Journal of orthopaedics最新文献

{"title":"Lumbar spinal fusion in postmenopausal women with a history of hormone replacement therapy","authors":"Donald MacElroy ,&nbsp;Ankita Jain ,&nbsp;Geet Shukla ,&nbsp;Harshadkumar Patel ,&nbsp;John V. Wainwright ,&nbsp;Merritt Kinon","doi":"10.1016/j.jor.2025.05.057","DOIUrl":"10.1016/j.jor.2025.05.057","url":null,"abstract":"<div><h3>Introduction</h3><div>Recent re-evaluation of the Women's Health Initiative Hormone Therapy Trials has established that hormone replacement therapy (HRT) can be beneficial for patients, if begun shortly after menopause. This study investigates the impact of a history of postmenopausal HRT on patient demographics and perioperative complications in women undergoing lumbar spinal fusion.</div></div><div><h3>Methods</h3><div>The National Inpatient Sample was queried from 2016 to 2020 for postmenopausal women (&gt;55 years old or applicable diagnosis) undergoing lumbar spinal fusion for degenerative etiologies, using International Classification of Disease Tenth Revision diagnostic and procedural codes. Patient characteristics and perioperative complications were evaluated for history of HRT versus non-HRT patients undergoing lumbar spinal fusion surgery.</div></div><div><h3>Results</h3><div>Of the 202,945 postmenopausal patients undergoing lumbar spinal fusion, 2645 (1.3 %) had a history of receiving HRT. Analysis demonstrated that HRT was a negative predictor of acute kidney injury (OR: 0.672; p = 0.006), pneumonia (OR: 0.320; p = 0.010), and anemia (OR: 0.887; p = 0.020). It was a positive predictor of bowel/bladder dysfunction (OR: 1.371; p &lt; 0.001).</div></div><div><h3>Conclusions</h3><div>The findings of this study highlight the unique demographics, comorbidities, and perioperative complications of postmenopausal women with a history of HRT undergoing lumbar spinal fusion surgery. While HRT history was associated with a favorable inpatient course, including reduced risk of acute kidney injury, pneumonia, deep venous thrombosis and myocardial infarction, these findings should be interpreted with caution due to limitations in coding accuracy and lack of long-term follow-up. HRT status may reflect broader differences in baseline health and healthcare access.</div></div>","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":"67 ","pages":"Pages 243-247"},"PeriodicalIF":1.5,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144168957","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Immune thrombocytopenic purpura as a predictor of postoperative complications in total knee arthroplasty: A nationwide cohort study","authors":"Aruni S. Areti ,&nbsp;Paul Gudmundsson ,&nbsp;Vinayak Perake ,&nbsp;Senthil N. Sambandam","doi":"10.1016/j.jor.2025.05.041","DOIUrl":"10.1016/j.jor.2025.05.041","url":null,"abstract":"<div><h3>Background</h3><div>Total knee arthroplasty (TKA) is one of the most common joint replacement procedures in the United States, with increasing use among medically complex populations. Immune thrombocytopenic purpura (ITP), a rare autoimmune disorder marked by low platelet counts, may increase the risk of adverse postoperative outcomes.</div></div><div><h3>Methods</h3><div>We conducted a retrospective cohort study using the TriNetX Research Network, which includes de-identified electronic health records from over 74 million U.S. patients. Patients undergoing primary total knee arthroplasty (TKA) between 2005 and 2023 were identified using CPT code 27447. Immune thrombocytopenic purpura (ITP) was defined using ICD-9 code 287.3 and ICD-10 code D69.3 within one year prior to surgery. ITP patients were compared to non-ITP controls before and after 1:1 propensity score matching. Postoperative complications were identified using ICD codes. Odds ratios (ORs) and 95 % confidence intervals (CIs) were reported; p &lt; 0.05 was considered significant.</div></div><div><h3>Results</h3><div>We identified 3817 ITP patients and 233,543 non-ITP controls, with 3817 matched pairs in the final analysis. ITP was associated with increased odds of several postoperative complications. Infectious outcomes included higher rates of wound dehiscence (OR = 2.77), periprosthetic joint infection (OR = 5.40), and pneumonia (OR = 2.44) (all p &lt; 0.001); deep surgical site infection was elevated pre-matching. Hematologic and cardiovascular complications included blood loss anemia (OR = 2.58), acute renal failure (OR = 2.67), and myocardial infarction (OR = 4.20). VTE events were more common, including deep vein thrombosis (OR = 2.44) and pulmonary embolism (OR = 2.90). Mechanical complications included periprosthetic fracture (OR = 3.18) and mechanical failure (OR = 4.20) (all p ≤ 0.002).