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

{"title":"The CPT 22-Modifier at a Single Private-Practice Orthopaedic Institution: Success, Reimbursement, and Financial Burden.","authors":"Allyson N Pfeil, Brenton Jennewine, Benjamin Sketchler, Michael C Cusick, Corey F Hryc, T Bradley Edwards, Anay R Patel","doi":"10.2106/JBJS.26.00089","DOIUrl":"https://doi.org/10.2106/JBJS.26.00089","url":null,"abstract":"<p><strong>Background: </strong>The Current Procedural Terminology (CPT) 22-modifier on surgical billing is one method to denote higher surgical procedure complexity and obtain adequate surgeon compensation for increased time, skill, and effort. However, the addition of a 22-modifier can result in delays to reimbursement, variable amounts of reimbursement, and unpredictable success of modifier approval. This study sought to investigate a single U.S. private-practice group's experience with 22-modifier success across multiple orthopaedic surgical subspecialties.</p><p><strong>Methods: </strong>All surgical claims during a 3-year period across 4 surgical subspecialties (adult reconstruction, hand, shoulder, and sports medicine) were reviewed. The use of a 22-modifier amendment, payer, reimbursement amount, days to payment, and rebilling rate were collected for all claims. The data were analyzed to depict overall claim success and the variability that existed on the basis of payer status and subspecialty service.</p><p><strong>Results: </strong>A total of 18,612 claims were included, of which 2,741 (14.7%) were amended with a 22-modifier. The overall success rate of amended claims was 71.7%. By subspecialty, sports medicine had the lowest success rate (64.7%), followed by adult reconstruction (72.8%), shoulder (73.8%), and hand (76.3%). The success rate was 62.9% for Workers' Compensation, 65.0% for commercial, and 78.0% for government payers, and the modifier resulted in a 7.7% increase in reimbursement overall. Significant delays in reimbursement were seen after claims with a 22-modifier compared with unmodified claims, with increases in time until reimbursement ranging from 39.1% (hand) to 77.4% (shoulder). Claim denial also resulted in a significantly higher rebilling rate than for unmodified claims in adult reconstruction.</p><p><strong>Conclusions: </strong>The 22-modifier was more often successfully approved by government payers than by other payers, but resulted in marginal increases in reimbursement, variable approval rates, delays to reimbursement, and increased claim rebilling rates across various orthopaedic subspecialties. The financial gain may be offset by the increased administrative work and billing burden in some procedures or subspecialties.</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":4.5,"publicationDate":"2026-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149016943","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 Management of Pelvic and Vertebral Fragility Fractures: An Unmet Care Need.","authors":"Paul A Anderson, Lora M Giangregorio, Milton L C Routt","doi":"10.2106/JBJS.26.00966","DOIUrl":"https://doi.org/10.2106/JBJS.26.00966","url":null,"abstract":"<p><p>➢ Vertebral compression fractures and pelvic insufficiency fractures are common and result in increased mortality and morbidity.➢ These fractures can be difficult to diagnose because many patients are asymptomatic or have symptoms ascribed to other causes. Additionally, pelvic and sacral fractures are difficult to visualize radiographically.➢ Nonoperative treatment is appropriate for most patients and focuses on pain management, the improvement of mobility and activities of daily living, and nutritional support.➢ The surgical indications are intractable pain, poor functional ability, radiographic evidence of deterioration, and neurologic deficits.➢ Secondary fracture prevention is critical to prevent further fractures and may speed up recovery.</p>","PeriodicalId":15273,"journal":{"name":"Journal of Bone and Joint Surgery, American Volume","volume":" ","pages":""},"PeriodicalIF":4.5,"publicationDate":"2026-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149001957","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":"A Novel Mini-Prosthesis with a Nano-Multilayer Film-Coated Surface and 3D-Printed Porous Stem for Focal Cartilage Lesions: In Vivo Performance in a Porcine Model.","authors":"Guangqian Shang, Yuhao Mu, Ketao Wang, Zheng Guo, Zhongli Li, Ji Li","doi":"10.2106/JBJS.26.00538","DOIUrl":"https://doi.org/10.2106/JBJS.26.00538","url":null,"abstract":"<p><strong>Background: </strong>Focal cartilage lesions (FCLs) of the knee can cause pain and dysfunction. Focal resurfacing with mini-prostheses offers an alternative to biological treatments, yet current clinical options remain limited. This preliminary study investigated a novel mini-prosthesis in a porcine model.</p><p><strong>Methods: </strong>A Ti6Al4V mini-prosthesis with a carbon-based nano-multilayer film (NMF)-coated articular surface and a 3D-printed porous stem was developed (NMF@3D-Ti). Two comparators were included in the study: an NMF-coated Ti articular surface with a hydroxyapatite (HA)-coated stem (NMF@HA-Ti) and a cobalt-chromium (CoCr) prosthesis with a polished articular surface and an HA-coated stem (HA-CoCr). Twenty-five Bama pigs underwent bilateral medial femoral condyle surgery and were divided into 5 treatment groups: NMF@3D-Ti, NMF@HA-Ti, HA-CoCr, microfracture (MF), and sham. All animals were killed at 24 weeks. Evaluations included radiography, biocompatibility, overall joint condition, gross and histological analysis of opposing and adjacent cartilage, gene expression analysis in opposing cartilage, synovial inflammatory cytokines, and osseointegration.