Clinical Orthopaedics and Related Research®最新文献

{"title":"CORR Synthesis: What Is the Role of Robotic-assisted Technology in Knee Arthroplasty?","authors":"Alexander W Richards,Randall E Marcus","doi":"10.1097/corr.0000000000003586","DOIUrl":"https://doi.org/10.1097/corr.0000000000003586","url":null,"abstract":"","PeriodicalId":10404,"journal":{"name":"Clinical Orthopaedics and Related Research®","volume":"108 1","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144320346","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®: 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":"Thomas J Blumenfeld","doi":"10.1097/CORR.0000000000003587","DOIUrl":"https://doi.org/10.1097/CORR.0000000000003587","url":null,"abstract":"","PeriodicalId":10404,"journal":{"name":"Clinical Orthopaedics and Related Research®","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144324645","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 Does Tendon Region, Donor, and the Presence of Disease Affect Protein Composition of the Achilles Tendon?","authors":"Rachana S Vaidya,Petra E Gilmore,Qiang Zhang,Keith R Lohse,Necat Havlioglu,Robert W Sprung,R Reid Townsend,Jonathon Backus,Jeremy McCormick,Andrew Thome,Spencer P Lake,Simon Y Tang,Farshid Guilak,Jennifer A Zellers","doi":"10.1097/corr.0000000000003578","DOIUrl":"https://doi.org/10.1097/corr.0000000000003578","url":null,"abstract":"BACKGROUNDResponse to treatment for tendinopathy is variable, which may reflect variability in underlying etiology and capacity for the tendon to respond to treatment. Understanding variability in tendon protein composition may help improve our understanding of the mechanistic underpinnings of painful tendon degeneration and inform treatment targets.QUESTIONS/PURPOSES(1) What factors (tendon region, individual characteristics, presence of disease) contribute to protein compositional (proteomic) and structural variation in human Achilles tendons? (2) What compositional changes characterize tendinopathy, and what protein interactions might contribute to tendon degeneration? (3) How does diabetes influence tendon composition, and what mechanisms might underlie tendon dysfunction in individuals with diabetes?METHODSIn this exploratory, cross-sectional study, human Achilles tendon specimens were obtained from individuals with (diabetes group, n = 5) or without diabetes (control group, n = 5) undergoing lower extremity amputation and from individuals undergoing tendon debridement surgeries for tendinopathy (tendinopathy group, n = 8). Specimens were collected between 2019 and 2023. Protein abundances were quantified and analyzed using mass spectrometry, hierarchical clustering, and principal component analysis. To evaluate the role of tendon region and donor on tendon protein compositional variability, we assessed proteomic differences between three regions in nontendinopathic tendons from three individuals. To identify the contribution of disease (that is, presence of tendinopathy or diabetes) on protein composition, we compared tendons from the tendinopathy (n = 8 [2 males, 6 females], mean ± SD age 48 ± 11 years), diabetes (n = 5 [3 males, 2 females], age 54 ± 9 years), and control (n = 5 [3 males, 2 females], age 42 ± 12 years) groups. Proteomic differences associated with tendinopathy and diabetes were further examined using functional enrichment and protein-protein interaction network analysis.RESULTSVariability in tendon protein composition was primarily from presence of disease, followed by donor and then tendon region. Protein composition distinguished tendons with tendinopathy from controls, with 311 proteins differentially expressed (152 overexpressed and 159 underexpressed; fold change ≥ 1.5, p < 0.05) and higher Bonar scores indicating greater degeneration (mean ± SD Bonar score tendinopathy group 8.6 ± 1.2 versus control group 2.1 ± 0.7; p = 0.01). Pathway analysis identified dysregulation in extracellular matrix remodeling (TIMP1, MMP3, MMP10), inflammatory response (TNF-α, EGFR1), and metabolic reprogramming. Tendons from individuals with diabetes exhibited minimal proteomic changes compared with the control group, with 66 differentially expressed proteins (31 overexpressed and 35 underexpressed; fold change ≥ 1.5, p < 0.05) with no histopathologic differences between diabetes and control group tendons (mean ± SD Bonar score diabetes gr","PeriodicalId":10404,"journal":{"name":"Clinical Orthopaedics and Related Research®","volume":"10 1","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144295674","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":"Lymphedema Is Severely Underdiagnosed in the Arthroplasty Clinic Population: A Bioimpedance Investigation.","authors":"William Sgrignoli,Caleb McCabe,Yumeng Gao,Cale Dobson,Victoria Tappa,Jacob M Elkins","doi":"10.1097/corr.0000000000003580","DOIUrl":"https://doi.org/10.1097/corr.0000000000003580","url":null,"abstract":"BACKGROUNDLymphedema is a recognized risk factor for postoperative complications after total joint arthroplasty (TJA). Edema from sources other than lymphedema