</div></div><div><h3>Conclusion</h3><div>ITP was a significant risk factor for complications following TKA, underscoring the need for preoperative risk stratification and tailored perioperative management in this high-risk population.</div></div>","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":"68 ","pages":"Pages 137-142"},"PeriodicalIF":1.5,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144166265","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Revision for initial periprosthetic femur fracture increases likelihood of subsequent fracture in total hip arthroplasty","authors":"Alan D. Lam ,&nbsp;Nihir Parikh ,&nbsp;Adam S. Kohring ,&nbsp;R. Craig Juniewicz ,&nbsp;Elizabeth Abe ,&nbsp;Samuel P. Alfonsi III ,&nbsp;Ryan M. Sutton ,&nbsp;Chad A. Krueger","doi":"10.1016/j.jor.2025.05.052","DOIUrl":"10.1016/j.jor.2025.05.052","url":null,"abstract":"<div><h3>Background</h3><div>Although a rare complication, periprosthetic fractures (PPF) following total hip arthroplasty (THA) are becoming more common. Revision THA (rTHA) for PPF is associated with high failure rates, and there is a paucity of literature reporting how often there is a subsequent PPF in these patients. This study aimed to determine the rate of femoral re-fracture following rTHA in patients with an initial PPF after primary THA.</div></div><div><h3>Methods</h3><div>The retrospective study identified 2044 patients who underwent rTHA between 2017 and 2023. Propensity score-matched cohort analysis was conducted to control for demographic variables. The primary outcome was the re-fracture rate and survivability of those patients who were revised for PPF.</div></div><div><h3>Results</h3><div>There were 183 patients who sustained an initial PPF and underwent subsequent rTHA. Of these patients, five (2.7 %) sustained re-fracture of the femur. After matching, there was a 3.7 % re-fracture rate in patients revised for an initial PPF compared to those who were not revised for PPF (0.37 %, <em>P</em> = 0.017). The 1-year re-fracture-free survivability of patients revised for initial PPF was 95.9 %, which was significantly lower compared to patients revised for non-PPF indications (99.6 %; <em>P</em> = 0.008). Older patients, women, elevated Charlson Comorbidity Index (CCI), and posterior approach during rTHA were found to be risk factors for PPF (<em>P</em> &lt; 0.001).</div></div><div><h3>Conclusion</h3><div>Patients who were revised for an initial PPF had nearly a 10 times increased risk of re-fracturing compared to patients revised for other indications in THA. However, the similar readmission and failure rates and 1-year implant survivorship suggest comparable outcomes. Further analysis with a larger cohort and more outcome events is necessary.</div></div>","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":"67 ","pages":"Pages 238-242"},"PeriodicalIF":1.5,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144168956","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reliability of a modified Berger protocol for TKA component rotation using an anatomical tibial component","authors":"Stefan Gelderman ,&nbsp;Hans-Peter van Jonbergen ,&nbsp;Ellie Landman ,&nbsp;Ydo Kleinlugtenbelt","doi":"10.1016/j.jor.2025.05.064","DOIUrl":"10.1016/j.jor.2025.05.064","url":null,"abstract":"<div><h3>Background</h3><div>Malrotation in total knee prostheses can cause persistent pain and dissatisfaction. While the Berger protocol is the standard for assessing component rotation, it is unsuitable for anatomically designed tibial components. This study evaluates the inter- and intra-observer reliability of a modified method for anatomical prostheses and its clinical applicability.</div></div><div><h3>Method</h3><div>In this prospective study, 500 patients underwent postoperative CT scans. Femoral rotation was measured as the angle between the transepicondylar axis and posterior condylar line. Tibial rotation was defined by the angle between a perpendicular axis on the tibial plateau and a line through the tuberosity. Inter- and intra-observer reliability was assessed using the intraclass correlation coefficient (ICC) with a two-way mixed effect model with single measurement/observer and absolute agreement.To determine the clinical applicability, we calculated the percentage of agreement per degree of deviation between observers.