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

{"title":"Patient-Reported Outcomes of Pain and Related Quality of Life 1 Year After Bone-Anchored Limb Implantation in Patients with Lower-Limb Amputation.","authors":"Kylie G Shaw, Mohamed E Awad, Danielle Melton, Brecca M M Gaffney, Cory L Christiansen, Jason W Stoneback","doi":"10.2106/JBJS.24.00148","DOIUrl":"10.2106/JBJS.24.00148","url":null,"abstract":"<p><strong>Background: </strong>Patients with lower-extremity amputations experience various pain types. Osseointegration allows for prosthesis wear through a bone-anchored implant. Patient-reported outcome measures following osseointegration have not been well studied. Our aim was to evaluate differences in pain and quality of life at 1 year after osseointegration of a bone-anchored limb.</p><p><strong>Methods: </strong>We analyzed the severity and types of pain as measured by validated patient-reported outcome measures. Data were compared between the initial visit and the 1-year postoperative visit.</p><p><strong>Results: </strong>Fifty-four patients were included in this study and demonstrated improvement in pain intensity as measured by the Numeric Rating Scale (p < 0.001) and Patient-Reported Outcomes Measurement Information System Global Health (PROMIS-GH) (p < 0.001), as well as residual limb pain when walking (p < 0.001), at 1 year postoperatively. The self-reported impact of pain on quality of life improved in both transfemoral and transtibial amputees (p < 0.001).</p><p><strong>Conclusions: </strong>The osseointegration of a bone-anchored limb improved patient-reported pain and quality of life in lower-extremity amputees.</p><p><strong>Level of evidence: </strong>Therapeutic Level IV . See Instructions for Authors for a complete description of levels of evidence.</p>","PeriodicalId":15273,"journal":{"name":"Journal of Bone and Joint Surgery, American Volume","volume":" ","pages":"e32"},"PeriodicalIF":4.4,"publicationDate":"2025-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143523108","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":"Association Between Surgeon Volume and Patient Outcomes After Elective Patellofemoral Arthroplasty: A Population-Based Cohort Study Using Data from the National Joint Registry and Hospital Episode Statistics for England.","authors":"Martinique Vella-Baldacchino, Andrew Rhys Davies, Alex Bottle, Justin Cobb, Alex D Liddle","doi":"10.2106/JBJS.24.00703","DOIUrl":"10.2106/JBJS.24.00703","url":null,"abstract":"<p><strong>Background: </strong>The objective of this study was to determine the relationship between surgical volume and patient outcome after arthroplasty of the patellofemoral joint, to improve patient outcomes and inform future resource planning.</p><p><strong>Methods: </strong>All patellofemoral arthroplasty (PFA) records in the National Joint Registry from January 2003 to December 2021 were linked to the Hospital Episode Statistics database for England. The main outcome measure was revision surgery. Secondary outcome measures were serious adverse effects, patient selection characteristics, and implant designs used. Associations of early and late revision with surgical volume were examined based on surgical volume, and reasons for revision were explored.</p><p><strong>Results: </strong>Of the knee arthroplasty surgeons in the database, 858 (26%) performed ≥1 PFA during the study period; 14,615 PFA cases were available for analysis. The modal caseload was 2 per year. High-volume surgeons were defined as surgeons performing >5 PFAs per year. The hazard ratio (HR) for a high-volume surgeon was 0.98 per additional PFA per year, and the patients treated by these surgeons had a lower risk of revision than than those treated by low-volume surgeons irrespective of the patient's age. High-volume surgeons were more likely to identify and treat patients with patellar disorders than low-volume surgeons (odds ratio [OR], 1.34; 95% confidence interval [CI], 1.09 to 1.77; p < 0.05), and their patients were less likely to have serious adverse effects as these surgeons' experience increased (OR per additional PFA per year, 0.97; 95% CI, 0.95 to 0.99; p = 0.02). Inlay implants had a higher risk of revision than onlay implants irrespective of surgical experience: for low-volume surgeons, inlays had an HR of 1.68 (95% CI, 1.23 to 2.30; p = 0.01), and for high-volume surgeons, inlays had an HR of 2.38 (95% CI, 1.83 to 3.11; p = 0.01). The most common reason for revision was progressive osteoarthritis. High-volume surgeons' patients were less likely than low-volume surgeons' patients to have an early revision (<2 years postoperatively) (OR, 0.72; 95% CI, 0.55 to 0.93; p < 0.05).</p><p><strong>Conclusions: </strong>An association was found between surgeons performing >5 PFAs per year and a lower revision rate. This study should inform surgical planning services to improve the outcomes of PFA.