Clinical Orthopaedics and Related Research®最新文献

Letter to the Editor: Leptin Enhances M1 Macrophage Polarization and Impairs Tendon-Bone Healing in Rotator Cuff Repair: A Rat Model.

IF 4.2 2区医学

Clinical Orthopaedics and Related Research® Pub Date : 2025-04-22 DOI: 10.1097/corr.0000000000003475

Xu Cai,Bolun Wang,Lin Cheng,Qifeng Ou

引用次数: 0

CORR Insights®: Are Gabapentinoids Effective at Reducing Pain and Improving Sleep After Nerve Injury? A Systematic Review and Meta-analysis.

IF 4.2 2区医学

Clinical Orthopaedics and Related Research® Pub Date : 2025-04-22 DOI: 10.1097/corr.0000000000003512

Robert J Barth

引用次数: 0

CORR Insights®: Is Civilian Hospital Treatment of Lumbar Spinal Disorders Associated With Greater Odds of Fusion Procedures?

IF 4.2 2区医学

Clinical Orthopaedics and Related Research® Pub Date : 2025-04-22 DOI: 10.1097/corr.0000000000003511

Jiayong Liu

引用次数: 0

Association of Payment Model Changes With the Rate of Total Joint Arthroplasty in Patients Undergoing Kidney Replacement Therapy.

IF 4.2 2区医学

Clinical Orthopaedics and Related Research® Pub Date : 2025-04-18 DOI: 10.1097/corr.0000000000003502

Jennifer D Motter,Sunjae Bae,Amanda Paredes-Barbeito,Antonia F Chen,Mara McAdams-DeMarco,Dorry L Segev,Allan B Massie,Casey Jo Humbyrd

{"title":"Association of Payment Model Changes With the Rate of Total Joint Arthroplasty in Patients Undergoing Kidney Replacement Therapy.","authors":"Jennifer D Motter,Sunjae Bae,Amanda Paredes-Barbeito,Antonia F Chen,Mara McAdams-DeMarco,Dorry L Segev,Allan B Massie,Casey Jo Humbyrd","doi":"10.1097/corr.0000000000003502","DOIUrl":"https://doi.org/10.1097/corr.0000000000003502","url":null,"abstract":"BACKGROUNDTo encourage high-quality, reduced-cost care for total joint arthroplasty (TJA), the Centers of Medicare & Medicaid Services mandated a pay-for-performance model, the Comprehensive Care for Joint Replacement (CJR), as part of the Patient Protection and Affordable Care Act (PPACA). The CJR incentivizes cost containment, and it was anticipated that its implementation would reduce access to TJA for high-cost populations. Patients with end-stage kidney disease (ESKD) undergoing kidney replacement therapy (dialysis and kidney transplant) are costly compared with healthier patients, but it was unknown whether this population lost access to hip and knee replacement because of CJR implementation. This population allows study of whether TJA is accessible for medically complex patients whose risk of surgical complications has been mitigated, as kidney transplantation improves outcomes compared with dialysis, allowing evaluation as to whether access improved when patients crossed over from dialysis to transplantation. Because all patients with ESKD are included in a mandated national registry, we can quantify whether access changed for patients who underwent dialysis and transplantation.QUESTIONS/PURPOSES(1) How did the rate of TJA change amid the shift to bundled payments for patients with ESKD receiving dialysis? (2) How did the rate of TJA change amid the shift to bundled payments for patients with ESKD after kidney transplant?METHODSThis was an observational cohort study from 2008 to 2018 using the United States Renal Data System, a mandatory national registry that allows for the opportunity to study all individuals with ESKD. During the study period, we identified 1,324,614 adults undergoing routine dialysis and 187,212 adult kidney transplant recipients; after exclusion for non-Medicare primary insurance (n = 785,224 for dialysis and 78,011 for transplant), patients who were 100 years or older (n = 79 and 0, respectively), those who resided outside of 50 US states and Puerto Rico (n = 781 and 87, respectively), missing dialysis status for the dialysis cohort (n = 8658), and multiorgan transplant recipients for the transplant cohort (n = 2442), our study population was 40% (529,872) of patients who underwent routine dialysis and 57% (106,672) of adult kidney transplant recipients, respectively. TJA was ascertained using Medicare Severity Diagnosis Related Groups and ICD-9 and ICD-10 codes. We divided the study period by PPACA (January 1, 2014, to March 31, 2016) and CJR (April 1, 2016, to December 31, 2018) implementation and compared the incidence of TJA by era using mixed-effects Poisson regression adjusting for calendar time and clinical and demographic variables.RESULTSAfter adjustment for linear temporal trend and patient case mix, there was no evidence of association between policy implementation and the incidence of TJA. In the dialysis cohort, the adjusted incidence rate ratio (IRR) for TJA was 1.06 (95% confidence interval [CI] 0.98 ","PeriodicalId":10404,"journal":{"name":"Clinical Orthopaedics and Related Research®","volume":"53 1","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143872062","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}

