Clinical Orthopaedics and Related Research®最新文献

{"title":"Are Levels of Loneliness Associated With Levels of Comfort and Capability in Musculoskeletal Illness?","authors":"Haley Ponce, Rafael Cordero, David Ring, George Sayegh, Ali Azarpey, Prakash Jayakumar","doi":"10.1097/CORR.0000000000003321","DOIUrl":"10.1097/CORR.0000000000003321","url":null,"abstract":"<p><strong>Background: </strong>Variation in levels of pain intensity and incapability among patients with musculoskeletal conditions is associated with measures of mindset (unhelpful thoughts [such as hurt equals harm] and feelings of distress [overwhelm, rumination] regarding bodily sensations) and circumstances (social health as well as security in finances, roles, home, and support) as much or more so than pathophysiology severity. Loneliness is an important aspect of social health, it is associated with worse mental health, and it has been identified as worthy of attention and intervention by health authorities in several countries. It is estimated that up to one-third of adults older than 45 years of age experience loneliness. Given that a large percentage of people seeking musculoskeletal specialty care are older than 45 years, identification of notable levels of loneliness and an association with greater levels of pain intensity and incapability would support screening and treatment of feelings of loneliness as part of comprehensive, whole-person, musculoskeletal care strategies.</p><p><strong>Questions/purposes: </strong>In a cross-sectional study of people seeking musculoskeletal specialty care for upper and lower extremity conditions, we asked: (1) Are there factors associated with levels of capability including greater feelings of loneliness? (2) Are there factors associated with levels of pain intensity including greater feelings of loneliness?</p><p><strong>Methods: </strong>We recruited 146 new and returning, English-speaking, adult patients without cognitive deficiencies seeking care in metropolitan musculoskeletal specialty offices. Three patients were excluded because they did not complete the measures of pain intensity and incapability, and 143 were analyzed, including 57% (82) women with a mean age ± SD of 56 ± 17 years and 71% (102) with an upper extremity condition. Participants completed validated measures of feelings of loneliness (University of California, Los Angeles [UCLA] Loneliness Scale), thoughts and feelings regarding sensations (three items each validated in a factor analysis of commonly used measures), and levels of incapability (PROMIS Physical Function computer adaptive test), and pain intensity (pain intensity on an 11-point ordinal scale between 0 [no pain] and 10 [the most intense possible pain]). In the multivariable analysis, we measured the relationship between levels of incapability and pain intensity and feelings of loneliness, accounting for demographic factors and thoughts and feelings regarding sensations.</p><p><strong>Results: </strong>Accounting for potential confounding variables such as income level and insurance status, we found that lower levels of capability were moderately associated with greater feelings of distress regarding symptoms (such as rumination or a sense of overwhelm; regression coefficient [RC] -0.99 [95% confidence interval (CI) CI -1.5 to - 0.51]; p < 0.001) and that higher le","PeriodicalId":10404,"journal":{"name":"Clinical Orthopaedics and Related Research®","volume":" ","pages":"635-642"},"PeriodicalIF":4.2,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11936547/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142681005","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"CORR Insights®: Does Discussing Patient-reported Outcome Measures Increase Pain Self-efficacy at an Orthopaedic Visit? A Prospective, Sequential, Comparative Series.","authors":"Robert J Barth","doi":"10.1097/CORR.0000000000003362","DOIUrl":"10.1097/CORR.0000000000003362","url":null,"abstract":"","PeriodicalId":10404,"journal":{"name":"Clinical Orthopaedics and Related Research®","volume":" ","pages":"632-634"},"PeriodicalIF":4.2,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11936621/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142913859","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Editorial: The Goal is Health, Not Surgery.","authors":"David Ring, Seth S Leopold","doi":"10.1097/CORR.0000000000003399","DOIUrl":"10.1097/CORR.0000000000003399","url":null,"abstract":"","PeriodicalId":10404,"journal":{"name":"Clinical Orthopaedics and Related Research®","volume":" ","pages":"551-553"},"PeriodicalIF":4.2,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11936580/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143188131","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Editor's Spotlight/Take 5: How Does Shame Relate to Clinical and Psychosocial Outcomes in Knee Osteoarthritis?","authors":"Seth S Leopold","doi":"10.1097/CORR.0000000000003416","DOIUrl":"10.1097/CORR.0000000000003416","url":null,"abstract":"","PeriodicalId":10404,"journal":{"name":"Clinical Orthopaedics and Related