Background: Osteoarthritis (OA) is the most common degenerative joint disease and affects millions of people worldwide, particularly the elderly population. The pathophysiology of OA is complex and involves multiple factors. Methods: Several studies have emphasized the crucial role of inflammation in this process. The receptor activator of NF-κB ligand (RANKL), the receptor activator of NF-κB (RANK), and osteoprotegerin (OPG) trigger a signaling cascade that leads to the excessive production of RANKL in the serum. Conclusions: The aim of this narrative review is (i) to assess the role of the RANK/RANKL/OPG signaling pathway in the context of OA progression, focusing especially on the physiopathology and on all the mechanisms leading to the activation of the inflammatory cascade, and (ii) to evaluate all the potential therapeutic strategies currently available that restore balance to bone formation and resorption, reducing structural abnormalities and relieving pain in patients with OA.

Charcot Neuro-Osteoarthropathy (CNO) is a debilitating complication predominantly affecting individuals with diabetes and peripheral neuropathy. Radiological assessment plays a central role in the diagnosis, staging, and management of CNO. While plain radiographs remain the cornerstone of initial imaging, advanced modalities such as Magnetic Resonance Imaging (MRI) and Computed Tomography (CT) have significantly enhanced diagnostic accuracy. Nuclear imaging, including bone scintigraphy, radiolabeled leukocyte scans, and FDG-PET/CT, offers additional diagnostic precision in complex cases, especially when differentiating CNO from infections or evaluating patients with metal implants. This review underscores the importance of a multimodal imaging approach suited to the clinical stage and specific diagnostic challenges of CNO. It highlights the critical need for standardized imaging protocols and integrated diagnostic algorithms that combine radiological, clinical, and laboratory findings. Advances in imaging biomarkers and novel techniques such as diffusion-weighted MRI hold promise for improving early detection and monitoring treatment efficacy. In conclusion, the effective management of CNO in diabetic foot patients requires a multidisciplinary approach that integrates advanced imaging technologies with clinical expertise. Timely and accurate diagnosis not only prevents debilitating complications but also facilitates the development of personalized therapeutic strategies, ultimately improving patient outcomes.

Background: Foot and ankle injuries are one of the leading orthopedic causes of emergency department (ED) admissions. The purpose of this study was to analyze, through 5 years of data collection, differences in number and type of admissions, as well as the severity of foot and ankle trauma to the ED in the pre-pandemic period, during the COVID-19 emergency, and in the post-pandemic period. This study aims to assess epidemiological and clinical data. Methods: Five years of data were collected on admissions to the ED at the Fondazione Policlinico Universitario A. Gemelli using an electronic database. The system allowed the use of a numeric code assessed at triage ranging from 1 to 5, where 1 indicated a patient with compromised vital functions, and it continued in decreasing criticality. Data were extensively analyzed and extrapolated to obtain epidemiological and clinical evaluation. Results: Data from 3787 patients, including 1945 males with a mean age of 41.4 years, were collected. Data were evaluated in the three different periods. In the pre-pandemic period, 2228 ED admissions were recorded, including 1138 males with a mean age of 37.4 years and a mean of 2.79 admissions per day. Codes 3 and 4 reported in the ED triage were 4.8% and 90.1%, respectively; the average surgical treatment was 5.6%. During the COVID period, the total number of admissions was 981, with 501 males with an average age of 43.8 years and a mean of 1.30 admissions per day. Codes 3 and 4 were 22.5% and 72.7%, respectively; the average surgical treatment was 10.4%. In the post-COVID period, 578 admissions were, including 306 males with a mean age of 43.2 years, and a daily access rate of 1.58 patients. Codes 3 and 4 reported in the ED triage were 25.4% and 70.8%, respectively; the average surgical treatment was 8.6%. Conclusions: During the pandemic period due to COVID-19 a substantial decrease in total admissions per day in the ED was noted, but an increase in more complex codes occurred, as evidenced by the percentage increase in surgical admissions compared to total admissions during the pandemic; the mean age of users gradually increased. Total hospitalization data remained stable in the post-pandemic period, likely due to the global impact of the pandemic. COVID-19 radically and concretely changed people’s living habits and priorities for accessing the ED.

