Clinical Orthopaedics and Related Research®最新文献

{"title":"Editor's Spotlight/Take 5: Is Your Surgical Helmet System Compromising the Sterile Field? A Systematic Review of Contamination Risks and Preventive Measures in Joint Arthroplasty.","authors":"Seth S Leopold","doi":"10.1097/CORR.0000000000003479","DOIUrl":"10.1097/CORR.0000000000003479","url":null,"abstract":"","PeriodicalId":10404,"journal":{"name":"Clinical Orthopaedics and Related Research®","volume":" ","pages":"967-971"},"PeriodicalIF":4.2,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12106193/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143802783","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®: How Do Patients Perceive Success and Satisfaction After Vertebral Body Tethering and Fusion for Adolescent Idiopathic Scoliosis? A Qualitative Study.","authors":"Richard M Schwend","doi":"10.1097/CORR.0000000000003408","DOIUrl":"10.1097/CORR.0000000000003408","url":null,"abstract":"","PeriodicalId":10404,"journal":{"name":"Clinical Orthopaedics and Related Research®","volume":" ","pages":"1139-1141"},"PeriodicalIF":4.2,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12106222/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143363841","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":"Letter to the Editor: How Can the Environmental Impact of Orthopaedic Surgery Be Measured and Reduced? Using Anterior Cruciate Ligament Reconstruction as a Test Case.","authors":"Charu Jain","doi":"10.1097/CORR.0000000000003418","DOIUrl":"10.1097/CORR.0000000000003418","url":null,"abstract":"","PeriodicalId":10404,"journal":{"name":"Clinical Orthopaedics and Related Research®","volume":" ","pages":"1163-1164"},"PeriodicalIF":4.2,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12106238/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143467266","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":"Letter to the Editor: How Is Preoperative Opioid Use Associated With Readmissions and Outcomes in Lower Extremity Trauma?","authors":"Jiaxing Ding, Peilong Jiang, Yanfei Yang, Wei Qu","doi":"10.1097/CORR.0000000000003456","DOIUrl":"10.1097/CORR.0000000000003456","url":null,"abstract":"","PeriodicalId":10404,"journal":{"name":"Clinical Orthopaedics and Related Research®","volume":" ","pages":"1167-1168"},"PeriodicalIF":4.2,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12106233/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143662978","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":"Is Your Surgical Helmet System Compromising the Sterile Field? A Systematic Review of Contamination Risks and Preventive Measures in Total Joint Arthroplasty.","authors":"Joshua R Porto, Monish S Lavu, Christian J Hecht, Atul F Kamath","doi":"10.1097/CORR.0000000000003383","DOIUrl":"10.1097/CORR.0000000000003383","url":null,"abstract":"<p><strong>Background: </strong>Surgical helmet systems remain widely used in total joint arthroplasty (TJA) despite evidence to suggest that they may increase infection risk via contamination of sterile equipment and operating room air. However, the challenging nature of conducting high-quality clinical trials to study outcomes with low incidence, such as prosthetic joint infection (PJI), has made drawing definitive conclusions from the available experimental studies difficult. Therefore, a comprehensive analysis of the best available evidence is needed to clarify the association between surgical helmet system use and contamination and infection risk and to provide clinical recommendations for use in TJA.</p><p><strong>Questions/purposes: </strong>This systematic review aimed to address the following questions: (1) What is the level of sterility of surgical helmet systems and concomitantly used personal protective equipment (PPE)? (2) Is there an association between surgical helmet systems and air contamination within the operating room? (3) Does the use of a surgical helmet system affect wound contamination and/or infection?</p><p><strong>Methods: </strong>PubMed, Medline, EBSCOhost, and Google Scholar were queried on July 31, 2024, to identify studies published from inception to July 2024 that have evaluated the impact of surgical helmet system use in TJA on sterile field contamination (operating room air, PPE, sterile equipment), wound contamination and infection, or practices that may impact related outcomes. Inclusion criteria were that the study evaluate the sterility, donning, or intraoperative use (including mock TJA) of a surgical helmet system in association with contamination or infection. The following articles were excluded: case reports, case series, reviews, commentaries, editorials, duplicate studies among databases, gray literature, studies specific to a procedure other than TJA, and studies unavailable as a full-text English manuscript. After screening 536 articles, 21 were included. The 13 studies that evaluated the sterility of surgical helmet systems