The Journal of Bone & Joint Surgery最新文献

{"title":"Pyrocarbon Shoulder Hemiarthroplasty Seems to Outperform Metallic Hemiarthroplasty at a Short-Term Follow-up: Commentary on an article by Armodios M. Hatzidakis, MD, et al.: \"Clinical Outcomes of Pyrocarbon Hemiarthroplasty. A Short-Term, Multicenter Study\".","authors":"Joaquin Sanchez-Sotelo","doi":"10.2106/jbjs.25.01142","DOIUrl":"https://doi.org/10.2106/jbjs.25.01142","url":null,"abstract":"","PeriodicalId":22625,"journal":{"name":"The Journal of Bone & Joint Surgery","volume":"21 1","pages":"529-530"},"PeriodicalIF":0.0,"publicationDate":"2026-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147680411","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":"Beyond Case Counts: Defining Quality and Accountability in Short-Term Arthroplasty Missions.","authors":"Ahmed Siddiqi,Paul Jacob,Khalid M Yousuf","doi":"10.2106/jbjs.26.00279","DOIUrl":"https://doi.org/10.2106/jbjs.26.00279","url":null,"abstract":"Short-term surgical missions have expanded access to total joint arthroplasty (TJA) in regions where degenerative joint disease remains undertreated. Reports from these initiatives frequently highlight procedural volume and low early complication rates, reinforcing the perception of success. However, these metrics capture only the earliest phase of outcome assessment following TJA. Durable arthroplasty quality is defined by implant survivorship, complication surveillance, revision capacity, and longitudinal follow-up. In many short-term mission models, long-term tracking, implant traceability, and local capacity for complication management are described incompletely. Without standardized benchmarks, the orthopaedic community risks equating surgical throughput with sustained impact. This article examines the limitations of the current reporting practices in mission-based arthroplasty and proposes an accountability framework that is centered on safety surveillance, follow-up infrastructure, implant traceability, revision capability, capacity development, and financial transparency. As global TJA efforts expand, defining meaningful quality metrics is essential to ensure that episodic interventions translate into durable patient benefit and resilient local systems.","PeriodicalId":22625,"journal":{"name":"The Journal of Bone & Joint Surgery","volume":"134 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-04-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147666697","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":"A Novel Hybrid Training Model for Open Fracture Management in Rwanda.","authors":"Samhita Kadiyala,Emily Powis,Alireza Mirahmadi,Carlos Mercado,Sion Yu,Suhas Rao Velichala,Alyssa Colannino,Isabella Hung,Joël B Bikoroti,Olivier Kubwimana,Lambert R Dusingizimana,Barnabas Tobi Alayande,J C Allen Ingabire,Jean Claude Byiringiro,Edward K Rodriguez,Kiran J Agarwal-Harding","doi":"10.2106/jbjs.26.00129","DOIUrl":"https://doi.org/10.2106/jbjs.26.00129","url":null,"abstract":"➢ Open fractures are a critical global health challenge that disproportionately affect individuals in low- and middle-income countries (LMICs), primarily due to road traffic collisions. Surgical management of open fractures is 1 of the 3 essential bellwether procedures identified by The Lancet Commission on Global Surgery.➢ We developed and evaluated a novel hybrid course on open fracture management for surgical trainees and practicing surgeons in Rwanda, combining a self-directed, virtual, pre-course curriculum with a live, in-person workshop in Kigali in June 2025 that was simultaneously live-streamed for virtual attendees. Prerecorded multilingual lectures (English and French) and curated peer-reviewed articles provided foundational knowledge in advance and prepared learners for in-person didactics, case discussions, and skills training.➢ The in-person workshop included didactic sessions and discussions of local clinical cases from Rwanda related to open fracture management and other orthopaedic emergencies, along with hands-on practice in fracture external fixation and negative pressure wound therapy using affordable devices designed for resource-constrained practice.➢ The workshop engaged 160 active learners (37 in-person, 123 virtual) and demonstrated high overall satisfaction among 84 survey respondents, with an average rating of 4.6 out of 5.➢ Self-reported confidence in managing open fractures increased substantially following the course, from a mean rating of 3.83 to 4.69 on a 5-point scale (p < 0.001). Most survey respondents reported that the course moderately or significantly improved their knowledge (96.4%) and would change their clinical practice (96.5%).➢ Participant feedback highlighted opportunities for improvement, including extending the workshop duration to increase hands-on time, expanding the content on complex soft-tissue management, and improving the engagement of remote learners through mechanisms such as the provision of low-cost external fixation models for at-home practice.