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

{"title":"Preseason Patellar Tendon Thickness Predicts Symptomatic Patellar Tendinopathy in Male NCAA Division I Basketball Players.","authors":"Sohil S Desai, John D Mueller, Tony T Wong, Stavros Thomopoulos, William K Crockatt, Natasha N Desai, Elan L Goldwaser, Charles A Popkin","doi":"10.2106/JBJS.24.00680","DOIUrl":"10.2106/JBJS.24.00680","url":null,"abstract":"<p><strong>Background: </strong>The purpose of this study was to evaluate whether increased anteroposterior (AP) thickness of the proximal patellar tendon at preseason evaluation is predictive of symptomatic patellar tendinopathy and associated sequelae.</p><p><strong>Methods: </strong>Thirty-one male National Collegiate Athletic Association (NCAA) Division I basketball players voluntarily participated in this study (n = 52 tendons from 27 athletes after application of exclusion criteria, with evaluation at preseason, midseason, and postseason time points). At each time point, Victorian Institute of Sport Assessment-Patellar Tendon (VISA-P) scores, patellar tendon tenderness, patellar tendon AP thickness, and the presence of a proximal patellar tendon hypoechoic region were evaluated. Measurement of patellar tendon AP thickness and the identification of hypoechoic regions were performed using a portable ultrasound device. Outcome measures included a proximal patellar tendon hypoechoic region, a trip to the training room (TTR), time-loss symptomatic patellar tendinopathy (TLPT), and patellar tendon rupture. Covariates evaluated in the multivariable regression model included body mass index and a patient-reported history of patellar tendinopathy (α = 0.05).</p><p><strong>Results: </strong>The mean preseason tendon thickness was 4.78 ± 1.22 mm. Nine (17.3%) of the tendons were symptomatic to the point of requiring a TTR. Preseason tendon thickness was associated with increased odds of a TTR (adjusted odds ratio [aOR] = 3.68 [95% confidence interval (CI) = 1.73 to 7.81]; p < 0.01). The predicted probability of a TTR was 86.0% with a preseason tendon thickness of 8 mm versus 3.4% with a preseason tendon thickness of 4 mm. Preseason tendon thickness was also predictive of TLPT (aOR = 1.96 [95% CI = 1.03 to 3.71]; p = 0.04). Preseason VISA-P scores were not predictive of a TTR (p = 0.66) or TLPT (p = 0.60).</p><p><strong>Conclusions: </strong>Increased patellar tendon thickness on preseason ultrasound is predictive of symptomatic patellar tendinopathy and associated sequelae during an NCAA Division I basketball season. Ultrasound identification of at-risk individuals may allow triage toward additional physical therapy and activity modification for these athletes to prevent progression to irreversible patellar tendon disease. These data support the use of ultrasound as a screening tool for elite jumping athletes.</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":"e51"},"PeriodicalIF":4.4,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143657122","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: Treat the Patient Instead of the Disease.","authors":"Janae Rasmussen","doi":"10.2106/JBJS.24.01274","DOIUrl":"10.2106/JBJS.24.01274","url":null,"abstract":"","PeriodicalId":15273,"journal":{"name":"Journal of Bone and Joint Surgery, American Volume","volume":" ","pages":"1163-1164"},"PeriodicalIF":4.4,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143472483","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":"4-Aminopyridine Promotes BMP2 Expression and Accelerates Tibial Fracture Healing in Mice.","authors":"Govindaraj Ellur, Prem Kumar Govindappa, Sandeep Subrahmanian, Gerardo Figueroa Romero, David A Gonzales, David S Margolis, John C Elfar","doi":"10.2106/JBJS.24.00311","DOIUrl":"10.2106/JBJS.24.00311","url":null,"abstract":"<p><strong>Background: </strong>Delayed bone healing is common in orthopaedic clinical care. Agents that alter cell function to enhance healing would change treatment paradigms. 4-aminopyridine (4-AP) is a U.S. Food and Drug Administration (FDA)-approved drug shown to improve walking in patients with chronic neurological disorders. We recently showed 4-AP's positive effects in the setting of nerve, wound, and even combined multi-tissue limb injury. Here, we directly investigated the effects of 4-AP on bone fracture healing, where differentiation of mesenchymal stem cells into osteoblasts is crucial.