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

{"title":"The CR Versus PS Debate: A Throwback Throw-Down in Total Knee Arthroplasty: Commentary on an article by Young-Hoo Kim, MD, et al: \"No Discernible Difference in Revision Rate or Survivorship Between Posterior Cruciate-Retaining and Posterior Cruciate-Substituting TKA\".","authors":"Ayesha Abdeen","doi":"10.2106/JBJS.24.00741","DOIUrl":"10.2106/JBJS.24.00741","url":null,"abstract":"","PeriodicalId":15273,"journal":{"name":"Journal of Bone and Joint Surgery, American Volume","volume":"106 21","pages":"e45"},"PeriodicalIF":4.4,"publicationDate":"2024-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142581495","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":"Patients' Preferences for Bone-Anchored Prostheses After Lower-Extremity Amputation: A 2-Center Discrete Choice Experiment in The Netherlands (PREFER-BAP-1).","authors":"Gabriel-Kyrillos M Saleib, Marcel F Jonker, Mark G Van Vledder, Michael H J Verhofstad, Maria A Paping, Ruud A Leijendekkers, Oscar J F Van Waes","doi":"10.2106/JBJS.24.00204","DOIUrl":"10.2106/JBJS.24.00204","url":null,"abstract":"<p><strong>Background: </strong>The rising popularity and use of a bone-anchored prosthesis (BAP) involving an osseointegrated implant for patients with lower-limb amputations experiencing socket-related issues have led to increased interest in the measurement of clinical and functional outcomes. However, the value of BAP treatment characteristics from the patient perspective has not yet been investigated. This study aimed to determine the relative importance of specific BAP characteristics, and the effect of complications in quality-of-life (QoL) points and monetary utility decrement (loss [€]), using a 2-center discrete choice experiment (DCE) conducted in The Netherlands.</p><p><strong>Methods: </strong>A DCE was developed that included the most salient characteristics of BAP treatment based on a review of the literature and qualitative and quantitative methods. The following characteristics were selected: QoL change, short- and long-term complications, osseointegrated implant survival, and out-of-pocket contributions (costs). Patients aged 18 to 99 years who were eligible for, or had already received, an osseointegrated implant were invited to participate, after informed consent, to elicit BAP treatment preferences. A Bayesian mixed logit model was used.</p><p><strong>Results: </strong>Two hundred and forty-seven completed surveys were collected; 64% of the patients were male, 73% had undergone a transfemoral amputation, and 33% had >36 months of experience with a BAP. Patients considered long-term complications and QoL the most important characteristics. Long-term complications were 3.4 times more important than short-term complications. Opting out was undesirable, and patients valued better and beneficial levels (associated with better outcomes) of BAP characteristics positively. Implant removal was the level with the greatest loss among all complications, at 1.15 (95% credible interval [CI], 0.96 to 1.38) QoL points and €16,940 (95% CI, €14,780 to €19,040) loss.</p><p><strong>Conclusions: </strong>To our knowledge, this is the first study to use a DCE to elicit patients' preferences regarding BAP treatment, outcomes, and related complications; we found that patients strongly care about long-term complications. The results suggest that osseointegrated implant teams and policy-makers should consider these areas when proposing treatment protocols. Furthermore, policy and clinical guidelines for BAP treatment could be enhanced by our results with respect to patients' perspectives, management of patients' expectations, and associated losses in QoL points and monetary loss secondary to complications.</p><p><strong>Level of evidence: </strong>Therapeutic 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":"2017-2027"},"PeriodicalIF":4.4,"publicationDate":"2024-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11548816/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142143078","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":"Long-Term Outcomes of Arthroscopically Verified Focal Cartilage Lesions in the Knee: A 19-Year Multicenter Follow-up with Patient-Reported Outcomes.","authors":"Thomas Birkenes, Ove Furnes, Stein Haakon Laastad Lygre, Eirik Solheim, Asbjorn Aaroen, Gunnar Knutsen, Jon Olav Drogset, Stig Heir, Lars Engebretsen, Sverre Loken, Haavard Visnes","doi":"10.2106/JBJS.23.00568","DOIUrl":"10.2106/JBJS.23.00568","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Focal cartilage lesions (FCLs) are frequently found during knee arthroscopies and may impair quality of life (QoL) significantly. Several treatment options with good short-term results are available, but the natural history without any treatment is largely unknown. The aim of this study was to evaluate patient-reported outcome measures (PROMs), the need for subsequent cartilage surgery, and the risk of treatment failure 20 years after diagnosis of an FCL in the knee.