➢ Future directions include integrating the course into medical student and general practitioner education in Rwanda, adapting it for major surgical conferences regionally and internationally, and continuing to prioritize hands-on training modules. Iterative refinement of the course is planned on the basis of participant feedback.","PeriodicalId":22625,"journal":{"name":"The Journal of Bone & Joint Surgery","volume":"18 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-04-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147666696","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":"Survivorship of Femoroacetabular Impingement Surgery at Mean 10-Year Follow-up: A Prospective, Multicenter Cohort Study.","authors":"Jeffrey J Nepple,Hunter Hood,Young-Jo Kim,Paul Beaulé,Rafael Sierra,Michael Millis,Zachary Robben,Caroline Drain,John C Clohisy, ","doi":"10.2106/jbjs.25.01341","DOIUrl":"https://doi.org/10.2106/jbjs.25.01341","url":null,"abstract":"BACKGROUNDLong-term outcomes of femoroacetabular impingement (FAI) surgery, particularly survivorship, are critical to guide treatment decision-making and patient counseling, yet only a limited number of studies have reported mid- to long-term survivorship. The purpose of this study was to report survivorship rates at a mean 10-year follow-up in a large, multicenter FAI surgery cohort and to identify clinical predictors of survivorship.METHODSA prospective, multicenter cohort study assessed patients treated for FAI with hip arthroscopy or surgical dislocation from 2008 to 2012. At a minimum of 8 years, 362 hips (80.1%) had follow-up that permitted assessment of total hip arthroplasty (THA)-free survivorship. A Cox proportional-hazards model was developed to identify risk factors for THA.RESULTSThe cohort included 362 hips with a mean patient age of 32.1 years; 53% were in females, and 95.6% were in Caucasian patients. The THA-free survivorship of the cohort was 90.6% at a mean of 10.4 ± 1.6 years postoperatively. Risk factors for THA were older age at surgery (p = 0.01), male sex (p = 0.02), body mass index of ≥30 kg/m2 (p = 0.009), and femoral head chondromalacia (p < 0.001).CONCLUSIONSThis study demonstrates that FAI surgery yielded durable 10-year THA-free survivorship of 90.6%. Older age at surgery, obesity, male sex, and femoral head chondromalacia were key predictors of conversion to THA.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":"1028 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-04-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147666698","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":"Evaluating Concordance Between Complex Outcome Measures: Letter to the Editor Regarding \"Satisfied but Failed: Patient Satisfaction Compared with Total Knee Arthroplasty Success Defined by the U.S. Centers for Medicare & Medicaid Services\".","authors":"Daniel L Riddle,Levent Dumenci","doi":"10.2106/jbjs.26.00202","DOIUrl":"https://doi.org/10.2106/jbjs.26.00202","url":null,"abstract":"","PeriodicalId":22625,"journal":{"name":"The Journal of Bone & Joint Surgery","volume":"33 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147649071","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":"Nontraumatic Osteonecrosis of the Femoral Head: An International Evidence-Based Clinical Practice Guideline.","authors":"Edward Y Cheng,Alireza Mirzaei,Stuart B Goodman,Quanjun Cui,Michael A Mont,Lynne C Jones, ","doi":"10.2106/jbjs.25.01616","DOIUrl":"https://doi.org/10.2106/jbjs.25.01616","url":null,"abstract":"BACKGROUNDNontraumatic osteonecrosis of the femoral head (ONFH) can lead to major disability in patients of all ages. It presents at various levels of severity and can be either symptomatic or asymptomatic. There is a vast array of management strategies. Treatment is often subject to physician bias. Clinical practice guidelines that are broad-based, internationally developed, consensus-driven, and strictly evidence-based are needed. The aim of this guideline by the Association Research Circulation Osseous (ARCO) was to develop international evidence-based recommendations to assist physicians and patients in managing ONFH.METHODSARCO convened an international, multidisciplinary guideline panel that was balanced to minimize potential bias from conflicts of interest. