The Journal of Bone & Joint Surgery最新文献

{"title":"A Review of Medical Ethics in Orthopaedic Surgery: Current Foci and Future Considerations.","authors":"Ryan X Lam,Zhi Mei Sonia He,Ruhi Thapar,Maggie Wang,Dion G Birhiray,Matthew Milad,Lara Ouellette,Umar Ghilzai,Tucker J Cushing,M Brent Price,Brenden B Ronna,Omar H Atassi,Christopher H Perkins,John R Dawson,William M Granberry,Melvyn A Harrington,Douglas R Dirschl,Lorenzo R Deveza","doi":"10.2106/jbjs.24.01137","DOIUrl":"https://doi.org/10.2106/jbjs.24.01137","url":null,"abstract":"➢ Medical ethics education is a required component of orthopaedic surgery resident training per the Accreditation Council for Graduate Medical Education (ACGME) guidelines, although no standardized curriculum currently exists.➢ Beyond the 4 principles of bioethics (autonomy, beneficence, nonmaleficence, justice), additional ethical concepts relevant to orthopaedic care include utilitarianism, deontology, virtue ethics, moral intuitionism, microethics, and narrative ethics.➢ Ethical themes identified in the literature relevant to orthopaedic surgery include the ethics involved in medical decision-making, use of new technologies, caring for vulnerable patients, performing high-stakes procedures, the impacts of trainee status on patient care, and patient attitude regarding conflict of interest.➢ Ethical themes that we sought to identify in the literature but found lacking include the ethics of providing orthopaedic care in low-resource settings, orthopaedics entrepreneurship, disability ethics, trainee mistreatment by their supervisors, and the ethics involved in the recognition and reporting of child and elder abuse.","PeriodicalId":22625,"journal":{"name":"The Journal of Bone & Joint Surgery","volume":"124 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144122033","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":"Balancing Risks and Benefits: Arthroscopic Lysis of Adhesions After Total Knee Arthroplasty: Commentary on an article by Kian Niknam, BS, et al.: \"Rates of Periprosthetic Joint Infection and Revision Increase After Arthroscopic Lysis of Adhesions Subsequent to Primary TKA\".","authors":"Mona Badawy","doi":"10.2106/jbjs.24.01515","DOIUrl":"https://doi.org/10.2106/jbjs.24.01515","url":null,"abstract":"","PeriodicalId":22625,"journal":{"name":"The Journal of Bone & Joint Surgery","volume":"26 1","pages":"e56"},"PeriodicalIF":0.0,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144103548","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":"Effects of Depression and/or Anxiety on the Outcomes of Hip Arthroscopy for Femoroacetabular Impingement and Labral Tears: A Minimum 5-Year Follow-up Study.","authors":"Roger Quesada-Jimenez,Elizabeth G Walsh,Jessica C Keane,Ady H Kahana-Rojkind,Elijah S Domb,Benjamin G Domb","doi":"10.2106/jbjs.24.01054","DOIUrl":"https://doi.org/10.2106/jbjs.24.01054","url":null,"abstract":"BACKGROUNDDepression and anxiety are recognized as adverse prognostic factors in various orthopaedic surgical interventions. The aim of this study is to report the intermediate-term outcomes of hip arthroscopy for the treatment of femoroacetabular impingement (FAI) and labral tears in patients with depression and/or anxiety.METHODSData were retrospectively analyzed for patients with a self-reported history of depression and/or anxiety who had undergone primary hip arthroscopy for the treatment of FAI and labral tears from 2008 to 2018. Included patients had at least 1 of the following patient-reported outcome (PRO) scores: the modified Harris hip score (mHHS), Non-Arthritic Hip Score (NAHS), Hip Outcome Score-Sports-Specific Subscale (HOS-SSS), International Hip Outcome Tool (iHOT-12), patient satisfaction, Short Form 12-Mental (SF-M), Veterans RAND 12 Item-Mental (VR-M), and visual analog scale (VAS) for pain, or a revision procedure during the study period. Patients were propensity-matched with a benchmark control group of patients without depression and/or anxiety, in a 1:1 ratio, to control for confounding variables. Clinically relevant thresholds, revision procedures, and survivorship rates were also included in the analysis.RESULTSOne hundred and twenty-five hips in patients with depression and/or anxiety were included in the study and were successfully matched to 125 control hips in patients without depression and/or anxiety. The depression/anxiety cohort demonstrated significant improvement in all functional outcome scores, with a magnitude of improvement that was comparable with that in the control group. However, the depression/anxiety group started with significantly lower preoperative scores for the HOS-SSS, SF-M, and VR-M; ended with lower intermediate-term scores for the mHHS, NAHS, HOS-SSS, SF-M, and VR-M; and had lower rates of achievement