引用次数: 0

Medicolegal Sidebar: Is Hospital CQI and Peer Review Information Always Protected?

IF 4.2 2区医学

Clinical Orthopaedics and Related Research® Pub Date : 2025-04-17 DOI: 10.1097/corr.0000000000003501

B Sonny Bal

引用次数: 0

Is Rotationplasty Still a Reasonable Reconstruction Option for Patients With a Femoral Bone Sarcoma? A Comparative Study of Patients With a Minimum of 20 Years of Follow-up After Rotationplasty and Lower Extremity Amputation.

IF 4.2 2区医学

Clinical Orthopaedics and Related Research® Pub Date : 2025-04-17 DOI: 10.1097/corr.0000000000003495

Gerhard Martin Hobusch,Christoph Hofer,Kevin Döring,Florian Ellersdorfer,Tryphon Kelaridis,Reinhard Windhager

{"title":"Is Rotationplasty Still a Reasonable Reconstruction Option for Patients With a Femoral Bone Sarcoma? A Comparative Study of Patients With a Minimum of 20 Years of Follow-up After Rotationplasty and Lower Extremity Amputation.","authors":"Gerhard Martin Hobusch,Christoph Hofer,Kevin Döring,Florian Ellersdorfer,Tryphon Kelaridis,Reinhard Windhager","doi":"10.1097/corr.0000000000003495","DOIUrl":"https://doi.org/10.1097/corr.0000000000003495","url":null,"abstract":"BACKGROUNDRotationplasty was first introduced as an alternative to above-the-knee amputation after resection of bone sarcomas of the distal femur by Salzer in 1974. Although the procedure involves a substantial body image issue, it has many advantages such as durability of the reconstruction (compared with limb salvage procedures) and avoidance of phantom pain (compared with amputation). Although several reports have shown intermediate outcomes of rotationplasty, very long-term results in terms of function, activity levels, and quality of life (QoL) in comparison with above-the-knee amputation have not been reported. This work aims to fill this gap left by prior reports.QUESTIONS/PURPOSES(1) Is there a difference in revision-free survival in very long-term follow-up after rotationplasty and transfemoral amputation or knee disarticulation? (2) Are patient activity levels after rotationplasty comparable with those after transfemoral amputation or knee disarticulation in the very long term? (3) Do activity levels differ in terms of QoL? (4) Within the group of patients who have undergone rotationplasty, is the ROM in the neo-knee associated with QoL 20 to 40 years later?METHODSBetween 1961 and 1995, a total of 360 patients were treated for bone and soft tissue sarcoma of the lower extremity. Fifty-four patients were treated with A1 rotationplasty, 124 were treated with an amputation, and 182 were treated with a limb salvage procedure. Of those who underwent amputation or rotationplasty, 9% (11 of 124) and 15% (8 of 54), respectively, were lost to follow-up before a period of 20 years without meeting a study endpoint, and another 71% (88 of 124) and 44% (24 of 54), respectively, died prior to 20 years with intact residual limbs, leaving 20% (25 of 124) and 41% (22 of 54), respectively, of the original group who had a follow-up time of at least 20 years. Four patients with amputations declined to participate in the study, while three patients with transtibial amputations and one patient with a complete language barrier after rotationplasty were excluded. These 39 patients with a minimum follow-up time of 20 years (mean [range] 36 years [23 to 55]) were available and gave their consent to this retrospective comparative study at the local orthopaedic department. The decision between rotationplasty and endoprosthetic replacement was made after thorough consultation and according to the patient's choice. As general guidance, Salzer's idea was to provide rotationplasty to patients who had a strong desire for higher levels of activity. Endoprosthetic reconstructions were more likely indicated given a patient's preference for a cosmetically uncompromised limb. Amputation was primarily performed one decade before the availability of rotationplasty and was mostly an alternative to rotationplasty because of patient refusal or surgical limitations. Therefore, the two groups differed in age at follow-up; however, they did not differ in age at surgery, BMI, gender","PeriodicalId":10404,"journal":{"name":"Clinical Orthopaedics and Related Research®","volume":"46 1","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143861991","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}

