The Journal of Bone & Joint Surgery最新文献

{"title":"Comparing the in Vitro Efficacy of Commonly Used Surgical Irrigants for the Treatment of Implant-Associated Infections.","authors":"Christopher D Hamad,William L Sheppard,Rene F Chun,Zara Mamouei,Trevor S Lloyd,Alan K Li,Rahul Sobti,Jack W Pearce,Adolfo Hernandez,Matthew V Dipane,Serena S Hu,Nicholas M Bernthal,Edward J McPherson","doi":"10.2106/jbjs.24.01225","DOIUrl":"https://doi.org/10.2106/jbjs.24.01225","url":null,"abstract":"BACKGROUNDImplant-associated infections (IAIs) require aggressive debridement to eliminate microbial bioburden. The use of irrigants may improve microbial killing during debridement. This study compared the efficacy of surgical irrigants in vitro against Staphylococcus aureus alone and in combination with Candida albicans, in both planktonic and biofilm states.METHODSFull-strength Dakin's solution, 0.35% povidone-iodine (PI), 10% PI, 3% hydrogen peroxide (HP), a 1:1 combination of 10% PI and 3% HP (PI + HP), Irrisept, XPERIENCE, Bactisure, and normal saline solution were tested. For planktonic testing, 1 × 106 colony-forming units (CFUs) of S. aureus and C. albicans were utilized, and biofilms were grown in these conditions on 0.8 × 10-mm titanium alloy Kirschner wires for 48 hours. Killing assays were performed using 5-minute dwell times. Success was defined by complete eradication of planktonic or biofilm CFUs.RESULTSPI + HP and Bactisure were the only irrigants to eradicate S. aureus in both planktonic and biofilm states. PI + HP was the only irrigant to eradicate polymicrobial S. aureus + C. albicans bioburden in both states.CONCLUSIONSPI + HP and Bactisure were superior irrigants against S. aureus, eliminating it in planktonic and biofilm states. PI + HP was the only irrigant to eradicate polymicrobial S. aureus + C. albicans bioburden in both states. In vivo studies are needed to evaluate the clinical effectiveness.CLINICAL RELEVANCESurgical irrigants have variable efficacy in eradicating microbes depending on their state of existence (planktonic versus biofilm). In this study, the most effective eradication of polymicrobial S. aureus + C. albicans bioburden was a 1:1 combination of 10% PI and 3% HP, which is of nominal cost.","PeriodicalId":22625,"journal":{"name":"The Journal of Bone & Joint Surgery","volume":"24 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144328778","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":"Bridging Health Literacy Gaps in Spine Care: Using ChatGPT-4o to Improve Patient-Education Materials.","authors":"Joseph E Nassar,Michael J Farias,Lama A Ammar,Rhea Rasquinha,Andrew Y Xu,Manjot Singh,Daniel Alsoof,Bassel G Diebo,Alan H Daniels","doi":"10.2106/jbjs.24.01484","DOIUrl":"https://doi.org/10.2106/jbjs.24.01484","url":null,"abstract":"BACKGROUNDPatient-education materials (PEMs) are essential to improve health literacy, engagement, and treatment adherence, yet many exceed the recommended readability levels. Therefore, individuals with limited health literacy are at a disadvantage. This study evaluated the readability of spine-related PEMs from the American Academy of Orthopaedic Surgeons (AAOS), the North American Spine Society (NASS), and the American Association of Neurological Surgeons (AANS), and examined the potential of artificial intelligence (AI) in optimizing PEMs for improved patient comprehension.METHODSA total of 146 spine-related PEMs from the AAOS, NASS, and AANS websites were analyzed. Readability was assessed using the Flesch-Kincaid Grade Level (FKGL) and Simple Measure of Gobbledygook (SMOG) Index scores, as well as other metrics, including language complexity and use of the passive voice. ChatGPT-4o was used to revise the PEMs to a sixth-grade reading level, and post-revision readability was assessed. Test-retest reliability was evaluated, and paired t tests were used to compare the readability scores of the original and AI-modified PEMs.RESULTSThe