of patient-acceptable symptom state (PASS) thresholds for the mHHS and HOS-SSS. There was no significant difference between the 2 groups with regard to secondary procedures and complications.CONCLUSIONSHip arthroscopy for the treatment of FAI and labral tears in patients with depression and/or anxiety resulted in significant intermediate-term improvements in functional and health-related quality-of-life scales. However, compared with a benchmark control group, the functional scores in this patient population started lower and ended lower. In addition, the patients in the depression/anxiety cohort had a lower rate of achieving PASS thresholds than those in the control group.LEVEL OF EVIDENCEPrognostic 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":"45 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144114292","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":"Worth the Hype(rglycemia)? Dexamethasone in Diabetic Patients Undergoing Total Knee Arthroplasty: Commentary on an article by Hyung Jun Park, MD, PhD, et al.: \"Intravenous Dexamethasone Transiently Elevates Blood Glucose Levels and Reduces Pain After TKA in Patients with Type-2 Diabetes Mellitus. A Randomized Controlled Study\".","authors":"Elizabeth G Lieberman","doi":"10.2106/jbjs.24.01542","DOIUrl":"https://doi.org/10.2106/jbjs.24.01542","url":null,"abstract":"","PeriodicalId":22625,"journal":{"name":"The Journal of Bone & Joint Surgery","volume":"59 1","pages":"e54"},"PeriodicalIF":0.0,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144103557","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":"Traditional Bonesetters: Risks, Complications, and the Way Forward.","authors":"B A Petrisor","doi":"10.2106/jbjs.25.00206","DOIUrl":"https://doi.org/10.2106/jbjs.25.00206","url":null,"abstract":"","PeriodicalId":22625,"journal":{"name":"The Journal of Bone & Joint Surgery","volume":"41 1","pages":"1041-1042"},"PeriodicalIF":0.0,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144103550","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":"Rigorous Control in Clinical Research: Evaluating the EmeTerm Bracelet for PONV Prevention: Commentary on an article by Yidan Yang, MMSc, et al.: \"Risk of Postoperative Nausea and Vomiting After Total Hip or Knee Arthroplasty Under Spinal Anesthesia: Randomized Trial Comparing Conventional Antiemetics with or without the EmeTerm Bracelet\".","authors":"William L Bargar","doi":"10.2106/jbjs.25.00014","DOIUrl":"https://doi.org/10.2106/jbjs.25.00014","url":null,"abstract":"","PeriodicalId":22625,"journal":{"name":"The Journal of Bone & Joint Surgery","volume":"91 1","pages":"e53"},"PeriodicalIF":0.0,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144103551","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":"Workplace Culture-A Different Look at the Perspective of Orthopaedic Women Faculty Members: Commentary on an article by Katherine M. Gerull, MD, et al.: \"Addressing Issues of Inclusive Workplace Culture for Women Orthopaedic Surgeons in Academia. A Qualitative Investigation\".","authors":"J L Marsh","doi":"10.2106/jbjs.25.00087","DOIUrl":"https://doi.org/10.2106/jbjs.25.00087","url":null,"abstract":"","PeriodicalId":22625,"journal":{"name":"The Journal of Bone & Joint Surgery","volume":"40 1","pages":"e55"},"PeriodicalIF":0.0,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144103549","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 Too-Long Anterior Process of the Calcaneus: Defining Normative Values for the Calcaneonavicular Distance Using MRI in a Pediatric Population.","authors":"Nastassia Pralong-Guanziroli,Blaise Cochard,Elvin Gurbanov,Anne Tabard-Fougère,Nathaly Gavira,Silvia Valisena,Romain Dayer,Dimitri Ceroni","doi":"10.2106/jbjs.24.01096","DOIUrl":"https://doi.org/10.2106/jbjs.24.01096","url":null,"abstract":"BACKGROUNDThe calcaneonavicular distance has yet to be definitively defined on the basis of morphological studies and thus remains a somewhat elusive value for orthopaedists. The purposes of the present study were to measure the calcaneonavicular distance with use of magnetic resonance imaging (MRI) in a control pediatric population and to assess whether sex and age affected this distance.METHODSWe retrospectively reviewed 363 MRI scans of the feet of healthy controls and measured calcaneonavicular distances (i.e., the distance between the bone margins of the anterior process of the calcaneus and the navicular and the distance between the cartilaginous margins of the anterior process of the calcaneus and the navicular) in the axial and sagittal planes.RESULTSInterobserver and intraobserver agreements were better for the bone measurements than for the cartilaginous measurements. The mean calcaneonavicular distance was 5.6 mm for values based on bone margins and 