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

{"title":"Balancing Tumor Control and Cartilage Preservation for Patients with Giant Cell Tumor of Bone Around the Knee: A Clinical Report from a Single Institute.","authors":"Kuan-Lin Chen, Cheng-Fong Chen, Po-Kuei Wu, Pai-Han Wang, Tain-Hsiung Chen, Chao-Ming Chen, Wei-Ming Chen","doi":"10.2106/JBJS.23.01478","DOIUrl":"https://doi.org/10.2106/JBJS.23.01478","url":null,"abstract":"<p><strong>Background: </strong>When managing aggressive giant cell tumor of bone (GCTB) around the knee joint, surgeons are often caught in a dilemma when determining whether to perform marginal excision or intralesional curettage. The purpose of this study was to report the long-term results of different treatment strategies in our institute.</p><p><strong>Methods: </strong>We retrospectively reviewed 64 eligible cases (34 female and 30 male) with a GCTB (37 in the distal femur, 27 in the proximal tibia) treated from 2002 to 2013. Forty patients received intralesional curettage (group A). Twenty-four received marginal excision of the tumor, with 18 of them undergoing reconstruction with unicondylar osteoarticular allograft (UOA) (group B) and 6 receiving arthroplasty reconstruction (group C). The minimum follow-up was 8 years, and the oncological status, clinical outcomes, and cartilage condition were analyzed.</p><p><strong>Results: </strong>Tumor recurrence was most common in group A (10 of 40, 25.0%), followed by group B (1 of 18, 5.6%) and group C (0 of 6). Eleven patients in group A (27.5%) and 6 in group B (33.3%) developed osteoarthritis (Kellgren-Lawrence grade 3 or 4). Five patients in group A (12.5%) and 3 patients in group B (16.7%) received total knee arthroplasty. Risk factors for the development of osteoarthritis in group A included a centrally located tumor, tumor length of >6 cm, a tumor-cartilage distance of ≤3 mm, and >50% subchondral bone involvement. In group B, osteoarthritis mostly resulted from postoperative complications. The mean Musculoskeletal Tumor Society (MSTS) score was 87.9 in group A, 84.8 in group B, and 93.3 in group C.</p><p><strong>Conclusions: </strong>Although intralesional curettage preserved cartilage and resulted in better function, it was associated with a higher tumor recurrence rate in our series. For advanced tumors close to the articular cartilage with significant subchondral bone involvement, marginal excision with UOA reconstruction might be a viable alternative. Arthroplasty should be reserved for patients who have bicondylar involvement with severe bone and cartilage loss making cartilage preservation impossible.</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":"2025-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143573012","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":"Examining Preoperative Risk Factors for Nerve Injury in Pediatric Monteggia Fracture-Dislocations.","authors":"Jason Zarahi Amaral, Basel M Touban, Rebecca J Schultz, Pablo Coello, Benjamin M Martin, Jessica A McGraw-Heinrich, Scott D McKay","doi":"10.2106/JBJS.24.00640","DOIUrl":"https://doi.org/10.2106/JBJS.24.00640","url":null,"abstract":"<p><strong>Background: </strong>The risk factors for fracture-related nerve injury in pediatric Monteggia fracture-dislocations are not well understood. As such, this study aimed to determine the incidence of, and preoperative risk factors for, nerve injury in pediatric Monteggia fracture-dislocations.</p><p><strong>Methods: </strong>Patients aged ≤18 years with acute Monteggia or Monteggia-equivalent fracture-dislocations that underwent reduction in the operating room, including closed reduction and casting under general anesthesia and internal fixation of the ulnar fracture with or without opening the radiocapitellar joint, from 2011 to 2021 were retrospectively identified. Exclusion criteria included reduction in the emergency department, concomitant ipsilateral upper-extremity fractures, malunions, or patients without preoperative imaging. Nerve function was assessed preoperatively, and nerve injury was defined as persistent motor and/or sensory deficits on postoperative examination. Patients were followed until nerve-related symptoms resolved. Logistic regression controlled for age and fracture pattern to determine preoperative risk factors.