Background/Objectives: Total ankle replacement (TAR) is considered an effective solution for end-stage ankle arthritis. New-generation implants have shown promising intermediate clinical outcomes and are available in two main designs: fixed-bearing and mobile-bearing prostheses. The aims of this study are to compare both prosthetic systems, focusing on (i) the revision rate for major complications, including conversion to arthrodesis, revision of components, and below-knee amputation; (ii) minor complications requiring additional surgery; and (iii) providing a comprehensive overview of total ankle replacement. Methods: A systematic review of the literature was conducted using the main databases. The inclusion criteria were patients aged 18 years or older and individuals who had undergone total ankle arthroplasty. Case reports, case series, original articles, and systematic reviews were excluded from the final selection. The pooled incidence of events was reported using odds ratios (ORs) with corresponding 95% confidence intervals (CIs). Results: A total of 33 studies, pooling data from 3652 observations and identifying 635 events, met the inclusion criteria. Relevant demographic and surgical data were systematically extracted and analyzed. A meta-analysis of comparable data revealed revision and failure risks for both prosthesis types. No statistically significant differences in complication rates were observed between fixed-bearing and mobile-bearing prostheses. Conclusions: Both fixed-bearing and mobile-bearing prostheses are viable options for treating ankle arthritis, demonstrating an intermediate risk of complications over short, medium, and long-term follow-ups.

Background: This comprehensive systematic review aims to explore and discuss existing treatment modalities for infections in total ankle arthroplasty (TAA), providing insights that may contribute to the establishment of a “standard of care” for these challenging cases. The study analyses the intricate landscape of infected TAA, addressing gaps in the current literature and emphasizing the need to refine treatment strategies. With the reported incidence of periprosthetic joint infection after TAA surpassing rates observed in total hip and knee replacements, the research navigates through various treatment modalities, underscoring the lack of a universally accepted standard of care. Methods: In this systematic review, following PRISMA guidelines, PubMed, Scopus, and Google Scholar, we identified 15 papers addressing the management strategies for infected TAA (162 infected ankle arthroplasty cases).These databases were chosen for their extensive coverage, strong relevance to the research topic, and ease of access, ensuring a thorough and focused retrieval of pertinent literature on the treatment of infected ankle prostheses. The review involved the identification and evaluation of articles providing insights into complications, treatment outcomes, and risk factors. Extracted data were summarized and reported. A descriptive analysis was performed, and when feasible, a statistical analysis was conducted. Results: Treatment modalities included irrigation and debridement (48.8%), revision total ankle arthroplasty (36.3%), primary arthrodesis (7.9%), spacer arthroplasty (4.5%), and primary amputation (3.9%). Complication rates varied, with 46.5% for irrigation and debridement, 20% for two-stage revision, 7.14% for primary arthrodesis, and 25% for spacer arthroplasty. Conclusions: The rising prevalence of TAA underscores the need for a definitive treatment protocol due to severe complications. This review emphasizes careful patient selection and accurate diagnosis. Irrigation and debridement are effective for acute infections, while two-stage revision is a valid alternative for chronic infections. High-quality randomized controlled trials are important for establishing an evidence-based treatment protocol.

Total knee arthroplasty (TKA) remains a cornerstone of orthopedic surgery, with optimal coronal alignment playing a pivotal role in determining both clinical outcomes and implant longevity. Traditionally, mechanical alignment has been regarded as the gold standard. However, the emergence of alternative philosophies—such as kinematic alignment and hybrid techniques—has shifted the focus toward individualized approaches. Recent advancements in robotic and computer-assisted systems have significantly enhanced the precision of implant positioning, allowing surgeons to better replicate native knee biomechanics and improve patient satisfaction. This narrative review examines current alignment philosophies in TKA, including mechanical, kinematic, and hybrid methods. It analyzes each technique’s principles, functionalities, benefits, and limitations while highlighting ongoing debates regarding their clinical application. Special attention is given to the role of technology in enabling more accurate, patient-specific surgical execution. Despite promising developments, challenges remain in standardizing these techniques and validating their long-term efficacy. To ensure a comprehensive evaluation relevant literature was reviewed, focusing on studies that explore alignment strategies, biomechanical outcomes, and the integration of technology in TKA. This review aims to synthesize current evidence, identify gaps in knowledge, and outline directions for future research needed to optimize alignment strategies in modern knee arthroplasty.