Journal of orthopaedics最新文献

{"title":"Comparing patient outcomes following outpatient total joint arthroplasty in a hospital setting versus an ambulatory surgery center","authors":"Kyle M. Altman,&nbsp;Sara Workman,&nbsp;Matthew R. Price","doi":"10.1016/j.jor.2024.12.004","DOIUrl":"10.1016/j.jor.2024.12.004","url":null,"abstract":"<div><h3>Background</h3><div>Traditionally, total joint arthroplasty has been performed as an inpatient procedure, sometimes requiring a hospital stay of a few days. However, outpatient total joints have gained popularity in recent years. The purpose of this study is to compare patient outcomes following an outpatient total knee arthroplasty (TKA) or a total hip arthroplasty (THA) in a hospital setting versus an ambulatory surgical center.</div></div><div><h3>Method</h3><div>This study was a prospective study of patients receiving either a TKA or THA, with results up to one year. All cases were performed by one board certified orthopedic surgeon. Each of the patients routinely completed patient reported outcome measures at the preoperative and postoperative visits for up to one year postoperatively.</div></div><div><h3>Results</h3><div>At three-month follow-up, there were no observed differences in the PROMIS, KOOS Jr, HOOS Jr, Oxford Hip, Oxford Knee, or mHHS scores between the cohorts. At one-year follow-up, there were no statistical differences in any PROMs between the ASC and hospital cohorts. In addition, subgroup analysis was performed comparing PROMs between patient's based on specific subgroups: diabetics, BMI &gt;30, BMI&lt;30, gender, and age, which showed non-statitistical differences at one year.</div></div><div><h3>Conclusion</h3><div>We believe that this study confirms that same day discharge, outpatient total joint procedures can be performed safely and effectively from either the hospital or ASC setting. While there were some differences in perceived outcomes at 3-months for some subgroups, these were not statistically significant at the 1-year after follow-up.</div></div>","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":"65 ","pages":"Pages 112-118"},"PeriodicalIF":1.5,"publicationDate":"2024-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143047020","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":"Causal language and inferences in observational rotator cuff database studies published from 2013 to 2022","authors":"Nadim Barakat ,&nbsp;Brian C. Werner ,&nbsp;Monica M. Arney ,&nbsp;Wendy M. Novicoff ,&nbsp;James A. Browne ,&nbsp;J. Brett Goodloe","doi":"10.1016/j.jor.2024.12.020","DOIUrl":"10.1016/j.jor.2024.12.020","url":null,"abstract":"<div><h3>Background</h3><div>The use of large multi-institutional databases in rotator cuff repair (RCR) research is expanding, but these studies are observational and cannot establish causation. This study examines the prevalence of causal language in clinical RCR database studies published from 2013 to 2022.</div></div><div><h3>Methods</h3><div>Administrative database and clinical registry studies on RCR published in eight orthopaedic journals from 2013 to 2022 were systematically identified and graded by two reviewers for the presence, absence, or inconsistent use of causal language in both the title/abstract and the full text. <em>Chi</em>-squared analyses were conducted to examine if there was an association between the gradings of articles and both the journal and year of publication.</div></div><div><h3>Results</h3><div>Of 44 eligible articles, 14 were graded as consistently causal, 16 as inconsistent, and 14 as consistently non-causal. <em>Chi</em>-squared analyses revealed no statistically significant associations between the journal or year of publication and the title and abstract grading (p = 0.626, p = 0.277) or the full text grading (p = 0.374, p = 0.822).</div></div><div><h3>Conclusion</h3><div>Causal language was present in over two-thirds of observational RCR database studies published from 2013 to 2022. Authors should refrain from using causal language in database studies to prevent misleading readers and misinterpretation of findings.