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Patients undergoing any knee arthroscopy for an FCL between 1999 and 2012 in 6 major Norwegian hospitals were identified. Inclusion criteria were an arthroscopically classified FCL in the knee, patient age of ≥18 years at surgery, and any preoperative PROM. Exclusion criteria were lesions representing knee osteoarthritis or \"kissing lesions\" at surgery. Demographic data, later knee surgery, and PROMs were collected by questionnaire. Regression models were used to adjust for and evaluate the factors impacting the long-term PROMs and risk factors for treatment failure (defined as knee arthroplasty, osteotomy, or a Knee injury and Osteoarthritis Outcome Score-Quality of Life [KOOS QoL] subscore of &lt;50).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Of the 553 eligible patients, 322 evaluated patients (328 knees) were included and analyzed. The mean follow-up was 19.1 years, and the mean age at index FCL surgery was 36.8 years (95% confidence interval [CI], 35.6 to 38.0 years). The patients without knee arthroplasty or osteotomy had significantly better mean PROMs (pain, Lysholm, and KOOS) at the time of final follow-up than preoperatively. At the time of follow-up, 17.7% of the knees had undergone subsequent cartilage surgery. Nearly 50% of the patients had treatment failure, and the main risk factors were a body mass index of ≥25 kg/m 2 (odds ratio [OR] for overweight patients, 2.0 [95% CI, 1.1 to 3.6]), &gt;1 FCL (OR, 1.9 [CI, 1.1 to 3.3]), a full-thickness lesion (OR, 2.5 [95% CI, 1.3 to 5.0]), and a lower level of education (OR, 1.8 [95% Cl, 1.1 to 2.8]). Autologous chondrocyte implantation (ACI) was associated with significantly higher KOOS QoL, by 17.5 (95% CI, 3.2 to 31.7) points, and a lower risk of treatment failure compared with no cartilage treatment, microfracture, or mosaicplasty.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;After a mean follow-up of 19 years, patients with an FCL who did not require a subsequent knee arthroplasty had significantly higher PROM scores than preoperatively. Nonsurgical treatment of FCLs had results equal to those of the surgical FCL treatments except for ACI, which was associated with a better KOOS and lower risk of treatment failure. Full-thickness lesions, &gt;1 FCL, a lower level of education, and a greater BMI were the main risk factors associated with poorer results.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Level of evidence: &lt;/strong&gt;Therapeutic Level III . See Instructions for Authors for a complete description of levels of evid","PeriodicalId":15273,"journal":{"name":"Journal of Bone and Joint Surgery, American Volume","volume":" ","pages":"1991-2000"},"PeriodicalIF":4.4,"publicationDate":"2024-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11548812/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142288127","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":"Delayed Unions or Nonunions of the Distal Femur: A Comprehensive Overview.","authors":"Elsa B Rodriguez-Baron, Hosaam Gawad, Basem Attum, William T Obremskey","doi":"10.2106/JBJS.23.00985","DOIUrl":"10.2106/JBJS.23.00985","url":null,"abstract":"<p><p>➢ The failure rate of treatment of nonunions of the distal femur with internal fixation and autologous bone grafting remains high at 20% to 30%.➢ Successful treatment of nonunions of the distal femur requires good mechanical stability combined with autologous bone graft. This may require dual-plate fixation or intramedullary nail-plate combinations.➢ Autologous bone graft remains the bone graft of choice. Bone-graft substitutes and biologics require further research.