Journal of orthopaedics最新文献

{"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}

{"title":"What to expect after a tibial tubercle osteotomy? A 10-year retrospective study of clinical and radiologic outcomes","authors":"Joana Almeida ,&nbsp;Ana Rita Senra ,&nbsp;Maria Clara Correia ,&nbsp;Maria João Leite ,&nbsp;Paulo Oliveira ,&nbsp;Francisco Serdoura ,&nbsp;João Torres","doi":"10.1016/j.jor.2025.05.024","DOIUrl":"10.1016/j.jor.2025.05.024","url":null,"abstract":"<div><h3>Introduction</h3><div>Patellofemoral instability (PFI) is a multifactorial entity that combines osseous and soft tissue abnormalities. Tibial tubercle osteotomy (TTO) addresses biomechanical malalignment but faces 50 % recurrence rates with TT-TG &gt;20 mm. Long-term outcomes show 62.5 % success at 10–15 years post-TTO, though 16–21 % require reoperations. Current evidence lacks long-term data, underscoring the need for individualized surgical planning. This study evaluates 10-year outcomes via MRI and clinical outcomes to identify predictors of suboptimal results.</div></div><div><h3>Methods</h3><div>A retrospective observational study was designed. Demographic and clinical data, including age, gender, number of dislocations, and revision surgery, were collected. Radiologic measures were patellar height, tilt, displacement, maltracking, and trochlear dysplasia. They were assessed with computed tomography (CT) preoperatively and magnetic resonance imaging (MRI) postoperatively, with further identification of chondral lesions. Functional evaluation was based on the Kujala and Lysholm scores.</div></div><div><h3>Results</h3><div>Data from 36 knees were included. Recurrent dislocation occurred in 14 % (5 cases), primarily in younger females (median age 16) with residual malalignment. Symptomatic hardware removal (50 %) was the most common complication. Significant improvements were observed in the TT-TG distance (23 IQR 15.05–25.3 V S 15 IQR 10–18 mm, p = 0.002), patellar tilt and displacement with 0° of extension (patellar tilt: 28.5 IQR 17.75–34.25 V S 16.5 IQR 10–24.25°, p &lt; 0.005; patellar displacement: 6.3 IQR 3.07–14.6 V S 2.5 IQR 0–8.25 mm, p = 0.01) and with active contraction only patellar tilt (34 IQR 24–42.5 V S 29 IQR 15-36° p = 0.014). Despite 54.8 % present with advanced chondropathy (Outerbridge III/IV), no correlation was found with age, alignment, or functional scores. The median Kujala score was 89.5 IQR 82.5–97.5, and the median Lysholm was 91 IQR 81.75–95.75.</div></div><div><h3>Conclusion</h3><div>TTO provides reliable long-term outcomes for patellofemoral instability. The risk of joint degeneration is non-negligible, especially in the setting of malalignment or older age on admission.</div></div><div><h3>Level of evidence</h3><div>III.</div></div>","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":"66 ","pages":"Pages 239-244"},"PeriodicalIF":1.5,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144138615","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":"Preoperative range of motion as a predictor of postoperative outcomes in total knee arthroplasty under enhanced recovery after surgery protocols: Defining clinically relevant cut-offs","authors":"R. Radhakrishnan,&nbsp;A. Padki,&nbsp;A.X. Han,&nbsp;X. Liu,&nbsp;M.H. Liow,&nbsp;D.K.J. Tay,&nbsp;S.J. Yeo,&nbsp;H.N. Pang,&nbsp;J.Y. Chen","doi":"10.1016/j.jor.2025.05.026","DOIUrl":"10.1016/j.jor.2025.05.026","url":null,"abstract":"<div><h3>Background</h3><div>The predictive role of preoperative range of motion (ROM) in total knee arthroplasty (TKA) under Enhanced Recovery After Surgery (ERAS) protocols remains underexplored.</div></div><div><h3>Objective</h3><div>To identify clinically relevant preoperative ROM thresholds predictive of suboptimal postoperative motion in ERAS-based TKA.</div></div><div><h3>Methods</h3><div>A retrospective cohort of 339 TKA patients managed under ERAS was analyzed. Preoperative ROM in extension (ROMS) and flexion (ROME) were assessed as predictors of postoperative ROM and functional outcomes. Correlation, regression, and ROC analyses were performed.