Journal of Bone and Joint Surgery, American Volume最新文献

{"title":"What's New in Osteoporosis and Fragility Fractures.","authors":"Cecilia Rogmark, Frede Frihagen","doi":"10.2106/JBJS.25.00574","DOIUrl":"https://doi.org/10.2106/JBJS.25.00574","url":null,"abstract":"","PeriodicalId":15273,"journal":{"name":"Journal of Bone and Joint Surgery, American Volume","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2025-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144715082","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Bupivacaine-Meloxicam Extended-Release Solution Compared with a Standard Periarticular Injection in Primary Total Knee Arthroplasty: A Randomized Clinical Trial Showing Similar Efficacy in Postoperative Analgesia.","authors":"Harold I Salmons, Adam W Amundson, Christopher M Duncan, Dirk R Larson, Benjamin D Mallinger, Cory G Couch, Mark W Pagnano, Robert T Trousdale, Matthew P Abdel","doi":"10.2106/JBJS.25.00086","DOIUrl":"https://doi.org/10.2106/JBJS.25.00086","url":null,"abstract":"<p><strong>Background: </strong>The U.S. Food and Drug Administration has approved a bupivacaine and meloxicam extended-release (ER) intra-articular injection for pain during total knee arthroplasty (TKA). However, the real-world evidence with regard to analgesic efficacy of that medication has been limited. This randomized clinical trial investigated the efficacy of this new medication compared with our standard periarticular injection for postoperative analgesia after primary TKA.</p><p><strong>Methods: </strong>Eligible patients undergoing primary, unilateral TKA for osteoarthritis at our academic center were enrolled. Patients were blinded and were randomized 1:1 to the bupivacaine-meloxicam ER (ZYNRELEF) injection group or the standard injection (ropivacaine, ketorolac, epinephrine) control group. A standardized, multimodal analgesic pathway was implemented. Numeric Rating Scale (NRS) pain scores and tallies of opioid consumption were collected. The primary outcome was the area under the curve (AUC) for NRS pain, adjusted for opioid consumption, over 72 hours. The minimal clinically important difference was considered to be 30%. Power analysis determined a minimum of 44 patients per group. The final groups included 53 patients in the experimental group and 48 patients in the control group.</p><p><strong>Results: </strong>Similar postoperative analgesia was observed, with an AUC for the adjusted NRS pain score up to 72 hours of 331 in the experimental group and 373 in the control group (p = 0.09). The mean maximum NRS pain scores were similar and reflected good, but not complete, analgesia. Scores were 3 to 5 on the day of the surgery, 4 to 6 on postoperative day (POD) 1, 5 to 6 on POD 2, and 4 to 5 on POD 3 (p > 0.05). One patient in the experimental group and 2 patients in the control group had early postoperative complications, none of which was deemed to be related to the analgesic choice.</p><p><strong>Conclusions: </strong>This randomized clinical trial demonstrated similar analgesia with a bupivacaine-meloxicam ER solution and a standard periarticular injection up to 72 hours after primary TKA. Cost, reimbursement, and convenience may ultimately prove to be more important than analgesic differences when choosing between these 2 effective options for managing postoperative pain.</p><p><strong>Level of evidence: </strong>Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.</p>","PeriodicalId":15273,"journal":{"name":"Journal of Bone and Joint Surgery, American Volume","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2025-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144715080","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Coronal and Sagittal Balance Following Posterior Spinal Fusion for Adolescent Idiopathic Scoliosis.","authors":"Joel Turtle, John M Flynn, Lucas Hauth, Patrick J Cahill, Jason B Anari","doi":"10.2106/JBJS.24.01520","DOIUrl":"https://doi.org/10.2106/JBJS.24.01520","url":null,"abstract":"<p><strong>Background: </strong>Achieving and maintaining global spinal balance is a crucial goal in posterior spinal fusion for adolescent idiopathic scoliosis (AIS). Despite its substantial impact on operative success, there is a noticeable gap in the literature regarding a systematic evaluation of the trajectory and durability of this critical parameter. With this study, we aimed to characterize the evolution of global balance after posterior spinal fusion for AIS.</p><p><strong>Methods: </strong>A prospective, multicenter spinal deformity database was retrospectively queried for patients with AIS undergoing posterior spinal fusion. Standing, 2-view radiographs (anteroposterior and lateral) were obtained at the first-erect visit, 6 months, 1 year, 2 years, and 5 years, with a subset of patients having radiographs at the 10-year mark. Coronal balance was defined as the difference, in centimeters, between the C7 plumb line and the central sacral vertical line (CSVL). The sagittal vertical axis (SVA) measured sagittal balance, calculated as the difference, in centimeters, between the C7 plumb line and the posterosuperior corner of the superior end plate of S1.