Atypical joint spaces, such as those encountered in complex segmental bone loss and large structural defects, remain challenging to manage with conventional implants within divisions across orthopedics, including arthroplasty, tumor reconstruction, trauma, and spine. Additive manufacturing advances have made patient-specific implants a possibility, and this promising solution has enabled the creation of implants with customized geometry and controlled surface porosity to enhance osseointegration, reduce rejection rates, optimize biomechanics, and promote longevity. Despite its potential, patient-specific implants are still eclipsed in use by conventional, “off-the-shelf” implants due to their lower cost, documented long-term durability, insurance coverage, and the strength of available clinical evidence supporting their use. This narrative review summarizes current materials and manufacturing approaches for additively manufactured metal porous implants, including imaging and design workflows, lattice and pore architecture, and how the printing process influences implant stiffness, fatigue strength, surface roughness, and porosity. We also discuss the experimental and preclinical data on mechanical performance, fatigue resistance, and osseointegration for new developments in the field. Emerging trends such as material innovation, streamlined digital planning-to-implant workflows, 4D printing and other advanced additive manufacturing concepts, and cost-reduction efforts are examined in the context of clinical practicality. In this review, the integration of engineering principles with early clinical outcomes will provide orthopedic surgeons with a realistic understanding of the benefits and limitations of the future utilization of additive manufacturing in clinical practice.

Diabetes mellitus (DM) is highly prevalent among patients undergoing foot and ankle surgery and is associated with substantially increased perioperative and postoperative risk. This narrative review synthesizes the current literature on optimization of DM patients undergoing foot and ankle surgery. Complications of chronic hyperglycemia, including neuropathy and peripheral vascular disease, make the foot and ankle particularly vulnerable to ulceration, infection, and deformity, contributing to high rates of both operations and postoperative complications such as surgical site infection and readmission. Glycemic control and obesity are modifiable predictors of surgical outcomes and represent key targets for preoperative optimization. Lifestyle modification and pharmacologic therapy play central roles in DM optimization. Traditional agents such as metformin, sulfonylureas, thiazolidinediones, and dipeptidyl peptidase-4 inhibitors remain foundational therapies, while newer therapies such as sodium–glucose cotransporter-2 inhibitors (SGLT2is) and glucagon-like peptide-1 (GLP-1) agonists offer meaningful improvements to glycemic control and weight loss. Pharmacologic regimens must be individualized, and many agents require careful perioperative management. Despite advances in medical therapy, high-quality evidence specific to foot and ankle surgery remains limited. Future research should focus on developing procedure- and agent-specific guidelines to reduce the substantial clinical and economic burden of DM in foot and ankle surgical patients.

Musculoskeletal disorders involving bone, cartilage, tendon, and joint tissues represent a leading cause of disability worldwide, and conventional surgical and graft-based interventions are limited by donor site morbidity, incomplete integration, and finite durability. Despite substantial preclinical progress, translation into reliable clinical benefit has remained inconsistent. This narrative review synthesizes recent advances in bioengineered approaches to bone and joint repair, emphasizing how materials design and regenerative strategy selection influence translational feasibility. Advances in scaffold-based systems highlight the role of material composition, architectural organization, and structure–function matching in supporting musculoskeletal regeneration. Regenerative platforms including stem cell therapies, extracellular matrix-derived constructs, and smart materials are evaluated for biological performance, manufacturability, and regulatory feasibility. Early translational and clinical studies demonstrate encouraging outcomes across selected musculoskeletal indications; however, variability in efficacy and adoption highlights persistent barriers to broader implementation. Key challenges include scalable manufacturing, cost and reimbursement uncertainty, and heterogeneity in clinical infrastructure, factors that may also influence access to advanced regenerative therapies. Future innovations should emphasize manufacturability and real-world evidence generation that align with practical clinical pathways.

Study Design.: Retrospective cohort study. Objective.: To evaluate the association between hospital price markup and perioperative and long-term outcomes following elective anterior cervical discectomy and fusion (ACDF). Summary of Background Data.: Hospital price markup, defined as the ratio of billed charges to actual costs, varies widely across U.S. institutions and is largely unregulated. While prior studies in general surgery have linked high-markup hospitals to poorer outcomes, this relationship has not been characterized in cervical spine surgery. Methods.: Adult patients undergoing elective ACDF from 2016 to 2022 were identified from the PINC AI Healthcare Database. Hospital-level charge-to-cost ratios were calculated using ACDF encounters, and hospitals in the highest regional markup decile were designated as high-markup hospitals (HMH). Outcomes included perioperative complications, 30-day readmission, long-term complications, and reoperation. Multivariable regression models adjusted for patient-, procedural-, and hospital-level covariates. Results.: A total of 241,965 patients were included; 22,495 (9.3%) were treated at HMH. Mean markup was significantly higher at HMH versus non-HMH (7.81x vs. 4.10x, P <0.001). After multivariable adjustment, HMH were associated with higher 30-day readmission (2.94% vs. 2.63%, P =0.007), perioperative complications (2.61% vs. 2.36%, P =0.020), long-term complications (6.99% vs. 6.58%, P =0.021), and reoperation (4.07% vs. 3.75%, P =0.020). Conclusion.: Among patients undergoing elective ACDF, treatment at high-markup hospitals was independently associated with worse postoperative outcomes despite greater expenditure. These findings challenge the assumption that higher-cost care confers higher quality and have important implications for spine surgery healthcare policy. Level of Evidence.: III

Purpose: Meniscal repair failure is a significant clinical concern, but existing literature treats it as a single outcome without differentiating timing. Early and late failures may represent mechanistically distinct phenomena; identifying their differential predictors could improve risk stratification and postoperative monitoring. Methods: A retrospective cohort study used a national database to identify patients undergoing arthroscopic meniscal repair, including both isolated repairs and repairs performed with concomitant anterior cruciate ligament reconstruction, classified into early failure (reoperation <365 days, approximating the conventional period of meniscal healing), late failure (≥365 days) or no failure. Cause‐specific Cox proportional hazards regression identified independent predictors of each failure type separately. Results: Of 38,003 patients, 3399 (8.9%) experienced failure (1996 early; 1403 late). A bimodal hazard pattern supported phenotypic distinction between groups. Early failure was independently predicted by female sex (hazard ratio [HR] 1.15), bucket‐handle tear (HR 1.30), traumatic mechanism (HR 1.14), concomitant microfracture (HR 1.54), hamstring autograft (HR 1.21) and single‐anchor repair (HR 1.28); three or more anchors were protective (HR 0.83). Late failure was uniquely predicted by knee osteoarthritis (HR 1.33), whereas increasing age was independently protective (HR 0.98/year) as well as three or more anchors (HR 0.86). Among isolated meniscal repairs, partial meniscectomy was the most common reoperation in both groups, but more frequent in late failures (60.1% vs. 53.7%). Re‐repair was more common after early failure (22.5% vs. 16.1%), while TKA was more prevalent after late failure (9.8% vs. 5.4%). All reported associations and between‐group differences were statistically significant ( p < 0.05). Conclusion: Early and late meniscal repair failures are distinct clinical phenotypes with differing risk factors and reoperation patterns. Early failure appears driven by mechanical and technical factors; late failure is more strongly associated with degenerative joint disease and host biology. These findings may inform individualised monitoring and risk stratification strategies. Level of Evidence: Level III, retrospective cohort study.