</div></div><div><h3>Results</h3><div>A preoperative ROMS cut-off of 30° demonstrated 100 % specificity for predicting poor postoperative extension (&gt;10°) and flexion (&lt;100°) (AUC = 0.361 and 0.420, respectively). Preoperative ROME predicted postoperative flexion with higher accuracy (AUC = 0.778) and an optimal threshold of 150°, achieving 100 % sensitivity and 99.6 % specificity. Preoperative ROM parameters, however, showed limited correlation with functional scores and patient-reported outcomes.</div></div><div><h3>Conclusion</h3><div>A 30-degree preoperative ROMS serves as a highly specific predictor of postoperative ROM limitation, offering an actionable benchmark for patient selection and perioperative planning within ERAS pathways.</div></div><div><h3>Level of evidence</h3><div>Level III, Retrospective cohort study.</div></div>","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":"66 ","pages":"Pages 232-238"},"PeriodicalIF":1.5,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144131311","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":"Does the cartilage proteome differ between osteoarthritic knees with varus and valgus deformities? Insights from proteomic analysis","authors":"Dhanasekaran Soundarrajan ,&nbsp;Divya Arunachalam ,&nbsp;Sharon Miracle Nayagam ,&nbsp;Chitra Thangavel ,&nbsp;Shanmuganathan Rajasekaran","doi":"10.1016/j.jor.2025.05.023","DOIUrl":"10.1016/j.jor.2025.05.023","url":null,"abstract":"<div><h3>Purpose</h3><div>To elucidate the proteome profile of cartilage tissue with two distinct phenotypes namely varus and valgus osteoarthritic (OA) knees in response to different loading conditions.</div></div><div><h3>Methods</h3><div>Global proteomic analysis was performed on cartilage tissues isolated from weight-bearing and non-weight-bearing regions of varus (OA-varus) and valgus (OA-valgus) knees. The study group consists of eight samples in each category. Insolution digested cartilage tissue extracts were subjected to Q-exactive plus orbitrap quadrupole mass spectrometer for protein identifications. Downstream bioinformatic analysis were carried out to detect the altered proteins and pathways in OA-valgus and OA-varus groups.</div></div><div><h3>Results</h3><div>Mass spectrometric analysis revealed that 645 and 742 proteins were identified from OA-valgus and OA-varus respectively. The differential analysis showed that 44 proteins were up regulated and 29 proteins were down regulated in OA-varus after assigning sample cutoff to 50 %. SOD2 was the top up regulated protein (log2FC = 2.688) and serum amyloid protein SAA2-SAA4 was the top down regulated protein (log2FC = −1.983) in OA-varus. KEGG pathway analysis revealed that upregulated proteins and unique proteins of OA-varus were enriched for complement and coagulation cascade and regulation of actin cytoskeleton. While the downregulated proteins of OA-varus (i.e. upregulation in OA-valgus) and unique proteins of OA-valgus were enriched for metabolic pathways including glycolysis, cholesterol metabolism, etc. Further GO analysis revealed that OA-varus proteins were enriched for immune responses and OA-valgus proteins were enriched for ECM related functions.</div></div><div><h3>Conclusion</h3><div>Distinct proteomic profiles between OA-valgus and OA-varus knees were identified, with immune response pathways prominently in varus knees, and metabolic and structural pathways predominantly in valgus knees. These findings can inform targeted therapeutic strategies and OA management.</div></div>","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":"67 ","pages":"Pages 194-202"},"PeriodicalIF":1.5,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144139404","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":"Evaluation of the relationship between muscle-tendon preservation and gait analysis in total hip arthroplasty","authors":"Ryuichi Sato ,&nbsp;Hajime Sugiyama ,&nbsp;Yohei Matsushita ,&nbsp;Tatsuya Kanno ,&nbsp;Yasunori Kashihara ,&nbsp;Hisahiro Tonotsuka ,&nbsp;Tetsuo Hayama ,&nbsp;Mitsuru Saito","doi":"10.1016/j.jor.2025.05.029","DOIUrl":"10.1016/j.jor.2025.05.029","url":null,"abstract":"<div><h3>Background</h3><div>For total hip arthroplasty (THA), minimally invasive surgery (MIS) has been reported to enhance early functional recovery. The conjoined tendon-preserving posterior (CPP) approach is a posterior MIS-THA technique designed to minimise muscle-tendon dissection while preserving the piriformis muscle, conjoined tendon, and the joint capsule covered by the conjoined tendon. This approach is expected to facilitate early postoperative functional recovery; however, clinical outcomes remain unreported. This study aimed to evaluate the impact of muscle preservation on walking ability by comparing THA performed using the CPP and posterolateral (PL) approaches through gait analysis and patient-reported outcome measures (PROMs).