</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":"819-828"},"PeriodicalIF":4.4,"publicationDate":"2025-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143122913","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":"Economic Incentives in Orthopaedic Surgery: A Primer.","authors":"Matthew L Magruder, Mitchell K Ng, Michael A Mont, Andrea Coppolecchia, David J Jacofsky","doi":"10.2106/JBJS.24.00050","DOIUrl":"10.2106/JBJS.24.00050","url":null,"abstract":"<p><p>➢ Orthopaedic surgeon pay structures are diverse, but most commonly are productivity-based.➢ Physician ownership of ambulatory surgery centers is a growing phenomenon and may have effects on clinical decision-making.➢ Hospital systems are paid by multiple mechanisms, including case-based reimbursement (based on Diagnosis-Related Groups). Incentives are substantially different between the types of payers (Medicare and Medicaid compared with private insurance).➢ Payer revenues stem from risk-adjusted premiums and investments in income-generating assets; a growing focus on cost-effective care and outcome-focused data by payers has led to changes in pay structures.</p>","PeriodicalId":15273,"journal":{"name":"Journal of Bone and Joint Surgery, American Volume","volume":" ","pages":"888-894"},"PeriodicalIF":4.4,"publicationDate":"2025-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143527793","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":"Computer-Assisted Virtual Preoperative Planning for the Treatment of Pilon Fractures: A Retrospective Propensity Score-Matched Cohort Study.","authors":"Xiaoyang Jia, Kun Zhang, Minfei Qiang, Gengxin Jia, Tianhao Shi, Qinghui Han, Ying Wu, Yanxi Chen","doi":"10.2106/JBJS.24.00473","DOIUrl":"10.2106/JBJS.24.00473","url":null,"abstract":"<p><strong>Background: </strong>Preoperative planning is critical for the operative management of any fracture. Unfortunately, conventional planning methods for pilon fractures have not yielded satisfactory results. Therefore, the purpose of this study was to evaluate whether the outcomes of surgically treated pilon fractures could be improved with computer-assisted preoperative planning.</p><p><strong>Methods: </strong>Between January 2010 and December 2019, 611 East Asian patients (≥18 years old) with a pilon fracture were identified. After 107 patients were excluded, the final cohort comprised 504 patients: 294 received conventional planning and 210 received computer-assisted preoperative planning. The primary outcome measure was the Olerud-Molander Ankle Score (OMAS) at 12 months. The secondary outcomes were lower-limb function, pain, quality of life, quality of fracture reduction, and complications related to soft-tissue and bone healing. Propensity score matching for 20 baseline characteristics yielded 204 patient pairs.</p><p><strong>Results: </strong>In the entire cohort of 504 patients, the median age was 41 years (interquartile range, 37 to 46 years) and 375 patients (74.4%) were male. After matching (408 patients; 204 patients in each cohort), patients who received computer-assisted preoperative planning had a better mean OMAS value at 12 months (80.3 points [95% CI, 79.5 to 81.1]) than patients for whom the conventional planning method was used (73.2 points [95% CI, 72.5 to 74.0]; mean difference, -7.1 points [95% CI, -8.2 to -6.0]; p < 0.001). Similarly, better outcomes were observed for lower-limb function, pain, quality of life, and reduction quality in the computer-assisted planning group. Patients who received computer-assisted planning had a lower rate of soft-tissue complications (9.3% [19 of 204 patients]) than patients who received conventional planning (18.6% [38 of 204 patients]; absolute rate difference, -9.3% [95% CI, -16.1% to -2.6%]; relative risk, 0.45 [95% CI, 0.25 to 0.81]; p = 0.008), but a significant difference was not found with respect to bone-healing complications.</p><p><strong>Conclusions: </strong>In patients with a pilon fracture, the use of computer-assisted preoperative planning yielded better functional and radiographic outcomes and a lower rate of soft-tissue complications compared with the use of conventional planning methods.