Background: Total hip and knee arthroplasty are common procedures for end-stage osteoarthritis, with rehabilitation playing a central role in functional recovery. Conventional face-to-face programs are often limited by accessibility, costs, and logistical barriers. Digital telerehabilitation has been increasingly investigated as an alternative. This review aims to summarize current evidence on its effectiveness, patient-reported outcomes, satisfaction, and economic impact. Materials and Methods: A narrative review was conducted using Medline, Web of Science, and Scopus up to April 2025. Randomized controlled trials and longitudinal studies evaluating telerehabilitation after total hip or knee arthroplasty were included. Data were extracted on functional performance, pain, autonomy, quality of life, patient satisfaction, and cost-effectiveness. Results: Across multiple RCTs, telerehabilitation produced functional outcomes generally comparable to conventional rehabilitation, with some studies reporting superior short-term improvements. For example, in a retrospective trial, Timed Up and Go improved by −8.0 ± 2.6 s in the digital group versus −4.9 ± 2.5 s with standard care (p < 0.01). Tablet-assisted programs reduced Five Times Sit-to-Stand times to 11.7 s at 6 months compared with 14.7 s in controls (p = 0.05). In hip arthroplasty, digital rehabilitation resulted in higher active flexion (97.4° vs. 89.9°, p = 0.018) and abduction (51.7° vs. 43.8°, p = 0.024). Quality-of-life measures, such as EQ-5D VAS, also showed improvements (82.9 ± 4.3 vs. 68.7 ± 4.6 at 6 months). Some studies reported higher patient satisfaction, for instance, a VR-based RCT found GPE at day 15 of 4.76 ± 0.43 in the intervention group versus 3.96 ± 0.65 in controls (p < 0.001). Conclusions: Telerehabilitation after hip and knee arthroplasty appears to produce short-term functional and patient-reported outcomes comparable to conventional rehabilitation in selected populations. Evidence of superiority is limited and heterogeneous, and long-term effectiveness, equity, and cost-effectiveness remain uncertain. Heterogeneity in protocols and digital literacy barriers highlight the need for standardized guidelines and further independent validation.

Background: Pigmented villonodular synovitis (PVNS), also known as tenosynovial giant cell tumor, is a rare proliferative disorder of the synovial membrane that primarily affects the knee joint. Despite advances in imaging and surgical techniques, diagnosis is often delayed, and optimal treatment remains debated. Methods: A Narrative review was conducted according to PRISMA guidelines using PubMed, MEDLINE, and Scopus databases from January 2000 to December 2024. Studies reporting on epidemiology, clinical features, imaging, treatment, and outcomes of PVNS were included. Results: Sixty-six studies encompassing 120 patients were included. The majority of cases were diffuse PVNS. MRI was the most effective imaging tool. Arthroscopic synovectomy was the most common treatment, though recurrence rates remained high, particularly in diffuse forms. Adjuvant treatments, including radiosynoviorthesis and biologic therapies such as infliximab or pexidartinib, were employed in recurrent or unresectable cases. Conclusions: Early diagnosis and complete surgical excision remain the mainstay of treatment. Combined open and arthroscopic approaches are recommended in diffuse PVNS. Further prospective studies are needed to define optimal long-term management.

Background. Nondiabetic patients with open leg fractures who have elevated blood glucose levels on arrival in the emergency department have an increased risk of surgical-site infections (SSIs). Objective. This study evaluates the association between the incidence of SSIs in nondiabetic patients with an open leg fracture and blood glucose levels registered on arrival in the ER. We also analyzed the correlation between patients’ days of hospital stay and the incidence of SSIs and the time elapsed between the damage control with external fixation and final fixation and the incidence of SSI. Methods. We retrospectively studied nondiabetic patients admitted to our emergency unit from 2017 to 2021 with a diagnosis of open leg fracture consecutively treated. Based on the diagnosis of SSIs, all enrolled patients were divided into two groups based on the developed (group A) or not developed (group B) SSIs within 1 year after surgery. All patients enrolled in the study underwent damage control within 24 hours after admission to the ER. At stabilization of general clinical and local wound conditions, all patients underwent definitive surgery. Results. We enrolled 80 patients. In group A, glycemia on arrival in the ER was on average 148.35 ± 19.59 mg/dl, and in group B, it was 122.61 ± 22.22 mg/dl ( value: 0.0001). In group A, glycemia in the first postoperative day was on average 113.81 ± 21.07 mg/dl, and in group B, it was 99.02 ± 17.60 mg/dl ( value: 0.001). In group A, the average hospitalization was 57.92 ± 42.43 days, and in group B, it was 18.41 ± 14.21 days ( value: 0.01). Through Youden’s J, we therefore analyzed the value with the highest sensitivity and specificity which proved to be 132 mg/dl. Conclusion. Our findings show that nondiabetic patients with SIH have a significantly increased risk of SSIs compared to patients without SIH within 1 year after surgery. Patients with open leg fractures with SIH have a significantly higher average hospital stay than patients without SIH. Further studies are needed to confirm 132 mg/dl of blood glucose levels as a value to stratify the risk of SSIs in these patients.