</div></div><div><h3>Methods</h3><div>Seventy-two patients who underwent THA with preoperative and postoperative gait analyses were included. To minimise physical bias, sex, age, height, and weight were matched between groups using propensity score matching, resulting in 14 participants per approach. Walking velocity, cadence, step length, and hip motion angle were assessed preoperatively, as well as at 3, 6, and 12 months postoperatively. Additionally, PROMs were evaluated using the Japanese Orthopaedic Association Hip Disease Evaluation Questionnaire (JHEQ) at each time point.</div></div><div><h3>Results</h3><div>At 3 months postoperatively, the CPP group exhibited significantly higher walking velocity (CPP: 120.4 ± 17.1 cm/s; PL: 103.2 ± 22.5 cm/s, <em>p</em> = 0.041) and cadence (CPP: 118.0 ± 6.1 steps/min; PL: 110.3 ± 9.4 steps/min, <em>p</em> = 0.012) compared to the PL group. However, no significant differences were observed after 6 months. Among the JHEQ scores, only the ‘movement’ domain was significantly higher in the CPP group at 3 months, mirroring the gait analysis results, with no significant differences thereafter.</div></div><div><h3>Conclusions</h3><div>Compared to the PL approach, the CPP approach enhanced walking velocity, cadence, and movement-related PROMs during the early postoperative period of up to 3 months.</div></div>","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":"66 ","pages":"Pages 225-231"},"PeriodicalIF":1.5,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144131310","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":"Does stem length affect proximal humeral stress shielding? A systematic review","authors":"Maxwell Harrell,&nbsp;Dev Dayal,&nbsp;Clay Rahaman,&nbsp;Matthew T. Sankey,&nbsp;Caleb Berta,&nbsp;Jacques Van Zyl,&nbsp;Vamsisaikrishna Morla,&nbsp;Thomas Evely,&nbsp;Walter Smith,&nbsp;Aaron Casp,&nbsp;Amit Momaya,&nbsp;Eugene Brabston","doi":"10.1016/j.jor.2025.05.037","DOIUrl":"10.1016/j.jor.2025.05.037","url":null,"abstract":"<div><h3>Introduction</h3><div>Total shoulder arthroplasty (TSA) has increased in use, with revision surgeries also increasing. One cause of revision is aseptic loosening driven by stress shielding—a condition where altered load distribution leads to proximal humeral osteolysis surrounding the humeral prosthesis. This systematic review compares stress shielding between traditional-length (TL) and short-stem (SS) humeral prostheses, hypothesizing that SS stems reduce stress shielding.</div></div><div><h3>Methods</h3><div>A systematic search of Cochrane, Embase, and Medline databases was conducted. Inclusion criteria targeted studies from the last 10 years reporting radiographic outcomes of TL and SS stems. Pooled radiographic measures were stratified into a 5-zone analysis of the proximal humerus for comparison. These included cortical thinning and osteopenia (CNO), condensation lines (CL), spot welds (SW), and an overall adaptive change score. An additional GLIMMIX procedure was performed to evaluate the effect that technique and stem length had on radiographic outcomes using random effects modeling.