</p><p><strong>Methods: </strong>All animal experiments conformed to the protocols approved by the Institutional Animal Care and Use Committee at the University of Arizona and Pennsylvania State University. Ten-week-old C57BL/6J male mice (22 to 28 g), following midshaft tibial fracture, were assigned to 4-AP (1.6 mg/kg/day, intraperitoneal [IP]) and saline solution (0.1 mL/mouse/day, IP) treatment groups. Tibiae were harvested on day 21 for micro-computed tomography (CT), 3-point bending tests, and histomorphological analyses. 4-AP's effect on human bone marrow mesenchymal stem cell (hBMSC) and human osteoblast (hOB) cell viability, migration, and proliferation; collagen deposition; matrix mineralization; and bone-forming gene/protein expression analyses was assessed.</p><p><strong>Results: </strong>4-AP significantly upregulated BMP2 gene and protein expression and gene expression of RUNX2, OSX, BSP, OCN, and OPN in hBMSCs and hOBs. 4-AP significantly enhanced osteoblast migration and proliferation, collagen deposition, and matrix mineralization. Radiographic and micro-CT imaging confirmed 4-AP's benefit versus saline solution treatment in mouse tibial fracture healing (bone mineral density, 687.12 versus 488.29 mg hydroxyapatite/cm 3 [p ≤ 0.0021]; bone volume/tissue volume, 0.87 versus 0.72 [p ≤ 0.05]; trabecular number, 7.50 versus 5.78/mm [p ≤ 0.05]; and trabecular thickness, 0.08 versus 0.06 mm [p ≤ 0.05]). Three-point bending tests demonstrated 4-AP's improvement of tibial fracture biomechanical properties versus saline solution (stiffness, 27.93 versus 14.30 N/mm; p ≤ 0.05). 4-AP also increased endogenous BMP2 expression and matrix components in healing callus.</p><p><strong>Conclusions: </strong>4-AP increased the healing rate, biomechanical properties, and endogenous BMP2 expression of tibiae following fracture.</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":"936-947"},"PeriodicalIF":4.4,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12058417/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143692295","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":"Total Ankle Arthroplasty in Obese Patients: An Ethical Analysis.","authors":"Andrew D Lachance, Roman Steika, Frank Chessa, Mohammad T Azam, Jeffrey Lutton, Wonyong Lee","doi":"10.2106/JBJS.24.01142","DOIUrl":"10.2106/JBJS.24.01142","url":null,"abstract":"","PeriodicalId":15273,"journal":{"name":"Journal of Bone and Joint Surgery, American Volume","volume":" ","pages":"1034-1039"},"PeriodicalIF":4.4,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143735698","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 Minimal Clinically Important Difference (MCID) for Total Joint Arthroplasty Outcome Measures Varies Substantially by Calculation Method.","authors":"Matthew J Solomito, Robert Carangelo, Heeren Makanji","doi":"10.2106/JBJS.24.00916","DOIUrl":"10.2106/JBJS.24.00916","url":null,"abstract":"<p><strong>Background: </strong>As the United States health-care system transitions to a value-based model, the minimal clinically important difference (MCID) has become an important metric for assessing perceived benefit in clinical settings. However, there is substantial ambiguity surrounding the MCID value because the calculation method used can lead to substantial changes in the clinical interpretation of surgical success.</p><p><strong>Methods: </strong>A total of 1,113 patients who underwent either total knee arthroplasty (TKA) or total hip arthroplasty (THA) between June 2021 and June 2023 and completed their patient-reported outcomes (the KOOS JR [Knee injury and Osteoarthritis Outcome Score for Joint Replacement] or HOOS JR [Hip disability and Osteoarthritis Outcome Score for Joint Replacement]) preoperatively and at 1 year postoperatively were reviewed for this study. The MCID values for the HOOS JR and KOOS JR were determined using 16 statistically appropriate methods, and the resulting MCID values were applied to the study group to assess how differences in methods changed the number of patients who met the MCID at 1 year postoperatively.