Clinical Orthopaedics and Related Research®最新文献

{"title":"Patients With Moderate to Severe Dementia Who Undergo Elective TKA Face Elevated Risks of Death, Delirium, and Intensive Interventions: A Large, Propensity-weighted Database Study.","authors":"Taylor D Ottesen,Lingwei Xiang,Rachel R Adler,Kaitlyn E Holly,Clancy J Clark,Karen Sepucha,Samir K Shah,Dae Hyun Kim,John Hsu,Antonia F Chen,Joel S Weissman,Andrew J Schoenfeld","doi":"10.1097/corr.0000000000003542","DOIUrl":"https://doi.org/10.1097/corr.0000000000003542","url":null,"abstract":"BACKGROUNDAlthough TKA is one of the most commonly performed and successful orthopaedic interventions, its efficacy may be reduced in individuals living with dementia. Prior studies have not effectively accounted for confounding by indication or the use of intensive interventions, or considered the fact that cognitive impairment exists on a continuum and that patients with mild dementia may have different risk profiles when compared with those with moderate to severe dementia.QUESTIONS/PURPOSES(1) Are there differences in the risk of death after TKA in patients based on the severity of dementia? (2) Are there differences in intensive interventions and delirium after TKA in patients based on the severity of dementia?METHODSWe used Medicare data to allow for complete surveillance of all medical encounters and events that transpired before and after TKA surgery. We retrospectively identified Medicare beneficiaries living with dementia who underwent primary elective TKA between January 1, 2017, and June 30, 2018. We used the Claims-based Frailty Index (CFI) to stratify dementia severity. Patients with CFI scores of 0.25 to 0.28 and an ICD-10 code for dementia were recorded as living with mild dementia. Patients with an ICD-10 code for dementia and CFI scores of ≥ 0.28 were classified as having moderate to severe dementia. Our cohort included 156,596 patients, with 98% (152,728 of 156,596) classified as not having dementia, 1% (2123 of 156,596) having mild dementia, and 1% (1745 of 156,596) having moderate to severe dementia. We had complete surveillance of outcomes and events after surgery for this cohort of patients. The primary outcome was death within 180 days of surgery. Intensive interventions (such as feeding tube insertion, intubation, resuscitation) and delirium were considered secondarily. We used inverse probability weights to account for confounding and compared outcomes between cohorts using Cox proportional hazards models, generalized estimation equations, and Fine and Gray models.RESULTSAfter adjusting for potentially confounding variables such as age, gender, and comorbidities, we found that individuals with mild dementia (HR 1.74 [95% confidence interval (CI) 1.12 to 2.70]; p = 0.01) and moderate to severe dementia (HR 3.05 [95% CI 1.80 to 5.17]; p < 0.001) both demonstrated elevated hazards of death compared with patients without dementia. Patients with mild dementia (HR 4.25 [95% CI 2.59 to 5.03]; p < 0.001) and moderate to severe dementia (HR 6.40 [95% CI 5.18 to 7.92]; p < 0.001) exhibited elevated hazards of delirium, and those with moderate to severe dementia were found to have greater hazards of one or more intensive interventions (HR 3.24 [95% CI 1.76 to 5.96]; p < 0.001).CONCLUSIONWe observed elevations in the risk of death and delirium in patients after TKA, irrespective of the severity of dementia and marked elevations in the likelihood of intensive interventions after surgery for those with moderate to severe dementia. We ","PeriodicalId":10404,"journal":{"name":"Clinical Orthopaedics and Related Research®","volume":"123 1","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143945297","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reply to the Letter to the Editor: Artificial Intelligence Shows Limited Success in Improving Readability Levels of Spanish-language Orthopaedic Patient Education Materials.","authors":"Rodnell Busigó Torres, Mariana Restrepo, Brocha Z Stern, B Israel Yahuaca, Rafael A Buerba, Ivan A García, Victor H Hernandez, Ronald A Navarro","doi":"10.1097/CORR.0000000000003527","DOIUrl":"https://doi.org/10.1097/CORR.0000000000003527","url":null,"abstract":"","PeriodicalId":10404,"journal":{"name":"Clinical Orthopaedics and Related Research®","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143987805","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reply to the Letter to the