</p><p><strong>Results: </strong>Of 148 patients (mean age, 6.4 ± 2.8 years), 18.2% (27) had preoperative nerve injury. The posterior interosseous nerve (PIN) was injured in 15 patients, the anterior interosseous nerve (AIN) was injured in 7 patients, and other nerves were injured in 6 patients. All the nerve injuries resolved spontaneously, with a mean resolution time of 63.6 days (range, 8 to 150 days). Risk factors for nerve injury included patient age of ≥8 years (odds ratio [OR], 7.7; 95% confidence interval [CI], 2.6 to 22.8; p < 0.001), lateral radial head dislocation (OR, 6.8; 95% CI, 2.0 to 22.4; p = 0.002), an open fracture (OR, 4.5; 95% CI, 1.2 to 16.5; p = 0.025), and a comminuted ulnar fracture (OR, 4.1; 95% CI, 1.4 to 12.2; p = 0.012). PIN injury was associated with lateral radial head dislocation (p < 0.001) and a comminuted ulnar fracture (p < 0.001). AIN injury was associated with an open fracture (p = 0.002) and diaphyseal ulnar fracture (p = 0.004).</p><p><strong>Conclusions: </strong>The incidence of preoperative nerve-related injury in pediatric Monteggia fracture-dislocations was 18.2%. Risk factors for preoperative nerve injury included patient age of ≥8 years, lateral radial head dislocation, an open fracture, and a comminuted ulnar fracture. All the nerve injuries resolved within 150 days, suggesting that early operative intervention may be unnecessary.</p><p><strong>Level of evidence: </strong>Prognostic 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":"2025-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143573014","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":"Common Comorbidities and a Comparison of 4 Comorbidity Indices in Patients Undergoing Orthopaedic Oncology Surgery.","authors":"Shalin S Patel, Theresa Nalty, Douglas H Fletcher, Timothy S Ballard, Spencer J Frink, Justin E Bird, Valerae O Lewis","doi":"10.2106/JBJS.22.01273","DOIUrl":"10.2106/JBJS.22.01273","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Comorbidity indices are used to help to estimate patients' length of hospital stay, care costs, outcomes, and mortality. Increasingly, they are considered in reimbursement models. The applicability of comorbidity indices to patients undergoing orthopaedic oncology surgery has not been studied. The purpose of this study was to determine the predominant comorbidities in patients undergoing orthopaedic oncology surgery and to evaluate the predictive value of these indices.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Patient demographic characteristics, diagnoses, and preoperative comorbidities were collected retrospectively on 300 patients undergoing orthopaedic oncology surgery between January 2014 and March 2023. In this study, 3 subsets of 100 patients each with malignant primary bone tumors, malignant primary soft-tissue tumors, or osseous metastatic disease were randomly selected. Comorbidities were tabulated and weighted according to the guidelines of the Charlson Comorbidity Index (CCI), the National Institute on Aging/National Cancer Institute (NIA/NCI) index, the van Walraven Index, and the Agency for Healthcare Research and Quality (AHRQ) Index. Two-tailed bivariate Pearson correlations were performed to assess the relationship between the indices and between each index and patient outcomes. Comorbidities in our patient population were compared with those published in other studies.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The predominant comorbidities in patients undergoing orthopaedic oncology surgery were hypertension, deficiency anemias, metastatic disease, recent unintended weight loss or being underweight, and fluid or electrolyte disorders. The percentage of patients with certain comorbidities exceeded those reported in other cancer, orthopaedic, and inpatient populations. The 4 comorbidity indices had variable correlation when assessing our patient population. The number of comorbidities and the weighted scores from all indices demonstrated little to no correlation with length of stay and survival in our patient sample.