</p><p><strong>Results: </strong>The study cohort consisted of 570 patients who underwent TKA and 543 who underwent THA. The overall cohort was 62.2% female, had a mean age of 69.3 ± 8.3 years, and was 92.3% Caucasian, 2.9% African American, and 4.8% other race (i.e., Asian, multiracial, or \"other\"). The MCID values varied substantially among the methods evaluated. The mean MCID was 11.5 ± 9.2 (range, 0.5 to 36.6) for the KOOS JR and 12.2 ± 8.9 (range, 0.6 to 34.3) for the HOOS JR. Distribution-based methods led to smaller but more variable MCID values, whereas anchor-based methods were noted to have larger but more consistent MCID values.</p><p><strong>Conclusions: </strong>Different statistical approaches resulted in substantial variation in the MCID threshold value, which affected the number of patients who reached the MCID. This study demonstrates the ambiguity of the MCID and casts some doubt regarding its utility for assessing the surgical benefit of total joint arthroplasty.</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":"994-999"},"PeriodicalIF":4.4,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143670031","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":"Identifying Risk Factors from Preoperative MRI Measurements for Failure of Primary ACL Reconstruction: A Nested Case-Control Study with 5-Year Follow-up.","authors":"Zhi-Yu Zhang, Wen-Bin Bai, Wei-Li Shi, Qing-Yang Meng, Xiao-Yu Pan, Xiao-Yue Fu, Jian-Quan Wang, Cheng Wang","doi":"10.2106/JBJS.23.01137","DOIUrl":"10.2106/JBJS.23.01137","url":null,"abstract":"<p><strong>Background: </strong>Identifying patients at high risk for failure of primary anterior cruciate ligament reconstruction (ACLR) on the basis of preoperative magnetic resonance imaging (MRI) measurements has received considerable attention. In this study, we aimed to identify potential risk factors for primary ACLR failure from preoperative MRI measurements and to determine optimal cutoff values for clinical relevance.</p><p><strong>Methods: </strong>Retrospective review and follow-up were conducted in this nested case-control study of patients who underwent primary single-bundle ACLR using hamstring tendon autograft at our institution from August 2016 to January 2018. The failed ACLR group included 72 patients with graft failure within 5 years after primary ACLR, while the control group included 144 propensity score-matched patients without failure during the 5-year follow-up period. Preoperative MRI measurements were compared between the 2 groups. Receiver operating characteristic (ROC) curve analyses were conducted to determine the optimal cutoff values for the significant risk factors. Odds ratios (ORs) were calculated, and survival analyses were performed to evaluate the clinical relevance of the determined thresholds.</p><p><strong>Results: </strong>A greater lateral femoral condyle ratio (LFCR) (p = 0.0076), greater posterior tibial slope in the lateral compartment (LPTS) (p = 0.0002), and greater internal rotational tibial subluxation (IRTS) (p < 0.0001) were identified in the failed ACLR group compared with the control group. ROC analyses showed that the optimal cutoff values for IRTS and LPTS were 5.8 mm (area under the curve [AUC], 0.708; specificity, 89.6%; sensitivity, 41.7%) and 8.5° (AUC, 0.655; specificity, 71.5%; sensitivity, 62.5%), respectively. Patients who met the IRTS (OR, 6.14; hazard ratio [HR], 3.87) or LPTS threshold (OR, 4.19; HR, 3.07) demonstrated a higher risk of primary ACLR failure and were significantly more likely to experience ACLR failure in a shorter time period.</p><p><strong>Conclusions: </strong>Preoperative MRI measurements of increased IRTS, LPTS, and LFCR were identified as risk factors for primary ACLR failure. The optimal cutoff value of 5.8 mm for IRTS and 8.5° for LPTS could be valuable in the perioperative management of primary ACLR.