Background: Iliopsoas impingement (IPI) is an increasingly recognized cause of persistent groin pain following total hip arthroplasty (THA), often resulting from mechanical conflict between the iliopsoas tendon and the anterior rim of the acetabular component. Despite its clinical relevance, risk factors contributing to IPI remain poorly defined. Methods: A systematic search of PubMed, Embase, Scopus, and the Cochrane Library was conducted according to PRISMA guidelines. Studies were eligible if they evaluated adult patients undergoing primary THA and reported at least one risk factor associated with IPI. Only studies with a clearly defined clinical diagnosis of IPI were included. Data extraction and risk of bias assessments were performed independently by two reviewers. Risk of bias in each study was assessed through the Newcastle-Ottawa Scale. Results: Twelve observational studies met the inclusion criteria. Diagnosis of IPI was based on clinical symptoms of anterior groin pain exacerbated by hip flexion; 9 studies confirmed diagnosis with anesthetic injections. Key surgical risk factors included anterior cup prominence (ORs 1.16–35.20), oversized cups (cup-to-head ratio > 1.2, OR = 5.39, or ≥6 mm difference, OR = 26.00), decreased cup inclination, collared stem protrusion (OR = 13.89), and acetabular screw protrusion > 6.4 mm. Patient-specific risk factors included female sex (ORs 2.56, 2.79), higher BMI (OR = 1.07), younger age, previous hip arthroscopy (OR = 9.60) and spinal fusion (OR = 4.60). The anterolateral approach was also associated with higher IPI risk when compared to the posterior approach (OR = 4.20). Conclusions: IPI after THA is a multifactorial complication influenced by modifiable surgical variables and patient-specific anatomy. Careful preoperative planning, precise implant positioning, and attention to individual risk factors are essential to reduce IPI incidence and improve outcomes.

Introduction: Arthroscopy for femoroacetabular impingement (FAI) yields inferior outcomes when subchondral edema and cystic degeneration are present. Subchondroplasty (SCP), which involves injecting osteoconductive calcium phosphate into Bone Marrow Lesions (BMLs), may enhance subchondral structural support and can be performed alongside hip arthroscopy. Materials and Methods: This single-center retrospective study included patients who underwent SCP for acetabular BMLs during primary hip arthroscopy for FAI from March 2019 to March 2023. Clinical and radiographic outcomes were recorded at ≥2-year follow-up. Survivorship with treatment failure as the endpoint was assessed using Kaplan–Meier analysis. Results: Thirty-four patients were evaluated at a mean 3.1-year follow-up. No perioperative, early, or late complications or adverse events occurred. No bone substitute migration or intra-articular extravasation was seen. Four patients (11.8%) showed osteoarthritis progression and required conversion to total hip arthroplasty; no intraoperative issues with acetabular preparation were encountered. All clinical scores improved significantly (p < 0.001), and 82.4% returned to sport. Conclusions: SCP performed during hip arthroscopy appears safe in selected patients with early hip osteoarthritis and BMLs. Calcium phosphate injection may help restore subchondral integrity and load distribution, though the independent contribution of SCP beyond standard arthroscopic management remains uncertain.

Background: Long-term survivorship in total hip arthroplasty (THA) is influenced by implant stability and stress distribution to surrounding bone. Isoelastic acetabular components are monoblock polyethylene cups with a low elastic modulus, which were developed to reduce stress shielding and enhance periacetabular bone preservation. This systematic review aimed to evaluate the mid- to long-term clinical outcomes, wear rate, and survivorship of isoelastic cups in primary THA with a minimum follow-up of five years. Materials and methods: A systematic literature search was performed in April 2025 across PubMed, Embase, Cochrane Library, and Google Scholar following PRISMA 2020 guidelines. Inclusion criteria comprised clinical studies on isoelastic acetabular cups in primary THA with a minimum of five years of follow-up. Data on survivorship, complications, clinical outcomes, wear, and radiological performance were extracted and analyzed. Risk of bias in each study was assessed through the Newcastle–Ottawa Scale (NOS) for observational studies and the Cochrane Risk of Bias 2 (RoB 2) tool for randomized controlled trials. Results: Twelve studies, encompassing 1491 hips, met the inclusion criteria. Mean follow-up was 8.1 years. Overall implant survival rate ranged from 82.7% to 100%. Mean Harris Hip Score was 92.6, with low reported pain and high satisfaction. Mean annual wear was 0.05 mm/year. Vitamin E-infused highly cross-linked polyethylene (VEHXLPE) cups demonstrated lower femoral head penetration compared to UHMWPE. A randomized trial showed reduced bone loss in the polar region with isoelastic cups versus modular titanium cups (4.9% versus 15.9%, p = 0.005). Complication and revision rates were low, though heterogeneity in cup positioning reporting and variable follow-up durations were noted. Conclusions: Isoelastic acetabular components demonstrate excellent survivorship, low wear rates, and favorable clinical outcomes at mid- to long-term follow-up. High-quality, long-term comparative studies are needed to confirm these findings across broader patient populations.