</div></div><div><h3>Results</h3><div>Inter-observer reliability was good for both femoral (ICC 0.752, 95 % CI 0.71–0.79) and tibial (ICC 0.866, 95 % CI 0.84–0.89) measurements. Femoral measurements differed less than 2° in 91.4 % of cases, versus 52.2 % for tibial. Intra-observer reliability was found excellent: femoral (observer 1: ICC 0.941 (95 % CI 0.929–0.950); observer 2: ICC 0.943 (95 % 0.907–0.954)) and tibial (observer 1: ICC 0.941 (95 % CI 0.921–0.956); observer 2: ICC 0.972 (95 % CI 0.960–0.980).</div></div><div><h3>Conclusion</h3><div>The modified Berger protocol shows high reliability for anatomical tibial components. However, the percentage agreement for the tibial component between and within observers was low and therefore might influence the applicability.</div></div>","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":"68 ","pages":"Pages 143-148"},"PeriodicalIF":1.5,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144166224","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mid-to-long-term outcomes of posterior-stabilized type total knee arthroplasty in asian patients: A single-center retrospective cohort study","authors":"Hiroya Akase,&nbsp;Masashi Miyazaki,&nbsp;Masashi Hirakawa,&nbsp;Yu Nagashima,&nbsp;Shougo Matsuda,&nbsp;Nobuhiro Kaku","doi":"10.1016/j.jor.2025.05.053","DOIUrl":"10.1016/j.jor.2025.05.053","url":null,"abstract":"<div><h3>Background</h3><div>Total knee arthroplasty (TKA) is a widely performed orthopedic procedure, yet patient satisfaction remains suboptimal, especially in Asian populations due to implant size mismatches. The FINE total knee prosthesis was anatomically designed for Japanese patients and incorporates medial pivot mechanics. However, mid-to-long-term outcomes of the posterior-stabilized (PS) type remain unreported.</div></div><div><h3>Methods</h3><div>We retrospectively analyzed 247 consecutive primary TKAs performed using the PS-type FINE prosthesis at our institution between 2010 and 2017. Patients with at least 5 years of follow-up were included. Clinical outcomes were evaluated using the Knee Society Score (KSS), Knee Injury and Osteoarthritis Outcome Score (KOOS), and passive range of motion (ROM). Radiographic assessments included femorotibial angle (FTA), hip-knee-ankle angle (HKAA), and radiolucent line evaluation. Implant survivorship was analyzed using Kaplan–Meier methods.</div></div><div><h3>Results</h3><div>A total of 114 knees (84 patients) met the inclusion criteria with a mean follow-up of 112.2 months. Passive ROM improved significantly (extension from −8.9° to −2.6°, flexion from 121.4° to 124.5°). Favorable improvements in KSS and KOOS were observed. Radiolucent lines ≥2 mm were found in only 4.4 % of tibial zones and none on the femoral side. No revisions were required. Four knees (3.5 %) underwent reoperation for non-mechanical complications. The 10-year reoperation-free survival rate was 95.4 %.</div></div><div><h3>Conclusion</h3><div>The PS-type FINE prosthesis demonstrated excellent mid-to-long-term clinical and radiographic outcomes in Asian patients. Its anatomical design and material properties contribute to its durability and functional success, supporting its use in population-specific TKA strategies.</div></div>","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":"67 ","pages":"Pages 248-252"},"PeriodicalIF":1.5,"publicationDate":"2025-05-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144168842","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Patients have restored extensor mechanism function with low complication rates following quadriceps tendon repair: A systematic review","authors":"Udit Dave ,&nbsp;Jared Rubin ,&nbsp;Jacob T. Morgan ,&nbsp;Nicole Chang ,&nbsp;Cameron Gerhold ,&nbsp;Andrew S. Bi ,&nbsp;Myles Atkins ,&nbsp;Fernando Gómez-Verdejo ,&nbsp;Nikhil N. Verma ,&nbsp;Jorge Chahla","doi":"10.1016/j.jor.2025.05.046","DOIUrl":"10.1016/j.jor.2025.05.046","url":null,"abstract":"<div><h3>Introduction</h3><div>The quadriceps tendon (QT), which is formed by the confluence of the vastus intermedius, vastus lateralis, vastus medialis, and rectus femoris muscles plays a vital role in knee extension, hip flexion, and lower extremity mobility. The purpose of this systematic review is to evaluate post-operative outcomes, range of motion, and complications in patients who undergo quadriceps tendon repair.