original PEMs had a mean FKGL of 10.2 ± 2.6, which significantly exceeded both the recommended sixth-grade reading level and the average U.S. eighth-grade reading level (p < 0.05). ChatGPT-4o generated articles with a significantly reduced mean FKGL of 6.6 ± 1.3 (p < 0.05). ChatGPT-4o also improved other readability metrics, including the SMOG Index score, language complexity, and use of the passive voice, while maintaining accuracy and adequate detail. Excellent test-retest reliability was observed across all of the metrics (intraclass correlation coefficient [ICC] range, 0.91 to 0.98).CONCLUSIONSSpine-related PEMs from the AAOS, the NASS, and the AANS remain excessively complex, despite minor improvements to readability over the years. ChatGPT-4o demonstrated the potential to enhance PEM readability while maintaining content quality. Future efforts should integrate AI tools with visual aids and user-friendly platforms to create inclusive and comprehensible PEMs to address diverse patient needs and improve health-care delivery.","PeriodicalId":22625,"journal":{"name":"The Journal of Bone & Joint Surgery","volume":"37 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144328587","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":"Risk of Revision and Patient-Reported Outcomes Following Primary UKR Performed Using Computer Navigation or Patient-Specific Instrumentation: An Analysis of National Joint Registry Data.","authors":"M M Farhan-Alanie,D Gallacher,P Craig,J Griffin,J Kozdryk,J Mason,P D H Wall,J M Wilkinson,A Metcalfe,P Foguet","doi":"10.2106/jbjs.24.01483","DOIUrl":"https://doi.org/10.2106/jbjs.24.01483","url":null,"abstract":"BACKGROUNDComputer navigation and patient-specific instrumentation in unicompartmental knee replacement (UKR) improve the precision of implant positioning, but there is limited information regarding their impact on implant survival and patient-reported outcomes. We aimed to compare postoperative implant survival, Oxford Knee Score (OKS) values, health-related quality of life (measured using the EuroQol-5 Dimension 3-level version [EQ-5D-3L]), and intraoperative complications between UKRs performed using computer navigation or patient-specific instrumentation versus conventional instrumentation.METHODSUsing National Joint Registry data, an observational study of patients who underwent primary UKR for osteoarthritis between 2003 and 2020 was performed. The primary analyses focused on all-cause revision, and the secondary analyses focused on differences in the OKS and EQ-5D-3L at 6 to 12 months postoperatively. To account for several covariates, weights based on propensity scores were generated. Cox proportional hazards models and generalized linear models were used to assess for differences in revision risk, and OKS and EQ-5D-3L change scores, respectively, between patient groups. Sensitivity analyses accounting for body mass index were performed. Effective sample sizes (ESSs) were computed, representing the statistical power comparable with that of an unweighted sample.RESULTSCompared with conventional instrumentation, the hazard ratio (HR) for all-cause revision was 1.126 (95% confidence interval [CI], 0.909 to 1.395; p = 0.277; ESS, 4,273) with computer navigation and 0.805 (95% CI, 0.442 to 1.467; p = 0.478; ESS, 1,199) with patient-specific instrumentation. No difference was found in the change in OKS between the groups (-1.287; 95% CI, -2.851 to 0.278; p = 0.107; ESS, 470), although improvement in the EQ-5D-3L scores was relatively lower for computer-navigated UKR compared with conventional instrumentation (-0.049, 95% CI, -0.093 to -0.005; p = 0.028; ESS, 455). However, sensitivity analyses demonstrated that computer navigation was associated with an increased risk of all-cause revision (HR, 1.446; 95% CI, 1.102 to 1.898; p = 0.008; ESS, 3,011) and relatively smaller improvements in the OKS (-2.845; 95% CI, -5.006 to -0.684; p = 0.010; ESS, 272) and