</p><p><strong>Results: </strong>Radiographs revealed no implant-related complications, and biocompatibility was confirmed. The HA-CoCr group had the most severe opposing-cartilage damage, with significantly worse macroscopic and microscopic scores, upregulated catabolic gene expression, and elevated synovial inflammatory cytokines compared with all other groups (all p < 0.05), along with disrupted collagen organization. The NMF@3D-Ti and NMF@HA-Ti groups were comparable with the sham group across all cartilage assessments. The MF group showed intermediate histological and gene expression changes in the opposing cartilage. Furthermore, the NMF@3D-Ti group demonstrated superior osseointegration, with significantly greater bone volume/total volume, bone mineral density, and bone-implant contact than the other implant groups (all p < 0.05), and no evidence of stress-shielding in the comparison with the sham group.</p><p><strong>Conclusions: </strong>At 24 weeks, the NMF@3D-Ti mini-prosthesis exhibited favorable biocompatibility and robust osseointegration, and achieved superior cartilage protection compared with both the CoCr mini-prosthesis and MF.</p><p><strong>Clinical relevance: </strong>This mini-prosthesis provides a joint-preserving approach that may be a valuable addition to the current armamentarium, enriching the stepped-care algorithm for osteoarthritis.</p>","PeriodicalId":15273,"journal":{"name":"Journal of Bone and Joint Surgery, American Volume","volume":" ","pages":""},"PeriodicalIF":4.5,"publicationDate":"2026-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148982852","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 Unexamined Practice: Five Philosophical Concepts in an Orthopaedic Encounter.","authors":"Rob Parisien","doi":"10.2106/JBJS.26.00032","DOIUrl":"10.2106/JBJS.26.00032","url":null,"abstract":"","PeriodicalId":15273,"journal":{"name":"Journal of Bone and Joint Surgery, American Volume","volume":" ","pages":"1419-1421"},"PeriodicalIF":4.5,"publicationDate":"2026-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147987613","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":"Concentration and Frequency of Intraoperative Irrigation as a Strategy Against Implant-Associated Infection: Insights from a Preclinical Rat Model: Commentary on an article by Musashi Ima, MD, et al.: \" Diluted Povidone-Iodine Irrigation for Prevention of Implant-Related Infection. A Comparative Analysis of Concentration and Frequency in a Rat Model \".","authors":"Andriy Kobryn, Edward M Schwarz","doi":"10.2106/JBJS.26.00371","DOIUrl":"10.2106/JBJS.26.00371","url":null,"abstract":"","PeriodicalId":15273,"journal":{"name":"Journal of Bone and Joint Surgery, American Volume","volume":" ","pages":"1403-1404"},"PeriodicalIF":4.5,"publicationDate":"2026-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147972561","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 Functional Vital Sign: Interpreting Physical Function to Guide Treatment.","authors":"Judith F Baumhauer, David Cella","doi":"10.2106/JBJS.26.00342","DOIUrl":"10.2106/JBJS.26.00342","url":null,"abstract":"","PeriodicalId":15273,"journal":{"name":"Journal of Bone and Joint Surgery, American Volume","volume":" ","pages":"1415-1418"},"PeriodicalIF":4.5,"publicationDate":"2026-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147972725","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 and Complications of Vertebral Body Tethering in Skeletally Immature Patients with Idiopathic Scoliosis.","authors":"Rachelle Imbeault, Jesse Shen, Abdulmajeed Alzakri, Soraya Barchi, Marjolaine Roy-Beaudry, Isabelle Turgeon, Stefan Parent","doi":"10.2106/JBJS.25.01102","DOIUrl":"10.2106/JBJS.25.01102","url":null,"abstract":"<p><strong>Background: </strong>Vertebral body tethering (VBT) aims to gradually correct scoliosis using patients' growth while preserving spinal motion. We report 5 to 8-year outcomes and complications in skeletally immature patients.</p><p><strong>Methods: </strong>This prospective single-center cohort study included 74 patients who had idiopathic scoliosis and a ≥5-year follow-up. Preoperative, first postoperative visit, 1-year, 2-year, and ≥5-year radiographs were analyzed. A ≥5° increase in the interscrew angle suggested tether breakage.</p><p><strong>Results: </strong>All 74 patients (5 male and 69 female) were skeletally immature at surgery. The mean age at surgery was 11.8 ± 1.3 years, and the mean follow-up time was 63.4 ± 8.4 months. Of the 74 patients, 68 patients were White, 4 were Black, and 2 were Middle Eastern or North African. VBT was performed on a mean of 7.4 vertebral levels. The maximum Cobb angle was 47.9° ± 9.4° preoperatively, whereas the instrumented Cobb angle measured 17.2° ± 12.3° at 2 years and 25.7° ± 14.0° at ≥5 years postoperatively. An unplanned return to the operating room occurred in 16 patients (21.6%). Forty-nine patients (66%) had a suspected broken tether at the final follow-up. The mean time of the first tether breakage was 38.1 ± 15 months. Forty-nine patients (66%) also had a curve of <40° without an unplanned return to the operating room at a minimum of 5 years postoperatively.