Background: Glenohumeral instability is one of the most frequent and clinically impactful complications following proximal humerus resection and reconstruction with a megaprosthesis, especially in patients treated for bone tumors or complex fractures. Its incidence, risk factors, and influence on functional recovery remain variably reported in the literature. Methods: A systematic review was conducted according to PRISMA guidelines, searching PubMed, Scopus, and Google Scholar up to April 2025. Studies reporting on postoperative instability, dislocation, functional outcomes (MSTS, DASH), and related complications were included. Two independent reviewers performed data extraction and quality assessment. A pooled analysis was performed using random-effects models. Results: A total of 17 studies including 387 patients were analyzed. The pooled incidence of glenohumeral instability was 32%, with a revision surgery rate of 10% due to instability. The most common reconstruction technique was modular megaprosthesis (47%), followed by allograft–prosthesis composites (APCs) and reverse total shoulder arthroplasty (RSA). Functional outcomes were reported in 12 studies using the Musculoskeletal Tumor Society (MSTS) score, with a weighted mean of 22.3 ± 3.8 (74.3% ± 12.7%). Disabilities of the Arm, Shoulder, and Hand (DASH) scores, reported in 3 studies, showed worse outcomes in unstable shoulders (mean 61.4 ± 5.2 vs. 26.6 ± 4.1). Soft tissue reconstruction, particularly involving the rotator cuff and deltoid, significantly influenced postoperative stability and function. Conclusions: Glenohumeral instability after proximal humerus megaprosthesis is a common and disabling complication that adversely affects functional outcomes and revision rates. Optimizing soft tissue management and prosthetic design is essential to improve joint stability and long-term results.

Anterior cruciate ligament (ACL) reconstruction is a common orthopedic procedure, but graft failure remains a significant complication, particularly in young and active individuals. Understanding the multifactorial etiology of failure and optimizing revision strategies are crucial for improving outcomes. A structured narrative review of the literature was conducted, including studies published from January 2000 to May 2024. Databases searched included PubMed/MEDLINE, Embase, and Google Scholar. Eligible studies addressed definitions, etiology, classification, and surgical management of ACL reconstruction failure. Data were synthesized qualitatively, integrating evidence on technical, biological, and traumatic causes, as well as neuromuscular and psychosocial factors influencing functional outcomes. ACL reconstruction failure is primarily caused by technical errors, particularly tunnel malposition (60–70% of cases), followed by traumatic (15–25%) and biological (10–15%) mechanisms. Failure timing provides diagnostic clues: early (12 months) to trauma or degeneration. Revision strategies include individualized graft selection, anatomical tunnel placement, repair of associated lesions, and consideration of biomechanical abnormalities. Overall success rates of revision procedures average 70–75%, with lower outcomes in adolescents and high-demand athletes. Emerging techniques, including lateral extra-articular tenodesis and biologic augmentation, may enhance revision outcomes, although long-term evidence remains limited. ACL reconstruction failure is a multifactorial event requiring thorough preoperative assessment, precise surgical planning, and individualized management. Addressing technical, biological, and neuromuscular factors, alongside patient-specific considerations, is essential to optimize functional outcomes and reduce failure rates. Future research should focus on standardized reporting, multicenter prospective studies, and advanced surgical planning tools to further improve revision success.