EQ-5D-3L scores (-0.087; 95% CI, -0.145 to -0.030; p = 0.003; ESS, 286). There were no differences in intraoperative complications (p = 0.073).CONCLUSIONSThis study found no clinically meaningful differences in patient-reported outcomes following computer-navigated UKR. Although likely underpowered, the primary analyses showed no difference in implant survival. While a sensitivity analysis suggested that computer navigation could worsen implant survival, this analysis had a smaller sample size. These findings highlight potential signals that warrant further investigation.LEVEL OF EVIDENCETherapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.","PeriodicalId":22625,"journal":{"name":"The Journal of Bone & Joint Surgery","volume":"24 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144328589","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":"Measurement of Value in Uncomplicated Total Knee Arthroplasty: Patient-Level and Provider-Level Value Analyses of a 1-Year Episode of Care.","authors":"Rebekah M Kleinsmith,Haley D Puckett,Nicholas F Banfield,Cole E Bothun,Stephen A Doxey,Patrick K Horst,Joshua S Bingham,Brian P Cunningham","doi":"10.2106/jbjs.24.01485","DOIUrl":"https://doi.org/10.2106/jbjs.24.01485","url":null,"abstract":"BACKGROUNDPatient-level value analysis (PLVA) has been applied to several orthopaedic procedures but has not yet been utilized to assess the value of total knee arthroplasty (TKA). The purpose of this study was to evaluate the 1-year episode of care for TKA with use of PLVA to identify characteristics that influence value at both the patient and surgeon level.METHODSThe institutional patient-reported outcome (PRO) database was queried for all patients who underwent TKA from 2020 to 2022. Patients were excluded on the basis of an index revision procedure, a pathology other than primary osteoarthritis, unicompartmental knee arthroplasty, robotic-assisted TKA, incomplete baseline or 1-year PROs, concomitant procedures (i.e., bilateral TKA or hardware removal), complications requiring readmission or reoperation, TKA without patellar resurfacing, the use of constrained implants, incomplete cost information, or other hip or knee arthroplasty procedure during the 1-year episode of care. PROs of interest included preoperative and 1-year postoperative Knee injury and Osteoarthritis Outcome Score-Joint Replacement (KOOS-JR) scores. Episode-of-care costs were calculated using time-driven activity-based costing. The 1-year value quotient (VKOOS) was calculated for each patient as the ratio of the 1-year change in KOOS-JR score to the total episode-of-care cost.RESULTSA total of 684 patients (62% female; mean age, 68 ± 8 years) met the inclusion criteria. The mean KOOS-JR score significantly increased from baseline (53 ± 11) to 1 year (79 ± 14; p < 0.001), with a mean improvement of 26 ± 16. The mean total episode-of-care cost was $9,563 ± $2,370. There was no significant correlation between episode-of-care costs and the change in KOOS-JR score (r = 0.02; p = 0.581). Surgery performed at an ambulatory surgery center (p < 0.001) and as an outpatient procedure (p = 0.036) were predictive of lower costs. Patient-specific instrumentation (p < 0.001) and a tibial stem extension (p < 0.001) were predictive of higher costs. Older age (p = 0.023) and male sex (p = 0.007) were predictive of less improvement in KOOS-JR scores from baseline to 1 year.CONCLUSIONSOur study identified patient and surgical characteristics that drive costs and PROs in TKA. PLVA can be used to identify \"bright spots\" in orthopaedic procedures to optimize care delivery.LEVEL OF EVIDENCEPrognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.","PeriodicalId":22625,"journal":{"name":"The Journal of Bone & Joint Surgery","volume":"5 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144328586","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":"The Patient's View of Success: Commentary