引用次数: 0

Standardized Intraoperative Robotic Laxity Assessment in TKA Leads to No Clinically Important Improvements at 2 Years Postoperatively: A Randomized Controlled Trial.

IF 4.2 2区医学

Clinical Orthopaedics and Related Research® Pub Date : 2025-04-16 DOI: 10.1097/corr.0000000000003505

Hannes Vermue,Nele Arnout,Thomas Tampere,Lenka Stroobant,Alexander Dereu,Jan Victor

{"title":"Standardized Intraoperative Robotic Laxity Assessment in TKA Leads to No Clinically Important Improvements at 2 Years Postoperatively: A Randomized Controlled Trial.","authors":"Hannes Vermue,Nele Arnout,Thomas Tampere,Lenka Stroobant,Alexander Dereu,Jan Victor","doi":"10.1097/corr.0000000000003505","DOIUrl":"https://doi.org/10.1097/corr.0000000000003505","url":null,"abstract":"BACKGROUNDJoint stability is a major factor associated with success after TKA. However, most assistive technologies, such as robotic-assisted TKA, do not incorporate a standardized laxity assessment. To address this gap, we opted to perform a randomized controlled trial comparing the results of a manual versus a robot-assisted TKA system with standardized laxity assessment.QUESTIONS/PURPOSES(1) Does robot-assisted TKA with a standardized laxity assessment provide superior patient-reported outcomes compared with conventional TKA with a manual tensioner, and does it result in a higher percentage of patients achieving the patient acceptable symptom state (PASS) thresholds 2 years after surgery? (2) Does robot-assisted TKA with a standardized laxity assessment provide different coronal alignment or coronal laxity compared with conventional TKA with a manual tensioner after surgery?METHODSThis was a prospectively registered randomized trial performed at a single center in Belgium. Patients with end-stage knee osteoarthritis unresponsive to conservative treatment were eligible. Exclusion criteria included severe deformity, limited ROM, prior fractures, infection, ligament insufficiency, and neurologic conditions. Between September 2020 and August 2022, we randomized 60 patients to receive TKA either with a manual tensiometer (n = 30) or a robotic-assisted TKA with an imageless system using a standardized laxity system (distraction of the tibiofemoral joint with 80N throughout ROM; n = 30). Of those, 100% (30 of 30) and 90% (27 of 30) of patients were available for follow-up at 2 years in the robotic-assisted and conventional groups, respectively. In both groups, a posterior stabilized implant was used. Patient-reported outcome measures (Knee Society Score [KSS], WOMAC, and 5-level EuroQol 5-domain scores) were obtained preoperatively and at 2 years postoperatively. Coronal alignment and implant position were evaluated on full-leg weightbearing radiographs. Stress radiographs were obtained to assess coronal laxity in 10° of flexion. There were no differences between the groups in baseline characteristics of age, BMI, side, gender, hip-knee-ankle axis, ROM, or patient-reported outcome measures. To account for multiple comparisons in this study, a Bonferroni correction was applied. All differences between both groups were evaluated considering minimum clinically important difference values for patients who have undergone TKA. The power analysis indicated 80% power to detect a clinically meaningful difference of 9.7 points in KSS function score, with an alpha of 0.05.RESULTSWe found no clinically important differences in patient-reported outcomes 2 years after surgery between the conventional and the robotic group (for example, the KSS function score in those groups was 66 ± 20 versus 74 ± 24, respectively, mean difference 8 [95% confidence interval (CI) -3 to 21]; p = 0.18), and no difference in the proportion of patients in those groups who achieved the ","PeriodicalId":10404,"journal":{"name":"Clinical Orthopaedics and Related Research®","volume":"33 1","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143861992","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}