Research®","volume":" ","pages":"554-557"},"PeriodicalIF":4.2,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11936632/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143440057","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Not the Last Word: A Joint Registry for Resident Selection.","authors":"Joseph Bernstein","doi":"10.1097/CORR.0000000000003431","DOIUrl":"10.1097/CORR.0000000000003431","url":null,"abstract":"","PeriodicalId":10404,"journal":{"name":"Clinical Orthopaedics and Related Research®","volume":" ","pages":"573-576"},"PeriodicalIF":4.2,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11936627/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143584953","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"What Is the Functional Spinopelvic Relationship in Three Dimensions? A CT and EOS Study.","authors":"Angelika Ramesh, Johann Henckel, Xing Lim, Patrick Tompsett, Alister Hart, Anna Di Laura","doi":"10.1097/CORR.0000000000003473","DOIUrl":"https://doi.org/10.1097/CORR.0000000000003473","url":null,"abstract":"<p><strong>Background: </strong>Understanding the spinopelvic relationship is essential in THA planning, especially given the elevated hip dislocation risk in patients exhibiting abnormal spinopelvic movements. Rotations of the spinopelvic unit affect the functional orientation of the acetabulum and, in turn, the placement of the acetabular cup. Currently, however, the kinematic behavior of the pelvis is not considered preoperatively. Standard CT scans and radiographs only guide component positioning based on the supine position, which may result in suboptimal acetabular cup alignment in more functionally relevant positions. Therefore, the ideal imaging for 3-dimensional (3D) planning of hip surgery is full-length standing CT, which is yet to be implemented given the technical and logistical challenges and high radiation doses involved.</p><p><strong>Questions/purposes: </strong>(1) What is the pelvic tilt in the functional positions of supine, standing, and seated? (2) How does the pelvic orientation change when transitioning between these positions?</p><p><strong>Methods: </strong>Between 2020 and 2023, we treated 36 patients for osteoarthritis (OA) who underwent preoperative CT and EOS imaging for their primary THA at our tertiary center. We considered all of those with a satisfactory CT and EOS scan as potentially eligible for this study. Based on that, 86% (31) were confirmed as eligible for analysis here; 14% (5) were excluded because of an incomplete scan field of view, presence of a spinal implant, or because of difficulty in identifying the anterior pelvic plane (APP). The final analysis included 31 patients with OA (23 women and 8 men, mean ± SD age 63 ± 13 years). We proposed a comparison method that uses 3D models of the supine CT-generated bony anatomy and standing and seated full-body biplanar radiography (EOS scans) to obtain the absolute and relative values of pelvic orientation in this patient cohort. To answer our first research question, we performed computational measurements of the patients' pelvic tilt in all three planes (sagittal, coronal, and axial) and in three functional positions: supine, standing, and seated. To answer our second question, we compared and studied each patient's pelvic rotation as they transitioned between these positions. The outcome measures were the angular measurements of (1) pelvic tilt from CT (supine) and EOS (standing and seated) and (2) the change in pelvic tilt when transitioning from supine-standing, supine-seated, and standing-seated.</p><p><strong>Results: </strong>The mean ± SD sagittal pelvic tilt was greatest in the seated position, least in the standing position, and intermediate in the supine position (-26° ± 12° versus -2° ± 9° versus 6° ± 7°, respectively; p < 0.001). A positive pelvic tilt value denoted an anterior tilt of the APP with respect to the coronal plane and a negative value denoted a posterior tilt. The mean difference in the sagittal pelvic tilt between the supine and s","PeriodicalId":10404,"journal":{"name":"Clinical Orthopaedics and Related Research®","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143718258","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 Private Sector Treatment of Lumbar Spinal Disorders Associated With Greater Odds of Fusion Procedures?","authors":"Mark C Lawlor, Madison N Cirillo, Kaitlyn E Holly, Patawut Bovonratwet, Brendan M Striano, Christian Coles, Tracey P Koehlmoos, Andrew J Schoenfeld","doi":"10.1097/CORR.0000000000003487","DOIUrl":"https://doi.org/10.1097/CORR.0000000000003487","url":null,"abstract":"<p><strong>Background: </strong>Technological advancements in spine surgical care are disproportionately slanted toward fusion-based procedures, which may influence surgeons to prefer these over other less expensive techniques. These issues may be particularly magnified within the context of integrated care delivery systems such as the Military Health System, where patients can be treated at centers with different philosophies regarding care or manner of provider reimbursement (direct care Department of Defense facilities versus the private sector) within the same network. Understanding how these factors may influence the preferential use of lumbar fusion could better inform healthcare expenditures and the cost-efficiency of spine surgical care.