Background/Objectives: In the elderly population, thoracic kyphosis often progresses with age, leading to secondary postural adaptations including scapular protraction, internal rotation, and anterior tilt. These alterations can potentially compromise shoulder biomechanics, particularly in patients undergoing reverse shoulder arthroplasty (RSA). The purpose of this study was to evaluate the relationship between thoracic sagittal alignment, quantified by the Cobb angle, and scapular internal rotation (SIR) assessed on CT scans in patients scheduled for RSA. Methods: A retrospective study was conducted on 164 patients who underwent RSA between 2016 and 2024 at a single tertiary referral center. Sagittal thoracic kyphosis was assessed using the Cobb angle measured on preoperative chest radiographs. SIR and anterior scapular tilt were evaluated using preoperative CT scans. Patients were divided into three groups according to the Cobb angle: Group A (≤36°), Group B (>36–46°), and Group C (≥47°). Statistical analysis was performed using the Spearman correlation coefficient and Kruskal–Wallis test, with a significance threshold set at p < 0.05. Results: Analysis demonstrated a weak but statistically significant positive correlation between age and SIR, as well as between thoracic kyphosis (Cobb angle) and SIR. Patients in Group C (Cobb angle ≥ 47°) showed higher mean SIR values (43.7°) compared to Group A (40.3°), with statistical significance achieved (p = 0.047). These findings suggest that greater thoracic kyphosis is associated with increased scapular internal rotation. No significant correlation was identified between anterior scapular tilt and thoracic kyphosis. Conclusions: This study reveals a correlation between increased thoracic kyphosis and greater scapular internal rotation in patients undergoing RSA. These postural and biomechanical alterations may have critical implications for surgical planning and postoperative outcomes. Preoperative assessment of sagittal spinal alignment, particularly thoracic kyphosis, should be integrated into the planning process for RSA to optimize implant positioning and improve functional results.

Background: Femoral neck fractures in the elderly often necessitate hemiarthroplasty, but the optimal surgical approach remains a highly debated topic. The postero-lateral and direct lateral approaches are commonly employed, each with benefits and drawbacks. Despite their widespread use, robust, long-term comparative studies on definitive outcomes, including pain, functional recovery, and complication rates, are notably lacking. This systematic review and meta-analysis aim to address this critical gap by meticulously comparing these approaches with long-term follow-up. Methods: A systematic literature search was performed, including only comparative studies with a minimum 1-year follow-up. A meta-analysis was performed for the primary outcome measures: operative time, dislocations, infections, perioperative fractures and reoperations. Secondary outcomes included a qualitative synthesis of patient-reported outcomes (quality of life, pain, and satisfaction). Methodological quality was assessed using RoB 2.0 for randomized controlled trials and MINORS criteria for cohort studies. Results: Our meta-analysis provides robust quantitative evidence. The direct lateral approach is associated with a significantly lower risk of post-operative dislocations (I² = 58%; OR = 2.86, 95% CI: 2.53 to 3.22; p < 0.00001) and a significantly lower rate of reoperation (I² = 0%; OR = 1.25, 95% CI: 1.12 to 1.40; p = 0.0001) compared to postero-lateral approach. Operative time, infection, and perioperative fracture rates were found to be statistically comparable. However, patient-reported outcomes yielded inconsistent results across studies, often becoming non-significant after adjusting for confounders. Conclusions: This meta-analysis shows that the direct lateral approach is associated with lower rates of dislocation and reoperation compared with the postero-lateral approach, while patient-reported outcomes remain variable across studies. Further high-quality comparative trials are needed to confirm these associations and guide surgical decision-making.