can also contribute to postoperative complications, as preoperative leg edema is known to worsen postoperatively, prolonging recovery and increasing complication risks. Current evidence surrounding lymphedema in the arthroplasty context is scarce, and historical barriers have hindered its diagnosis. Given these limitations, research investigating preoperative identification of patients with lymphedema may have a profound impact on postoperative outcomes in TJA.QUESTIONS/PURPOSES(1) What percentage of patients in the highest quintile of extracellular water to total body water (ECW/TBW) ratios were found to have a diagnosis of lymphedema or edema according to ICD-10 codes? (2) Among patients in this group, were there any differences in BMI, ECW/TBW ratios, age, sex, or concurrent diagnoses of hypertension (HTN), diabetes mellitus (DM), and chronic kidney disease (CKD) between those who had a diagnosis and those who did not?METHODSBetween February 2020 and March 2024, a total of 4133 patients from the hip/knee arthroplasty clinic at the University of Iowa Hospitals & Clinics underwent bioelectrical impedance analysis (BIA) scans. BIA scans were routinely performed preoperatively on all patients undergoing TJA at their initial clinic visit, except for those unable to stand for 60 seconds and/or those with an implanted electronic cardiac device. We considered the top 20% of ECW/TBW ratios as eligible for inclusion in this retrospective study. From this subset, 20% (823) were eligible. Of the entire cohort, 8% (349 of 4133) were excluded because of duplicate records or having their BIA scan performed at a non-TJA clinic, and 1% (2) were excluded because of incorrect height measurements resulting in inaccurate BIA data, leaving 11% (472 of 4133) for final analysis. BIA scans were performed using the InBody 770 and InBody 970 (InBody USA), which have been found to demonstrate good repeatability and validity when compared with the current gold standard: the dual-energy X-ray absorptiometry scan. We reviewed electronic medical records (EMRs) for ICD-10-Clinical Modification codes containing lymphedema (I89) or edema (R60) diagnoses. Because health conditions that impact bodily fluid distribution can potentially confound BIA measurements, patient EMRs were also evaluated for diagnoses of HTN, DM, and CKD to analyze their impact on lymphedema diagnosis. The patients included in the final analysis had a median (range) age of 69 years (63 to 76), with a median (range) BMI of 36.9 kg/m2 (30.7 to 44.1); 55% (261 of 472) were female. Wilcoxon rank sum testing and chi-square testing were performed to analyze differences in BMI, ECW/TBW leg ratios, sex, age, and diagnosis of concurrent chronic disease (HTN, DM, CKD) between the lymphedema- or edema-diagnosed group and the nondiagnosed group.RESULTSOf the 472","PeriodicalId":10404,"journal":{"name":"Clinical Orthopaedics and Related Research®","volume":"5 1","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144295675","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":"Younger Age Is a Risk Factor for Discontinuing Military Service After THA.","authors":"Skyler D Walker,Vivek M Abraham,Ileya Yancey,George C Balazs,Ashton H Goldman","doi":"10.1097/corr.0000000000003581","DOIUrl":"https://doi.org/10.1097/corr.0000000000003581","url":null,"abstract":"BACKGROUNDWith improved implant survival, THA is becoming more common in younger patients. Despite similar patient-reported outcomes between younger and older cohorts, it remains unclear whether age at THA may limit a patient's ability to return to their job. Evaluation of the return-to-duty rate in military personnel after THA may shed light on the potential functional status of civilian patients who are of a similar demographic in physically demanding professions.QUESTIONS/PURPOSES(1) What proportion of active-duty military personnel return to duty after THA? (2) What demographic and surgical factors were associated with this return-to-duty proportion?METHODSWe performed a retrospective chart audit of all active-duty US military personnel who underwent primary THA between 2017 and 2020 at US military hospitals globally. A total of 452 patients underwent primary THA during the study period. Twenty-one percent (93 of 452) of patients with medical records lacking critical information for the primary analysis were excluded, leaving 79% (358) eligible for analysis. Most patients were men (85% [306 of 358]), and the median (range) age was 46 years (22 to 65). Approaches included direct anterior (58% [206]), posterior (40% [143]), and lateral (3% [9]). The most common indications were primary osteoarthritis (63% [226]), avascular necrosis (18% [64]), and secondary osteoarthritis attributed to dysplasia (15% [52]). Univariate analyses considered demographic and operative variables. Multivariable logistic regression analysis was utilized to assess independent factors for return to duty versus medical separation.RESULTSTen percent (35 of 358) of patients underwent medical separation from service because of their hip after THA, with