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

{"title":"Shoulder Periprosthetic Joint Infection: Principles of Prevention, Diagnosis, and Treatment.","authors":"Ehab M Nazzal, Zachary J Herman, Matthew Como, Janina Kaarre, Rajiv P Reddy, Eric R Wagner, Brian A Klatt, Albert Lin","doi":"10.2106/JBJS.23.01073","DOIUrl":"https://doi.org/10.2106/JBJS.23.01073","url":null,"abstract":"<p><p>➢ Shoulder periprosthetic joint infection (PJI) is a potentially devastating complication after arthroplasty and is projected to rise with increasing numbers of performed arthroplasties, particularly reverse shoulder arthroplasties.➢ Important considerations for the diagnosis and treatment of shoulder PJI include age, sex, implant type, primary compared with revision shoulder surgery, comorbidities, and medications (i.e., corticosteroids and disease-modifying antirheumatic drugs).➢ Diagnosis and management are unique compared with lower-extremity PJI due to the role of lower-virulence organisms in shoulder PJI, specifically Cutibacterium acnes.➢ Treatment pathways depend on chronicity of infection, culture data, and implant type, and exist on a spectrum from irrigation and debridement to multistage revision with temporary antibiotic spacer placement followed by definitive revision arthroplasty.</p>","PeriodicalId":15273,"journal":{"name":"Journal of Bone and Joint Surgery, American Volume","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2024-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142545707","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":"In Appreciation.","authors":"","doi":"10.2106/JBJS.24.01325","DOIUrl":"https://doi.org/10.2106/JBJS.24.01325","url":null,"abstract":"","PeriodicalId":15273,"journal":{"name":"Journal of Bone and Joint Surgery, American Volume","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2024-10-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142545705","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":"Early-Stage Femoral Head Hypoperfusion Correlates with Femoral Head Deformity at Intermediate Follow-up in Legg-Calvé-Perthes Disease.","authors":"Michael Seungcheol Kang, David Zimmerhanzel, Shamrez Haider, Harry Kwang-Woo Kim","doi":"10.2106/JBJS.23.01429","DOIUrl":"https://doi.org/10.2106/JBJS.23.01429","url":null,"abstract":"<p><strong>Background: </strong>Perfusion MRI (pMRI) can quantify femoral head hypoperfusion in early-stage Legg-Calvé-Perthes disease. We investigated whether the severity of hypoperfusion measured at the early stage correlates with femoral head deformity at intermediate-term follow-up.</p><p><strong>Methods: </strong>Sixty-three patients who were 5 to 11 years of age at the diagnosis of Legg-Calvé-Perthes disease and who had pMRI performed at an early stage (Waldenström Stage 1 to 2a) were retrospectively reviewed. Twenty-eight patients were treated nonoperatively and 35 were treated with proximal femoral varus osteotomy (PFVO). The sphericity deviation score (SDS) was used as the primary outcome. Femoral head perfusion and SDS were measured by 2 observers. Models assessing the relationship between hypoperfusion and SDS were fitted without and with stratifications by age at diagnosis and treatment method.</p><p><strong>Results: </strong>All 63 patients had a minimum of 4 years of follow-up (mean follow-up, 7.5 ± 2.6 years). All had reached the healed stage (Stage 4), and their mean age was 15.6 ± 2.8 years. The SDS outcome showed a significant positive correlation with the hypoperfusion % (p < 0.001). In the <50% hypoperfusion range, the SDS indicated no-to-low deformity, with narrow variability of outcome. However, the SDS became exponentially worse and had a wider variability of outcome at the ≥50% hypoperfusion range. Multivariable analyses revealed age at diagnosis, hypoperfusion %, and treatment method as significant prognostic factors for SDS (p = 0.007, <0.001, and 0.042, respectively). When treatment outcomes were stratified by age at diagnosis and hypoperfusion %, PFVO showed significantly better SDS outcome than nonoperative treatment in patients with an age at diagnosis of ≥8 years and low (<50%) and intermediate (50% to 80%) hypoperfusion ranges (p = 0.036 and 0.021, respectively).</p><p><strong>Conclusions: </strong>Our study found a significant relationship between femoral head hypoperfusion measured in early-stage Legg-Calvé-Perthes disease and femoral head deformity at intermediate-term follow-up. This study provides new insight into the relationship between early-stage femoral head hypoperfusion and deformity.</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":"2024-10-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142545704","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":"Muscle Compensation Strategies to Maintain Glenohumeral Joint Stability in Rotator Cuff Tears: A Cadaveric Study.","authors":"Kyosuke Hoshikawa, Manuela Dominguez, Rebekah L Lawrence, Philip M Jacobs, Takuma Yuri, Nariyuki Mura, Hugo Giambini","doi":"10.2106/JBJS.24.00411","DOIUrl":"https://doi.org/10.2106/JBJS.24.00411","url":null,"abstract":"<p><strong>Background: </strong>Superior translation of the humeral head is often identified in large and massive rotator cuff (RC) tears. However, the ability of the remaining RC muscles to compensate for the forces causing such superior translation in RC tears remains unclear. The purpose of this study was to investigate the impact of compensatory forces exerted by the remaining RC muscles on humeral head translation using a progressive RC tear model.