引用次数: 0

How Do Gunshot and Explosive Injuries to the Lower Extremities Differ in Severity and Treatment? A Comparative Study From the Israel-Gaza Conflict.

IF 4.2 2区医学

Clinical Orthopaedics and Related Research® Pub Date : 2025-04-15 DOI: 10.1097/corr.0000000000003498

Dan Prat,Maya Braun,Adi Givon,Sharon Goldman,Eldad Katorza,Shachar Shapira

{"title":"How Do Gunshot and Explosive Injuries to the Lower Extremities Differ in Severity and Treatment? A Comparative Study From the Israel-Gaza Conflict.","authors":"Dan Prat,Maya Braun,Adi Givon,Sharon Goldman,Eldad Katorza,Shachar Shapira","doi":"10.1097/corr.0000000000003498","DOIUrl":"https://doi.org/10.1097/corr.0000000000003498","url":null,"abstract":"BACKGROUNDLower extremity injuries are common in conflict-related trauma, with gunshot wounds (GSWs) causing localized damage and explosive trauma leading to extensive tissue injuries. Existing research lacks direct comparisons of injury severity and treatment outcomes between GSWs and explosive trauma in modern conflicts. This study clarifies these differences to improve triage strategies, surgical planning, and rehabilitation protocols.QUESTIONS/PURPOSES(1) How did GSWs and explosive trauma differ in terms of injury severity, including the proportion of patients in each group who experienced open fractures, neurovascular injuries, and amputations, during the Israel-Gaza conflict? (2) What was the comparative frequency and type of surgical intervention performed for GSWs versus explosive trauma in lower extremities?METHODSBetween October 7, 2023, and December 31, 2023, a total of 1815 patients were entered into the Israel National Trauma Registry (INTR) as having been injured during the Israel-Gaza conflict. The INTR is a comprehensive national database that collects standardized injury and treatment information from all Level 1 and Level 2 trauma centers in Israel, ensuring high-quality, consistent reporting of war-related injuries. Of these, we considered patients with lower extremity injuries and ICD-9 E-codes E979 and E990-E999 (terror and war-related injuries) as potentially eligible. Based on this criterion, 1318 patients sustained extremity injuries, and 51% (674) met our inclusion criteria for this study. Among them, 53% (357 of 674) sustained GSWs and 47% (317) suffered explosive injuries. The groups did not differ in terms of mean ± SD ages (gunshot 28.5 ± 11.7 years, explosive 28.0 ± 11.4 years; p = 0.61). Most patients in both groups were men (gunshot 91%, explosive 95%; p = 0.09), with no between-group difference in terms of the proportion of patients who were men. Missing data were minimal in both groups, with complete data sets available for all primary outcomes. Comparisons were made between the two groups regarding the severity of injuries (such as open fractures and amputations), frequency and type of surgical interventions, and associated injuries (including those to the chest, abdomen, and face). Statistical analysis included chi-square tests for categorical variables and independent t-tests for continuous variables, with a significance threshold of p < 0.01 because of the large number of comparisons made.RESULTSGSWs resulted in a higher proportion of patients with open fractures (32% [115 of 357] versus 20% [64 of 317]; p = 0.001), particularly in the tibia and fibula (17% [62 of 357] versus 10% [33 of 317]; p = 0.01), whereas explosive injuries led to more amputations (10% [31 of 317] versus 3% [11 of 357]; p < 0.001); neurovascular injuries did not differ (p = 0.14 for nerve and p = 0.54 for vascular). A higher proportion of gunshot injuries were treated surgically (73% versus 59%; p < 0.001).CONCLUSIONUnderstanding the di","PeriodicalId":10404,"journal":{"name":"Clinical Orthopaedics and Related Research®","volume":"69 1","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143861993","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}

引用次数: 0

Should We Stop Assessing Intraoperative Frozen Section Marrow Margins During Ewing Sarcoma Resection?