</p><p><strong>Results: </strong>The study included 477 patients with 5 years of follow-up and 84 patients with a decade of follow-up. The mean patient age was 14.1 years, 67.9% of the patients were White, and 81.6% of the patients were female. Preoperative assessment revealed that 50.7% of the patients demonstrated optimal global balance. The initial postoperative evaluation showed essentially no improvement, with only 55.6% achieving optimal balance (Coronal and Sagittal Harmony [CASH] A0) at the first-erect visit. Subsequent follow-up demonstrated steady improvement, with 81.8% reaching optimal balance at 5 years and 87.7% at the 10-year mark.</p><p><strong>Conclusions: </strong>This study offers a comprehensive analysis of global spinal alignment and traces the balance trajectory (in both the coronal and sagittal planes) after posterior spinal fusion in AIS. To our knowledge, it is the largest and longest follow-up study of its kind. The findings highlight a profound and steady postoperative improvement in global balance over time, advancing our understanding of postoperative spinal balance in AIS. The novel CASH classification introduced here serves as a possible tool for evaluating overall alignment and balance in patients with AIS.</p><p><strong>Level of evidence: </strong>Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.</p>","PeriodicalId":15273,"journal":{"name":"Journal of Bone and Joint Surgery, American Volume","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2025-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144715081","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ten-Year Outcomes of Hip Arthroscopy for the Treatment of FAI and Labral Tears in Patients with a Workers' Compensation Claim.","authors":"Benjamin G Domb, Drashti Sikligar, Jessica Keane, Tyler R McCarroll, Ady H Kahana-Rojkind, Roger Quesada-Jimenez","doi":"10.2106/JBJS.24.00996","DOIUrl":"https://doi.org/10.2106/JBJS.24.00996","url":null,"abstract":"<p><strong>Background: </strong>Workers' Compensation (WC) status has been associated with inferior outcomes in orthopaedic procedures. The purpose of this study was to determine the impact of WC on the long-term outcomes of patients undergoing hip arthroscopy for femoroacetabular impingement (FAI) and labral tears and to compare these findings with those of a propensity-matched control group.</p><p><strong>Methods: </strong>A retrospective analysis was conducted that included patients with a WC claim who underwent hip arthroscopy for FAI and labral tears between 2008 and 2013. Included patients had complete preoperative and minimum 10-year postoperative questionnaires for patient-reported outcomes (PROs) or a documented end point. Patients were propensity-matched to a control group without a WC claim in a 1:3 ratio on the basis of age at the time of surgery, sex, body mass index, acetabular Outerbridge grade, and capsular treatment. Clinically meaningful thresholds, complications, survivorship, work type, and return-to-work rates were analyzed.</p><p><strong>Results: </strong>A total of 280 patients (WC group, 70; control group, 210) were included in the study. The WC group had a mean follow-up time of 123.9 ± 22.6 months. Compared with the matched control group, the WC group had worse preoperative PRO scores but a greater magnitude of improvement. The groups had similar (p > 0.05) rates of reaching the minimal clinically important difference (MCID) and patient acceptable symptomatic state (PASS) values for the modified Harris hip score (MCID: 93.0% [WC group], 79.2% [control group]; PASS: 83.7% [WC], 77.8% [control]), the Non-Arthritic Hip Score (MCID: 90.7% [WC], 77.8% [control]; PASS: 74.4% [WC], 63.2% [control]), and the Hip Outcome Score Sport-Specific Subscale (MCID: 87.5% [WC], 72.3% [control]; PASS: 72.7% [WC], 55.6% [control]). In the WC group, 82.9% of patients returned to work, with a mean time to return to work of 8.0 ± 7.4 months. The WC group had a higher rate of revision hip arthroscopy than the control group, with a threefold relative risk (95% confidence interval, 1.6 to 5.7; p < 0.001) and a mean time to revision of 28.3 ± 37.1 months.</p><p><strong>Conclusions: </strong>Hip arthroscopy for the treatment of FAI and labral tears in patients with a WC claim was associated with favorable outcomes and a high return-to-work rate at a minimum 10-year follow-up. These results were comparable with those of a benchmark control group. However, the WC group had a significantly higher rate of revision hip arthroscopy than the control group.</p><p><strong>Level of evidence: </strong>Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.