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;The prevalence of many comorbidities in patients undergoing orthopaedic oncology surgery is greater than those reported in other patient populations. Commonly utilized indices demonstrate variable correlation with one another. With these tools, there was little to no correlation between comorbidities and patient outcomes in our patient population. The comorbidities deemed protective in these tools may underestimate the true assessment of the comorbidities in patients undergoing orthopaedic oncology surgery. This highlights the importance of developing tools to properly assess the comorbidities in defined patient populations, especially as these models are used to set benchmarks for measuring patient outcomes; assessing quality, efficiency, and safety; and determining reimbursement criteria.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Level of evidence: &lt;/strong&gt;Prognostic Level III . See Instruction","PeriodicalId":15273,"journal":{"name":"Journal of Bone and Joint Surgery, American Volume","volume":" ","pages":"488-495"},"PeriodicalIF":4.4,"publicationDate":"2025-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143023538","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":"TXA Use in Adolescent Patients Undergoing Sarcoma Surgery: Commentary on an article by Ahmed Mohamed El Ghoneimy, MD, et al.: \"Intraoperative Tranexamic Acid Infusion Reduces Perioperative Blood Loss in Pediatric Limb-Salvage Surgeries. A Double-Blinded Randomized Placebo-Controlled Trial\".","authors":"Yi Guo","doi":"10.2106/JBJS.24.01157","DOIUrl":"https://doi.org/10.2106/JBJS.24.01157","url":null,"abstract":"","PeriodicalId":15273,"journal":{"name":"Journal of Bone and Joint Surgery, American Volume","volume":"107 5","pages":"e13"},"PeriodicalIF":4.4,"publicationDate":"2025-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143557057","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":"Multidimensional Approach for Predicting 30-Day Mortality in Patients with a Hip Fracture: Development and External Validation of the Rotterdam Hip Fracture Mortality Prediction-30 Days (RHMP-30).","authors":"Louis de Jong, Eveline de Haan, Veronique A J I M van Rijckevorsel, T Martijn Kuijper, Gert R Roukema","doi":"10.2106/JBJS.23.01397","DOIUrl":"10.2106/JBJS.23.01397","url":null,"abstract":"<p><strong>Background: </strong>The aim of this study was to develop an accurate and clinically relevant prediction model for 30-day mortality following hip fracture surgery.</p><p><strong>Methods: </strong>A previous study protocol was utilized as a guideline for data collection and as the standard for the hip fracture treatment. Two prospective, detailed hip fracture databases of 2 different hospitals (hospital A, training cohort; hospital B, testing cohort) were utilized to obtain data. On the basis of the literature, the results of a univariable analysis, and expert opinion, 26 candidate predictors of 30-day mortality were selected. Subsequently, the training of the model, including variable selection, was performed on the training cohort (hospital A) with use of adaptive least absolute shrinkage and selection operator (LASSO) logistic regression. External validation was performed on the testing cohort (hospital B).</p><p><strong>Results: </strong>A total of 3,523 patients were analyzed, of whom 302 (8.6%) died within 30 days after surgery. After the LASSO analysis, 7 of the 26 variables were included in the prediction model: age, gender, an American Society of Anesthesiologists score of 4, dementia, albumin level, Katz Index of Independence in Activities of Daily Living total score, and residence in a nursing home. The area under the receiver operating characteristic curve of the prediction model was 0.789 in the training cohort and 0.775 in the testing cohort. The calibration curve showed good consistency between observed and predicted 30-day mortality.</p><p><strong>Conclusions: </strong>The Rotterdam Hip Fracture Mortality Prediction-30 Days (RHMP-30) was developed and externally validated, and showed adequate performance in predicting 30-day mortality following hip fracture surgery. The RHMP-30 will be helpful for shared decision-making with patients regarding hip fracture treatment.</p><p><strong>Level of evidence: </strong>Prognostic Level II . 