</div></div>","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":"65 ","pages":"Pages 106-111"},"PeriodicalIF":1.5,"publicationDate":"2024-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143007049","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":"Comparison of outcomes between resurfaced and unresurfaced patella in total knee arthroplasty using medial congruent liners: A retrospective study","authors":"Nebojsa Kuljic,&nbsp;Wyatt Tyndall,&nbsp;Michael Thatcher,&nbsp;Michaela Nickol,&nbsp;Johannes M. van der Merwe","doi":"10.1016/j.jor.2024.12.016","DOIUrl":"10.1016/j.jor.2024.12.016","url":null,"abstract":"<div><h3>Introduction</h3><div>Total knee replacements are becoming more prevalent. There is still a lot of controversy regarding patellar resurfacing. Surgeons advocating for resurfacing state reduced risk for anterior knee pain and need for future revision surgery. Our goal was to determine if patients would have similar outcomes if the patella is left unresurfaced or resurfaced with a medial congruent liner design.</div></div><div><h3>Patients and methods</h3><div>A multi-surgeon retrospective chart review was conducted in a tertiary academic center, to identify all patients who received a total knee arthroplasty utilizing a medial congruent (MC) polyethylene liner between January 1, 2020 to December 31, 2020. All included patients were subsequently sent a survey package via mail to complete. Patients who did not return mail packages were contacted via phone.</div></div><div><h3>Results</h3><div>We included 188 patients in the final analysis. There was no statistical difference between the groups in regards to age (p = 0.77), sex (p = 0.075), BMI (p = 0.22), hospital stay (p = 0.86), laterality (p = 0.51), ASA score (p = 0.52), Kellgren Lawrence medial compartment OA score (p = 0.33) and Kellgren Lawrence lateral compartment OA score (p = 0.49). There was a statistically significant difference in favour of the control group (patella not resurfaced) with the KOOS JR score (p = 0.045). This difference was not observed with the Kujala score (p = 0.98) and the Oxford knee score (0.89).</div></div><div><h3>Conclusion</h3><div>There might be a role in performing a patella resurfacing, even in newer total knee designs. We did not observe a clinically meaningful difference in PROMS between PR and non-PR TKA at medium-term follow-up. In addition, we did not observe any demographic factors that influenced the surgeon's decision to perform patella resurfacing. Further high-quality research is warranted.</div></div>","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":"67 ","pages":"Pages 7-13"},"PeriodicalIF":1.5,"publicationDate":"2024-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143052883","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":"Correlation between changes in spinal pelvic parameters and lower back pain in patients with hip spinal syndrome after total hip arthroplasty: A short-term follow-up study","authors":"Jiawei Liu ,&nbsp;Shuai Yu ,&nbsp;Di Jia ,&nbsp;Guangfeng Sun ,&nbsp;Ya Ding ,&nbsp;Hongliang Wang","doi":"10.1016/j.jor.2024.12.015","DOIUrl":"10.1016/j.jor.2024.12.015","url":null,"abstract":"<div><h3>Backgroud</h3><div>A number of patients with hip osteoarthritis (HOA) have lower back pain (LBP) and hip joint pain, a symptom named hip spine syndrome (HSS). The purpose of this study is to analyze the efficacy of total hip arthroplasty (THA) in treating HSS using spinal pelvic parameters and multiple clinical scoring systems.</div></div><div><h3>Methods</h3><div>We prospectively collected HOA patients who underwent THA by surgeons from the same medical research center. 52 patients were included in the study according to the inclusion and exclusion criteria. Analyze patient baseline information, take full-length lateral radiographs of the spine before and 6 months after surgery, measure PI, PT, LL, SS, and SVA. Calculate the Oswestry Disability Index score (ODI), Visual Analog Scale score (VAS), and Hip Harris score (HHS) before and 6 months after surgery.