IF 4.2 2区医学

Clinical Orthopaedics and Related Research® Pub Date : 2025-04-15 DOI: 10.1097/corr.0000000000003497

Stephen W Chenard,Akhil Rekulapelli,Rachel B Mersfelder,Hakmook Kang,Jennifer L Halpern,Herbert S Schwartz,Ginger E Holt,Reena Singh,Scott C Borinstein,Joshua M Lawrenz

{"title":"Should We Stop Assessing Intraoperative Frozen Section Marrow Margins During Ewing Sarcoma Resection?","authors":"Stephen W Chenard,Akhil Rekulapelli,Rachel B Mersfelder,Hakmook Kang,Jennifer L Halpern,Herbert S Schwartz,Ginger E Holt,Reena Singh,Scott C Borinstein,Joshua M Lawrenz","doi":"10.1097/corr.0000000000003497","DOIUrl":"https://doi.org/10.1097/corr.0000000000003497","url":null,"abstract":"BACKGROUNDEwing sarcoma is a rare and highly aggressive pediatric bone cancer that is histologically composed of small, round blue cells. These histologic findings can make it difficult to assess intraoperative frozen section bone marrow margins because the bone marrow that regenerates after preoperative chemotherapy has a similar appearance, especially on frozen section analysis. Prior studies have more broadly questioned the utility of intraoperative assessment of bone marrow margins using frozen sections during the resection of bone sarcomas; however, to our knowledge, no prior study has specifically characterized the accuracy or clinical utility of evaluating bone marrow margins on frozen sections during long bone Ewing sarcoma resection.QUESTIONS/PURPOSES(1) How accurate is the assessment of intraoperative bone marrow margins using frozen sections during the resection of long bone Ewing sarcoma? (2) What changes to the prespecified surgical plan were made in response to positive intraoperative assessments of bone marrow margins? (3) Is intraoperative assessment of bone marrow margins on frozen sections associated with improved survival free from local recurrence, development of metastatic disease, or Ewing sarcoma-specific death?METHODSSixty-four patients who underwent primary resection of a conventional Ewing sarcoma of a long bone at our institution were analyzed. In this cohort, 81% (52 of 64) of patients had frozen bone marrow margins assessed intraoperatively. There were no identifiable reasons for why some patients had or did not have a frozen section performed, and we could not detect differences in demographic or surgical features between patients who did versus those who did not have intraoperative margins assessed. Intraoperative margins were assessed as negative on frozen sections in 88% (46 of 52) of patients and positive in the remaining 12% (6 of 52) of patients. To determine the rates of false-positive and false-negative intraoperative assessments, the results of intraoperative frozen sections were compared with the assessments of those same initial intraoperative margins as reviewed on final pathology reports. In patients with positive intraoperative assessment of bone marrow margins on frozen sections, we reviewed the surgical records and operative notes to determine whether additional bony resection was performed or if any other changes were made to the prespecified operative plan as a result of the concern for a positive intraoperative margin. Data were available on all study endpoints in 86% (55 of 64) of patients at a minimum follow-up time of 2 years. Kaplan-Meier curves and log-rank tests were used to compare survival free from local recurrence, development of metastatic disease, and Ewing sarcoma-specific death between patients with intraoperative margin assessment and those without. We also compared these same oncologic outcomes between patients whose margins were called positive versus negative intraoperatively.RESU","PeriodicalId":10404,"journal":{"name":"Clinical Orthopaedics and Related Research®","volume":"108 1","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143841054","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}

引用次数: 0

CORR Insights®: Releasing Forces in Adhesive Capsulitis Are Important Indicators of Shoulder Stiffness and Postoperative Function.

IF 4.2 2区医学

Clinical Orthopaedics and Related Research® Pub Date : 2025-04-11 DOI: 10.1097/corr.0000000000003406

Betsy McAllister Nolan

引用次数: 0