</p><p><strong>Questions/purposes: </strong>(1) Compared with direct care models (Department of Defense facilities), does the private sector (civilian hospitals) have higher odds of performing interbody fusion versus other procedures for the surgical treatment of lumbar spine conditions? (2) For spinal conditions such as disc herniation, radiculopathy, spondylolisthesis, and spinal stenosis, are there higher odds of interbody fusion and posterolateral fusion in the private sector?</p><p><strong>Methods: </strong>We used TRICARE healthcare claims to retrospectively compare surgical care delivery between direct and private sector care (October 2015 to September 2023). The population covered by TRICARE has previously been shown to be representative of the US demographic ages 18 to 64 years, while the unique tiered nature of the system serves as a model of care delivery that is translatable to civilian integrated hospital networks. Direct care represents a proxy for those academic medical centers with salaried reimbursement; private sector care is representative of community facilities employing fee-for-service models. We included patients 18 years and older surgically treated for a disc herniation, lumbar spinal stenosis, lumbar radiculopathy, and/or spondylolisthesis. There were minimal missing data for the factors of interest. The mean ± SD age of the cohort as a whole was 53 ± 15 years, with 82% (50,747 of 61,735) of the population male and 79% (48,966 of 61,735) White. Lumbar spinal stenosis (42% [25,942 of 61,735]) was the most common surgical indication, followed by disc herniation (30% [18,708 of 61,735]). Overall, and within each lumbar spine disorder (disc herniation, spinal stenosis, radiculopathy, and spondylolisthesis), initial bivariate comparisons were made between type of surgery (decompression, posterolateral fusion, and interbody fusion) and the environment of care using multinomial logistic regression. Adjustments were then made for patient mix using multivariable multinomial logistic regression.</p><p><strong>Results: </strong>After adjusting for confounders such as age, race, gender, medical comorbidities, sponsor rank, and census region, compared with the direct care environment, lumbar s","PeriodicalId":10404,"journal":{"name":"Clinical Orthopaedics and Related Research®","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143735750","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":"Letter to the Editor: Artificial Intelligence Shows Limited Success in Improving Readability Levels of Spanish-language Orthopaedic Patient Education Materials.","authors":"Hinpetch Daungsupawong, Viroj Wiwanitkit","doi":"10.1097/CORR.0000000000003470","DOIUrl":"https://doi.org/10.1097/CORR.0000000000003470","url":null,"abstract":"","PeriodicalId":10404,"journal":{"name":"Clinical Orthopaedics and Related Research®","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143735774","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":"How Accurate Are Fulcrum Bending Radiographs in Estimating Postoperative Outcomes in Adolescent Idiopathic Scoliosis? A Systematic Review and Meta-analysis.","authors":"Victoria Yuk Ting Hui, Samuel Tin Yan Cheung, Jason Pui Yin Cheung, Prudence Wing Hang Cheung","doi":"10.1097/CORR.0000000000003468","DOIUrl":"https://doi.org/10.1097/CORR.0000000000003468","url":null,"abstract":"<p><strong>Background: </strong>Fulcrum bending radiographs can be used to assess coronal flexibility in patients with adolescent idiopathic scoliosis (AIS) to estimate postoperative correction. To obtain fulcrum bending radiographs, patients are passively bent over a radiolucent fulcrum at the apex of the curve. Available studies have disagreed about the accuracy in estimating postoperative correction, although these studies differed in terms of patients' baseline characteristics as well as other methods. Moreover, factors associated with accuracy were never explored. By pooling (meta-analyzing) results from these studies, we hoped to address these gaps in knowledge.</p><p><strong>Questions/purposes: </strong>In a meta-analysis, we asked: (1) Can fulcrum bending radiographs accurately estimate postoperative curve correction in patients with AIS? (2) What factors are associated with the accuracy of fulcrum bending estimation on postoperative coronal correction? (3) Is fulcrum flexibility associated with other surgical outcomes such as shoulder and coronal balance?