on an article by Bahar Entezari, MD, et al.: \"Successful Management of Periprosthetic Joint Infection Following Total Joint Arthroplasty, as Defined by the Patient. A Qualitative Study\".","authors":"Nicholas Michael Hernandez,JaeWon Yang","doi":"10.2106/jbjs.25.00097","DOIUrl":"https://doi.org/10.2106/jbjs.25.00097","url":null,"abstract":"","PeriodicalId":22625,"journal":{"name":"The Journal of Bone & Joint Surgery","volume":"45 1","pages":"e66"},"PeriodicalIF":0.0,"publicationDate":"2025-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144319937","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":"Skin Antisepsis: When New Evidence Emerges, Reevaluate Your Practice: Commentary on an article by Iberê Pereira Datti, MD: \"Skin Antisepsis in the Surgical Treatment of Extremity Fractures. Should We Reject the Null Hypothesis?\"","authors":"Gerard Slobogean,Nathan N O'Hara,Sheila Sprague,","doi":"10.2106/jbjs.25.00366","DOIUrl":"https://doi.org/10.2106/jbjs.25.00366","url":null,"abstract":"","PeriodicalId":22625,"journal":{"name":"The Journal of Bone & Joint Surgery","volume":"13 1","pages":"e69"},"PeriodicalIF":0.0,"publicationDate":"2025-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144320212","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":"Local Antibiotics and the Risk of Antimicrobial Resistance in Extremity Fractures Complicated by Fracture-Related Infection.","authors":"Gregory M Schrank,Nicolas Jozefowski,Robert D Zura,Kyle J Jeray,Joshua L Gary,Greg E Gaski,Steven F Shannon,Sofia Bzovsky,Sheila Sprague,Gerard P Slobogean,Ashley E Levack,","doi":"10.2106/jbjs.24.01178","DOIUrl":"https://doi.org/10.2106/jbjs.24.01178","url":null,"abstract":"BACKGROUNDWe evaluated antimicrobial resistance (AMR) patterns following local antibiotic use in a large cohort of patients with fractures from the PREP-IT (A Program of Randomized Trials to Evaluate Preoperative Antiseptic Skin Solutions in Orthopaedic Trauma) study. We hypothesized that, among patients with extremity fractures who developed fracture-related infection (FRI), there would be no difference in AMR rates between those who had or had not received local antibiotic therapy with surgical fixation.METHODSThis was a secondary analysis of all patients in the PREP-IT trial who developed FRI. Patient demographics, injury and fracture characteristics, and the primary outcome of the presence of an antimicrobial-resistant FRI were evaluated on the basis of whether the patient had or had not received local antibiotics in the operating room prior to, or at, definitive fixation.RESULTSA total of 555 FRIs in 546 patients (mean age, 50 years; 39% female; and 82% White) were included. A total of 268 fractures (264 patients) received local antibiotics. The Injury Severity Score and the proportion of open fractures were higher among patients and fractures that received local antibiotics, respectively. There were more Gustilo-Anderson type-IIIB or IIIC fractures in the local antibiotic group, but the rate did not differ significantly from that in the group with no local antibiotics (20% versus 14%; p = 0.14). Other baseline and fracture characteristics were similar between the groups, with the exception of age (lower in the group with local antibiotics). When examining FRIs with gram-positive organisms, we found that 3 (1.7%) of the FRIs in fractures that had been treated with local vancomycin had organisms resistant to vancomycin compared with 2 (0.9%) of the FRIs in fractures for which local vancomycin had not been used (p = 0.67). When examining FRIs with gram-negative organisms, the number of FRIs with aminoglycoside-resistant organisms was 8 (11.6%) among fractures that received local aminoglycosides and 10 (6.2%) among fractures that did not receive local aminoglycosides (p = 0.26).CONCLUSIONSAmong extremity fractures that developed FRI, we were unable to detect differences in the rates of AMR between fractures treated with or