</div></div><div><h3>Results</h3><div>A total of 52 patients with hip spine syndrome were included for follow - up and were divided into two groups based on whether postoperative back pain was relieved: the group with continued in back pain and the group with improvement in back pain. Among them, 33 people (63 %) achieved relief in back pain. There were significant differences (p &lt; 0.05) in postoperative LL, SVA, and PI-LL between the two groups. There were significant differences in spinal parameter changes among patients with improved LBP after THA, with increased LL, decreased SVA, and matched PI-LL. The postoperative clinical scoring scale showed that the HHS score of the group without improvement in LBP was significantly lower than that of the group with improvement in LBP, and all clinical scores of the group without improvement in LBP were poor after surgery.</div></div><div><h3>Conclusion</h3><div>There was a significant difference in the changes of spinal pelvic parameters in patients with improved LBP after THA, i.e., LL was elevated and SVA were decreased, PI-LL maintains matching. These spinal pelvic parameters may be key factors in the mechanism of low back pain improvement after THA surgery.</div></div>","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":"65 ","pages":"Pages 100-105"},"PeriodicalIF":1.5,"publicationDate":"2024-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143181792","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of the effects between arthroscopic transtibial pullout technique and all-inside repair in the treatment of medial meniscus posterior root tears","authors":"Jun Li ,&nbsp;Pengfei Shen ,&nbsp;Tao Zou ,&nbsp;Wen Min ,&nbsp;Yuxing Qu ,&nbsp;Zikang Xie ,&nbsp;Chengjian Wei","doi":"10.1016/j.jor.2024.12.003","DOIUrl":"10.1016/j.jor.2024.12.003","url":null,"abstract":"<div><h3>Background</h3><div>Medial meniscus posterior root tears (MMPRTs) significantly contribute to knee dysfunction, leading to abnormal biomechanics and accelerated cartilage degeneration. Arthroscopic transtibial pullout and all-inside repair are two commonly used techniques for treating MMPRTs, each with unique advantages and limitations.</div></div><div><h3>Objective</h3><div>To compare the clinical and functional outcomes of the transtibial pullout and all-inside repair techniques in the treatment of MMPRTs, with a focus on postoperative recovery, knee function, and complications.</div></div><div><h3>Methods</h3><div>40 patients with MMPRTs were randomized to undergo either the transtibial pullout or all-inside repair technique. Clinical outcomes were evaluated using the International Knee Documentation Committee (IKDC) score, Tegner activity scale, Lysholm score, and active range of motion (AROM) of knee flexion, both before and after surgery. Data on operative time, time to ambulation, hospital stay duration, and complications were also collected.</div></div><div><h3>Results</h3><div>Both surgical groups showed significant improvements in clinical outcomes postoperatively (p &lt; 0.001). The transtibial group exhibited greater functional recovery, with IKDC, Tegner, and Lysholm scores improving by approximately 60 %, 110 %, and 68 %, respectively, compared to the all-inside group. However, complications were more frequent in the transtibial group, including three cases of wound healing issues and one infection, while the all-inside group had one case of deep vein thrombosis. No re-tears were observed in either group during follow-up.</div></div><div><h3>Conclusion</h3><div>Both the transtibial pullout and all-inside repair techniques effectively restore knee function in patients with MMPRTs. While the transtibial pullout provides better functional outcomes, it is associated with a higher complication rate. The choice of surgical approach should consider patient-specific factors, including tear characteristics and overall health, to optimize results.</div></div>","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":"65 ","pages":"Pages 78-85"},"PeriodicalIF":1.5,"publicationDate":"2024-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11718332/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142971307","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Anatomic total shoulder arthroplasty in the 7th decade of life demonstrates superior long-term maintenance than in older patients","authors":"Christoph A. Schroen,&nbsp;William A. Ranson,&nbsp;Priya Singh,&nbsp;Troy Li,&nbsp;Akshar V. Patel,&nbsp;Jordan Bernstein,&nbsp;Dave R. Shukla,&nbsp;Bradford O. Parsons,&nbsp;Evan L. Flatow,&nbsp;Paul J. Cagle","doi":"10.1016/j.jor.2024.12.010","DOIUrl":"10.1016/j.jor.2024.12.010","url":null,"abstract":"<div><h3>Background</h3><div>Anatomic total shoulder arthroplasty (aTSA) is often delayed due to concerns about a more rapid loss of postoperative improvements in younger, more active patients. This retrospective study investigated the effects of patient age on activity-specific functional outcomes at a minimum of 10 years following aTSA.