Introduction: Critical-sized bone defects remain a major challenge and often require reconstruction grafts. Conventional scaffolds don’t reproduce the dynamic electromechanical behavior of native bone. Piezoelectric scaffolds have emerged as a promising strategy to overcome these limitations by converting mechanical stimuli into bioactive electrical signals capable of enhancing osteogenesis. Methods: A systematic review was conducted in accordance with the PRISMA 2020 guidelines and registered in PROSPERO (ID: 1359740). A comprehensive search of PubMed/MEDLINE, Scopus, Embase, and Cochrane Central Register of Controlled Trials was performed. In vivo animal and clinical studies evaluating piezoelectric scaffolds for bone defect repair were included. Data extraction and risk of bias assessment were performed independently by two reviewers. Outcomes of interest included micro-computed tomography (micro-CT), histological findings, and biomechanical properties. Results: Ten preclinical in vivo studies (2020–2025) were included. No eligible human clinical studies were identified. The included studies involved mainly rodent models, with some studies in rabbits and sheep. Most studies investigated critical-sized calvarial defects, while others evaluated load-bearing models. Piezoelectric scaffolds—primarily based on PVDF, PVDF-TrFE, and BaTiO ₃ composites—consistently demonstrated improved bone regeneration compared with conventional scaffolds. Micro-CT analysis showed higher bone volume fraction (BV/TV) and bone mineral density (BMD) across studies, with BV/TV values reaching approximately 35%–36% at 8 weeks in several models. Histological analyses confirmed enhanced new bone formation, improved tissue organization, and better scaffold–bone integration, often with reduced fibrous tissue formation. Additive manufacturing techniques enabled precise control of scaffold architecture and were widely used, while external mechanical stimulation further enhanced osteogenic outcomes in some studies. Conclusion: Piezoelectric scaffolds represent a promising approach for bone regeneration, demonstrating superior regenerative performance compared with conventional scaffolds in preclinical models. Their ability to generate bioactive electrical signals, combined with advanced fabrication techniques, supports their potential for clinical translation. However, current evidence is limited to preclinical studies with heterogeneous methodologies. Further standardized studies and clinical investigations are needed to confirm their safety, efficacy, and long-term performance.

Purpose: Sarcopenia has emerged as a potential prognostic factor for postoperative complications, functional recovery, patient-reported outcomes, and healthcare costs in patients undergoing total knee arthroplasty (TKA). This systematic review aimed to evaluate its impact on these outcomes following primary TKA. Methods: A systematic review was conducted according to PRISMA guidelines and prospectively registered in PROSPERO (CRD420261320013). PubMed/MEDLINE, EMBASE, and Cochrane Library were searched up to 1 December 2025. Comparative clinical studies including sarcopenic and non-sarcopenic patients undergoing primary TKA and reporting postoperative outcomes were included. Methodological quality was assessed using the MINORS tool. Due to heterogeneity in study design, diagnostic criteria, and outcome measures, a narrative synthesis was performed. Results: Nine studies including more than 93,000 patients were analyzed. Sarcopenia prevalence ranged from 7.7% to 25%. Sarcopenic patients demonstrated higher rates of postoperative complications, including medical events, blood transfusion, falls, fractures, reoperations, and implant-related complications. Functional recovery was delayed, particularly in patients with sarcopenic obesity, with slower improvements in range of motion and gait speed. Although both groups improved after TKA, short- to mid-term patient-reported outcomes were often inferior in sarcopenic patients, while long-term differences were less consistent. Sarcopenia was also associated with longer hospital stay and increased healthcare costs. Conclusions: Sarcopenia is associated with worse postoperative outcomes following primary TKA and may represent a modifiable risk factor for perioperative optimization.