</p><p><strong>Conclusions: </strong>In our cohort, 66% (49 patients) had a radiographically suspected tether breakage after 5 years and 13.5% (10 patients) required posterior spinal fusion to date. VBT yielded significant correction in the coronal plane (p < 0.001) and transverse plane (p = 0.006) postoperatively, with a reoperation rate of 21.6%.</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":"1461-1468"},"PeriodicalIF":4.5,"publicationDate":"2026-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147512295","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":"Diluted Povidone-Iodine Irrigation for Prevention of Implant-Related Infection: A Comparative Analysis of Concentration and Frequency in a Rat Model.","authors":"Musashi Ima, Tamon Kabata, Daisuke Inoue, Yu Yanagi, Takahiro Iyobe, Naoya Fujimaru, Masaharu Tokoro, Takayuki Nojima, Satoru Demura","doi":"10.2106/JBJS.25.01235","DOIUrl":"10.2106/JBJS.25.01235","url":null,"abstract":"<p><strong>Background: </strong>Povidone-iodine (PVI) irrigation is widely used to reduce surgical site infection risk; however, the appropriate concentration and timing remain uncertain. We evaluated how the PVI concentration and irrigation interval influence the early bacterial burden and tissue response in a rat model of implant-related infection.</p><p><strong>Methods: </strong>Female rats received a stainless steel plate contaminated with methicillin-susceptible Staphylococcus aureus . The rats were randomized to receive 0.13% PVI, 0.35% PVI, or normal saline solution irrigation every 30 or 60 minutes during a 60-minute procedure. Irrigation consisted of a 3-minute exposure followed by a saline solution rinse. Outcomes included the bacterial count after sonication, soft-tissue infection score, peri-implant bone mineral density (BMD) on microcomputed tomography (µCT), histological inflammation grading, and body weight trajectory.</p><p><strong>Results: </strong>Higher PVI concentrations and a shorter irrigation interval were associated with reduced recoverable bacterial burden. Among the 30-minute interval groups, no culturable bacteria were recovered in the 0.35% PVI group (i.e., the values were below the assay detection limit); in contrast, culturable bacteria were detectable in all of the 60-minute interval groups. PVI-treated rats demonstrated lower macroscopic infection scores and a trend toward more rapid body weight recovery compared with saline solution controls. For both irrigation intervals, µCT showed higher peri-implant BMD in the PVI-treated groups than in the saline solution controls. Histology showed less inflammation and fewer abscesses in the PVI-treated groups compared with controls, with the least inflammation observed in the group that received 0.35% PVI at 30-minute intervals.</p><p><strong>Conclusions: </strong>In this rat model, PVI concentration and irrigation interval were associated with early differences in bacterial recovery and peri-implant tissue and bone responses. These findings are hypothesis-generating and should be interpreted as mechanistic, preclinical signals rather than as guidance for clinical practice. Further translational and clinical studies are needed to determine the relevance of these signals in humans.</p><p><strong>Clinical relevance: </strong>Current practice typically involves a single 3-minute 0.35% PVI soak before wound closure. This study provides preclinical mechanistic data on how PVI concentration and irrigation timing influence early bacterial recovery in an implant-related infection model. The findings do not support changes to clinical protocols, but highlight the need for careful evaluation of cytotoxicity and safety.</p>","PeriodicalId":15273,"journal":{"name":"Journal of Bone and Joint Surgery, American Volume","volume":" ","pages":"1477-1485"},"PeriodicalIF":4.5,"publicationDate":"2026-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147930005","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 Hip Surgery.","authors":"Seper Ekhtiari, Malik I Ali, Amir Human Hoveidaei, T David Luo, Özkan Köse, Ernesto Guerra-Farfán, Mustafa Citak","doi":"10.2106/JBJS.26.00664","DOIUrl":"10.2106/JBJS.26.00664","url":null,"abstract":"","PeriodicalId":15273,"journal":{"name":"Journal of Bone and Joint Surgery, American Volume","volume":" ","pages":"1406-1414"},"PeriodicalIF":4.5,"publicationDate":"2026-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148536070","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":"Importance of Medial Ligament Complex Tears Associated with Posterior Cruciate Ligament Avulsion Fractures: Commentary on an article by Binghao Wang, MD, et al.: \" Medial Collateral Ligament Injury in Posterior Cruciate Ligament Tibial Avulsion Fractures. An Underrecognized Finding \".","authors":"Stuart C Marshall","doi":"10.2106/JBJS.26.00067","DOIUrl":"10.2106/JBJS.26.00067","url":null,"abstract":"","PeriodicalId":15273,"journal":{"name":"Journal of Bone and Joint Surgery, American Volume","volume":" ","pages":"1399-1400"},"PeriodicalIF":4.5,"publicationDate":"2026-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148005348","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}