</div></div><div><h3>Methods</h3><div>In accordance with PRISMA guidelines, PubMed, Embase, and Cochrane Library databases were searched in August 2024 for studies published after 2004. Studies were included if they evaluated patients who underwent quadriceps tendon (QT) repair with any technique, were prospective or retrospective studies, and reported outcomes or complications. Studies not written in English or that did not evaluate complications or outcomes following QT repair were excluded.</div></div><div><h3>Results</h3><div>The initial screen identified 662 studies, 6 of which were included. There were three retrospective case series, two retrospective cohort studies, and one prospective non-randomized study. Each study had low risk of bias. A total of 324 patients (89.5 % male) were included. Mean age across studies ranged from 32.0 to 65.8 years. Five studies pertained to patients over 50 years old; one study focused on patients under age 40. Otherwise, there were similar patient demographics across studies. Fixation techniques included transosseous tunnels, suture anchors, simple sutures, and adjustable cortical fixation. Mean post-operative Lysholm scores ranged from 85.4 to 94.0 (range 30–100). Full extension was reached by 88.7–100 % of patients. Mean knee flexion across studies ranged from 124.3 to 133.0°, with overall ranges of 110–150°. Re-rupture or failure occurred in 0–15.4 % of patients. Other complications included VTE (0–15.4 %), arthrofibrosis (0–7.7 %), infection (0–2.0 %), paresthesias over the anterior knee (0–13.2 %), and wound dehiscence (0–7.7 %).</div></div><div><h3>Conclusions</h3><div>Quadriceps tendon repair restores extensor mechanism function in patients with a low complication rate. There are no differences in outcomes or complications based on operative technique used. Decisions regarding operative technique should be tailored to individual patient characteristics and surgeon preferences with special consideration of medical comorbidities and systemic diseases that can affect tissue quality and post-operative healing.</div></div><div><h3>Level of evidence</h3><div>Level IV, systematic review of level II- IV studies.</div></div>","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":"67 ","pages":"Pages 214-222"},"PeriodicalIF":1.5,"publicationDate":"2025-05-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144147461","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Persistent functional deficits after ankle fracture surgery: A long-term gait and functional analysis","authors":"Firat Tan ,&nbsp;Sibel Bozgeyik Bagdatli ,&nbsp;Gizem Irem Kinikli ,&nbsp;Semra Topuz ,&nbsp;Hande Guney Deniz","doi":"10.1016/j.jor.2025.05.045","DOIUrl":"10.1016/j.jor.2025.05.045","url":null,"abstract":"<div><h3>Introduction</h3><div>Ankle fractures are among the most common lower limb fractures, particularly in individuals over 50 years of age. Despite surgical interventions, long-term functional impairments, such as joint stiffness and gait abnormalities, may persist. This study aimed to evaluate long-term gait and functional outcomes following ankle fracture surgery.</div></div><div><h3>Objective</h3><div>To investigate spatiotemporal gait parameters, heel-rise performance, and ankle dorsiflexion mobility in individuals who underwent surgical treatment for ankle fractures.</div></div><div><h3>Study design</h3><div>A cross-sectional observational study.</div></div><div><h3>Methods</h3><div>Fourteen participants (mean age 53.7 years) were evaluated at a mean follow-up of 4.5 years post-surgery. Spatiotemporal gait parameters were assessed using the GAITRite® system. Functional performance was examined with the Heel Rise Test and Weight-Bearing Lunge Test (WBLT), along with validated clinical scales, including the American Orthopaedic Foot and Ankle Society Ankle-Hindfoot Scale (AOFAS) and the Olerud-Molander Ankle Score (OMAS). Intrarater reliability of the functional tests was determined using intraclass correlation coefficients (ICCs).