Editor: Value-based Healthcare: The Impact of Consolidation in Healthcare on the Field of Orthopaedic Surgery.","authors":"Victor C Agbafe, David N Bernstein, Kevin J Bozic","doi":"10.1097/CORR.0000000000003537","DOIUrl":"https://doi.org/10.1097/CORR.0000000000003537","url":null,"abstract":"","PeriodicalId":10404,"journal":{"name":"Clinical Orthopaedics and Related Research®","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143976000","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Is Proximal Tibial Hemiarthroplasty Reconstruction Effective in Minimizing Limb Length Discrepancy Among Skeletally Immature Patients With Primary Bone Sarcomas?","authors":"Zhuoyu Li,Daoyang Fan,Jilong Zhao,Zhiping Deng,Yongkun Yang,Tao Jin,Qing Zhang,Xiaohui Niu,Weifeng Liu","doi":"10.1097/corr.0000000000003543","DOIUrl":"https://doi.org/10.1097/corr.0000000000003543","url":null,"abstract":"BACKGROUNDProximal tibial resection and reconstruction with a hinged knee megaprostheses may result in severe limb length discrepancy (LLD) in very young children because of the removal of the distal femoral and proximal physis. An alternative reconstruction using a proximal tibial hemiarthroplasty reconstruction has been proposed and reduces the degree of LLD because the distal femoral physis is preserved. However, there are very few reports on the results from this reconstruction, and it is not certain that the disadvantages of a more unstable knee are outweighed by the possibility of reducing limb length inequality.QUESTIONS/PURPOSES(1) What was the survivorship at 5 and 10 years after proximal tibial hemiarthroplasty reconstruction in children with malignant tumors, using amputation, endoprosthesis removal, and revision surgery as the main endpoints of interest? (2) What was the Musculoskeletal Tumor Society Score-93 (MSTS-93) after reconstruction at a minimum of 2 years after the procedure? (3) What percentage of patients experienced a major complication (resulting in unplanned reoperation), and what percentage of patients experienced minor complications (resulting in nonoperative treatment)? (4) What factors were associated with knee subluxation, and what factors were associated with an LLD measuring ≥ 4 cm?METHODSThis was a retrospective study performed by four consultant surgeons at a tertiary tumor referral center (Beijing Jishuitan Hospital, National Center for Orthopaedics, PR China) between 2005 and 2022. During that time, we generally recommended a tibial hemiarthroplasty to children with primary malignant tumors of the proximal tibia (Enneking stages IA, IB, and IIA and chemotherapy-responsive Stage IIB and IIIB tumors), as well as some metastatic tumors and some soft tissue sarcomas involving and surrounding the proximal tibia in children. We considered the ideal age range to be 9 to 13 years for males and 9 to 12 years for females, and we generally did not offer this procedure unless the surgeon believed that the neurovascular bundle was either uninvolved or could be separated during surgery. During that time, we considered 883 patients with primary malignant bone tumors to be potentially eligible. Of those, 781 were excluded because they underwent joint-preserving endoprosthetic reconstruction, recycled autografts, or extraarticular resection, leaving 110 who met the inclusion criteria for this study. Of those, 15% (16) of patients were lost to follow-up before the minimum follow-up of 2 years, leaving 85% (94) for analysis in this article at a mean ± SD follow-up time of 7 ± 4 years. The most common diagnoses were osteosarcoma (97% [91 of 94]) and Ewing sarcoma (3% [3 of 94]). The mean ± SD age was 11 ± 2 years; 57% (54 of 94) were male. At the last follow-up, 72% (68 of 94) of the patients had no evidence of disease, 9% (8) were alive with disease, 18% (17) had died of disease, and 1% (1) had died of other causes. Survivorship ","PeriodicalId":10404,"journal":{"name":"Clinical Orthopaedics and Related Research®","volume":"113 1","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143945250","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"CORR Insights®: Can Oritavancin Be Used for Treatment and/or Suppressive Antimicrobial Therapy of Bone and Joint Infections Caused by Vancomycin-resistant Enterococcus faecium?","authors":"Matthew L Webb","doi":"10.1097/CORR.0000000000003530","DOIUrl":"https://doi.org/10.1097/CORR.0000000000003530","url":null,"abstract":"","PeriodicalId":10404,"journal":{"name":"Clinical