</p><p><strong>Methods: </strong>Eight fresh-frozen cadaveric shoulders (mean donor age, 57 years) were tested using a custom shoulder testing system. In addition to an intact RC model, 3 RC tear models were created: a supraspinatus tear (Tear I); combined supraspinatus and infraspinatus tears (Tear II); and combined tears of the supraspinatus, infraspinatus, and superior one-third of the subscapularis (Tear III). Compensatory conditions were simulated by increasing the loading of the remaining RC muscles in each RC tear model. Humeral head translation was measured at different abduction and neutral rotation angles in each condition with normal and high deltoid muscle loading.</p><p><strong>Results: </strong>Significant superior translation of the humeral head was observed in Tears II and III (but not Tear I), compared with the intact state, under high loading of the deltoid during abduction and during rotation. In Tear II, compensatory conditions involving increased loading of the teres minor and subscapularis muscles effectively reduced superior translation, so that no significant differences were observed compared with the intact state, even under high deltoid muscle loading. However, in Tear III, significant superior translation was still observed, regardless of the compensatory conditions.</p><p><strong>Conclusions: </strong>ompensation by the remaining RC muscles, particularly the teres minor and subscapularis, effectively reduced superior translation of the humeral head in the posterosuperior RC tear model, whereas this compensatory strategy was insufficient if tears also involved the superior one-third of the subscapularis.</p><p><strong>Clinical relevance: </strong>Patients with posterosuperior RC tears may find conservative treatment focusing on strengthening the remaining RC muscles, especially the subscapularis and teres minor, to be beneficial. Conversely, patients with repairable massive RC tears also involving the subscapularis tendon may benefit from surgical interventions aimed at primarily repairing the subscapularis tendon to restore the transverse force couple. Massive tears deemed not to be repairable should be evaluated for arthroplasty or other procedures.</p>","PeriodicalId":15273,"journal":{"name":"Journal of Bone and Joint Surgery, American Volume","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2024-10-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142545706","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 Musculoskeletal Basic Science.","authors":"Zbigniew Gugala","doi":"10.2106/JBJS.24.01086","DOIUrl":"https://doi.org/10.2106/JBJS.24.01086","url":null,"abstract":"","PeriodicalId":15273,"journal":{"name":"Journal of Bone and Joint Surgery, American Volume","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2024-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142466418","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":"Readability Analysis of Spanish-Language Patient-Reported Outcome Measures in Orthopaedic Surgery.","authors":"Jorge A Garavito, Patricia Rodarte, Ronald A Navarro","doi":"10.2106/JBJS.23.01367","DOIUrl":"10.2106/JBJS.23.01367","url":null,"abstract":"<p><strong>Background: </strong>Patient-reported outcome measures (PROMs) are increasingly used to quantify patient symptomatology when assessing intervention effectiveness as well as to guide patient-centered health-care management and research. Previous studies have analyzed the readability of PROMs used in orthopaedics in the English language; however, the readability of PROMs used in orthopaedics in the Spanish language has not been evaluated. Given the increasing number of Spanish-speaking individuals seeking orthopaedic care in the United States, it is imperative that PROMs are at an adequate reading level for patients to answer appropriately in their native language. This study aimed to assess the readability of publicly available Spanish-language PROMs used in orthopaedics.</p><p><strong>Methods: </strong>Searches of the PubMed, Google Scholar, and Embase databases were conducted to identify publicly available Spanish-language versions of PROMs used in orthopaedics. Additionally, the PROMIS Health Organization was contacted to obtain Spanish-language versions of the PROMIS (Patient-Reported Outcomes Measurement Information System) questionnaires. A total of 42 Spanish-language PROMs were identified and included in this study. The text of each PROM was inserted into multilingual readability software (legible.es), which analyzed the readability of each PROM using the Fernández Huerta and Índice de Legibilidad de Flesch-Szigriszt (INFLESZ) readability formulas. The mean and standard deviation (SD) of the raw readability scores were calculated for the PROMs. The percentage of PROMs at or below the 6th-grade reading level was also calculated.</p><p><strong>Results: </strong>The mean readability of PROMs using the INFLESZ formula was at a 7th to 10th-grade reading level (mean = 63, SD = 16), and the mean readability using the Fernández Huerta formula was 68 (SD = 15). On average, 57% of the PROMs used in orthopaedics were at or below the INFLESZ 6th-grade readability level.