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Grand RoundsWeekly Evidence Brief

Orthopedic Surgery

Edition

30-Second Takeaway

  • Preoperative PPI use is associated with higher long-term implant-related complication risks after total elbow arthroplasty.
  • Early-adopter surgeons report that Mako robotic rTSA improves positioning with manageable workload but occasional workflow conversions.
  • ESPB may modestly reduce early pain and opioid use after median sternotomy, but results vary widely across centers.

Week ending May 30, 2026

Selected recent evidence relevant to shoulder, elbow, and knee arthroplasty and perioperative care

Preop PPI exposure linked to higher revision and PJI after primary total elbow arthroplasty

JOURNAL OF SHOULDER AND ELBOW SURGERYMay 27, 2026

In a propensity-matched retrospective cohort of adults undergoing primary TEA, preoperative PPI exposure did not affect 90-day outcomes but increased later complications. By one year, PPI users had higher revision risk (HR 1.87) and higher PJI risk (HR 1.81). Within 5- and 10-year windows, PPI exposure was associated with higher hazards of revision, PJI, loosening, fracture, and VTE. The authors propose PPI use may mark elevated risk and recommend preoperative optimization and targeted postoperative surveillance.

Early-adopter surgeons report high perceived utility and manageable workload for Mako robotic rTSA

JOURNAL OF SHOULDER AND ELBOW SURGERYMay 29, 2026

A cross-sectional survey of 14 limited-release surgeons found strong agreement that Mako rTSA improves positioning accuracy and plan fidelity. NASA-TLX scores indicated low mental demand and high self-rated performance, with moderate physical demand and temporal pressure. Temporal demand was higher for less experienced users and decreased with experience (Spearman ρ = -0.63, p = 0.016). Forty-three percent experienced at least one workflow conversion, all due to registration or coracoid array issues.

Multicomponent mHealth program increased sit-to-stand transitions but did not reduce overall sedentary time after TKR

JMIR MHEALTH AND UHEALTHMay 26, 2026

In an RCT of adults within one year of TKR (N = 83), the NEAT!2 app plus coaching did not reduce total sedentary time or improve most outcomes at 2 or 5 months. At 5 months, the intervention increased sit-to-stand transitions compared with control (mean difference 4.06 transitions; P = .04). Greater app engagement correlated with higher moderate-to-vigorous activity (r = 0.335; P = .04). Retention was high (96% at 2 months), suggesting feasibility but limited clinical effect on overall activity levels.

References

Numbered in order of appearance. Click any reference to view details.

Additional Reads

Optional additional studies from this edition.

Edition context

Clinical signal

  • Discuss PPI use as a potential risk marker during TEA preop optimization and consider enhanced surveillance.
  • When adopting robotic rTSA, plan for registration/array failure contingencies and expect temporal demand to fall with experience.
  • Interpret ESPB benefit cautiously due to high heterogeneity; benefits appear limited in MICS/ERAS pathways.