</p>","PeriodicalId":15273,"journal":{"name":"Journal of Bone and Joint Surgery, American Volume","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2025-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144663851","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"What's New in Limb Lengthening and Deformity Correction.","authors":"Jill C Flanagan, Mani Kahn","doi":"10.2106/JBJS.25.00471","DOIUrl":"https://doi.org/10.2106/JBJS.25.00471","url":null,"abstract":"","PeriodicalId":15273,"journal":{"name":"Journal of Bone and Joint Surgery, American Volume","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144540364","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Ethics of Operating on a Patient with a Hip Fracture in Hospice Care.","authors":"Nathaniel P Mercer, Danielle Olson, Alex Lashgari, Arthur L Kaplan, Kenneth A Egol","doi":"10.2106/JBJS.25.00008","DOIUrl":"https://doi.org/10.2106/JBJS.25.00008","url":null,"abstract":"","PeriodicalId":15273,"journal":{"name":"Journal of Bone and Joint Surgery, American Volume","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2025-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144512028","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Prospective, Randomized Comparison of Functional Bracing and Spica Casting for Femoral Fractures Showed Equivalent Early Outcomes.","authors":"Lindsay M Andras, Julia S Sanders, Tiffany N Phan, Sarah R Purtell, Jasmine Gasca, Tishya A L Wren, Andrew T Sim, David Skaggs, Andrea Kramer, Michelle Chavez, Robert Kay","doi":"10.2106/JBJS.24.01081","DOIUrl":"https://doi.org/10.2106/JBJS.24.01081","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;AAOS Clinical Practice Guidelines recommend spica casting for the treatment of most femoral fractures in children 6 months to 5 years of age. The purpose of the present study was to compare the outcomes of treatment with prefabricated braces with those of spica casting.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;We performed a randomized prospective study of patients 6 months to 5 years of age who were managed with functional bracing or spica casting for the treatment of diaphyseal femoral fractures at 2 pediatric trauma centers. Patients with polytrauma, medical comorbidities impacting fracture-healing, or &lt;6 weeks of follow-up were excluded. Spica casts were placed in the operating room with the patient under anesthesia. Functional braces were placed at bedside.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Eighty patients (40 in the spica casting group and 40 in the functional bracing group) met the inclusion criteria and were analyzed. The mean age was 2.0 years in the casting group and 2.3 years in the bracing group (p = 0.15). Radiographs demonstrated similar shortening (9.0 ± 7.6 mm in the casting group and 6.8 ± 8.2 mm in the bracing group; p = 0.21), varus angulation (9.0º ± 11.9º in the casting group and 5.6º ± 9.4º in the bracing group; p = 0.19), and procurvatum (9.4º ± 12.9º in the casting group and 6.7º ± 8.4º in the bracing group; p = 0.31). At 6 weeks, there were no differences in shortening (13.1 ± 9.4 mm in the casting group and 11.0 ± 10.0 mm in the bracing group; p = 0.35), varus angulation (2.4º ± 7.3º in the casting group and 5.3º ± 6.3º in the bracing group, p = 0.06), or procurvatum (12.3º ± 9.8º in the casting group and 9.1º ± 8.1º in the bracing group; p = 0.11). Fifty-one patients (24 in the casting group and 27 in the bracing group) had 1 year of follow-up. There were no differences between the groups in terms of shortening (4.9 ± 5.4 mm in the casting group and 3.0 ± 6.9 mm in the bracing group; p = 0.23) or varus angulation (1.8º ± 3.5º in the casting group and 1.2º ± 4.1º in the bracing group; p = 0.56), but there was a slight difference in procurvatum (11.7º ± 8.3º in the casting group and 5.1º ± 5.8º in the bracing group; p &lt; 0.01). More superficial skin issues were observed in the bracing group than in the casting group (9 compared with 1; p = 0.02), but all skin issues resolved with local wound care. Patients in the casting group had more difficulty moving independently (median score, 8 of 10 in the casting group and 5 of 10 in the bracing group; p = 0.05). Patients in the bracing group were more likely to fit into their car seat (40% in the casting group versus 86% in the bracing group; p &lt; 0.01).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;In this prospective randomized trial, patients who were treated with functional bracing had equivalent outcomes to those who were treated with spica casting. Prefabricated functional braces provided a viable alternative, avoiding the cost and anesthesia associated with cast p","PeriodicalId":15273,"journal":{"name":"Journal of Bone and Joint Surgery, American Volume","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2025-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144505795","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"AOA Critical Issues Symposium: How Are Orthopaedic Leaders Chosen? Competency Versus Kingmaker.","authors":"Kristy Weber, Mary Lauria, Lilly Marks","doi":"10.2106/JBJS.24.01554","DOIUrl":"https://doi.org/10.2106/JBJS.24.01554","url":null,"abstract":"<p><strong>Abstract: </strong>Leadership selection in the field of orthopaedic surgery takes place in many settings, including national, regional, and local associations; academic departments; and private practice groups. In general, there is neither a consistent method of