</p><p><strong>Conclusions: </strong>Approximately half of Spanish-language PROMs used in orthopaedics are written at a reading level that does not meet the National Institutes of Health and the American Medical Association recommendations at or below the 6th-grade level. PROM developers and translators should consider the importance of readability when translating PROMs, to maximize their use and efficacy among orthopaedic patients speaking that language.</p>","PeriodicalId":15273,"journal":{"name":"Journal of Bone and Joint Surgery, American Volume","volume":" ","pages":"1934-1942"},"PeriodicalIF":4.4,"publicationDate":"2024-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141087238","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 Shoulder and Elbow Surgery.","authors":"Alicia K Harrison, Jonathan P Braman, Paul J Cagle","doi":"10.2106/JBJS.24.00812","DOIUrl":"10.2106/JBJS.24.00812","url":null,"abstract":"","PeriodicalId":15273,"journal":{"name":"Journal of Bone and Joint Surgery, American Volume","volume":" ","pages":"1843-1849"},"PeriodicalIF":4.4,"publicationDate":"2024-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142035962","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":"Early Compared with Delayed Reconstruction in Multiligament Knee Injury: A Retrospective Propensity Analysis.","authors":"Graeme Hoit, Jaskarndip Chahal, Ryan Khan, Matthew Rubacha, Aaron Nauth, Daniel B Whelan","doi":"10.2106/JBJS.23.00795","DOIUrl":"10.2106/JBJS.23.00795","url":null,"abstract":"<p><strong>Background: </strong>The purpose of this study was to compare outcomes following early compared with delayed reconstruction in patients with multiligament knee injury (MLKI).</p><p><strong>Methods: </strong>A retrospective cohort analysis of patients with MLKI from 2007 to 2019 was conducted. Patients who underwent a reconstructive surgical procedure with ≥12 months of postoperative follow-up were included. Patients were stratified into early reconstruction (<6 weeks after the injury) and delayed reconstruction (12 weeks to 2 years after the injury). Multivariable regression models with inverse probability of treatment weighting (IPTW) were utilized to compare the timing of the surgical procedure with the primary outcome (the Multiligament Quality of Life questionnaire [MLQOL]) and the secondary outcomes (manipulation under anesthesia [MUA], Kellgren-Lawrence [KL] osteoarthritis grade, knee laxity, and range of motion).</p><p><strong>Results: </strong>A total of 131 patients met our inclusion criteria, with 75 patients in the early reconstruction group and 56 patients in the delayed reconstruction group. The mean time to the surgical procedure was 17.6 days in the early reconstruction group compared with 280 days in the delayed reconstruction group. The mean postoperative follow-up was 58 months. The early reconstruction group, compared with the delayed reconstruction group, included more lateral-sided injuries (49 patients [65%] compared with 23 [41%]; standardized mean difference [SMD], 0.44) and nerve injuries (36 patients [48%] compared with 9 patients [16%]; SMD, 0.72), and had a higher mean Schenck class (SMD, 0.57). After propensity adjustment, we found no difference between early and delayed reconstruction across the 4 MLQOL domains (p > 0.05). Patients in the early reconstruction group had higher odds of requiring MUA compared with the delayed reconstruction group (24 [32%] compared with 8 [14%]; IPTW-adjusted odds ratio [OR], 3.85 [95% confidence interval (CI), 2.04 to 7.69]; p < 0.001) and had less knee flexion at the most recent follow-up (β, 6.34° [95% CI, 0.91° to 11.77°]; p = 0.023). Patients undergoing early reconstruction had lower KL osteoarthritis grades compared with patients in the delayed reconstruction group (OR, 0.46 [95% CI, 0.29 to 0.72]; p < 0.001). There were no differences in clinical laxity between groups.</p><p><strong>Conclusions: </strong>Early reconstruction of MLKIs likely increases the likelihood of postoperative arthrofibrosis compared with delayed reconstruction, but it may be protective against the development of osteoarthritis. When considering the timing of MLKI reconstruction, surgeons should consider the benefit that early reconstruction may convey on long-term outcomes but should caution patients regarding the possibility of requiring an MUA.</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":"1903-1909"},"PeriodicalIF":4.4,"publicationDate":"2024-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142035957","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 Microbial Road Trip: Are We Nearing the Golden Era of Orthopaedics?: Commentary on an article by Sunqi Nian, MM, et al.: \"Landscape of the Lumbar Cartilaginous End Plate Microbiota and Metabolites in Patients with Modic Changes\".","authors":"Jari Dahmen, Gino M M J Kerkhoffs","doi":"10.2106/JBJS.24.00576","DOIUrl":"https://doi.org/10.2106/JBJS.24.00576","url":null,"abstract":"","PeriodicalId":15273,"journal":{"name":"Journal of Bone and Joint Surgery, American Volume","volume":"106 20","pages":"e43"},"PeriodicalIF":4.4,"publicationDate":"2024-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142621366","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 Musculoskeletal Tumor Surgery.","authors":"Aaron Gazendam, Michelle Ghert","doi":"10.2106/JBJS.24.00945","DOIUrl":"https://doi.org/10.2106/JBJS.24.00945","url":null,"abstract":"","PeriodicalId":15273,"journal":{"name":"Journal of Bone and Joint Surgery, American Volume","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2024-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142466419","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}