</div></div><div><h3>Results</h3><div>A total of 7 studies were included, and 620 patients were analyzed, with 422 receiving SS and 198 receiving TL humeral prostheses. The weighted average follow-up was 34.8 months. TL showed higher rates of CNO around the superior-lateral humeral prosthesis, and SS showed higher rates of CNO around the inferior-lateral and medial prosthesis. TL showed higher rates of SW around the superior-lateral and medial prosthesis, but SS showed higher rates of SW around the distal-lateral and medial prosthesis. No differences were found in CL for any group or for any measure under the stem. A significantly greater proportion of TL patients had low adaptive change scores, with more SS patients possessing high adaptive change scores. Technique did not show any significant effects on radiographic outcomes while stem length showed a significant effect on CNO in the distal-lateral zone (F-Value = 19.72, p = 0.04, OR = 0.106, 95 % CI [0.012–0.932])</div></div><div><h3>Conclusion</h3><div>This study demonstrated radiographic differences between short and traditional-length stems that suggest unique patterns of bone remodeling. While short stems may better preserve proximal lateral bone, the higher incidence of distal cortical changes warrants careful patient selection, and traditional-length stems may remain preferable when metaphyseal fixation or bone quality is a concern.</div></div>","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":"67 ","pages":"Pages 188-193"},"PeriodicalIF":1.5,"publicationDate":"2025-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144139402","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":"Perioperative complications and postoperative outcome of primary total knee arthroplasty in octogenarians – A systematic review","authors":"Annemarie Rusche,&nbsp;Georg Osterhoff,&nbsp;Andreas Roth,&nbsp;Nikolas Schopow","doi":"10.1016/j.jor.2025.05.025","DOIUrl":"10.1016/j.jor.2025.05.025","url":null,"abstract":"<div><div>Osteoarthritis is a common disease worldwide, most commonly affecting the knee. With the rise of obesity, paired with higher life expectancy, prevalence of osteoarthritis of the knee will rise as well. Therefore, Total Knee Arthroplasty (TKA) rates are expected to increase 85 %, estimating 1.26 million procedures worldwide in 2030. Patients will become older with demographic changes and more elderly people will be eligible for procedure, a patient group is often considered vulnerable, with a higher risk of mortality and complications. This systematic review aimed to compare perioperative outcomes after TKA in Octogenarians with those in a younger cohort. After screening 33,336 publications on total joint arthroplasty in the elderly in the PubMed and Web of Science databases, four studies investigating TKA and matching criteria were included. No notable variations in outcomes were detected among elderly compared to younger patients. Eligibility for a procedure should be based on comorbidities and overall health status rather than age alone.</div></div>","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":"67 ","pages":"Pages 209-213"},"PeriodicalIF":1.5,"publicationDate":"2025-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144147460","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":"Low risk of periprosthetic fracture and subsidence with automated impaction device in arthroplasty following femoral neck fracture: A retrospective study","authors":"Courtney Levit ,&nbsp;Ryan Decook ,&nbsp;Joseph M. Schwab ,&nbsp;Thomas L. Bradbury ,&nbsp;Natalie L. Gresham ,&nbsp;Anita “Alex” Bradham ,&nbsp;Farideh Najafi ,&nbsp;Brandon Naylor","doi":"10.1016/j.jor.2025.05.036","DOIUrl":"10.1016/j.jor.2025.05.036","url":null,"abstract":"<div><h3>Background</h3><div>Manual broaching in hip arthroplasty for femoral neck fractures (FNFx) may introduce variability in force application, increasing the risk of periprosthetic fractures. Automated impaction devices (AID) deliver consistent, uniform force vectors during femoral preparation, potentially reducing implant-bone mismatch, stem subsidence, and fracture risk. This study evaluates early complication rates following AID use in hip arthroplasty for FNFx.</div></div><div><h3>Methods</h3><div>A retrospective cohort study was conducted on consecutive patients undergoing total hip arthroplasty (THA) or hemiarthroplasty (HA) for FNFx by two surgeons between January 1, 2019, and June 1, 2023. All patients received a cementless femoral stem implanted with an AID and had a minimum 30-day follow-up. Outcomes assessed included 30-day revision-free stem survivorship, intraoperative and postoperative periprosthetic fractures, femoral component subsidence, and 30-day reoperation and readmission rates.