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach was utilized, including GRADE Evidence-to-Decision frameworks. The panel prioritized clinical questions, defined criteria for the systematic review of evidence, evaluated the statistical analysis, and, by consensus, approved recommendation statements, which were then subject to external review by content experts and stakeholders (a health policy-maker and a patient).RESULTSThe panel agreed on 12 recommendations for the diagnosis, evaluation, and management of ONFH.CONCLUSIONSKey recommendations of these guidelines require accurately staging ONFH and determining when pain may be due to ONFH. They establish principles for optimal decision-making by assessing the quality of evidence backing various treatments and identifying numerous areas for additional investigation.CLINICAL RELEVANCEThis international evidence-based guideline provides standardized recommendations for the diagnosis and management of nontraumatic ONFH. It synthesizes all available evidence using GRADE methodology and offers practical, consensus-supported guidance for accurate staging, imaging selection, treatment decision-making, and the identification of patients who would benefit from joint-preserving interventions. The guideline supports clinicians in reducing practice variation, improving diagnostic accuracy, and optimizing treatment pathways for patients with ONFH.","PeriodicalId":22625,"journal":{"name":"The Journal of Bone & Joint Surgery","volume":"19 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147649074","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":"Intraoperative Bone-Quality Assessments Are Reliable Compared with Opportunistic CT-Based Hounsfield Unit Measurements.","authors":"Jennifer Lewis,Anthony Christiano,Mary Kate Erdman,Lily Upp,Kelly Hynes,Jennifer Wolf,Jason Strelzow","doi":"10.2106/jbjs.25.00551","DOIUrl":"https://doi.org/10.2106/jbjs.25.00551","url":null,"abstract":"BACKGROUNDBone density can impact treatment decisions for orthopaedic conditions. While ad-hoc intraoperative surgeon assessment of bone quality is common, the accuracy of such evaluation remains unknown. The primary purpose of this study was to determine whether orthopaedic surgeons' intraoperative assessment of bone quality closely correlated with validated measures.METHODSIn this prospective cross-sectional study, we enrolled adult patients undergoing orthopaedic surgery at a Level-I trauma center. Eligibility required an opportunistic computed tomography (CT) scan of the lumbar spine, glenoid, wrist, pelvis/femur, proximal tibia, or calcaneus. Seven surgeons, blinded to objective measures of bone quality, provided intraoperative bone-quality assessments using a 10-point Likert scale and categorized bone quality as normal, osteopenic, or osteoporotic. Hounsfield units (HUs) were measured on CT using a previously published technique. All images were reviewed by a single orthopaedic surgeon, blinded to intraoperative bone-quality assessments.RESULTSOf the 229 patients enrolled, 215 had available CT data and were included in the study. The average age of these patients was 44 years (range, 18 to 95 years), with 40.5% being female. Over half of the patients (61%) were Black or African American, while a quarter of the patients (25%) were White. The most common surgical sites included the femur (39 patients, 18.1%), ankle (31, 14.4%), and acetabulum (26, 12.1%). A positive linear relationship between HU and surgeon bone-quality assessments was observed (r = 0.66; p < 0.0001), which was consistent across surgical anatomic sites. Abnormal bone quality was correctly identified by surgeon assessment with 84% sensitivity and 97% specificity.CONCLUSIONSThis study demonstrated that surgeons can reliably detect abnormal bone quality through intraoperative assessment across numerous surgical sites. Intraoperative assessments may provide actionable and reliable feedback regarding bone density without additional cost or radiation in cases when opportunistic scans are not available. This information can inform intraoperative decision-making and presents opportunities for bone-health interventions.LEVEL OF EVIDENCEDiagnostic 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":"12 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147649068","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":"From Sideline to Specialty: The Birth of Sports Medicine in the United States of America.","authors":"John A Bergfeld","doi":"10.2106/jbjs.26.00394","DOIUrl":"https://doi.org/10.2106/jbjs.26.00394","url":null,"abstract":"","PeriodicalId":22625,"journal":{"name":"The Journal of Bone & Joint Surgery","volume":"2 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147649073","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":"Surprisingly Low Rates of Aseptic Loosening in 575 Rotating-Hinge Total Knee Arthroplasties.","authors":"E Bailey Terhune,Mason F Carstens,Kristin M Fruth,Charles P Hannon,Nicholas A Bedard,Kevin I Perry,Daniel J Berry,Matthew P Abdel","doi":"10.2106/jbjs.25.00837","DOIUrl":"https://doi.org/10.2106/jbjs.25.00837","url":null,"abstract":"BACKGROUNDContemporary rotating-hinge total knee arthroplasties (RH-TKAs) have shown reasonable short-term survivorship in smaller series, but concerns remain regarding risks of aseptic and septic failure. The purpose of this study was to assess outcomes of contemporary RH-TKAs in one of the largest series to date.METHODSWe retrospectively