</p>","PeriodicalId":15273,"journal":{"name":"Journal of Bone and Joint Surgery, American Volume","volume":" ","pages":"2028-2040"},"PeriodicalIF":4.4,"publicationDate":"2024-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142347408","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 Is the Best Way to Treat Focal Articular Cartilage Lesions of the Knee? Perhaps No Treatment at All: Commentary on an article by Thomas Birkenes, MD, et al.: \"Long-Term Outcomes of Arthroscopically Verified Focal Cartilage Lesions in the Knee. A 19-Year Multicenter Follow-up with Patient-Reported Outcomes\".","authors":"Matthew J Matava","doi":"10.2106/JBJS.24.00777","DOIUrl":"10.2106/JBJS.24.00777","url":null,"abstract":"","PeriodicalId":15273,"journal":{"name":"Journal of Bone and Joint Surgery, American Volume","volume":"106 21","pages":"e46"},"PeriodicalIF":4.4,"publicationDate":"2024-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142581684","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":"Individualized Surgeon Reports in a Statewide Registry: A Pathway to Improved Outcomes.","authors":"J Wesley Mesko, Huiyong Zheng, Richard E Hughes, Brian R Hallstrom","doi":"10.2106/JBJS.23.01297","DOIUrl":"10.2106/JBJS.23.01297","url":null,"abstract":"<p><strong>Abstract: </strong>Despite progress with the development of joint replacement registries in the United States, surgeons may have limited opportunities to determine the cumulative outcome of their own patients or understand how those outcomes compare with their peers; this information is important for quality improvement. In order to provide surgeons with accurate data, it is first necessary to have a registry with complete coverage and patient matching. Some international registries have accomplished this. Building on a comprehensive statewide registry in the United States, a surgeon-specific report has been developed to provide surgeons with survivorship and complication data, which allows comparisons with other surgeons in the state. This article describes funnel plots, cumulative sum reports, complication-specific data, and patient-reported outcome measure data, which are provided to hip and knee arthroplasty surgeons with the goal of improving quality, decreasing variability in the delivery of care, and leading to improved value and outcomes for hip and knee arthroplasty in the state of Michigan.</p>","PeriodicalId":15273,"journal":{"name":"Journal of Bone and Joint Surgery, American Volume","volume":" ","pages":"2045-2050"},"PeriodicalIF":4.4,"publicationDate":"2024-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141247227","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 Important (Arts & Humanities): My Death Education.","authors":"Shelley S Noland","doi":"10.2106/JBJS.24.00315","DOIUrl":"10.2106/JBJS.24.00315","url":null,"abstract":"","PeriodicalId":15273,"journal":{"name":"Journal of Bone and Joint Surgery, American Volume","volume":" ","pages":"2041"},"PeriodicalIF":4.4,"publicationDate":"2024-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141629698","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":"Multicenter Randomized Clinical Trial of Highly Cross-Linked Polyethylene Versus Conventional Polyethylene in 518 Primary TKAs at 10 Years.","authors":"Harold I Salmons, Dirk R Larson, Cedric J Ortiguera, Henry D Clarke, Mark J Spangehl, Mark W Pagnano, Michael J Stuart, Matthew P Abdel","doi":"10.2106/JBJS.24.00445","DOIUrl":"https://doi.org/10.2106/JBJS.24.00445","url":null,"abstract":"<p><strong>Background: </strong>Second-generation highly cross-linked polyethylene (HXLPE) has revolutionized total hip arthroplasty. However, the long-term risks and benefits of HXLPE in primary total knee arthroplasty (TKA) remain unknown. This randomized clinical trial evaluated implant survivorship, complications, radiographic results, and clinical outcomes of HXLPE and conventional ultra-high molecular weight polyethylene (UHMWPE) inserts in primary TKAs.</p><p><strong>Methods: </strong>We enrolled 518 patients (518 knees) who underwent primary TKA in 3 centers within 1 tertiary referral network. The mean age was 67 years, the mean body mass index was 32 kg/m2, and 58% of the patients were women. All of the patients underwent primary TKA with a cemented posterior-stabilized tibial insert and patellar resurfacing. Randomization proceeded via stratified dynamic allocation. The patients were blinded to their study group allocation: those in the control group (254 knees) underwent TKA with an UHMWPE insert (N2Vac; Stryker); those in the treatment group (264 knees) received an HXLPE insert (X3; Stryker). Kaplan-Meier survivorship, radiographic results, and clinical outcomes were assessed. This trial was registered with ClinicalTrials.gov. The mean follow-up was 11 years.