Orthopaedics and Related Research®","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143983747","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"What Is the Anatomic Footprint of the Anterolateral Ligament of the Knee? A Race- and Sex-based MRI Analysis.","authors":"Tianwen Huang,Xiaopeng He,Lihang Zhang,Changzhao Li,Yiming Yang,Jiaying Zhang,Dimitris Dimitriou,Tsung-Yuan Tsai,Pingyue Li","doi":"10.1097/corr.0000000000003519","DOIUrl":"https://doi.org/10.1097/corr.0000000000003519","url":null,"abstract":"BACKGROUNDThe anatomic location of the anterolateral ligament (ALL) of the knee is critical to ALL reconstruction, but there is not a clear consensus about the location of its footprint. Knowledge of the anatomic footprint is necessary to assess intraoperative positioning and postoperative functional outcomes of ALL reconstruction. Furthermore, while racial and sex-related variations in the ACL have been well documented, it remains unknown whether such differences extend to the ALL, as well as whether these differences influence surgical strategies.QUESTIONS/PURPOSESWe generated three-dimensional (3D) models based on MRI scans to (1) describe the differences in the ALL position between Chinese and White patient groups by establishing its anatomic footprint relative to adjacent anatomic structures, (2) assess the length of the ALL and the correlation between the ALL sagittal plane orientation and the position of its footprints, and (3) simulate the risk of injury to the lateral collateral ligament (LCL) while reconstructing the ALL by the use of drills of various diameters.METHODSIn our institution, patients' information was systematically gathered through a prospective database framework. Participants independently provided demographic details via a structured survey questionnaire, which were then recorded by our team of well-trained researchers. The collected data encompassed age, sex (female and male), ethnic background (White and Chinese), height (centimeters), weight (kilograms), and BMI (kg/m2). This study involved 120 volunteers, including 60 Chinese and 60 age-, sex-, and BMI-matched White participants, whose normal knees were scanned with MRI to generate 3D models. ALL femoral and tibial footprints were identified and digitally delineated on MRI images by two board-certified orthopaedic surgeons. Subsequently, the locations of the ALL femoral and tibial footprints were identified in relation to adjacent anatomic structures. The length of the ALL from the femoral footprint to tibial footprint was then measured, together with the angle formed by the ALL in the sagittal plane relative to a line parallel to the anatomic axis of the femur. Through regression analysis, we explored the correlation between the sagittal orientation of the ALL and the position of the footprint. Finally, simulations of ALL femoral tunnel drilling were performed to assess damage to the LCL footprint center caused by the use of drills of varying diameter.RESULTSThe ALL femoral footprint was adjacent to both the lateral epicondyle and the LCL, positioned anterior and distal to the LCL attachment, while the ALL tibial footprint was located between the Gerdy tubercle and the fibular head. The mean ± SD femoral footprint of the ALL in the Chinese population was more distal and anterior compared with the White population, which was located posterior to the lateral epicondyle (4 ± 2 mm versus 5 ± 2 mm, mean difference 1 [95% confidence interval (CI) 0 to 2]; normalized p va","PeriodicalId":10404,"journal":{"name":"Clinical Orthopaedics and Related Research®","volume":"26 1","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143921115","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"CORR Insights®: Association of Payment Model Changes With the Rate of Total Joint Arthroplasty in Patients Undergoing Kidney Replacement Therapy.","authors":"Paul Edward Levin","doi":"10.1097/CORR.0000000000003531","DOIUrl":"https://doi.org/10.1097/CORR.0000000000003531","url":null,"abstract":"","PeriodicalId":10404,"journal":{"name":"Clinical Orthopaedics and Related Research®","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143980292","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"CORR Insights®: No Difference in Outcome Scores or Persistent Instability After Latarjet Procedure for Anterior Instability in Patients With Shoulder Hyperlaxity Versus