identified 575 RH-TKAs (60% used for aseptic etiologies and 40% used during reimplantation in 2-stage treatment of periprosthetic joint infection [PJI]) from 2002 to 2021 at a single institution. The mean age was 67 years, 58% were female, and the mean body mass index was 33 kg/m2. Sixty-five percent had Anderson Orthopaedic Research Institute (AORI) type-2B or 3 bone loss. Kaplan-Meier survivorship analyses were performed. The mean follow-up was 6 years (range, 2 to 19 years).RESULTSSurvivorship free from any revision was 76% at 5 years and 64% at 10 years. The most common revision indications were PJI (54%) and aseptic loosening (20%). RH-TKA used in the primary setting showed better survivorship compared with RH-TKA used during reimplantation after PJI (79% versus 60% at 10 years). Survivorship free from revision for aseptic loosening was 96% at 5 years and 90% at 10 years. Survivorship free from revision for PJI was 84% at 5 years and 81% at 10 years. Survivorship free from revision for PJI was even lower for RH-TKAs used during reimplantation, 74% at 5 years and 73% at 10 years. RH-TKA used during reimplantation in the treatment of PJI was associated with an increased risk of any revision (HR = 2, p < 0.001). Radiographic analysis of 425 knees that were not revised and had radiographs available for review showed that 6% of femoral components and 8% of tibial components had evidence of loosening at the time of final follow-up. The mean Knee Society Score improved from 33 to 69 at 2 years (p < 0.001).CONCLUSIONSThe 10-year survivorship free from aseptic loosening was 90% in this large series of RH-TKAs. This represents one of the best survivorships free from aseptic loosening published to date. Knees with prior PJI had markedly poorer survivorship than knees treated for aseptic etiologies, with double the risk of revision.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":"10 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147649072","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":"Oocyte Cryopreservation Experiences and Attitudes Among Female Orthopaedic Surgeons.","authors":"Grace Q Chen,Alexandra H Seidenstein,Dawn M LaPorte","doi":"10.2106/jbjs.25.01438","DOIUrl":"https://doi.org/10.2106/jbjs.25.01438","url":null,"abstract":"BACKGROUNDFemale surgeons more commonly delay childbearing and experience higher rates of infertility than women in the general population. More women are entering orthopaedic surgery but face unique challenges in family building. The accessibility of fertility preservation strategies among female orthopaedic surgeons remains underexplored. We aimed to investigate facilitators of and barriers to oocyte cryopreservation, especially during orthopaedic residency.METHODSA survey regarding family planning and experiences surrounding oocyte cryopreservation was designed and distributed via residency program directors, regional orthopaedic societies, and the Ruth Jackson Orthopaedic Society. Female orthopaedic surgery residents, fellows, and attending physicians were invited to participate.RESULTSOf 169 participants, 107 (63%) reported intentionally delaying childbearing and 58 (34%) reported delaying or planning to delay for ≥4 years. Although 91 respondents (54%) had considered oocyte cryopreservation, only 36 (21%) had undergone or planned to undergo at least 1 cycle and 55 (33%) ultimately decided not to undergo it. Inflexible scheduling of work, lack of insurance coverage, and restrictive leave policy were the most important barriers to oocyte cryopreservation during residency. Among current residents and fellows, 30 (38%) would not have been comfortable telling program leadership that they were planning to undergo oocyte cryopreservation and 25 (32%) reported that they would not have been provided adequate scheduling flexibility. When given 5 multiple-choice questions about female fertility and the oocyte cryopreservation process, respondents answered a mean of 1.46 questions correctly.CONCLUSIONSThis study revealed a high degree of interest in oocyte cryopreservation among survey respondents but identified persistent barriers of financial burden, inflexible scheduling, institutional stigma, and limited fertility knowledge. Residency programs should prioritize schedule flexibility, proactive leadership support, and privacy-conscious accommodations for fertility-related care as well as structured reproductive health education for trainees.CLINICAL RELEVANCEBarriers to fertility preservation during orthopaedic training directly affect physician well-being and the ability to recruit and retain women in this specialty, which, in turn, impact patient access to quality care from a diverse physician workforce.","PeriodicalId":22625,"journal":{"name":"The Journal of Bone & Joint Surgery","volume":"4 12 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147649079","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}