</p><p><strong>Results: </strong>The 10-year overall survivorship free from any revision and from any reoperation was 96% and 94%, respectively. There were no differences in the risk of revision or reoperation between the groups (p > 0.05). There were a total of 19 revisions. Revision indications included periprosthetic joint infection (14 knees), instability (4 knees), and open reduction and internal fixation (ORIF) for a patellar fracture due to osteolysis around a UHMWPE insert (1 knee). There were no revisions due to polyethylene wear, osteolysis, or fracture of the post in the HXLPE group. The radiographic results and clinical outcomes were otherwise similar.</p><p><strong>Conclusions: </strong>Notably, no wear-related failures were identified in the HXLPE group, but there was 1 case of osteolysis in the UHMWPE group.</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":"2024-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142590824","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 Important (Patient Perspective): Never Too Old to Gain Empathy.","authors":"John E Herzenberg","doi":"10.2106/JBJS.24.00840","DOIUrl":"10.2106/JBJS.24.00840","url":null,"abstract":"","PeriodicalId":15273,"journal":{"name":"Journal of Bone and Joint Surgery, American Volume","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2024-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142557931","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":"Spondylolisthesis in Young Patients in a Large National Cohort: Reoperation Rate Depends on Surgical Approach.","authors":"Paal K Nilssen, Nakul Narendran, Ryan A Finkel, Kenneth D Illingworth, David L Skaggs","doi":"10.2106/JBJS.23.01242","DOIUrl":"10.2106/JBJS.23.01242","url":null,"abstract":"<p><strong>Background: </strong>The current literature investigating surgical treatments for lumbar spondylolisthesis in adolescent patients is limited by small sample sizes. There are high reoperation rates, and posterior interbody fusion has not been reported to help. The current study aimed to utilize a nationwide database to investigate outcomes of spinal fusion for spondylolisthesis in young patients.</p><p><strong>Methods: </strong>The PearlDiver database was queried for patients <21 years old who had undergone lumbar spinal fusion for spondylolisthesis between 2010 and 2020. Patients were divided into 4 cohorts based on surgical approach: (1) posterior spinal fusion with posterior instrumentation (PSF), (2) posterior spinal fusion with posterior instrumentation plus interbody (PSF+I), (3) anterior spinal fusion without posterior instrumentation (ASF), and (4) anterior spinal fusion plus posterior instrumentation (A+PSF). Patients with <2 years of follow-up were excluded. The primary outcome was reoperation.</p><p><strong>Results: </strong>Of 33,945 patients with spondylolisthesis, 578 (1.7%) underwent lumbar spinal fusion: 236 (40.8%) had PSF, 219 (37.9%) had PSF+I, 66 (11.4%) had ASF, and 57 (9.9%) had A+PSF. The mean age was 16.5 ± 1.1 years, and the mean follow-up was 5.4 ± 2.9 years. A higher percentage of girls underwent surgery compared with boys (2.0% versus 1.4%). Survival analysis using all-cause reoperation as the end point demonstrated an overall 5-year reoperation-free survival rate of 85.5% (95% confidence interval [CI]: 82.5% to 88.6%). The overall reoperation rate within 5 years was significantly different depending on the approach, with A+PSF being the lowest at 7.0% (PSF = 11.9%, PSF+I = 10.5%, and ASF = 31.8%).</p><p><strong>Conclusions: </strong>This is the largest reported series of spondylolisthesis surgery in young people. The lowest rate of revisions within 5 years was for a combined approach of A+PSF. The 5-year risk of reoperation of 31.8% for a stand-alone ASF appeared to be unacceptably high compared with other approaches, and was over 4 times higher than A+PSF (7.0%). Consistent with previous clinical series, the addition of an interbody fusion to a PSF did not decrease the reoperation rate and did not appear to offer any advantages to a PSF alone.</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":"2024-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142557930","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}