the remaining 90% returning to duty. After controlling for potentially confounding variables such as surgical approach, complications, and BMI, we found that decreasing age was associated with higher risk of medical separation, such that each year of increasing age was associated with a decreased risk of medical separation by 17% (OR 0.83 [95% CI 0.76 to 0.90]; p < 0.01). Patients serving in the US Navy were less likely to undergo separation from service than patients in the Army (OR 0.19 [95% CI 0.04 to 0.87]; p = 0.03). Complications and surgical approach were not found to be associated with increased odds of separation.CONCLUSIONWhen treating active-duty military patients who qualify for THA, one must consider the occupation and age implications that surgical intervention may have on the patient. Analysis of this unique patient population may allow for improved understanding of outcomes in the growing number of young active civilian patients who undergo THA. These data can potentially be applied to that population, especially those in physically demanding jobs that may be analogous to military duty. The results of this study would also be of use when providing an evidence-based preoperative risk assessment for these patient","PeriodicalId":10404,"journal":{"name":"Clinical Orthopaedics and Related Research®","volume":"25 1","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144295676","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®: High Risk of Venous Thromboembolism With Aspirin Prophylaxis After THA for High-riding Developmental Dysplasia of the Hip: A Retrospective, Comparative Study.","authors":"Rocco P Pitto","doi":"10.1097/CORR.0000000000003577","DOIUrl":"https://doi.org/10.1097/CORR.0000000000003577","url":null,"abstract":"","PeriodicalId":10404,"journal":{"name":"Clinical Orthopaedics and Related Research®","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144539245","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®: What Is the Cumulative Incidence of Femoral Stem Revision and Stem Complication in Cemented and Uncemented Hip Arthroplasty for Proximal Femoral Metastatic Bone Disease?","authors":"Sean P Kelly","doi":"10.1097/CORR.0000000000003579","DOIUrl":"https://doi.org/10.1097/CORR.0000000000003579","url":null,"abstract":"","PeriodicalId":10404,"journal":{"name":"Clinical Orthopaedics and Related Research®","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144641970","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®: 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":"Daniel C Allison","doi":"10.1097/CORR.0000000000003572","DOIUrl":"https://doi.org/10.1097/CORR.0000000000003572","url":null,"abstract":"","PeriodicalId":10404,"journal":{"name":"Clinical Orthopaedics and Related Research®","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144539246","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 Cumulative Incidence of Femoral Stem Revision and Stem Complication in Cemented and Uncemented Hip Arthroplasty for Proximal Femoral Metastatic Bone Disease?","authors":"Joshua M Lawrenz,Stephen W Chenard,Ethan P Winter,Dana G Rowe,Spencer M Richardson,Benjamin M Wright,Michael D Eckhoff,Hakmook Kang,Alexander L Lazarides,John H Alexander,Julia D Visgauss,Christopher D Collier,Lukas M Nystrom,","doi":"10.1097/corr.0000000000003541","DOIUrl":"https://doi.org/10.1097/corr.0000000000003541","url":null,"abstract":"BACKGROUNDHip arthroplasty is often indicated in metastatic bone lesions of the proximal femur, with or without pathologic fracture. Conventional knowledge is that cemented fixation is best, although uncemented fixation has potential advantages of shorter operative time, avoidance of the physiologic stress of cement, and the chance for osseointegration. However, both techniques are options that are employed, and there is no clear evidence to guide this choice.QUESTIONS/PURPOSESIn patients with proximal femoral metastatic bone lesions who were carefully selected either to receive cemented or uncemented fixation based on patient age, bone quality, tumor histology type, and the anatomic location of the lesion, we asked: (1) What is the cumulative incidence of femoral stem revision and stem complication in patients treated with cemented and uncemented hip arthroplasty for proximal femoral metastatic bone disease? (2) Are perioperative radiation and uncemented fixation independently associated with stem complication?METHODSBetween January 2011 and December 2022, six centers performed 337 primary hip arthroplasties (THA or hemiarthroplasty) for proximal femoral metastatic bone disease. While these relative indications for fixation technique varied by center and surgeon, cemented fixation was used in some centers exclusively; where used selectively, it was generally used more frequently in older patients (> 65 years), any patient with poorer radiographic proximal femoral bone quality, or in the setting of pathologic fractures and/or lesions requiring intralesional resection rather than complete resection. Uncemented fixation was often selectively used in