</div></div><div><h3>Methods</h3><div>A retrospective review of a shoulder arthroplasty database was performed. There were two cohorts: Patients who underwent aTSA at 60–70 years of age and patients 70+ years old with Minimum 10 years follow-up. Primary outcomes included range of motion (ROM) and patient reported outcomes (PROs) including American Shoulder and Elbow Surgeons (ASES), Simple Shoulder Test (SST), and Visual Analogue Scale (VAS) scores. Furthermore, individual survey responses to the ASES Score questionnaire were analyzed.</div></div><div><h3>Results</h3><div>46 shoulders, 30 shoulders in the 60–70 age cohort and 16 in the 70+ cohort, were included with a mean age of 65.5 ± 3.0 years and 74.2 ± 3.2 years, respectively. Interval from surgery was 15.6 ± 3.9 years in the 60–70 cohort, and 13.1 ± 3.2 years in the 70+ cohort. Postoperatively, scores for the 60–70 cohort versus 70+ respectively included: 141.7° versus 153.1° forward elevation (p = 0.12), 52.4° versus 51.3° external rotation (p = 0.82), L1 versus T11 internal rotation (p = 0.12), 2.1 versus 2.1 VAS (p = 0.94), 75.7 versus 73.8 ASES (p = 0.79), and 7.8 versus 8.8 SST (p = 0.35). Postoperative scores were similar between cohorts. No difference was seen in preoperative responses for any activity listed in the ASES-score questionnaire. However, younger patients showed improvement across all survey responses, while patients above age 70 had long-term improvement in only 5 of 10 activities.</div></div><div><h3>Conclusion</h3><div>Patients who receive surgery earlier may experience sustained improvement long-term, same as those who undergo aTSA at an older age. Patients undergoing aTSA earlier in life benefit from sustained long-term function and activity.</div></div><div><h3>Level of evidence</h3><div>3.</div></div>","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":"65 ","pages":"Pages 57-63"},"PeriodicalIF":1.5,"publicationDate":"2024-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142971303","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":"Motion mapping and positioning of lumbrical muscles in the carpal tunnel-a cadaveric study","authors":"Yogesh A. Kothari ,&nbsp;Raj Kanna ,&nbsp;Bhaskarananda Kumar ,&nbsp;Amrita Parida ,&nbsp;Anil K. Bhat","doi":"10.1016/j.jor.2024.12.009","DOIUrl":"10.1016/j.jor.2024.12.009","url":null,"abstract":"<div><h3>Aims and objectives</h3><div>Dynamic incursion of lumbrical muscle proximal to the distal edge of transverse carpal ligament (TCL) has been long debated for its role in causing median nerve compression in the carpal tunnel. This study aims to evaluate the pattern of lumbrical incursion into the carpal tunnel in various finger positions and determine their extent of presence and relationship with respect to the TCL and to each other in the carpal tunnel.</div></div><div><h3>Materials &amp; methods</h3><div>Dissection of 30 fresh frozen cadaveric hands was done to map the lumbrical muscles. The distance from each lumbrical muscle's proximal origin to the TCL's distal edge was measured using a Vernier caliper in three finger positions namely full extension, lumbrical, and full flexion position. Statistical tests like paired <em>t</em>-test, ANOVA and Chi-Square test were used to evaluate the mean changes in lumbrical incursion, percentage of incursion, relative positions and the proportion of hands showing lumbrical origins proximal to the TCL.</div></div><div><h3>Results</h3><div>The second lumbrical exhibited the highest mean incursion in all finger positions, followed by the third. Significant increases in incursion were observed from full extension to lumbrical position and from lumbrical position to full flexion in all lumbricals. The number of hands with lumbrical origins proximal to the TCL increased significantly from complete extension to complete flexion.