and concomitantly used PPE comprised 126 gowning simulations, 445 mock TJA procedures, and 191 patients who had undergone TJA. The seven studies that evaluated contamination of operating room air comprised 38 gowning simulations, 82 mock TJA procedures, and 96 patients who had undergone TJA. Three studies directly evaluated wound contamination or infection, comprising 83,888 patients who had undergone TJA. Risk of bias was determined via the Methodological Index for Nonrandomized Studies (MINORS) tool, with a mean ± SD score of 20 ± 1.4 (of 24) for comparative studies and 14 ± 0.8 (of 16) for noncomparative studies, indicating good study quality. Notably, the quality of evidence was limited by the inclusion of experimental study designs that did not directly measure infection; however, the inclusion of such studies is necessitated by the infeasibly large study population require","PeriodicalId":10404,"journal":{"name":"Clinical Orthopaedics and Related Research®","volume":" ","pages":"972-990"},"PeriodicalIF":4.2,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12106205/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143363934","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 the Degree of Liner Constraint Increase Risk of Complications in Articulating Spacers in Two-stage Revision After THA?","authors":"Carl A Deirmengian","doi":"10.1097/CORR.0000000000003567","DOIUrl":"10.1097/CORR.0000000000003567","url":null,"abstract":"","PeriodicalId":10404,"journal":{"name":"Clinical Orthopaedics and Related Research®","volume":" ","pages":"1245-1246"},"PeriodicalIF":4.2,"publicationDate":"2025-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12190026/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144233383","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®: Evaluation of Clinical Tests to Diagnose Iliopsoas Tendinopathy.","authors":"Carlos J Marques","doi":"10.1097/CORR.0000000000003568","DOIUrl":"https://doi.org/10.1097/CORR.0000000000003568","url":null,"abstract":"","PeriodicalId":10404,"journal":{"name":"Clinical Orthopaedics and Related Research®","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144198412","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 CMS' Merit-based Incentive Payment System Penalize or Reward Orthopaedic Surgeons Caring for Socially At-risk Patients?","authors":"Alec P Friswold, Arvind von Keudell, Clay Beagles, Devon Brameier, Mitchel B Harris, Christopher M Bono, David N Bernstein","doi":"10.1097/CORR.0000000000003566","DOIUrl":"https://doi.org/10.1097/CORR.0000000000003566","url":null,"abstract":"<p><strong>Background: </strong>The largest value-based payment system in the United States is the Merit-based Incentive Payment System (MIPS), implemented by the Centers for Medicare & Medicaid Services (CMS). MIPS was designed to adjust physician reimbursement based on performance across several categories. However, concerns arose that MIPS may inadvertently penalize physicians caring for patients of high social risk. To address this concern, CMS introduced the Complex Patient Bonus (CPB), which provides a performance bonus for serving a greater proportion of dually eligible, or socially at-risk (as defined by CMS), patients. In orthopaedic surgery, there is a paucity of evidence assessing MIPS performance (such as scores and payment adjustments), the association between patient social risk and MIPS scores, and the relationship of the newly implemented CPB with performance scores.</p><p><strong>Questions/purposes: </strong>In this study, we asked: (1) How do orthopaedic surgeons fare in MIPS based on positive, negative, and bonus payment adjustments? (2) Do orthopaedic surgeons caring for more socially at-risk patients receive worse performance scores and payment adjustments than orthopaedic surgeons who treat fewer socially at-risk patients? (3) To what extent is the CPB associated with differences in MIPS scores and payment adjustments for orthopaedic surgeons caring for a greater proportion of socially at-risk patients?</p><p><strong>Methods: </strong>Orthopaedic surgeons participating in MIPS in 2021 were identified using publicly available, nationally representative, standardized CMS data sets, consistent with prior studies assessing clinician performance under MIPS. In keeping with prior studies and consistent with how CMS defines social risk for the purpose of adjusting MIPS performance and payments using the CPB, dual eligibility for Medicare and Medicaid was used as a proxy for social risk. Surgeons were stratified into quintiles based on the proportion of patients dually eligible for Medicare and Medicaid. To answer the first question about how orthopaedic surgeons, in aggregate, perform in MIPS, CMS MIPS outcome data were used to quantify the proportion of surgeons who received a positive or negative payment adjustment, an exceptional performance bonus, and a maximum payment penalty. To address the second