Various imaging methods assist in diagnosing periprosthetic joint infection (PJI). These include radiological techniques such as radiography, computed tomography (CT), magnetic resonance imaging (MRI), and ultrasound (US); as well as advanced nuclear medicine techniques including bone scintigraphy (BS), anti-granulocyte antibody imaging (AGS), leukocyte scintigraphy (LS), and fluorodeoxyglucose positron emission tomography (FDG-PET and FDG-PET/CT). Each imaging technique and radiopharmaceutical has been extensively studied, with unique diagnostic accuracy, limitations, and benefits for PJI diagnosis. This review aims to detail and describe the most commonly used imaging techniques and radiopharmaceuticals for evaluating PJI, focusing particularly on knee and hip arthroplasties.

Background: Tibial intramedullary nailing (IMN) is the standard treatment for tibial shaft fractures, yet anterior knee pain (AKP) remains common, affecting nearly 47% of patients. Despite the reported advantages of suprapatellar techniques, infrapatellar approaches—medial parapatellar (MPP) and transpatellar (TP)—remain the most commonly used methods for tibial IMN. This systematic review and meta-analysis compares MPP and TP approaches regarding pain, AKP incidence, range of motion (ROM), knee function, and fracture healing. Methods: Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, PubMed, Embase, Scopus, and Web of Science were searched up to November 2024. Randomized clinical trials (RCTs) and comparative observational studies in adults undergoing tibial IMN via MPP or TP approaches were included. Outcomes were AKP incidence, pain intensity, knee function, ROM, and union-related variables. Pooled mean differences (MDs) and risk ratios (RRs) were calculated using random-effects and common-effects models. Results: Twelve cohort studies (782 patients) and 9 RCTs (462 patients) were included. Across cohort studies, MPP was associated with a significantly lower AKP risk at latest follow-up (RR = 0.76 [0.63; 0.90]) and at 6 months. Visual analog scale pain at 3-month postoperative also favored MPP (MD = −1.27 [−1.94; −0.60]) but did not reach the minimal clinically important difference. RCTs demonstrated similar trends toward lower pain and AKP with MPP, but without statistical significance. Functional outcomes and ROM generally favored MPP across both study designs, though findings were inconsistent and unsuitable for pooling. Fracture healing and union rates were comparable between approaches. Conclusion: The MPP approach for tibial IMN was linked to a lower incidence of AKP compared with the TP approach, while offering comparable or better functional outcomes, ROM, and pain intensity. These findings suggest MPP as the preferred infrapatellar approach in appropriate clinical settings. Nonetheless, high-quality studies with standardized outcome measures are essential to validate these findings. Level of Evidence: Level III (systematic review of RCTs and retrospective comparative studies). See Instructions for Authors for a complete description of levels of evidence.

Background: Tibial plateau fractures are complex knee injuries frequently accompanied by meniscal and ligamentous injuries. Although radiography and computed tomography (CT) are routinely used to evaluate fracture patterns, their ability to predict associated soft-tissue injuries has not been well established. This systematic review investigated the diagnostic value of tibial plateau depression and widening as radiographic predictors of meniscal and ligamentous injuries in patients with tibial plateau fractures. Methods: A systematic review and meta-analysis was conducted in accordance with PRISMA 2020. MEDLINE, Scopus, Embase, and Web of Science were searched up to July 2025. Studies evaluating the association between tibial plateau depression or widening and meniscal or major ligamentous injuries (cruciate and collateral ligaments) in adults were included. Random-effects models were used to pool mean differences (MDs) and diagnostic accuracy estimates. Results: A total of 17 studies encompassing 1348 patients were included. Patients with lateral meniscus (LM) injuries had significantly greater lateral plateau depression (LPD) than those without (MD 5.03 mm, 95% CI 3.94–6.12). The pooled diagnostic odds ratio (DOR) of LPD for detecting LM injury was 9.80, with a sensitivity of 84%, specificity of 63%, and an area under the sROC curve (AUC) of 0.724. Lateral plateau widening (LPW) was also significantly higher in patients with LM injuries (MD 1.37 mm, 95% CI 0.29–2.45), with a pooled DOR of 7.97, sensitivity of 71%, specificity of 71%, and AUC of 0.758. Associations between LPD/LPW and medial meniscus or cruciate ligament injuries were more heterogeneous, although LPD had consistent relationships with lateral collateral ligament injury and LPW showed a significant pooled association with anterior cruciate ligament (ACL) injury (MD = 3 mm). Conclusions: LPD was the most consistent radiographic predictor of LM injury, with injured patients demonstrating, on average, 5 mm greater depression, while LPW provided complementary value with a pooled MD of 1.37 mm in patients with LM injury and also showed a significant, though more heterogeneous, association with ACL injury. These routinely available CT- or radiograph-based parameters can help stratify the risk of soft-tissue injury and guide selective use of MRI or arthroscopic inspection with tibial plateau fractures.

Background: Total hip arthroplasty (THA) and total knee arthroplasty (TKA) are rarely performed in children and adolescents but may be required for end-stage joint disease. Evidence regarding safety, survivorship, and patient-reported outcomes in patients younger than 25 years remains limited. The aim of this study was to systematically evaluate postoperative complications, functional outcomes, quality of life, and revision rates following THA and TKA in this age group. Methods: A systematic review and meta-analysis was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020. MEDLINE, Embase, Scopus, and Web of Science were searched through October 2025 for studies reporting outcomes of THA or TKA in patients aged younger than 25 years. Random-effects models were used to pool complication rates, functional outcomes, quality of life, and all-cause revision separately for THA and TKA. Meta-regression explored the influence of age, sex, year of patient inclusion, arthroplasty indications, and bearing surface types. Results: A total of 44 studies involving 3,317 patients and 5,632 joints were included. Following THA, pooled rates of periprosthetic joint infection (PJI), aseptic loosening, and periprosthetic fracture were 1.6%, 5.4%, and 1.4%, respectively, and all-cause revision rate was 8.7%. Functional scores (standardized mean difference [SMD] = 4.9) and quality-of-life measures (SMD = 1.8) improved substantially after THA. For TKA, pooled PJI and aseptic loosening rates were 2.9% and 9.9%, with an all-cause revision rate of 12.4%. Subgroup analyses demonstrated that more recent years of patient inclusion were associated with lower revision and infection rates following THA. Conclusion: THA and TKA in patients younger than 25 years can improve function and quality of life, although the risks of revision and infection remain higher than those in older adults. Outcomes have improved in more recent cohorts with advances in implant design and surgical technique. Further prospective studies with standardized reporting are needed to define optimal implant selection and long-term outcomes in this population. PROSPERO Registration Code: CRD420261303010. Level of Evidence: Therapeutic Level III (systematic review of retrospective cohort studies). See Instructions for Authors for a complete description of levels of evidence.