</div></div><div><h3>Results</h3><div>The cohort included 118 patients [72.0 % women; mean age 77.4 (range, 52–95) years], with 82 (69.5 %) undergoing THA and 36 (30.5 %) HA. One intraoperative fracture (0.8 %, Vancouver AG) and one postoperative fracture (0.8 %, Vancouver B1) occurred. The 30-day reoperation rate was 3.4 % (n = 4), and the readmission rate was 16.3 % (n = 15). Mild femoral component subsidence occurred in 1.7 % (n = 2) without evidence of loosening. No femoral stem revisions were reported within 30 days, yielding a 100 % short-term survivorship rate.</div></div><div><h3>Conclusion</h3><div>Early outcomes suggest that AID use in hip arthroplasty for FNFx is associated with low rates of periprosthetic fracture, subsidence, and early complications. Further prospective studies are needed to assess long-term outcomes.</div></div>","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":"66 ","pages":"Pages 219-224"},"PeriodicalIF":1.5,"publicationDate":"2025-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144131405","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":"Methylprednisolone after shoulder arthroplasty leads to decreased opioid prescriptions without an increased risk of infection: A matched cohort analysis","authors":"Tej Joshi ,&nbsp;Tuckerman Jones ,&nbsp;Akhil Katakam ,&nbsp;Daniella Ogilvie ,&nbsp;Amanda Azer ,&nbsp;Sefy A. Paulose ,&nbsp;Balazs Galdi","doi":"10.1016/j.jor.2025.05.032","DOIUrl":"10.1016/j.jor.2025.05.032","url":null,"abstract":"<div><h3>Background</h3><div>Due to the increasing demand for total shoulder arthroplasty, safe opioid stewardship paired with appropriate pain management is imperative for long-term patient care. A recent study has shown the potential for methylprednisolone use in the peri-operative period in order to decrease opioid consumption postoperatively.</div></div><div><h3>Methods</h3><div>The large TriNetX database was queried to identify all patients who were methylprednisolone naïve that underwent total shoulder arthroplasty with a minimum follow-up of 3 months. These patients were then further separated into two cohorts – those who received post-operative methylprednisolone within 7 days of the arthroplasty procedure and those who did not. After 1:1 propensity score matching, 1304 patients were included in each cohort for analysis. The primary outcome was opioid prescription within the 30- and 90-day postoperative period. Additional hospitalization, surgical, and medical outcomes were analyzed at 30-day, 90-day, 1-year, and 2-year time points.</div></div><div><h3>Results</h3><div>For patients who received methylprednisolone, there were significantly fewer opioid prescriptions at 30 days (1.4 ± 1.6 versus 1.5 ± 1.8, p = 0.033) and 90 days (1.8 ± 2.3 versus 2.0 ± 3.4, p = 0.026). At both 30 and 90 day time points, there was no significant difference in the risk for medical complications like acute kidney injury, deep venous thrombosis, myocardial infarction, pulmonary embolism, pneumonia, urinary tract infection, glucose values, and A1C. between the two groups. At 1 year and 2 year time points, there was no significant difference in the risk of surgical complications like need for revision, prosthetic joint infection, surgical site infection, dislocation, wound complications, mechanical failure, periprosthetic fracture, and polywear/osteolysis.</div></div><div><h3>Conclusion</h3><div>Methylprednisolone use in the peri-operative period may lead to a decrease in the number of opioid prescriptions needed for patients post-operatively with no increased risk of surgical or medical complications. As opioids carry their own inherent risks, safe stewardship with multimodal pain regimens that include methylprednisolone may be beneficial in both the short and long term for patients.</div></div><div><h3>Level of evidence</h3><div>Level III Retrospective Cohort Comparison Using Large Database Prognosis Study.</div></div>","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":"66 ","pages":"Pages 192-197"},"PeriodicalIF":1.5,"publicationDate":"2025-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144116945","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}