without local antibiotic prophylactic strategies in our analysis of a randomized trial of various skin preparation solutions for extremity trauma surgery. These findings provide cautious reassurance regarding the safety of local antibiotics but underscore the need for further prospective analysis.LEVEL OF EVIDENCETherapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.","PeriodicalId":22625,"journal":{"name":"The Journal of Bone & Joint Surgery","volume":"101 1","pages":"28-35"},"PeriodicalIF":0.0,"publicationDate":"2025-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144320190","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":"Outcomes Associated with Choice of Prophylactic Antibiotics in Open Fractures.","authors":"Carol A Lin,Tim Kobes,Eric Kholodovsky,Giselle Hernandez,Nathan N O'Hara,Gregory M Schrank,Robert V O'Toole,Gerard P Slobogean,Sheila Sprague,Marilyn Heng,","doi":"10.2106/jbjs.24.01123","DOIUrl":"https://doi.org/10.2106/jbjs.24.01123","url":null,"abstract":"BACKGROUNDThe ideal antibiotic prophylaxis for open fractures is unknown. We evaluated outcomes following different antibiotic prophylaxis regimens for open fractures.METHODSThis is a secondary analysis of data from PREP-IT. Prophylactic antibiotics were defined as any intravenous antibiotic given on the day of admission. The outcomes were surgical site infection (SSI) within 90 days and reoperation within 1 year. Logistic regression and an instrumental variable analysis that leveraged site-level variation accounted for confounding. Subgroup variation was evaluated by stratifying by Gustilo-Anderson classification (Types I and II versus III).RESULTSOf the 3,331 included participants, the mean age was 45 ± 18 years, 63% were male, 73% were White, 21% were Black, 2% were Asian, and 10% were Hispanic. Cefazolin monotherapy (58% of patients), ceftriaxone monotherapy (10%), and cefazolin plus gentamicin (6%) were the most common regimens. In the instrumental variable analysis, the odds of infection did not significantly differ with ceftriaxone use (odds ratio [OR], 1.24; 95% confidence interval [CI], 0.70 to 2.20; p = 0.45) or cefazolin plus gentamicin use (OR, 0.25; 95% CI, 0.03 to 2.04; p = 0.20) compared with cefazolin monotherapy. There were no significant differences between the regimens with respect to infection when stratified by Gustilo-Anderson type. However, we did observe a nearly 3-fold increase in the odds of infection with ceftriaxone use compared with cefazolin monotherapy (OR, 2.73; 95% CI, 0.96 to 7.79; p = 0.06) in Type-I and II fractures, and a 75% decrease in the odds of infection with cefazolin plus gentamicin use (OR, 0.25; 95% CI, 0.03 to 2.02; p = 0.19) compared with cefazolin monotherapy in Type-III fractures.CONCLUSIONSAmong patients with open fractures, antibiotic prophylaxis with ceftriaxone monotherapy did not provide significant benefits compared with cefazolin monotherapy in preventing infection in Type-I and II fractures. The findings suggest that cefazolin plus gentamicin might reduce the odds of infection in Type-III fractures compared with cefazolin monotherapy, but this difference was not statistically significant.LEVEL OF EVIDENCETherapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.","PeriodicalId":22625,"journal":{"name":"The Journal of Bone & Joint Surgery","volume":"44 1","pages":"19-27"},"PeriodicalIF":0.0,"publicationDate":"2025-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144320191","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":"Deep Infections After Open and Closed Fractures.","authors":"Michael Polmear,Jennifer E Hagen,Gregory M Schrank,Marilyn Heng,Francesc A Marcano-Fernández,Kyle J Jeray,Mark J Gage,Gerard P Slobogean,Sheila Sprague,Terrie Vasilopoulos,","doi":"10.2106/jbjs.24.01249","DOIUrl":"https://doi.org/10.2106/jbjs.24.01249","url":null,"abstract":"BACKGROUNDThe purpose of this study was to describe the culture and speciation results