</div></div><div><h3>Conclusions</h3><div>Lumbrical incursion significantly increases the content within the carpal tunnel with various finger positions. In full flexion, there is significant pressure of lumbricals within the tunnel. Hence, along with the tendons and median nerve, the lumbricals should be considered a dynamic content of the carpal tunnel. These muscles could ¹significantly contribute to idiopathic Carpal tunnel syndrome in the backdrop of alteration in tunnel size or content. The second lumbrical, due to its proximal-most origin, is pivotal in this process.</div></div><div><h3>Level of evidence</h3><div>Level V.</div></div>","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":"65 ","pages":"Pages 91-95"},"PeriodicalIF":1.5,"publicationDate":"2024-12-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11729687/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143007050","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Risk factors for non-compliance of patient reported outcome measures following achilles tendon repair surgery","authors":"Christian B. Allen ,&nbsp;Kevin Kirk ,&nbsp;Randall Marx ,&nbsp;J. Michael Proffitt ,&nbsp;Justin Robbins","doi":"10.1016/j.jor.2024.12.014","DOIUrl":"10.1016/j.jor.2024.12.014","url":null,"abstract":"<div><h3>Background</h3><div>Patient-Reported Outcome Measures (PROMs) are increasingly utilized in orthopaedic research and assess the patient's response to care, allow for assessment of the patient's overall health, and provide tools to promote the shared decision-making process. Our hypothesis is that risk factors for non-compliance is increasing age and increasing time after surgery.</div></div><div><h3>Methods</h3><div>PROMs compliance was conducted from survey data of 90 individuals from May 2017 to July 2023 who had Achilles tendon surgery. After completion of surgical intervention, patients received electronic notification with a link to complete their own patient reported outcomes survey preoperatively, and at 3-month, 6-month, 1-year, and 2-year follow-up time points. Compliance by timepoint was calculated as the proportion of patients who completed the surveys compliantly relative to the total eligible cohort offered to participate in the survey.</div></div><div><h3>Results</h3><div>The median age at time of surgery was 50 years [IQR 38 to 61], and the majority were male (60%). For every year increase in age at treatment, the odds of compliance increased by approximately 4.1% (OR = 0.96, 95% CI [1.00, 0.93], p = 0.047). Compliance with PROMs was highest at 3-months postoperative (77%). Patients who identified as \"Not Hispanic or Latino\" were approximately 3.22 times less likely to be non-compliant with the survey completion (OR = 0.31, 95% CI [0.97, 0.099], p = 0.046) at two years. Self-reported race, language, and sex at birth did not demonstrate statistically significant (p &gt; 0.05).</div></div><div><h3>Conclusions</h3><div>Our hypothesis was rejected because within our study, younger age had the highest non-compliance with PROMs. Also, compliance did not decrease at every timepoint after surgery. Those identifying their ethnicity as “Hispanic or Latino” had the highest non-compliance with PROMs. Surgeons need to identify patients who are at risk for non-compliance to ensure those patients participate in completion of the outcome instrument.</div></div><div><h3>Level of evidence</h3><div>lll Retrospective Cohort Study.</div></div>","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":"65 ","pages":"Pages 96-99"},"PeriodicalIF":1.5,"publicationDate":"2024-12-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143100496","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":"Formal physical therapy may be unnecessary following total knee arthroplasty: A prospective randomized study","authors":"Jonathan Liu,&nbsp;Drew Clippert,&nbsp;Mohammad Daher,&nbsp;Noah Gilreath,&nbsp;John Milner,&nbsp;Eric M. Cohen,&nbsp;Valentin Antoci","doi":"10.1016/j.jor.2024.12.013","DOIUrl":"10.1016/j.jor.2024.12.013","url":null,"abstract":"<div><h3>Objectives</h3><div>Total knee arthroplasty (TKA) is the most commonly performed joint replacement surgery in the United States. With an aging population, the incidence of TKA is expected to significantly increase in future decades. Historically, outpatient physical therapy was considered a crucial aspect of TKA postoperative care. But in recent years, its necessity has been questioned, with national trends moving towards self-directed home exercise programs (HEP) in lieu of formal PT.