question regarding the association between caring for socially at-risk patients and MIPS performance, MIPS scores and payment adjustments were compared between surgeons in the highest and lowest quintiles of patient social risk, as determined by the proportion of dually eligible patients in each surgeon's practice per CMS definition. To evaluate the extent to which the CPB is associated with differences in MIPS performance, multivariable regression was used to assess whether the proportion of socially at-risk patients in a surgeon's practice was associated with differences in MIPS scores, payment adjustments, and exceptional perform","PeriodicalId":10404,"journal":{"name":"Clinical Orthopaedics and Related Research®","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144172986","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":"Compensatory Activation of Periscapular Muscles Aids Active Abduction in Patients With Massive Rotator Cuff Tears.","authors":"Hao-Chun Chuang, Nan-Tsing Chiu, Zhao-Wei Liu, Chih-Kai Hong, Kai-Lan Hsu, Fa-Chuan Kuan, Yueh Chen, Joe-Zhi Yen, Wei-Ren Su","doi":"10.1097/CORR.0000000000003556","DOIUrl":"https://doi.org/10.1097/CORR.0000000000003556","url":null,"abstract":"<p><strong>Background: </strong>Patients with massive rotator cuff tears can present with shoulder pain with preserved ROM, yet the compensatory mechanisms remain poorly understood. Identifying these mechanisms, particularly the role of periscapular muscles, could guide nonsurgical therapeutic strategies.</p><p><strong>Questions/purposes: </strong>(1) In patients with massive rotator cuff tears who achieved acceptable active ROM with physical therapy, which periscapular muscles provide compensatory motor activity? (2) What is the correlation between muscle metabolic activity and fatty infiltration and atrophy?</p><p><strong>Methods: </strong>Between January 2019 and April 2019, we evaluated 39 consecutive patients who presented to our outpatient clinic and were diagnosed with massive rotator cuff tears through sonographic screening. Of these, 41% (16) were excluded because of concomitant diseases. Of the remaining 59% (23) of patients who met the inclusion criteria and began the rehabilitation program, 13% (5) discontinued because of partial adherence or conversion to surgery. Ultimately, 46% (18) of patients completed the rehabilitation program and were included in the final analysis, comprising 8 with anterosuperior tears (median [IQR] age 56 years [54 to 61]) and 10 with posterosuperior tears (median [IQR] age 59 years [58 to 64]). Additionally, four nuclear medicine technicians without a history of shoulder injury or pain were recruited as the control group (median [IQR] age 54 years [52 to 56]). To address our first research question-identifying the muscles responsible for compensatory motor activity after a massive rotator cuff tear-participants underwent positron emission tomography/CT with fluorodeoxyglucose (FDG-PET/CT) imaging after performing a scaption exercise to assess muscle metabolic activity. Standardized uptake values (SUVs), reflecting glucose-based metabolic activity, were calculated for the periscapular, rotator cuff, and deltoid muscles using FDG-PET/CT and compared among groups using Kruskal-Wallis tests. To address the second research question-examining the correlation between muscle metabolic activity and fatty infiltration or atrophy-MRI was used to assess the Goutallier classification and occupation ratio, and Spearman correlation analysis was performed to evaluate their relationship with SUVs. Continuous variables were expressed as median and IQR.</p><p><strong>Results: </strong>In patients with posterosuperior rotator cuff tears who regained acceptable active ROM, several periscapular muscles exhibited increased activity after shoulder abduction exercises compared with controls. This pattern was not observed in those with anterosuperior tears. SUVs were significantly higher in the posterosuperior group than in controls for the levator scapulae (0.75 [95% confidence interval (95% CI) 0.73 to 0.81] versus 0.65 [95% CI 0.60 to 0.71], mean rank difference 9.33; p = 0.04), rhomboids (0.80 [95% CI 0.70 to 0.85] versus 0.65 ","PeriodicalId":10404,"journal":{"name":"Clinical Orthopaedics and Related Research®","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144198410","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® Curriculum-Orthopaedic Education: Fellowship Match Should Be Moved to the PGY-5 Year.","authors":"Paul J Dougherty","doi":"10.1097/CORR.0000000000003560","DOIUrl":"10.1097/CORR.0000000000003560","url":null,"abstract":"","PeriodicalId":10404,"journal":{"name":"Clinical Orthopaedics and Related Research®","volume":"483 7","pages":"1199-1200"},"PeriodicalIF":4.2,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12190072/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144599644","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}