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

{"title":"Maintaining or Increasing Physical Activity Is Essential for Managing Cardiovascular and Cerebrovascular Risks After Total Knee Arthroplasty: A Nationwide Cohort Study.","authors":"Hyung Jun Park, Bum Sik Tae, Dong Hun Suh, Jae Gyoon Kim","doi":"10.2106/JBJS.24.01588","DOIUrl":"10.2106/JBJS.24.01588","url":null,"abstract":"<p><strong>Background: </strong>We sought to evaluate the incidence of cardiovascular and cerebrovascular diseases in patients undergoing total knee arthroplasty (TKA) and the impact of perioperative physical activity levels on these risks.</p><p><strong>Methods: </strong>This nationwide cohort study used data from the National Health Insurance Service of the Republic of Korea. Patients who underwent a pair of health examinations at 2-year or 4-year intervals and did not have a diagnosis of cardiovascular or cerebrovascular disease at the first examination were included. The study population was divided into those who underwent TKA and those who did not between the 2 examinations. Physical activity was defined on the basis of the frequency of moderate-to-high-intensity activities and was categorized into inactive or active 1 to 2, 3 to 4, and ≥5 times weekly. Cox proportional hazards models were used to evaluate the association between physical activity changes and disease incidence over a 5-year follow-up.</p><p><strong>Results: </strong>Compared with controls who did not undergo TKA, patients who underwent TKA exhibited higher incidences of cardiovascular diseases (19.3% compared with 17.1%) and cerebrovascular diseases (25.7% compared with 23.9%). These incidences were associated with perioperative physical activity levels. Higher physical activity levels after TKA were associated with lower risks of both diseases. Specifically, engaging in physical activity ≥5 times per week was linked to lower cardiovascular risk (hazard ratio [HR], 0.918; p < 0.001) and cerebrovascular risk (HR, 0.890; p < 0.001). Previously inactive patients who began activity showed a reduction in the risks of both diseases, whereas previously active patients who became inactive had a significantly increased cerebrovascular risk.</p><p><strong>Conclusions: </strong>Patients who underwent TKA demonstrated higher incidences of cardiovascular and cerebrovascular diseases compared with controls over a 5-year follow-up. Our findings underscore the importance of initiating regular physical activity after surgery, particularly among previously inactive patients. Conversely, the increased cerebrovascular events among patients who ceased activity emphasize the critical need to maintain activity levels after surgery. Therefore, maintaining or initiating physical activity may be a core component of optimizing long-term outcomes after TKA.</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":4.3,"publicationDate":"2025-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144955761","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":"Fifteen-Year Mortality Following Periprosthetic Joint Infection in Total Knee Arthroplasty: A Registry Study of 8,642 Revisions for Infection.","authors":"Nicolai K Kristensen, Jeppe Lange, Richard de Steiger, Michelle Lorimer, Dylan Harries, Ian A Harris, Laurens Manning, Peter Lewis, David Campbell","doi":"10.2106/JBJS.24.01630","DOIUrl":"https://doi.org/10.2106/JBJS.24.01630","url":null,"abstract":"<p><strong>Background: </strong>Periprosthetic joint infection (PJI) following total knee arthroplasty (TKA) is a serious complication associated with notable loss of function, impaired quality of life, and excess short-term mortality. In this study, we aimed to report the impact of PJI on long-term mortality and its associated risk factors.</p><p><strong>Methods: </strong>Using data from the Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR), we used Kaplan-Meier estimates of survivorship and standardized mortality ratios (SMRs) based on Australian period life tables to describe mortality rates following revision for PJI, aseptic revisions (excluding those for fracture), and unrevised primary TKA. Additionally, hazard ratios (HRs) were calculated with multivariable proportional hazard models to assess the impact of the risk factors of age, gender, comorbidities, and minor versus major revisions.</p><p><strong>Results: </strong>Among 867,113 TKA procedures overall, there were 8,642 first revisions for PJI and 25,328 aseptic first revisions. At 5, 10, and 15 years, 16.1%, 34.4%, and 53.4% of patients with revision for PJI had died. When compared with a matched population, the SMR for revision for PJI was 1.33 (95% confidence interval [CI]: 1.28 to 1.39); for aseptic revision, 0.84 (95% CI: 0.82 to 0.87); and for unrevised primary TKA, 0.79 (95% CI: 0.78 to 0.79). Increasing age and higher American Society of Anesthesiologists (ASA) scores were significant mortality risk factors. Major revisions for PJI were not associated with a greater mortality risk compared with minor revisions for PJI.</p><p><strong>Conclusions: </strong>Patients with revision for PJI had a 33% greater-than-expected mortality. There was a high mortality in the early postoperative period, and the excess mortality risk persisted beyond 15 years. Increasing age and higher ASA scores were associated with increased mortality.