</div></div><div><h3>Results</h3><div>Step length was significantly greater on the surgical side (p = 0.016), while double support time was reduced (p = 0.043). The Heel Rise Test (p = 0.020) and WBLT (p = 0.006) demonstrated significant deficits on the surgical side compared to the non-surgical side. Despite high AOFAS (86.5) and OMAS (80) scores, functional limitations persisted. Reliability analysis showed excellent intrarater consistency for the Heel Rise Test (ICC = 0.98) and WBLT (ICC = 0.99), with low SEM and MDC values.</div></div><div><h3>Conclusions</h3><div>Long-term functional deficits, particularly in ankle dorsiflexion and plantarflexion strength, persist despite seemingly favorable clinical scores. These findings underscore the need for targeted rehabilitation strategies to improve soft tissue mobility and muscle function after ankle fracture surgery.</div></div><div><h3>Level of evidence</h3><div>Level III.</div></div>","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":"67 ","pages":"Pages 253-258"},"PeriodicalIF":1.5,"publicationDate":"2025-05-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144168843","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Factors influencing good knee joint range of motion and pain-free recovery 2 years after total knee arthroplasty","authors":"Hironao Shioiri ,&nbsp;Tsuneari Takahashi ,&nbsp;Tatsuya Kubo ,&nbsp;Masaki Iguchi ,&nbsp;Katsushi Takeshita","doi":"10.1016/j.jor.2025.05.040","DOIUrl":"10.1016/j.jor.2025.05.040","url":null,"abstract":"<div><h3>Introduction</h3><div>We investigated the factors associated with achieving a flexion angle of at least 120° and a numerical rating scale (NRS) score of 1.0 or less (maximum 0, minimum 10) 2 years after cruciate retaining-total knee arthroplasty (CR-TKA).</div></div><div><h3>Materials and methods</h3><div>We retrospectively studied 100 consecutive patients that underwent CR-TKA in July 2018–December 2021 and divided them into two groups: those that achieved at least 120° flexion and 1.0 or less NRS at 2 years postoperatively (group G) and those that did not (group NG). The endpoints were preoperative and 1-year postoperative NRS, preoperative and 1-year postoperative flexion range of motion (ROM), 2 years postoperative flexion ROM, and preoperative Oxford Knee Score (OKS). Univariate, logistic regression analyses determined items with significant differences that were then used in receiver operating characteristic (ROC) analysis to determine cut-off values.</div></div><div><h3>Results</h3><div>Group G showed a lower body mass index (24.6 ± 3.3 vs. 26.6 ± 4.0; P = 0.016), lower 1-year postoperative NRS (0.53 ± 0.99 vs. 2.0 ± 2.0; P &lt; 0.001), and higher 1-year postoperative flexion ROM (125.3° ± 6.2° vs. 114.9° ± 10.9°; P &lt; 0.001). Preoperative NRS and ROM did not differ between the groups. Multivariate analysis revealed that flexion ROM at 1 year (odds ratio [OR]: 1.17, 95 % confidence interval [CI]: 1.03–1.27; P &lt; 0.001) and NRS at 1 year (OR: 0.49, 95 % CI: 0.29–0.83; P &lt; 0.001) were significantly associated with achieving a postoperative flexion angle ≥120° and pain-free recovery. The ROC cut-off values were a flexion angle ≥125° and NRS ≤1.0 at 1 year postoperatively.</div></div><div><h3>Conclusion</h3><div>Predictors of achieving a flexion angle of 120° or more and NRS 1.0 or less at 2 years after CR-TKA were good ROM and adequate pain relief 1 year postoperatively, regardless of preoperative pain or ROM.</div></div>","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":"67 ","pages":"Pages 183-187"},"PeriodicalIF":1.5,"publicationDate":"2025-05-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144139403","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Global trends in fixation methods for primary total knee arthroplasty: An international registry-based analysis and review of outcomes","authors":"Bradley J. Lauck ,&nbsp;Landon Larabee ,&nbsp;Joshua L. Morningstar ,&nbsp;James F. Fraser","doi":"10.1016/j.jor.2025.05.031","DOIUrl":"10.1016/j.jor.2025.05.031","url":null,"abstract":"<div><h3>Background</h3><div>Despite the projected growth of total knee arthroplasty (TKA) in the United States (US) and worldwide, there remains debate regarding optimal implant fixation.</div></div><div><h3>Purpose</h3><div>The purpose of this study was to report the global trends in cementing rates for TKA using available data from national arthroplasty registries.</div></div><div><h3>Methods</h3><div>Data were extracted from the annual reports of 7 national joint registries, with annual trends in cementation rates calculated via linear regression. Data regarding revision rates were aggregated from national joint registries, and a literature search identified all meta-analyses published since 2012 that compared outcomes of cemented and cementless fixation.