</p><p><strong>Level of evidence: </strong>Diagnostic 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":"e35"},"PeriodicalIF":4.4,"publicationDate":"2025-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143527791","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":"Admission Neutrophil-to-Lymphocyte Ratio Is Superior to WBC Count at Predicting the Presence and Severity of Pediatric Musculoskeletal Infection.","authors":"Brian Q Hou, Anoop S Chandrashekar, Naadir H Jamal, William F Hefley, Malini Anand, Katherine S Hajdu, Stephen W Chenard, Michael Greenberg, Hui Nian, Jacquelyn S Pennings, Ryan A Seltzer, James E Cassat, Stephanie N Moore-Lotridge, Jonathan G Schoenecker","doi":"10.2106/JBJS.24.00481","DOIUrl":"10.2106/JBJS.24.00481","url":null,"abstract":"<p><strong>Background: </strong>Accurately determining the presence and severity of pediatric musculoskeletal infection (MSKI) is crucial for effective triage and treatment. Although the white blood-cell (WBC) count is often used as a marker for MSKI, we hypothesized that the use of the WBC count is limited by age-related variability in children. We proposed that the absolute neutrophil-to-lymphocyte ratio (NLR), which has less age-related variability, is a more reliable indicator for both diagnosing and assessing the severity of MSKI. The present study aims to compare the utility of WBC against that of the NLR, as well as C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR), for predicting MSKI presence and severity in children.</p><p><strong>Methods: </strong>A retrospective cohort study was conducted with use of a database of pediatric orthopaedic consultations for suspected MSKI between January 2013 and July 2022. Diagnoses were categorized as MSKI or no infection, and the severity of any present infection was stratified as local or disseminated. Admission laboratory values were collected. Statistical modeling was performed to assess the capabilities of the WBC, NLR, CRP, and ESR to diagnose MSKI and to assess infection severity, with cutoff thresholds established for clinical use.</p><p><strong>Results: </strong>This study included 650 patients (median age, 5.2 years; 63% male; 75% White). Of these, 247 patients had no infection, while 403 were diagnosed with an MSKI. Median WBC count, NLR, CRP, and ESR were all significantly higher in pediatric cases of confirmed MSKI. WBC was a poor predictor of infection severity, whereas NLR, CRP, and ESR each positively correlated with infection severity. At the time of admission, an NLR of 4 was highly specific for detecting the presence of infection, and an NLR of 5.8 was highly specific for predicting infection dissemination. CRP was the best predictor of both infection presence and severity, demonstrating the highest specificity and sensitivity, followed by NLR, which outperformed ESR and WBC.</p><p><strong>Conclusions: </strong>Because of considerable age-related variability, the predictive value of the WBC count for pediatric MSKI presence and severity is limited. NLR, which is less affected by age-related variability, is superior at predicting MSKI severity. Although CRP remains the benchmark, the NLR offers a valuable alternative to the WBC. Our study provides a comparative framework for these biomarkers, enhancing MSKI assessment across various clinical settings.</p><p><strong>Level of evidence: </strong>Diagnostic 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":"868-877"},"PeriodicalIF":4.4,"publicationDate":"2025-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143501477","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":"From Policy to Practice: Challenges in Implementing PROMs Reporting Under the New CMS Mandate.","authors":"Nickelas Huffman, Shujaa T Khan, Ignacio Pasqualini, Nicolas S Piuzzi","doi":"10.2106/JBJS.24.00593","DOIUrl":"10.2106/JBJS.24.00593","url":null,"abstract":"<p><strong>Abstract: </strong>The Centers for Medicare & Medicaid Services (CMS) recently introduced mandatory reporting of patient-reported outcomes (PROs) following primary, elective total joint arthroplasty (TJA) procedures. This article explores the implications and implementation challenges of this policy shift in the field of orthopaedic surgery. With a review of the existing literature, we analyze the potential benefits and limitations of PROs, discuss the role of CMS in health-care quality improvement initiatives, explain the predicted difficulties in the successful implementation of this new mandate, and provide recommendations for the successful integration of the reporting of PROs in clinical practice.</p>","PeriodicalId":15273,"journal":{"name":"Journal of Bone and Joint Surgery, American Volume","volume":" ","pages":"899-904"},"PeriodicalIF":4.4,"publicationDate":"2025-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143005961","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":"Outcomes of Autogenous Bone Grafting for Periprosthetic Osteolysis After Total Ankle Arthroplasty: Clinical and 3-Dimensional Computed Tomography Results.","authors":"Yeo Kwon Yoon, Kwang Hwan Park, Dong Woo Shim, Wonwoo Lee, Jae Seok Chae, Seung Hwan Han, Jin Woo Lee","doi":"10.2106/JBJS.24.00580","DOIUrl":"10.2106/JBJS.24.00580","url":null,"abstract":"<p><strong>Background: </strong>Periprosthetic osteolysis after total ankle arthroplasty (TAA) is a substantial problem. Bone grafting may be beneficial in the treatment of large osteolytic cysts; however, the literature regarding the outcomes of bone grafting is limited. This study analyzed the outcomes of autogenous bone grafting performed for the management of periprosthetic osteolysis following TAA.