</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":4.3,"publicationDate":"2025-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144955736","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":"Distinct 3-Dimensional Morphologies of Arthritic Knee Anatomy Exist: CT-Based Phenotyping Offers Outlier Detection in Total Knee Arthroplasty.","authors":"Joshua J Woo, Sayyida S Hasan, Yibin B Zhang, Danyal H Nawabi, Cory L Calendine, Andrew J Wassef, Antonia F Chen, Viktor E Krebs, Prem N Ramkumar","doi":"10.2106/JBJS.24.01466","DOIUrl":"https://doi.org/10.2106/JBJS.24.01466","url":null,"abstract":"<p><strong>Background: </strong>There is no foundational classification that 3-dimensionally characterizes arthritic anatomy to preoperatively plan and postoperatively evaluate total knee arthroplasty (TKA). With the advent of computed tomography (CT) as a preoperative planning tool, the purpose of this study was to morphologically classify pre-TKA anatomy across coronal, axial, and sagittal planes to identify outlier phenotypes and establish a foundation for future philosophical, technical, and technological strategies.</p><p><strong>Methods: </strong>A cross-sectional analysis was conducted using 1,352 pre-TKA lower-extremity CT scans collected from a database at a single multicenter referral center. A validated deep learning and computer vision program acquired 27 lower-extremity measurements for each CT scan. An unsupervised spectral clustering algorithm morphometrically classified the cohort. The optimal number of clusters was determined through elbow-plot and eigen-gap analyses. Visualization was conducted through t-stochastic neighbor embedding, and each cluster was characterized. The analysis was repeated to assess how it was affected by severe deformity by removing impacted parameters and reassessing cluster separation.</p><p><strong>Results: </strong>Spectral clustering revealed 4 distinct pre-TKA anatomic morphologies (18.5% Type 1, 39.6% Type 2, 7.5% Type 3, 34.5% Type 4). Types 1 and 3 embodied clear outliers. Key parameters distinguishing the 4 morphologies were hip rotation, medial posterior tibial slope, hip-knee-ankle angle, tibiofemoral angle, medial proximal tibial angle, and lateral distal femoral angle. After removing variables impacted by severe deformity, the secondary analysis again demonstrated 4 distinct clusters with the same distinguishing variables.</p><p><strong>Conclusions: </strong>CT-based phenotyping established a 3D classification of arthritic knee anatomy into 4 foundational morphologies, of which Types 1 and 3 represent outliers present in 26% of knees undergoing TKA. Unlike prior classifications emphasizing native coronal plane anatomy, 3D phenotyping of knees undergoing TKA enables recognition of outlier cases and a foundation for longitudinal evaluation in a morphologically diverse and growing surgical population. Longitudinal studies that control for implant selection, alignment technique, and applied technology are required to evaluate the impact of this classification in enabling rapid recovery and mitigating dissatisfaction after TKA.</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":""},"PeriodicalIF":4.3,"publicationDate":"2025-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144955714","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":"Multirod Constructs in Spine Surgery.","authors":"Dillon Benson, Tony Da Lomba, Michael Lee, Mostafa El Dafrawy","doi":"10.2106/JBJS.24.00733","DOIUrl":"https://doi.org/10.2106/JBJS.24.00733","url":null,"abstract":"<p><p>➢ The use of multirod constructs (≥3 rods) in complex spine surgery has increased as its utility has been recognized over the past decade.➢ There are multiple different rod configurations that may be utilized on the basis of the desired supplemental rod function, with each type having its own advantages and clinical indications.➢ Literature has continued to demonstrate a reduced incidence of pseudarthrosis, rod fracture, and reoperation when comparing multirod constructs with traditional dual-rod constructs.➢ The use of consistent nomenclature when describing multirod constructs will allow for more productive clinical and biomechanical research.</p>","PeriodicalId":15273,"journal":{"name":"Journal of Bone and Joint Surgery, American Volume","volume":" ","pages":""},"PeriodicalIF":4.3,"publicationDate":"2025-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144955747","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":"Why Am I Conflicted About Enrolling My Patients in Randomized Controlled Trials?: An Ethical Analysis.","authors":"Katherine J Krupa, Anna M Nolan, Benjamin C Silverman, Robert D Truog, Jeffrey N Katz","doi":"10.2106/JBJS.25.00524","DOIUrl":"10.2106/JBJS.25.00524","url":null,"abstract":"","PeriodicalId":15273,"journal":{"name":"Journal of Bone and Joint Surgery, American Volume","volume":" ","pages":""},"PeriodicalIF":4.3,"publicationDate":"2025-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144882901","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 Osteoporosis and Fragility Fractures.","authors":"Cecilia Rogmark, Frede Frihagen","doi":"10.2106/JBJS.25.00574","DOIUrl":"10.2106/JBJS.25.00574","url":null,"abstract":"","PeriodicalId":15273,"journal":{"name":"Journal of Bone and Joint Surgery, American Volume","volume":" ","pages":"1901-1906"},"PeriodicalIF":4.3,"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":"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":"1918-1925"},"PeriodicalIF":4.3,"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":"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":"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":"1940-1948"},"PeriodicalIF":4.3,"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":"10.2106/JBJS.25.00471","url":null,"abstract":"","PeriodicalId":15273,"journal":{"name":"Journal of Bone and Joint Surgery, American Volume","volume":" ","pages":"1763-1768"},"PeriodicalIF":4.3,"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":"10.2106/JBJS.25.00008","url":null,"abstract":"","PeriodicalId":15273,"journal":{"name":"Journal of Bone and Joint Surgery, American Volume","volume":" ","pages":"1757-1761"},"PeriodicalIF":4.3,"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}