</p><p><strong>Methods: </strong>PubMed, Embase, Medline, Journals@Ovid, Web of Science, and Scopus were searched from their inception up to August 27, 2024. Studies that (1) included patients with AIS undergoing single-stage posterior spinal fusion surgery without anterior release, (2) used fulcrum bending radiographs, (3) assessed radiographic surgical outcomes, and (4) had a minimum follow-up of 2 years were included. Studies that did not evaluate the use of fulcrum bending radiographs, those that did not report a p value, and studies with poor methodological quality were excluded. Our initial search yielded 433 articles, of which 172 remained after duplicate articles were removed. A total of 161 articles were excluded as the studies included patients who did not have AIS (n = 14), did not undergo surgery (n = 14), or did not undergo posterior spinal fusion (n = 23) or the studies did not evaluate the use of fulcrum bending radiographs (n = 59); had an insufficient follow-up duration of < 2 years (n = 15); did not evaluate the relationship between fulcrum bending radiographs and postoperative outcomes (n = 1); were reviews, commentaries, articles, conference proceedings, or non-English studies (n = 33); were animal studies (n = 1); or had poor methodological quality (n = 1). This left 11 studies for analysis. The Newcastle-Ottawa Quality Assessment Scale was used to evaluate the quality of evidence in three domains, including participant selection, comparability, and outcome measurement. Eleven included studies were of good quality except one with poor-quality evidence that was subsequently excluded from analysis. A random-effects meta-analysis was used to pool the data because of substantial statistical heterogeneity (I2 > 50%) in the included studies. The estimation of absolute correction was pooled using standardized mean differences, referred to as the mean difference; a value > 0","PeriodicalId":10404,"journal":{"name":"Clinical Orthopaedics and Related Research®","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143708918","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 Are the Medium-term Reciprocal Changes in Cervical Sagittal Alignment After Posterior Correction for Lenke 5C Adolescent Idiopathic Scoliosis?","authors":"Yiwei Zhao, You Du, Yang Yang, Haoran Zhang, Chenkai Li, Dihan Sun, Ziquan Li, Jianguo Zhang, Shengru Wang","doi":"10.1097/CORR.0000000000003448","DOIUrl":"https://doi.org/10.1097/CORR.0000000000003448","url":null,"abstract":"<p><strong>Background: </strong>Abnormal cervical sagittal alignment (CSA), typically cervical kyphosis, is more common in patients with adolescent idiopathic scoliosis (AIS) than in teenagers without AIS. Changes in CSA after posterior spinal fusion for AIS have been observed and may be associated with patient-reported clinical outcomes and age-related cervical disc degeneration. Previous studies have shown inconsistent postoperative reciprocal changes in CSA in patients with single structural thoracolumbar/lumbar (TL/L) AIS (Lenke 5C classification). However, little is known about the medium-term reciprocal changes in CSA after selective posterior TL/L fusion surgery.</p><p><strong>Questions/purposes: </strong>We sought to determine the following: (1) What proportion of patients with Lenke 5C AIS have abnormal CSA before surgery? (2) What were the changes in CSA after selective posterior TL/L fusion surgery in the overall Lenke 5C AIS cohort and in subgroups classified by thoracic kyphosis? (3) What global sagittal parameters were associated with CSA preoperatively and at the latest follow-up? (4) What is the correlation between CSA and Scoliosis Research Society Outcomes Questionnaire (SRS-22) scores?</p><p><strong>Methods: </strong>We queried our institutional database and identified 186 patients diagnosed with Lenke 5C AIS who underwent selective posterior TL/L fusion surgery from April 2010 to February 2018. Of these, 13% (25) of patients were lost to follow-up before 5 years, and 8% (15) of patients were excluded based on exclusion criteria, leaving 79% (146) of patients for analysis in this retrospective study. During this period, we typically offered selective posterior TL/L fusion surgery to patients with Lenke 5C AIS when the main TL/L Cobb angle exceeded 35°. All patients who were offered surgery for this diagnosis opted to have the procedure. Briefly, the surgical procedure consisted of pedicle screw insertion, multiple-level Ponte osteotomy, and segmental direct vertebral body derotation to correct the deformity. Ninety percent (132 of 146) of the patients were female, with a mean ± SD age of 15 ± 2 years. The mean follow-up time was 7 ± 1 years. All patients had a single structural TL/L curve, with a mean preoperative main TL/L Cobb angle of 43° ± 9°. Radiologic measurements included coronal deformity parameters, cervical sagittal parameters, and global sagittal parameters. SRS-22 scores were used to evaluate clinical outcomes. The preoperative cervical sagittal parameters were analyzed to assess the abnormal CSA proportion. Cervical sagittal parameters were compared preoperatively, postoperatively, and at the latest final follow-up. Based on the degree of thoracic kyphosis, patients were classified into a hypokyphotic group (thoracic kyphosis < 20°) and a normokyphotic group (thoracic kyphosis ≥ 20°), with further comparison of CSA within subgroups. Multiple linear regression analysis was performed to assess the correlation betwee","PeriodicalId":10404,"journal":{"name":"Clinical Orthopaedics and Related Research®","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143673315","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}