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":"459-468"},"PeriodicalIF":4.4,"publicationDate":"2025-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143005963","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":"Spine-Abductor Syndrome: Novel Associations Between Lumbar Spine Disease and Hip Gluteal Muscle Pathology.","authors":"Monish S Lavu, Christian J Hecht, David C Kaelber, George Grammatopoulos, Yasuhiro Homma, Atul F Kamath","doi":"10.2106/JBJS.24.00012","DOIUrl":"10.2106/JBJS.24.00012","url":null,"abstract":"<p><strong>Background: </strong>Risk factors for gluteal tears include age-related deterioration, female sex, and increased body mass index. As the literature that supports the sagittal relationship between the lumbar spine and the hip is increasing, there may be a parallel relationship between the perturbations in spinopelvic alignment caused by lumbar spine disease and gluteal muscle tears. Because no prior studies other than single-institution series have reported on this phenomenon, we investigated spine-abductor syndrome at the population level.</p><p><strong>Methods: </strong>This study utilized TriNetX, a federated research network that continuously aggregates deidentified electronic health record data from >92 million patients across the United States. The relative risks of gluteal tear encounter diagnoses and procedures were calculated for patients with and without the following characteristics: age ≥45 years, female sex, obesity, lumbar spine diagnoses, lumbar spine injections, and lumbar spine surgery. Utilizing the Cox proportional hazard model, we also analyzed gluteal tear-free survival over a period of ≥10 years in subgroups of patients who had been diagnosed with lumbar pathology, had been administered a lumbar injection, or had received lumbar surgery.</p><p><strong>Results: </strong>Of the 8,475,800 patients who had received lumbar spine diagnoses, undergone lumbar injections, and/or undergone lumbar surgeries, 458,311 patients (5.4%) had gluteal tears, representing a relative risk of 13.6 (95% confidence interval [CI]:13.6 to 13.6). After controlling for age, sex, and obesity, survival analysis showed markedly increased hazard ratios (HRs) for patients having a gluteal tear encounter diagnosis in the intervening 13 years (2010 to 2023) if they had had a previous lumbar spine pathology encounter diagnosis (HR: 4.8, 95% CI: 4.5 to 5.1), had undergone lumbar spine injections (HR: 7.7, 95% CI: 6.2 to 9.5), or had undergone lumbar spine surgery (HR: 6.6, 95% CI: 5.3 to 8.1) in 2010.</p><p><strong>Conclusions: </strong>These findings suggest a strong association between lumbar spine pathology and abductor tears. Further biomechanical and neuroanatomic studies may elucidate the effects of lumbar spine disease in relation to gluteal tears. Additionally, there may be a need to optimize diagnostic protocols for lateral hip pain in patients with a history of lumbar spine disease.</p><p><strong>Level of evidence: </strong>Prognostic 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":"496-503"},"PeriodicalIF":4.4,"publicationDate":"2025-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11882372/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143006153","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Surgery for Olecranon Fractures in the Elderly (SOFIE): Results of the SOFIE Randomized Controlled Trial.","authors":"Mithun A Joshi, Michael Le, Ryan Campbell, Brahman Sivakumar, John Limbers, Ian A Harris, Michael Symes","doi":"10.2106/JBJS.24.00655","DOIUrl":"10.2106/JBJS.24.00655","url":null,"abstract":"<p><strong>Background: </strong>The financial and resource burden of management of olecranon fractures in the elderly is likely to increase with an aging population. There is limited evidence guiding treatment choice in this cohort. This study aimed to determine whether operative treatment of displaced olecranon fractures in elderly patients provides superior 12-month functional outcomes compared to nonoperative treatment.</p><p><strong>Methods: </strong>A multicenter pragmatic randomized controlled trial was conducted across 24 hospitals in Australia and New Zealand. Patients aged ≥75 years presenting with an acute (within 14 days), displaced, closed, isolated olecranon fracture were included. Operative treatment involved reduction and stabilization using tension band wiring or plate fixation. Nonoperative treatment consisted of a sling for comfort and early movement as tolerated. The primary outcome was the Disabilities of the Arm, Shoulder and Hand (DASH) score at 12 months. Secondary outcomes were the DASH score at 3 months and pain, quality of life, Mayo Elbow Performance Score (MEPS), active elbow range of motion, and complication rate at 3 and 12 months. Data were analyzed based on an intention-to-treat principle, with sensitivity analyses using as-treated groups.