of patients with surgical site infection (SSI) from the PREPARE and Aqueous-PREP studies from the PREP-IT Investigators.METHODSPatients with suspected SSI underwent collection of deep or organ tissue samples for culture. The culture positivity rate was estimated as a percentage along with the exact binomial 95% confidence interval (CI). Microbial species were reported as percentages. Comparisons between open and closed fractures were conducted with the Z-test for proportions. Significance was set at p &lt; 0.05.RESULTSAmong the 2 primary studies, a total of 484 cases (defined as an anatomic fracture area; some patients had multiple fractures, which were each defined as a case if they developed an infection) had culture samples taken from deep or organ tissue. The culture positivity rate was 96.7% (95% CI, 94.7% to 98.0% [468 of 484 cases]). There were no significant differences (p = 0.507) in culture positivity between open fractures (97.2% [95% CI, 94.5% to 98.6%]; 273 of 281 cases) and closed fractures (96.1% [95% CI, 92.4% to 98.0%]; 195 of 203 cases). There was information on microbial species in 84.4% (395) of 468 cases. For patients with positive cultures, 43.3% (171 of 395 cases) were polymicrobial infections. Open fractures (47.8% [111 of 232 cases]), compared with closed fractures (36.8% [60 of 163 cases]), were more likely to be polymicrobial (p = 0.029). Staphylococcus aureus microbes (methicillin-sensitive S. aureus, methicillin-resistant S. aureus, and coagulase-negative S. aureus) accounted for 43.3% (462 of 1,066) of all positive cultures. The median time to infection was 58.5 days (95% CI, 49.0 to 67.0 days). The median time to infection was not significantly different in cases of open fractures (61.0 days [95% CI, 51.0 to 71.0 days]) compared with closed fractures (54.0 days [95% CI, 43.0 to 67.0 days]) (hazard ratio [HR], 0.92 [95% CI, 0.72 to 1.12]). SSIs associated with gram-negative bacteria had a shorter median time to infection at 46.0 days (95% CI, 36.0 to 58.0 days) compared with SSIs not associated with gram-negative bacteria at 70.0 days (95% CI, 56.0 to 88.0 days) (HR, 1.79 [95% CI, 1.55 to 2.03]). There was also a shorter median time to infection for patients with polymicrobial infections (47.0 days [95% CI, 38.8 to 52.1 days]) compared with patients with monomicrobial infections (78.6 days [95% CI, 57.2 to 86.8 days]) (HR, 1.26 [95% CI, 1.03 to 1.49]).CONCLUSIONSIn patients with SSI, tissue samples yielded high rates of microbial culture results. There was a higher proportion of gram-negative organisms in open fractures. Gram-negative infections were also associated with earlier time to infection. Clinicians should not hesitate to take deep-tissue culture samples in patients with suspected SSI and should be prepared to encounter polymicrobial infections.LEVEL OF EVIDENCEDiagnostic Level III. See Instructions for Authors for a complete","PeriodicalId":22625,"journal":{"name":"The Journal of Bone & Joint Surgery","volume":"29 1","pages":"71-79"},"PeriodicalIF":0.0,"publicationDate":"2025-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144320306","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":"Addressing the Inadequacy of BMI: Superior Prediction of Aseptic Loosening Risk in TKA Using Weight-to-Implant Surface Area Ratio: Commentary on an article by Nathan A. Huebschmann, BA, et al.: \"Ratio of Weight-to-Tibial Baseplate Surface Area in Predicting Aseptic Tibial Loosening in TKA and the Protective Effect of Tibial Stem Extensions\".","authors":"Morad Karimpour,Arash Sharafatvaziri","doi":"10.2106/jbjs.25.00034","DOIUrl":"https://doi.org/10.2106/jbjs.25.00034","url":null,"abstract":"","PeriodicalId":22625,"journal":{"name":"The Journal of Bone & Joint Surgery","volume":"20 1","pages":"e67"},"PeriodicalIF":0.0,"publicationDate":"2025-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144319935","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}