differences in ROM were observed between subgroups. Ankle moment was quite similar between different subgroups but to a lower extent in the unilateral group. All CP patients had reduced ankle power compared to controls. Conclusions: A cutoff value of clinical ≤ 5° dorsiflexion is the recommended value for defining a functionally relevant equinus foot in CP patients.

Background/Objectives: To compare the radiographic, perioperative, and patient-reported outcomes between anterior vertebral body tethering (VBT) and posterior spinal fusion (PSF) in adolescents with idiopathic scoliosis. Methods: A systematic search of PubMed, Scopus, Web of Science, and Google Scholar was performed through May 2025. Studies directly comparing anterior VBT and PSF in skeletally immature patients with adolescent idiopathic scoliosis were included. Data were pooled using random-effects meta-analysis and expressed as mean differences (MDs) or odds ratios (ORs) with 95% confidence intervals (CIs). The NIH quality assessment tool was used to evaluate risk of bias. Results: Ten studies comprising 1168 patients (573 VBT, 595 PSF) were included. At 2 years, VBT showed a significantly greater main thoracic curve (MD = 5.03°; 95% CI: 1.87–8.20) and proximal thoracic curve (MD = 3.27°; 95% CI: 1.16–5.38), but no difference in lumbar or main curve Cobb angles. VBT was associated with significantly reduced thoracic kyphosis (MD = −2.68°), increased T1 tilt (MD = 1.50°), shorter operative time (MD = −99.23 min), less blood loss (MD = −405.44 mL), and shorter hospital stay (MD = −1.34 days). However, VBT had a significantly higher revision rate (OR = 5.54; 95% CI: 2.81–10.94). No significant differences were noted in SRS-22 domains, except for higher mental health scores in the VBT group (MD = 0.56; 95% CI: 0.07–1.06). Conclusions: Anterior VBT offers perioperative advantages and comparable radiographic correction to PSF in selected adolescents with idiopathic scoliosis, but at the cost of higher revision rates.