</div></div><div><h3>Results</h3><div>Average rates of cementless fixation over the study period ranged from 1.4 % (Germany) to 15.4 % (Australia). The US led in cementless TKA usage with rates increasing at a rate of 2 % annually (<em>p</em>&lt;.001). In European countries, use of cementless fixation remains below 10 % with only Sweden showing increased adoption. Hybrid cementation is used <strong>less than cemented or cementless</strong> (&lt;10 % of cases/year) in countries analyzed in this study except for Australia which reports upwards of 20 % of cases/year in 2022. Summary of meta-analyses revealed no clear differences in rates of revision, reoperation, infection, range of motion (ROM), or knee society score (KSS).</div></div><div><h3>Conclusion</h3><div>The vast majority of TKAs performed worldwide use cement fixation, but rates of cemented and cementless TKA fixation vary widely by country. Recent meta-analyses generally indicate cementless TKA provides similar outcomes when compared to cemented TKA. In contrast, registry data still associates cemented TKAs with lower revision rates.</div></div>","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":"67 ","pages":"Pages 230-237"},"PeriodicalIF":1.5,"publicationDate":"2025-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144168996","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Rates of fractures by medication type in patients with bipolar disorder: A retrospective cohort analysis","authors":"Tarun R. Sontam ,&nbsp;Zaryab Alam ,&nbsp;Anuj Gupta ,&nbsp;Hetsinhji Chavda ,&nbsp;Adil Basha ,&nbsp;Omar Hamza ,&nbsp;Omar Atassi ,&nbsp;Nidal Moukaddam","doi":"10.1016/j.jor.2025.05.042","DOIUrl":"10.1016/j.jor.2025.05.042","url":null,"abstract":"<div><h3>Objective</h3><div>This study examined fracture incidence in patients with bipolar disorder compared to those without and assessed fracture risk based on exclusive use of lithium, mood-stabilizing antiepileptics, antipsychotics, or antidepressants versus no medication use.</div></div><div><h3>Methods</h3><div>Using TriNetX, patients aged 18 or older were divided into bipolar and non-bipolar cohorts. The bipolar cohort was subdivided into five sub-cohorts: no medication use, exclusive lithium use, exclusive atypical antipsychotic use, exclusive mood-stabilizing antiepileptics use, and exclusive antidepressant use. The incidence of central, upper extremity, lower extremity, and “any” skeletal fractures (encompassing the previous three groups) were compared between the bipolar and non-bipolar cohorts, between males and females with bipolar disorder, and between patients aged 18-64 and aged 65 or older with bipolar disorder. A second analysis was performed to determine the incidence and relative risk of different fracture types based on exclusive medication use compared to no medication use.</div></div><div><h3>Results</h3><div>Patients with bipolar disorder had a higher fracture risk than patients without, with an increased risk ranging from 0.43 % for upper extremity fractures to 2.41 % for any fractures. Male patients and patients aged 65 or older had a significantly higher risk of fractures compared to female patients and patients aged 18-64 (p &lt; 0.0001 for all outcomes). Lithium use was associated with a reduced risk of central fractures (p = 0.0065) and any fractures (p = 0.0037). Patients using mood-stabilizing antiepileptics exhibited a lower risk of lower extremity fractures (p = 0.0002) and any fractures (p = 0.0003). Antipsychotic use was linked to a decreased risk of all fracture types (p &lt; 0.0001). Antidepressant use was associated with an increased risk of upper extremity fractures (p &lt; 0.0001) and any fractures (p &lt; 0.0001).</div></div><div><h3>Conclusions</h3><div>Lithium, mood-stabilizing antiepileptics, and antipsychotics were associated with reduced fracture risk, while antidepressants increased fracture risk. Further research is needed to optimize bipolar disorder treatment strategies while minimizing fracture risk.</div></div>","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":"67 ","pages":"Pages 203-208"},"PeriodicalIF":1.5,"publicationDate":"2025-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144147462","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}