The impact of obesity on clinical outcomes following joint replacement procedures is resounding. Therefore, multiple strategies to achieve a substantial weight loss before surgery are needed in obese patients. The aim of the study was to test the effect of a fiber-enriched high carbohydrate (FEHC) diet on the reduction in body weight and pain in elderly obese patients undergoing total hip arthroplasty (THA). Sixty-one candidates for THA were included in our study. Prior to the procedure, the participants have been randomly assigned to a 3-month diet intervention (FEHC diet or free diet). Anthropometric measures and food questionnaires were collected at the enrollment and after 3 months. The Oxford Hip Score (OHS), the Hip disability and Osteoarthritis Outcome Score (HOOS) and the Western Ontario McMaster Universities OA Index (WOMAC) were administered at baseline and before surgery. A statistically significant variation of weight was found in the FEHC diet group (−3.7 kg, −4.4–−2.5) compared to the control group (−0.2 kg; −1.4–1.7; p < 0.0001), as well as significant improvements in the OHS (p < 0.0001), the HOOS (p < 0.0001) and the WOMAC (p < 0.0001) questionnaires. According to the results of the study, the FEHC diet in obese patients undergoing THA might help weight loss and improve related anthropometric parameters as well as hip function and pain.

The purpose of this study was to investigate how lateralization shoulder angle (LSA) and distalization shoulder angle (DSA) are related to clinical and kinematic outcomes after reverse total shoulder arthroplasty. Thirty-three patients were evaluated at least six months postoperatively. The Single Assessment Numeric Evaluation (SANE), Constant Murley Score (CMS), Simple Shoulder Test (SST), and Visual Analogue Scale (VAS) were used. Shoulder kinematics was evaluated with a stereophotogrammetric system. LSA and DSA inter-rater reliability was analysed through the interclass correlation coefficient (ICC). Stepwise forward linear regression analysis was conducted between LSA and DSA with clinical scales and kinematic measures, between which a correlation analysis was conducted. The inter-rater reliability for LSA (mean ICC = 0.93) and DSA (mean ICC = 0.97) results were good to excellent. Greater LSA values were associated with higher peaks of internal rotation (p = 0.012, R² = 0.188) and range of motion (ROM) (p = 0.037, R² = 0.133). SANE (p = 0.009), CMS (p = 0.031), and SST (0.026) were positively correlated to external rotation, while VAS (p = 0.020) was negatively related. Abduction peaks were positively related to CMS (p = 0.011) and SANE (p = 0.037), as well as abduction ROM (SANE, p = 0.031; CMS, p = 0.014).

Introduction: In glenohumeral osteoarthritis, progressive bone erosion often leads to posterior humeral head subluxation and increased glenoid retroversion. Correcting this deformity represents a major challenge in reverse shoulder arthroplasty (RSA), where surgical techniques commonly aim to restore neutral glenoid orientation (0°). Evidence regarding the influence of preoperative glenoid retroversion on postoperative outcomes remains limited. This study aimed to evaluate whether clinical and functional outcomes at a minimum 2-year follow-up differ according to preoperative glenoid retroversion in patients undergoing reverse total shoulder arthroplasty (RTSA) with systematic intraoperative correction to neutral. Methods: A total of 161 patients undergoing RTSA were retrospectively reviewed. Preoperative planning was performed using 3D software to restore neutral glenoid orientation via the bony-increased offset reverse shoulder arthroplasty technique. Glenoid retroversion was measured preoperatively on CT scans using the Friedman method, while postoperative glenoid version was assessed on axillary radiographs to confirm neutral orientation. Patients were stratified into two groups based on preoperative retroversion (<10° and ≥10°). Clinical outcomes and range of motion at a minimum follow-up of 24 months were compared between groups. Glenoid lateralization was assessed radiographically using the glenoid lateralization angle (GLA). Group comparisons were performed using the Mann–Whitney U test, and correlations were assessed using Spearman analysis. A p-value < 0.05 was considered statistically significant. Results: After exclusion of four patients with postoperative complications, 157 patients were included in the final analysis. The mean postoperative glenoid version was 0.35° ± 0.8° (range, −1° to +2°). No significant differences were observed in any clinical outcome between patients with <10° and ≥10° of preoperative glenoid retroversion, and no significant correlations were found between preoperative retroversion and postoperative outcomes. Radiographic analysis confirmed restoration of near-neutral glenoid version in all patients and demonstrated comparable glenoid lateralization between groups, with no significant differences in the GLA. Conclusion: In glenohumeral osteoarthritis, the most common pattern of bone loss results in increased glenoid retroversion and posterior humeral head subluxation. It remains debated whether, when applying standard correction techniques aimed at restoring neutral glenoid version, the severity of preoperative glenoid retroversion influences postoperative outcomes. The findings of this study indicate that, when RSA is performed with restoration of neutral glenoid version, postoperative clinical and functional outcomes are independent of the degree of preoperative glenoid retroversion. Level of evidence: Level III cohort study

Basicervical femoral fractures (AO/OTA 31B3) are considered extracapsular injuries located at the base of the femoral neck, with features intermediate between intracapsular and pertrochanteric fractures. Their anatomical "borderline" position and mechanical instability have led to uncertainty regarding optimal management. This systematic review aimed to evaluate outcomes of cephalomedullary nails (CMN), sliding hip screws (SHS) and hip arthroplasty (HA) for strictly defined basicervical fractures and to identify which treatment strategies are associated with fewer implant failures. A systematic literature search (Medline/PubMed, Scopus, Cochrane) was performed according to PRISMA guidelines. English-language randomised controlled trials and prospective or retrospective observational studies were included if they specifically reported basicervical femoral fractures defined as AO/OTA 31B3 or as extracapsular fractures lateral to the femoral neck and medial to the greater trochanter without involvement of the lesser trochanter, treated with CMN, SHS or HA. Cadaveric, biomechanical and purely technical reports were excluded. Risk of bias was assessed using RoB 2 for RCTs and the Newcastle-Ottawa Scale for observational studies. Due to heterogeneity, data were synthesised descriptively. Sixteen studies with 1144 patients were analysed: 416 treated with CMN, 668 with SHS and 60 with HA. Overall implant failure occurred in 27 CMN cases (6.5%), 54 SHS cases (8.1%) and 2 HA cases (3.3%). Cut-out and non-union were the main failure modes after internal fixation, whereas avascular necrosis and new femoral neck fracture were rare. Across contemporary series, CMN and SHS showed broadly comparable failure patterns when adequate reduction and implant positioning were achieved. HA demonstrated low mechanical failure rates but was used in small, highly selected cohorts. Most studies were at least at moderate risk of bias. When basicervical fractures are strictly defined, both CMN and SHS appear to be acceptable options provided that anatomic or near-anatomic reduction and proper implant placement are obtained, while primary HA may be considered in frail elderly patients at high risk of fixation failure. Recognising basicervical fractures as a distinct entity and standardising their radiographic definition are essential to refine treatment algorithms, and high-quality prospective comparative studies are still needed. I.