Those Without Hyperlaxity.","authors":"Betsy McAllister Nolan","doi":"10.1097/corr.0000000000003536","DOIUrl":"https://doi.org/10.1097/corr.0000000000003536","url":null,"abstract":"","PeriodicalId":10404,"journal":{"name":"Clinical Orthopaedics and Related Research®","volume":"138 1","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143915097","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"CORR Insights®: Frailty Is Associated With Increased 30-day Readmissions and Costs After Total Shoulder Arthroplasty.","authors":"Jashvant Poeran","doi":"10.1097/corr.0000000000003533","DOIUrl":"https://doi.org/10.1097/corr.0000000000003533","url":null,"abstract":"","PeriodicalId":10404,"journal":{"name":"Clinical Orthopaedics and Related Research®","volume":"15 1","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143915096","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"No Difference in Outcome Scores or Persistent Instability After Latarjet Procedure for Anterior Instability in Patients With Shoulder Hyperlaxity Versus Those Without Hyperlaxity.","authors":"Dipit Sahu,Darshil Shah","doi":"10.1097/corr.0000000000003485","DOIUrl":"https://doi.org/10.1097/corr.0000000000003485","url":null,"abstract":"BACKGROUNDThe prevalence of hyperlaxity in patients with shoulder instability is high, and its management is challenging. Shoulder hyperlaxity denotes a redundant anterior capsule with an elongated or weak glenohumeral ligament that may be associated with worse functional outcomes after procedures for instability. The functional outcomes and postoperative recurrence after a Latarjet procedure for recurrent instability in shoulders with hyperlaxity versus those without hyperlaxity has not been studied.QUESTIONS/PURPOSES(1) What are the differences in functional outcomes (Rowe score and shoulder subjective value [SSV]) after a Latarjet procedure for unidirectional anterior instability in shoulder hyperlaxity versus no hyperlaxity, and what proportion of shoulders achieve the patient acceptable symptom state (PASS) in both groups? (2) What is the difference in the proportion of patients who experienced a recurrence after a Latarjet procedure for unidirectional anterior instability in shoulder hyperlaxity versus no hyperlaxity? (3) What are the differences in radiologic outcomes after a Latarjet procedure for unidirectional anterior instability in shoulder hyperlaxity versus no hyperlaxity?METHODSBetween January 2014 and January 2022, one surgeon performed the Latarjet procedure for anterior shoulder instability in 155 patients. During that time, he performed the Latarjet for all patients with recurrent instability, with or without bone loss and with or without shoulder hyperlaxity. Of those who fit the prespecified inclusion criteria, 37% (48 of 131) had shoulder hyperlaxity (defined as external rotation [elbow adducted] ≥ 85° in the opposite normal shoulder) and 63% (83 of 131) had no hyperlaxity. A total of 90% (43 of 48) of the patients with shoulder hyperlaxity and 87% (72 of 83) of patients without hyperlaxity had a minimum follow-up time of 2 years and were evaluated for the first two study questions by comparing functional outcomes (SSV, Rowe scores, ROM) and the proportion of patients who experienced recurrent instability after a Latarjet procedure. We also compared the hyperlaxity group with a subgroup of 32 patients with no hyperlaxity who had ≥ 15% glenoid loss (defined as the \"critical defect, no hyperlaxity\" group). In addition, 84% (36 of 43) of patients in the hyperlaxity group and 81% (58 of 72) in the no hyperlaxity group had CT scans at a median (range) 3 years (1 to 7) after surgery, and this subset of patients was analyzed for radiologic outcomes. The PASS was defined as an SSV of 82.5%, per an earlier study. Recurrent instability after the procedure was defined as any overt instability (dislocation, subluxation) or anterior apprehension noted in the postoperative period. Subluxation was evaluated clinically based on the patient's history of a subjective instability event or a dislocation of the glenohumeral joint that could be self-reduced. The patients in the hyperlaxity group were younger (mean ± SD age 23 ± 4 years) and had a","PeriodicalId":10404,"journal":{"name":"Clinical Orthopaedics and Related Research®","volume":"65 1","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143915098","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}