</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":"e42"},"PeriodicalIF":4.4,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143597193","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: Diverse History to Diverse Practice: How the Society of Military Orthopaedic Surgeons E. Anthony Rankin Scholarship Molds Future Orthopaedic Surgeons.","authors":"Jalen L Warren, Jakara Morgan, Correggio Peagler, Symone Brown, Trayce Gray, Theodora Dworak, Marvin Dingle","doi":"10.2106/JBJS.24.01095","DOIUrl":"10.2106/JBJS.24.01095","url":null,"abstract":"","PeriodicalId":15273,"journal":{"name":"Journal of Bone and Joint Surgery, American Volume","volume":" ","pages":"1018-1021"},"PeriodicalIF":4.4,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142949603","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":"Evaluating Data-Sharing Policies and Author Compliance in Leading Orthopaedic Journals.","authors":"Josh Major, Klaire Wild, Annes Elfar, Brody Dennis, Eli Oldham, Alex Hagood, Eli Paul, Jake X Checketts, Alicia Ito Ford, Matt Vassar","doi":"10.2106/JBJS.24.00955","DOIUrl":"10.2106/JBJS.24.00955","url":null,"abstract":"<p><strong>Background: </strong>Orthopaedic surgery is a critical field, impacting global health-care expenditure and patient outcomes. Despite substantial research funding, issues of transparency and reproducibility persist, undermining the credibility of published in-print findings. Data-sharing initiatives aim to address these challenges by promoting accessibility and enhancing research reliability. We aimed to assess the landscape of data-sharing practices within the field of orthopaedic surgery, focusing on the top orthopaedic journals from 2020 to 2023.</p><p><strong>Methods: </strong>Original research articles from 10 of the top orthopaedic journals were screened and analyzed for data-sharing statements (DSSs). Furthermore, we identified variables that were influential on the inclusion of DSSs in orthopaedic clinical studies, and thematically analyzed DSS content to identify prevalent themes. Lastly, corresponding authors were contacted to assess their willingness to share their data.</p><p><strong>Results: </strong>Of the 1,084 reviewed articles, only 14% included a DSS. The Journal of Bone & Joint Surgery demonstrated the highest proportion of articles with a DSS. Over time, clinical trials exhibited an increasing trend in DSS adoption, contrasting with consistently low rates among cohort studies. Thematic analysis identified the gatekeeper role and conditional data availability as predominant themes in orthopaedic DSSs. Of the 115 emails sent to corresponding authors, only 22 (19.1%) yielded responses, and of those who responded, only 12 (54.5%) expressed a willingness to share their data.</p><p><strong>Conclusions: </strong>Our findings underscore a substantial disparity in data-sharing practices across orthopaedic journals, highlighting the need for standardization and mandates for DSSs. Adopting the Transparency and Openness Promotion (TOP) Guidelines can enhance accountability and foster a culture of open science within the field. By addressing these shortcomings, orthopaedic journals can improve research reproducibility and advance scientific knowledge effectively.</p>","PeriodicalId":15273,"journal":{"name":"Journal of Bone and Joint Surgery, American Volume","volume":" ","pages":"1024-1033"},"PeriodicalIF":4.4,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143390926","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":"Preservation Versus Release of Normal Long Head of Biceps Tendon in Repair of Isolated Stage-1 Supraspinatus Tears: Preservation Leads to Slightly Lower Constant-Murley Scores and More Reoperations.","authors":"Julien Berhouet, Adrien Jacquot, François Gadéa, Jacques Guery, Thierry Joudet, Nicolas Bonnevialle, Xavier Ohl, Lionel Neyton, Nicolas Gasse, Johannes Barth, Maxime Antoni, Franck Dordain, David Gallinet, Christophe Charousset","doi":"10.2106/JBJS.24.00423","DOIUrl":"10.2106/JBJS.24.00423","url":null,"abstract":"<p><strong>Background: </strong>The aim of this study was to determine whether preserving a normal-appearing long head of the biceps (LHB) tendon leads to better Constant-Murley scores (CMS) than releasing it in patients undergoing arthroscopic repair of an isolated stage-1 supraspinatus tendon tear.</p><p><strong>Methods: </strong>Patients (40 to 70 years old) who were undergoing arthroscopic repair of a minor supraspinatus tendon tear and who had a macroscopically normal LHB were randomized to LHB preservation or LHB release during a prospective clinical trial. The surgeon was free to choose whether to perform tenodesis in patients undergoing LHB release. The primary outcome was the involved shoulder's function based on the absolute CMS score at 6 and 24 months. Secondary outcomes included the American Shoulder and Elbow Surgeons (ASES) shoulder score and Subjective Shoulder Value (SSV). A post-hoc analysis of prospectively collected data was done using 1:1 propensity score matching without replacement. This resulted in 2 age- and sex-matched groups of 95 patients each. Race and ethnicity data were not collected.