</p><p><strong>Methods: </strong>We retrospectively reviewed 42 ankles (41 Korean patients) that underwent autogenous bone grafting for periprosthetic osteolysis following TAA. Clinical outcomes were evaluated using visual analog scale for pain scores, Ankle Osteoarthritis Scale pain and disability scores, and American Orthopaedic Foot & Ankle Society Ankle-Hindfoot Scale scores. Computed tomography (CT) was performed preoperatively and for at least 2 years postoperatively in order to evaluate the treatment response. Histology, prosthesis survivorship, reoperations, and complications were also evaluated.</p><p><strong>Results: </strong>The mean time to autogenous bone grafting was 64.4 months (range, 10 to 128 months), and the mean follow-up duration after autogenous bone grafting was 70.7 months (range, 24 to 137 months). All clinical scores significantly improved from preoperatively to the last follow-up visit. The mean osteolytic cyst volume improved from 4.8 cm 3 (range, 1.1 to 19.4 cm 3 ) to 0.8 cm 3 (range, 0 to 6.5 cm 3 ). A Kaplan-Meier survival analysis revealed that TAA with subsequent bone grafting was associated with similar prosthesis survivorship (100% and 85.7% at 5 and 10 years, respectively) but inferior reoperation-free survivorship (93.4% and 68.4% at 5 and 10 years, respectively) compared with TAA without osteolysis or with non-progressive osteolysis.</p><p><strong>Conclusions: </strong>Autogenous bone grafting performed for the management of periprosthetic osteolysis after TAA produced favorable clinical and radiographic outcomes. However, there was still a higher risk of subsequent surgery even after successful bone grafting, compared with TAA without osteolysis or with non-progressive osteolysis. Our results suggest that autogenous bone grafting and serial CT scan monitoring over time may prolong the survivorship of TAA prostheses in ankles with periprosthetic osteolysis.</p><p><strong>Level of evidence: </strong>Therapeutic Level IV . See Instructions for Authors for a complete description of levels of evidence.</p>","PeriodicalId":15273,"journal":{"name":"Journal of Bone and Joint Surgery, American Volume","volume":" ","pages":"e33"},"PeriodicalIF":4.4,"publicationDate":"2025-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143501490","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 Sports Medicine.","authors":"Matthew Frederickson, Shannon Tse, Cassandra A Lee","doi":"10.2106/JBJS.24.01628","DOIUrl":"10.2106/JBJS.24.01628","url":null,"abstract":"","PeriodicalId":15273,"journal":{"name":"Journal of Bone and Joint Surgery, American Volume","volume":" ","pages":"789-795"},"PeriodicalIF":4.4,"publicationDate":"2025-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143501503","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":"Accuracy and Precision of Anatomical Medial Patellofemoral Ligament Identification Using the CLASS MRI Method: A Cadaveric Study.","authors":"Grégoire Thürig, Marc Barrera Usó, Raul Panadero-Morales, Elisabeth Alonso Domenech, Joseph M Schwab, Moritz Tannast, Daniel Petek","doi":"10.2106/JBJS.24.00747","DOIUrl":"10.2106/JBJS.24.00747","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;The medial patellofemoral ligament (MPFL) serves as the primary stabilizer of the patellofemoral joint, and surgical reconstruction aims to replicate its biomechanical properties. However, misplacement of the femoral tunnel remains a major problem that leads to revision after surgery for patellar instability. The C-arm technique for identifying the femoral origin of the MPFL (fMPFL) during surgery may not account for individual variability. Magnetic resonance imaging (MRI) allows for personalized fMPFL identification. The CLASS (Compressed Lateral and Anteroposterior Anatomical Systematic Sequences) method compresses MRI data into a lateral view, similar to intraoperative C-arm imaging. Recent research has shown that C-arm positioning directly affects fMPFL localization. The aim of this study was to investigate how accurate the identification of the femoral MPFL footprint is with the CLASS method and on which side the C-arm must be positioned.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Ten Caucasian cadaveric knees were utilized in this study. MRIs of the native and dissected knee were obtained. The MRIs, with the fMPFL anatomy dissected and marked, were used to create the \"anatomical CLASS\" (aCLASS) data. Additionally, the \"native MRI\" was used to identify the fMPFL in order to simulate preoperative planning, generating the \"planned CLASS\" (pCLASS) data. True-lateral fluoroscopic images with the image receptor contralaterally or ipsilaterally positioned were obtained. Statistical tests included the Wilcoxon signed-rank test for positional comparisons across all groups. A 1-way analysis of variance (ANOVA) with the Bonferroni adjustment was conducted for clinically relevant groups. Significance was set at p &lt; 0.05.