Hip fractures are among the most serious health events in older adults, frequently leading to disability, loss of independence, and elevated mortality. In 2019, an estimated 9.6 million new cases occurred globally among adults aged ≥ 55 years, with an incidence rate of 681 per 100,000. Despite improved surgical care, one-year mortality remains high (15–30%), and fewer than half of survivors regain their pre-fracture functional status. Traditionally regarded as mechanical injuries, hip fractures are now increasingly recognized as systemic events reflecting and accelerating biological vulnerability and frailty progression. We synthesize evidence across biological, clinical, and social domains to explore the systemic implications of hip fracture, from the acute catabolic response and immune dysfunction to long-term functional decline. The concept of intrinsic capacity, introduced by the World Health Organization, offers a resilience-based framework to assess the multidimensional impact of hip fracture on physical, cognitive, and psychological function. We highlight the importance of orthogeriatric co-management, early surgical intervention, and integrated rehabilitation strategies tailored to the individual’s functional reserves and personal goals. Innovations such as digital health tools, biological aging biomarkers, and personalized surgical approaches represent promising avenues to enhance recovery and autonomy. Ultimately, we advocate for a shift toward interdisciplinary, capacity-oriented models of care that align with the goals of healthy aging and enable recovery that transcends survival, focusing instead on restoring function and quality of life.

Osteosarcoma (OS) is the most common primary malignant bone tumor, predominantly affecting adolescents and young adults. Despite advances in surgery and multi-agent chemotherapy, survival rates for metastatic or recurrent OS remain poor, highlighting the need for novel prognostic and therapeutic strategies. This review integrates histopathologic, molecular, and immune perspectives to provide a comprehensive understanding of OS biology in the context of precision medicine. We discuss classic morphologic and radiographic features alongside recent insights into the tumor microenvironment, including the role of tumor-infiltrating lymphocytes, tumor-associated macrophages, and immune checkpoint expression. Emerging molecular markers, such as gene expression–based immune risk signatures, circulating tumor DNA, and gasdermin D overexpression, are evaluated for their prognostic and therapeutic relevance. Key dysregulated pathways, including WNT/β-catenin and JAK/STAT, are examined in relation to metastasis, chemoresistance, and immune evasion, with emphasis on current targeted approaches under development. By bridging histopathology, immunogenomics, and translational research, this work outlines how integrated biomarker assessment can refine patient stratification and guide the implementation of individualized treatment strategies in OS.

Background: Proximal femur fractures are common in elderly patients and are strongly associated with frailty, increased mortality, and functional decline. The Clinical Frailty Scale (CFS) has emerged as a key predictor of outcomes, influencing perioperative management and rehabilitation strategies. This study aims to evaluate the impact of frailty on mortality, surgical timing, and length of hospital stay (LOS) in patients with hip fractures. Methods: This single-center retrospective study analyzed data from patients aged ≥ 65 years admitted with AO type 31A and 31B proximal femur fractures between 2018 and 2023. Patients were stratified according to CFS scores to assess the relationship between frailty and in-hospital mortality, surgical delay, and LOS. Multivariate logistic regression was performed to identify independent risk factors. Results: Among 2312 patients (median age: 85 years), frailty was a significant predictor of mortality ( p = 0.019). Patients with CFS 7–9 had a 6.6-fold higher mortality risk than those with CFS 1–3. Delays in surgery beyond 48 h were associated with a doubled risk of mortality ( p = 0.009), particularly in frail patients. Prolonged LOS (> 7.1 days) correlated with an increased incidence of infections, cardiovascular events, and mortality ( p < 0.001). Conclusions: Frailty significantly impacts hip fracture prognosis in elderly patients, increasing mortality, complications, and LOS. Early identification of frail patients and prioritization of timely surgery are crucial to improving outcomes. Future studies should explore tailored surgical strategies and optimized rehabilitation protocols to enhance recovery in this high-risk population.

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) is a rare, proliferative disorder of the synovium that predominantly affects the knee. Traditional treatment involves surgical resection; however, the high recurrence rates have prompted the exploration of alternative, minimally invasive treatments. This case report presents the novel use of genicular artery embolization (GAE) with imipenem/cilastatin as a therapeutic intervention. Case presentation: We present a case of a 52-year-old male with a 5-month history of progressive left-knee pain and swelling. Magnetic resonance imaging (MRI) suggested PVNS, which was confirmed through synovial biopsy. Because of concerns about surgical recovery and recurrence risk, the patient opted for GAE with imipenem/cilastatin over traditional synovectomy. This technique, employing the antibiotic’s anti-angiogenic and anti-inflammatory properties, was administered under local anesthesia without complications. Results: Post-procedural assessments demonstrated rapid and sustained symptom relief. At the 1-month follow-up, the patient’s Visual Analog Scale (VAS) pain score decreased from 7/10 to 3/10, and their Knee Injury and Osteoarthritis Outcome Score (KOOS) and SF-36 health survey scores indicated significant functional improvement. By the 6-month follow-up, the VAS had reached 0/10; the KOOS value reflected near-complete functional recovery; and MRI confirmed reduced synovial hypertrophy and absence of recurrence. No complications were observed. Discussion: GAE with imipenem/cilastatin shows potential as an effective alternative to surgery for PVNS, particularly in patients at risk of surgical complications or recurrence. While the preliminary findings are promising, the limitations include the case’s single-subject design and the need for extended follow-up to determine long-term outcomes and recurrence rates. Further studies comparing GAE with traditional surgical approaches are needed to assess its broader applicability in PVNS management. Conclusion: GAE with imipenem/cilastatin offers a promising, minimally invasive approach for PVNS, providing significant symptom relief and functional recovery with minimal complications. Although long-term studies are needed, this technique could serve as a viable alternative for patients with PVNS, especially those contraindicated for surgery.