</p><p><strong>Results: </strong>Sixty participants were randomized, 27 to the operative group (mean age and standard deviation [SD], 83 ± 5.8 years; 22 [81%] females) and 33 to the nonoperative group (mean age, 82 ± 4.5 years; 23 [70%] females), with no significant difference in baseline characteristics. There was no significant difference (mean difference, -6.6; 95% confidence interval [CI] = -14.9 to 1.8; p = 0.12) in the mean DASH scores at 12 months (the primary outcome) between the operative (12.3 ± 14) and nonoperative (18.9 ± 18) groups. Although active elbow extension was significantly superior in the operative group at 12 months, no other secondary outcome differed significantly between groups at 12 months.</p><p><strong>Conclusions: </strong>The study found no significant difference in DASH scores at 12 months between the operative and nonoperative groups. This supports nonoperative treatment as a reasonable option for displaced stable olecranon fractures in elderly patients.</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":"452-458"},"PeriodicalIF":4.4,"publicationDate":"2025-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142949602","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":"Intraoperative Tranexamic Acid Infusion Reduces Perioperative Blood Loss in Pediatric Limb-Salvage Surgeries: A Double-Blinded Randomized Placebo-Controlled Trial.","authors":"Ahmed Mohamed El Ghoneimy, Tamer Ahmed Mahmoud Kotb, Ismail Rashad, Dina Elgalaly, Kareem AlFarsi, Mohamed Ahmed Khalil","doi":"10.2106/JBJS.24.00261","DOIUrl":"10.2106/JBJS.24.00261","url":null,"abstract":"<p><strong>Background: </strong>Limb-salvage surgery for malignant bone tumors can be associated with considerable perioperative blood loss. The aim of this randomized controlled trial was to assess the safety and efficacy of the intraoperative infusion of tranexamic acid (TXA) in children and adolescents undergoing limb-salvage surgery.</p><p><strong>Methods: </strong>All participants were <18 years of age at the time of surgery and diagnosed with a malignant bone tumor of the femur that was treated with resection and reconstruction with a megaprosthesis. Exclusion criteria included anatomic locations other than the femur, reconstruction with a vascularized fibular graft, and a previous history of deep venous thrombosis, coagulopathy, or renal dysfunction. Participants were randomly allocated to either the TXA group (a preoperative loading dose infusion of 10 mg/kg of TXA followed by a continuous infusion of 5 mg/kg/hr until the end of surgery) or the placebo group (the same dosage but with TXA substituted with an infusion of normal saline solution). Intraoperative and perioperative blood loss were calculated with use of the hemoglobin balance method. Perioperative blood loss at postoperative day 1 and at discharge from the hospital were calculated. The total volumes of blood transfused intraoperatively and postoperatively were recorded. A statistical comparison between the groups was performed for blood loss and blood transfusion as well as for possible independent variables other than TXA, including age, body mass index, histopathologic diagnosis, tumor volume, preoperative hemoglobin level, type of resection, and the duration of surgery.</p><p><strong>Results: </strong>A total of 48 participants, with a mean age of 12.5 ± 3.44 years (range, 5 to 18 years) and a male-to-female ratio of 1.18, were included. All participants were Egyptians by race and ethnicity. There were no minor or major drug-related adverse events. There was no significant difference between the groups with respect to intraoperative blood loss (p = 0.0616) or transfusion requirements (p = 0.812), but there was a significant difference in perioperative blood loss at postoperative day 1 (p = 0.0144) and at discharge from the hospital (p = 0.0106) and in perioperative blood transfusion (p = 0.023).</p><p><strong>Conclusions: </strong>TXA can be safely infused intraoperatively in children and adolescents undergoing limb-salvage surgery, and it contributes significantly to the reduction of perioperative blood loss and transfusion requirements.