</div></div><div><h3>Methods</h3><div>A prospective randomized control study was conducted on 341 patients with TKA from January 2017 to December 2018. At 2 weeks, if 90° of flexion was observed, patients were recommended (1) no PT with home-exercises or (2) formal PT. Range of motion was recorded at 6 weeks and 3 months postoperatively.</div></div><div><h3>Results</h3><div>Of the 341 eligible patients who underwent primary TKA, 248 patients were enrolled and randomized to formal PT or HEP. Patients assigned to HEP achieved an average of 109° and 118° of flexion at 6 weeks and 3 months respectively, while patients randomized to PT achieved 106° and 121° of flexion (p &gt; 0.05). All patients achieved a target range of motion greater than 100° at 6 weeks and 110° at 3 months. Patients assigned HEP had an associated average cost savings of $900 per patient compared to PT patients.</div></div><div><h3>Conclusion</h3><div>Formal PT may not be necessary if patients are progressing appropriately after surgery. Instead, a home exercise plan could be a more efficient and cost-effective component of postoperative rehabilitation.</div></div><div><h3>Level of evidence</h3><div>I.</div></div>","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":"65 ","pages":"Pages 86-90"},"PeriodicalIF":1.5,"publicationDate":"2024-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143100495","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":"Patient specific variables impact sensitivity to association between joint balance and 2 Year outcomes","authors":"Timothy C. Keating ,&nbsp;Edgar A. Wakelin ,&nbsp;Christopher Plaskos ,&nbsp;John M. Keggi ,&nbsp;Jan A. Koenig ,&nbsp;Corey E. Ponder ,&nbsp;Jeffrey H. DeClaire ,&nbsp;Jeffrey M. Lawrence ,&nbsp;Vasili Karas","doi":"10.1016/j.jor.2024.12.007","DOIUrl":"10.1016/j.jor.2024.12.007","url":null,"abstract":"<div><h3>Background</h3><div>This study investigates the association between intra-operative balance and 2-year outcomes within subgroups defined by demographics and pre-operative joint balance. Our hypothesis is that patient demographics and the pre-operative state of the joint will impact patient sensitivity to post-operative balance and laxity and subsequent impact on outcome.</div></div><div><h3>Methods</h3><div>A retrospective analysis of prospectively captured data across 5 sites with 5 surgeons was performed. All cases completed pre-operative demographics surveys, 2-year post-operative Knee Injury and Osteoarthritis Outcome Score (KOOS) and had a robot assisted total knee arthroplasty with an integrated digital joint balancing tool. Differences in associations between intra-operative final joint balance and 2-year KOOS pain outcomes in demographic and pre-operative balance subgroups were characterized. Associations informed clinically relevant thresholds to optimize TKA treatment for subgroups.</div></div><div><h3>Results</h3><div>A total of 276 patients completed 2-year KOOS scores. Subgroups were defined from Sex, Age, BMI and pre-operative extension laxity. Men prefer a tight tolerance medially in extension and mid-flexion while females prefer a tight lateral flexion gap. Patients &lt;70 years show a strong preference for equal rectangular gaps in extension, mid-flexion, and flexion, while older patients do not show a preference. Patients with BMI ≤30 demonstrate a preference for rectangular gaps, while patients with higher BMI do not. Finally, patients with looser pre-operative extension laxity (&gt;3 mm) preferred a TKA with increased extension laxity compared to patients with minimal preoperative laxity.</div></div><div><h3>Conclusion</h3><div>Intraoperative differences in knee balance can influence patient outcome scores among different demographic groups at two years postoperatively. This suggests further research is warranted to determine how ligament balance and laxity may be optimized based on individual patient factors.</div></div>","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":"65 ","pages":"Pages 71-77"},"PeriodicalIF":1.5,"publicationDate":"2024-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142971348","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}