younger patients (< 65 years) with adequate radiographic proximal femoral bone quality and often for lesions where all macroscopically visible disease was removed with sufficient remaining bone to accept uncemented fixation. A total of 287 cemented reconstructions (of which 19% [55 of 287] were THAs and 81% [232 of 287] were hemiarthroplasties) and 50 uncemented reconstructions (of which 50% [25 of 50] were THAs and 50% [25 of 50] were hemiarthroplasties) were performed. A total of 66% (190 of 287) and 36% (18 of 50) of patients, respectively, had died before 2 years, and 21% (61 of 287) and 42% (21 of 50), respectively, were lost to follow-up before 2 years but were not known to have died. As expected, the groups were substantially different at baseline, with the uncemented group being younger, less likely to have had a pathologic fracture, more likely to have received attempted wide resection rather than intralesional resection, more likely to have received this fixation technique at certain centers, and more likely to have received a THA, indicating a generally better preoperative functional status. Because of those substantial baseline differences between the fixation groups, we did not compare them but rather will report each separately in terms of survivorship with respect to stem revision and ste","PeriodicalId":10404,"journal":{"name":"Clinical Orthopaedics and Related Research®","volume":"228 1","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144295677","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 Displacement of the Lesser Trochanter Associated With Functional Outcome in Older Adults With Intertrochanteric Fractures?","authors":"Napol Ratanasermsub,Chavarin Amarase,Saran Tantavisut,Pathit Sirichuchnin","doi":"10.1097/corr.0000000000003574","DOIUrl":"https://doi.org/10.1097/corr.0000000000003574","url":null,"abstract":"BACKGROUNDLesser trochanter displacement in intertrochanteric fractures has been linked to fracture instability and altered hip biomechanics, with evidence suggesting that proximal or medial displacement of the fragment by ≥ 10 mm may lead to poorer clinical outcomes. However, whether such displacement is associated with multidomain functional outcomes and patient performance remains unclear.QUESTIONS/PURPOSESIn older adults with intertrochanteric fractures treated with internal fixation using a cephalomedullary nail, we asked: (1) Were functional outcome measures, including the Harris hip score (HHS), de Morton Mobility Index (DEMMI), and the Barthel Index, negatively associated with lesser trochanter displacement of ≥ 10 mm? (2) Was lesser trochanter displacement of ≥ 10 mm associated with a decreased ability to complete tasks during performance assessments and inferior performance scores on the Functional Reach Test (FRT), Timed Up and Go test (TUG), and 5 Times Sit-to-Stand (5TSTS) test?METHODSBetween January 2021 and October 2023, four fellowship-trained orthopaedic surgeons at a Level I trauma center treated older adults with intertrochanteric hip fractures. Short cephalomedullary nails were used in approximately 90% of patients, typically for displaced fractures, including both stable and unstable types. Of the 123 patients treated with a cephalomedullary nail, 7% (9) were lost to follow-up before 1 year, 9% (11) died within 1 year, and 12% (15) were excluded based on predefined criteria, leaving 72% (88) of patients for analysis in this retrospective comparative study. There was no evidence of differential loss to follow-up or mortality between the displacement groups. Patients were divided into two groups based on postoperative lesser trochanter displacement: patients with < 10 mm of proximal or medial displacement, including an intact lesser trochanter (n = 44), and patients with displacement of ≥ 10 mm (n = 44). Baseline characteristics, including demographics, American Society of Anesthesiologists classification, and preinjury Barthel Index, did not differ between the groups. Functional outcomes, including the HHS, the DEMMI (which assesses mobility across a range of physical tasks), and the Barthel Index (which measures independence in activities of daily living) were assessed at 3 months and 1 year postoperatively. All three scores range from 0 to 100, with higher scores indicating better function. These capture different domains of recovery, allowing for a more comprehensive evaluation of patient outcomes. Performance tests (FRT, TUG, 5TSTS) were assessed at the same time points by experienced orthopaedic surgeons, and the groups were compared on those endpoints. The minimum clinically important difference (MCID) or minimal detectable change at 95% confidence (MDC95) values were: HHS (MCID = 16 to 18), DEMMI (MCID = 10), Barthel Index (MCID = 8.4), FRT (MDC95 = 6.4 to 8.2 cm), TUG (MCID = 2.9 to 4.9 seconds), and 5TSTS (MCID = 3.6 ","PeriodicalId":10404,"journal":{"name":"Clinical Orthopaedics and Related Research®","volume":"33 1","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144295959","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}