competency-based leadership selection nor a codified set of criteria by which to identify a successful leader in national organizations. This can potentially lead to leadership based on personality rather than process. Polling results among the orthopaedic leaders who were present at the 2024 American Orthopaedic Association (AOA) Annual Meeting Symposium revealed that 80% think that the selection process for board leadership for national orthopaedic organizations needs to improve, and 75% think that the selection process for academic department chairs also needs to improve. This summary of the 2024 AOA Symposium provides a strategy for consistent, competency-based leadership selection in orthopaedic organizations, identifies potential key selection criteria that are necessary to identify talent, and enumerates steps that can be used by nominating or search committees. Although the focus of this work is directed toward the process that is used to identify leaders for national orthopaedic organizations, features of academic medical leadership and corporate talent selection will be highlighted for consideration and translation to the orthopaedic community.</p>","PeriodicalId":15273,"journal":{"name":"Journal of Bone and Joint Surgery, American Volume","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2025-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144505796","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"AI Will Not Save Us: Technological Authoritarianism, the Electronic Medical Record, and the Erosion of the Practice of Medicine.","authors":"Melinda S Sharkey","doi":"10.2106/JBJS.24.01574","DOIUrl":"https://doi.org/10.2106/JBJS.24.01574","url":null,"abstract":"","PeriodicalId":15273,"journal":{"name":"Journal of Bone and Joint Surgery, American Volume","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2025-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144266252","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intraneural Ganglion Cysts Arising from the Hip Joint as Rare Causes of Sciatic Neuropathy: A Case Series of 13 Patients Treated with Hip Arthroscopy.","authors":"Chan-Woo Park, Sang Jin Jeong, Jae Soon Kim, Seung-Jae Lim, Youn-Soo Park","doi":"10.2106/JBJS.24.00737","DOIUrl":"https://doi.org/10.2106/JBJS.24.00737","url":null,"abstract":"<p><strong>Background: </strong>Sciatic neuropathy can result from pressure, injury, or inflammation around the sciatic nerve. In rare instances, sciatic neuropathy is caused by an intraneural ganglion cyst (IGC) originating from the hip joint. However, an effective treatment modality for this condition has not yet been established. The purpose of the present study was to evaluate the clinical and radiographic outcomes of hip arthroscopy for the treatment of IGCs involving the sciatic nerve.</p><p><strong>Methods: </strong>We reviewed the records on a consecutive series of hip arthroscopy procedures that had been performed by a single surgeon for the treatment of sciatic IGCs between July 2016 and February 2022. Thirteen Asian patients (13 hips) with symptomatic sciatic neuropathy were included. During arthroscopic surgery, IGCs were decompressed by enlarging their periarticular connection. Magnetic resonance imaging (MRI) and electrodiagnostic evaluation were routinely performed. The visual analog scale (VAS) for pain and modified Harris hip score (mHHS) were used for clinical evaluations. The mean age at the time of surgery was 57 years (range, 23 to 72 years), and the mean duration of follow-up was 41 months (range, 24 to 87 months).</p><p><strong>Results: </strong>The mean VAS score decreased from 8.3 preoperatively to 1.9 at the latest evaluation (p < 0.001). Satisfactory pain relief was reported by 12 patients (92%), including 9 patients (69%) who had complete remission. Four of the 6 patients with sensory impairment and 3 of the 4 patients with motor weakness reported complete recovery. The mean mHHS improved from 51.5 to 94.1 (p < 0.001). In MRI comparisons, the mean largest diameter and length of IGCs decreased from 2.6 to 0.5 cm (p < 0.001) and from 6.8 to 0.6 cm (p < 0.001), respectively. IGCs completely disappeared on MRI in 9 patients (69%). The latest electrodiagnostic studies confirmed improvement in all 12 patients with preoperative abnormalities. One patient (8%) with symptomatic recurrence was successfully treated with revision arthroscopic decompression.</p><p><strong>Conclusions: </strong>In patients with sciatic neuropathy, the possibility of IGCs arising from the hip should be considered. Our findings suggest that arthroscopic hip surgery is a less-invasive and more-effective treatment for relieving neuropathic pain and neurological deficits associated with sciatic IGCs.</p><p><strong>Level of evidence: </strong>Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.</p>","PeriodicalId":15273,"journal":{"name":"Journal of Bone and Joint Surgery, American Volume","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2025-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144258172","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}