4.5 mm for those based on cartilaginous margins. On the basis of current criteria, the distributions of these distances were such that 41% to 46% of participants presented with values that defined them as having a too-long anterior process of the calcaneus. Furthermore, age seemed to play a major role in males, with calcaneonavicular distances narrowing with bone maturation.CONCLUSIONSThe mean physiological calcaneonavicular distances measured in healthy pediatric controls are much shorter than reported previously. In almost 50% of cases, the calcaneonavicular distance measurements between the bone margins presented values that defined them as having a too-long anterior process of the calcaneus. Age played a major role in the calcaneonavicular distances in males, and we hypothesize that the calcaneonavicular distance narrows with bone maturation. We believe that it is essential to establish normative calcaneonavicular distance values based on sex and age so that they can be used as guidelines when diagnosing and treating patients suspected of having a too-long anterior process of the calcaneus.LEVEL OF EVIDENCEPrognostic 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":"31 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144066854","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 Direct Sonication Versus Conventional Sonication in the Diagnosis of Periprosthetic Joint Infection: Comparison of Diagnostic Accuracy and Time to Positivity of Fluid Culture.","authors":"Yicheng Li,Fei Wang,Tuerhongjiang Wahafu,Wenbo Mu,Baochao Ji,Abudousaimi Aimaiti,Xiaobin Guo,Haoyang Tian,Xiaogang Zhang,Li Cao","doi":"10.2106/jbjs.24.00744","DOIUrl":"https://doi.org/10.2106/jbjs.24.00744","url":null,"abstract":"BACKGROUNDConventional sonication is a recommended method in the diagnosis of periprosthetic joint infection (PJI), but the accuracy of diagnosis is still not ideal. We have applied the use of a handheld ultrasonic device and the intraoperative direct sonication of prostheses and soft tissues retrieved during surgery to improve the efficacy of the microbiological diagnosis of PJI and the incubation time of pathogens.METHODSThis was a retrospective study of patients diagnosed with PJI or aseptic loosening who underwent revision, DAIR (debridement, antibiotics, and implant retention), or resection, and for whom either sonication method was used between July 2017 and June 2023. Starting in August 2021, the removed implants and adjacent soft tissue were directly sonicated in a small metal container, and then the sonication fluid was incubated in blood culture bottles in the operating room under laminar air flow. Conventional sonication was continued through July 2021, and included vortex mixing for 30 seconds, sonication for 5 minutes, and additional vortex mixing for 30 seconds, as described by Trampuz et al. in 2007. The sensitivity, specificity, and time to positivity (TTP) of pathogen cultures were compared between intraoperative direct sonication and conventional sonication.RESULTSOf the 415 included patients, 266 had PJI and 149 had aseptic loosening. Fluid from intraoperative direct sonication and conventional sonication showed sensitivities of 88% and 69% (p < 0.001) and specificities of 84% and 93% (p = 0.105), respectively. Higher sensitivity was obtained by intraoperative direct sonication of only soft tissue than by direct sonication of only the prosthesis (80% versus 75%). Culture results from intraoperative direct sonication of soft tissue and the prosthesis were inconsistent in 55 cases (soft tissue plus prosthesis: 28 cases, soft tissue only: 17 cases, and prosthesis only: 10 cases). Gram-positive organisms grew significantly faster following direct sonication (median TTP for soft-tissue, 2.12 days [interquartile range (IQR), 1.40 to 3.16 days], and median TTP for the prosthesis, 2.02 days [IQR, 1.08 to 3.04 days]) compared with conventional sonication (median TTP, 2.92 days [IQR, 1.83 to 3.96 days]) (p = 0.003 and p < 0.001, respectively).CONCLUSIONSIntraoperative direct sonication was more sensitive than conventional sonication for the microbiological diagnosis of PJI and slightly shortened the TTP of microorganisms.LEVEL OF EVIDENCEDiagnostic 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":"13 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143945296","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's Important (Arts & Humanities): Scars of Courage.","authors":"Harjot Uppal","doi":"10.2106/jbjs.25.00071","DOIUrl":"https://doi.org/10.2106/jbjs.25.00071","url":null,"abstract":"","PeriodicalId":22625,"journal":{"name":"The Journal of Bone & Joint Surgery","volume":"27 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143945249","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}