</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":"437-443"},"PeriodicalIF":4.4,"publicationDate":"2025-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143023545","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":"Two Decades Since the Unequal Treatment Report: The State of Racial, Ethnic, and Socioeconomic Disparities in Elective Total Hip and Knee Replacement Use.","authors":"Caroline P Thirukumaran, Jordan J Cruse, Patricia D Franklin, Benjamin F Ricciardi, Linda I Suleiman, Said A Ibrahim","doi":"10.2106/JBJS.24.00347","DOIUrl":"10.2106/JBJS.24.00347","url":null,"abstract":"<p><strong>Abstract: </strong>Published in 2003 by the Institute of Medicine, Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care placed an unprecedented spotlight on disparities in the U.S. health-care system. In the 2 decades since the publication of that landmark report, disparities continue to be prevalent and remain an important significant national concern. This article synthesizes the evolution, current state, and future of racial and ethnic disparities in the use of elective total joint replacement surgeries. We contextualize our impressions with respect to the recommendations of the Unequal Treatment Report.</p>","PeriodicalId":15273,"journal":{"name":"Journal of Bone and Joint Surgery, American Volume","volume":" ","pages":"523-538"},"PeriodicalIF":4.4,"publicationDate":"2025-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11882376/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143005953","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Efficacy of Platelet-Rich Plasma Versus Placebo for the Treatment of Greater Trochanteric Pain Syndrome: A Double-Blinded Randomized Controlled Trial.","authors":"Ismael Atchia, Mohammed Ali, Eshan Oderuth, Richard Holleyman, Ajay Malviya","doi":"10.2106/JBJS.24.00763","DOIUrl":"10.2106/JBJS.24.00763","url":null,"abstract":"<p><strong>Background: </strong>Greater trochanteric pain syndrome (GTPS) is a painful condition that can impair a patient's quality of life. If nonoperative measures fail, progressively more invasive treatment options may be required. This clinical trial aimed to evaluate the effectiveness of ultrasound-guided leukocyte-rich platelet-rich plasma (LR-PRP) injections in the treatment of refractory GTPS caused by bursitis and/or gluteal tendinopathy.</p><p><strong>Methods: </strong>An ethically approved, adequately powered, double-blinded randomized controlled trial (RCT) was conducted to evaluate the clinical outcomes in randomized LR-PRP and placebo groups using the International Hip Outcome Tool-12 (iHOT-12), a visual analogue scale (VAS) for pain, the modified Harris hip score (mHHS), the EuroQol 5-Dimensions (EQ-5D) questionnaire, and the presence or absence of complications. All injections were performed under ultrasound guidance into the trochanteric bursa and gluteus medius tendon.</p><p><strong>Results: </strong>The final analysis included 79 patients (39 in the LR-PRP and 40 in the placebo group; 73 female and 6 male; all Caucasian). Both the LR-PRP and the placebo group generally had improvement from baseline that was maintained to 12 months. The only deterioration in scores compared to baseline was seen in the LR-PRP group for the iHOT-12 at 12 months, the EQ-5D index at 3 and 6 months, and the EQ-5D VAS at all follow-up time points. However, there was no significant difference between the 2 groups at any follow-up point (p > 0.05). A multivariable linear regression model, with adjustment for age, sex, body mass index, and preoperative baseline score, did not reveal any significant associations between iHOT-12 and EQ-5D score gains at 12 months and treatment.</p><p><strong>Conclusions: </strong>This randomized trial found no significant difference in outcomes between LR-PRP and placebo for the treatment of greater trochanteric pain up to 6 months following the intervention. As a result, we do not support the routine use of PRP for the treatment of this condition.</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":"444-451"},"PeriodicalIF":4.4,"publicationDate":"2025-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142978564","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}