</p><p><strong>Results: </strong>At 24 months, the mean CMS was significantly better in the LHB release group (mean and standard deviation, 86.8 ± 8.3) than in the LHB preservation group (82.9 ± 10.0) (p = 0.003), 97% of the patients in the LHB release group and 88% in the LHB preservation group had more than the minimal clinically important difference (MCID) for the CMS in rotator cuff repair (p = 0.048), 15% in the LHB preservation group and 3% in the LHB release group (p = 0.01) had an absolute CMS below 70, and the ASES was significantly higher in the LHB release group (91.4 ± 19.2) than in the LHB preservation group (83.6 ± 25.0) (p = 0.02). There were 4 reoperations in the LHB preservation group and no reoperations in the LHB release group.</p><p><strong>Conclusions: </strong>Based on our findings, a macroscopically normal-appearing biceps tendon should be released when treating stage-1 supraspinatus tendon tears.</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":"e41"},"PeriodicalIF":4.4,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143730196","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":"Weight Loss Before Total Joint Arthroplasty Using a Remote Dietitian and a Mobile Application: A Multicenter Randomized Controlled Trial.","authors":"Michael W Seward, Adriana P Liimakka, Matthew P Jamison, Lillian Zhu, Antonia F Chen","doi":"10.2106/JBJS.24.00838","DOIUrl":"10.2106/JBJS.24.00838","url":null,"abstract":"<p><strong>Background: </strong>Many surgeons recommend weight loss for patients with obesity before total joint arthroplasty (TJA), but few studies have evaluated weight loss interventions. This study compared weight loss using a remote dietitian and a mobile application (app) with weight loss using standard care for patients with severe obesity before TJA.</p><p><strong>Methods: </strong>This multicenter randomized controlled trial included 60 subjects with a body mass index (BMI) of 40 to 47 kg/m 2 who had been scheduled for primary total hip or knee arthroplasty from September 2019 to January 2023. The mean age was 61 years, 67% were women, and the mean BMI was 44 kg/m 2 . The control subjects (n = 29) received standard care; the intervention subjects (n = 31) completed video calls with dietitians and used a mobile app for 12 weeks preoperatively. Weights and surveys were collected at baseline and 12 weeks, with 87% follow-up. Weight loss, patient-reported outcomes, complications, revisions, and reoperations were compared. The mean follow-up was 1.8 years.</p><p><strong>Results: </strong>The intervention subjects lost more weight (-4.1 versus -2.1 kg, p = 0.22) and had larger decreases in BMI (-1.4 versus -0.9 kg/m 2 , p = 0.36 than the controls, but not significantly so. The intervention subjects had higher odds of achieving a BMI of <40 kg/m 2 (odds ratio = 1.9, p = 0.44), but not significantly so. There were no significant differences in the mean change in the Hip disability and Osteoarthritis Outcome Score, the Knee injury and Osteoarthritis Outcome Score, or the Lower Extremity Activity Scale score. At baseline, only 11% had seen a dietitian in the last 3 months. Most subjects (83%) felt that video calls were helpful. There were no differences in complications between the groups; there was a patellar fracture in the control group and a deep venous thromboembolism in the intervention group.</p><p><strong>Conclusions: </strong>A preoperative weight loss intervention using a dietitian and a mobile app was feasible and viewed favorably among patients. Remote dietitians and mobile apps may address gaps in access to obesity treatment before TJA. While the intervention subjects lost more weight and were more likely to achieve a BMI of <40 kg/m 2 , the differences were not significant. More intensive interventions may be needed to achieve enough weight loss for clinically important improvements in TJA.</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":"910-918"},"PeriodicalIF":4.4,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143670034","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}