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The pCLASS showed no significant differences compared with the aCLASS. The 1-way ANOVA showed significant differences between the ipsilateral group and the pCLASS and between the ipsilateral and contralateral groups only in the distal-proximal axis.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;This time-zero cadaveric study offers a novel method for determining the individual fMPFL. Various locations for femoral MFL attachment have been described in the literature, highlighting the need for individualized assessment methods. The CLASS method offered a reliable and reproducible approach for fMPFL identification. Also, proper intraoperative positioning of the C-arm, with the image receptor kept contralaterally, should be performed to increase the effectiveness of identifying the fMPFL using the CLASS method.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Clinical relevance: &lt;/strong&gt;The CLASS method offers a personalized approach for accurately identifying the fMPFL during surgery, which could potentially reduce tunnel misplacement and revision rates. Proper C-arm positioning with contralateral image receptor placement enhances the effectiveness of this technique, which has the potential to improve outcomes for patients underg","PeriodicalId":15273,"journal":{"name":"Journal of Bone and Joint Surgery, American Volume","volume":" ","pages":"e34"},"PeriodicalIF":4.4,"publicationDate":"2025-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143522857","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 PENG Block in Elective Primary Anterior Total Hip Arthroplasty Is Associated with Reduced Length of Stay: A Multidisciplinary Prospective Randomized Double-Blinded Controlled Trial.","authors":"Matthieu Hanauer, Alexander F Heimann, Pavel Kricka, Stefan Blümel, Darius Marti, Angela M Moosmann, Vlad Popa, Corinne A Zurmühle, Joseph M Schwab, Moritz Tannast","doi":"10.2106/JBJS.24.00825","DOIUrl":"10.2106/JBJS.24.00825","url":null,"abstract":"<p><strong>Background: </strong>The pericapsular nerve group (PENG) block has been shown to reduce pain and opioid consumption in posterior total hip arthroplasty (THA). The present study assessed the effects of the PENG block versus a placebo on postoperative (1) pain, (2) morphine consumption, and (3) length of stay in patients undergoing primary anterior THA.</p><p><strong>Methods: </strong>This was an institutional review board-approved, single-center, parallel-group, prospective, randomized, double-blinded, controlled trial of patients undergoing primary anterior THA between June 2022 and April 2023. Both groups underwent ultrasound-guided injection of a 20-mL solution (0.5% ropivacaine in the PENG group, 0.9% NaCl in the placebo group), according to the PENG block procedure. Sixty patients were included (32 in the PENG group, 28 in the placebo group). We assessed (1) postoperative pain at 1, 6, 12, and 24 hours with use of the visual analogue scale; (2) total morphine consumption as the morphine-equivalent dose (MED) during the first 24 hours postoperatively; and (3) the length of stay in days.</p><p><strong>Results: </strong>For the primary outcome, the median visual analogue scale pain score was 3.5 (range, 0 to 10) in the PENG group versus 4 (range, 0 to 10) in the placebo group at 1 hour postoperatively (p = 0.335); 1 (range, 0 to 7) versus 2 (range, 0 to 6) at 6 hours postoperatively (p = 0.306); 1 (range, 0 to 8) versus 1 (range, 0 to 6) at 12 hours postoperatively (p = 0.895); and 1.5 (range, 0 to 6) versus 1.5 (range, 0 to 6) at 24 hours postoperatively (p = 0.914). For secondary outcomes, the mean ± standard deviation 24-hour morphine consumption was 24 ± 17 MED in the PENG group versus 35 ± 29 MED in the placebo group (p = 0.110). The median length of stay was 2 days (range, 2 to 5 days) in the PENG group versus 4 days (range, 2 to 7 days) in the placebo group (p = 0.003).</p><p><strong>Conclusions: </strong>In this trial, the PENG block showed a significant decrease in hospital length of stay; however, no significant difference was found for visual analogue scale pain scores or morphine consumption following primary anterior THA compared with a placebo.</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":"805-810"},"PeriodicalIF":4.4,"publicationDate":"2025-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143527806","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}