An optimal hip implant is biocompatible, durable, and resistant to chemical and mechanical wear. This analysis aimed to compare failure (revision) and complication rates between ceramic-on-ceramic (CoC) and ceramic-on-highly-crosslinked-polyethylene (CoHXLPE) implants. This review comprised of scientific literature published between 1995 and 2019. We included randomized controlled trials in adults (>18 years) that presented results of CoC and CoHXLPE total hip arthroplasty (THA) with more than two years of mean follow-up and drafted in English. The primary outcomes for this analysis were complications, revision rates, and loosening rates. Eight studies (1,689 hips) were included in this systematic review. There was no significant differences between COC and CoHXLPE for the risk of post-surgical complications (relative risk [RR]: 1.98, 95% confidence interval [CI]: 0.83-4.69, P = 0.12). Revision rates (RR: 1.25, 95% CI: 0.71-2.20, P = 0.43] and loosening rates between the two implants were not significantly different (RR: 1.17, 95% CI: 0.30-4.52, P = 0.82). We report no significant differences between CoHXLPE and CoC in adults undergoing primary THA. Although introduced relatively recently, CoHXLPE is a cost-effective bearing that can be used for younger patients with no risk of increased complications in comparison to CoC. Further studies with longer follow-up periods are recommended to confirm the findings of this meta-analysis.

Lumbar spinal stenosis (LSS) is a prevalent degenerative condition, with ligamentum flavum hypertrophy (LFH) contributing significantly to neural compression. Despite its clinical importance, few studies have evaluated longitudinal trends in LFH. This study investigates the temporal progression and demographic associations of LFH over the past decade. This retrospective cohort study included adult patients undergoing surgery for LSS at a tertiary academic center during two periods: 2013-2017 and 2018-2023. Exclusion criteria included prior spinal surgery, trauma, malignancy, or inadequate imaging. Two radiologists reviewed axial MRI images to measure ligamentum flavum thickness (≥4 mm indicated hypertrophy). Demographic data and coexisting spinal conditions were also recorded. A total of 202 patients were analyzed-98 from the initial and 104 from the later period. LFH prevalence rose from 24.5 % to 44.7 % over time. Patients aged ≥60 demonstrated significantly higher LFH rates in both periods (p = 0.004). Although female predominance persisted, it declined from 71.4 % to 55 %. LFH was most commonly associated with disc bulging, particularly at the same spinal level. Multilevel LFH increased from 25 % to 44.1 %, though L4-L5 remained the most affected segment. The incidence of LFH has increased substantially over the past decade, particularly among older adults. Given its role in LSS pathogenesis, greater attention to LFH in imaging and surgical planning is warranted. Further research is needed to clarify its etiology and guide effective management strategies.

Background/Objectives: Low back pain (LBP) is the leading cause of disability in Saudi Arabia and contributes substantially to healthcare utilisation, reduced quality of life, and lost productivity. This guideline provides nationally standardised, evidence-based recommendations for the assessment and management of non-specific LBP and sciatica in adults, adapted to the clinical and health-system context in Saudi Arabia. Methods: A multidisciplinary Task Force developed the guideline using the GRADE ADOLOPMENT approach, using NICE guideline NG59 as the primary evidence source. One additional clinical question was formulated to address pain neuroscience education, informed by a relevant systematic review. Update literature searches were conducted in PubMed, Embase, and the Cochrane Library (2016–2022). The evidence was appraised using GRADE, and recommendations were formulated through structured Evidence-to-Decision deliberations and consensus voting. Results: The Task Force addressed eleven clinical questions in this guideline. Strong recommendations were provided for the use of validated risk assessment tools (very low certainty of evidence) and stratified management (moderate certainty of evidence). Conditional recommendations were made for indications for imaging, pharmacological treatment for sciatica, psychological interventions, multidisciplinary return to work programmes, epidural injections, prognostic value of image-concordant pathology, spinal decompression, radiofrequency denervation, and pain neuroscience education, with certainty of evidence ranging from very low to low. Conclusions: The findings indicate that management of non-specific LBP and sciatica in Saudi Arabia should be guided by clinical assessment, with restricted use of imaging, careful selection of pharmacological treatments, and appropriate use of psychological, multidisciplinary, and procedural interventions.