The Journal of Bone & Joint Surgery最新文献

{"title":"A Computer Modeling-Based Target Zone for Transposition Osteotomy of the Acetabulum in Patients with Hip Dysplasia.","authors":"Kenji Kitamura,Masanori Fujii,Goro Motomura,Satoshi Hamai,Shinya Kawahara,Taishi Sato,Ryosuke Yamaguchi,Daisuke Hara,Takeshi Utsunomiya,Yasuharu Nakashima","doi":"10.2106/jbjs.23.01132","DOIUrl":"https://doi.org/10.2106/jbjs.23.01132","url":null,"abstract":"BACKGROUNDThis study aimed to determine the acetabular position to optimize hip biomechanics after transposition osteotomy of the acetabulum (TOA), a specific form of periacetabular osteotomy, in patients with hip dysplasia.METHODSWe created patient-specific finite-element models of 46 patients with hip dysplasia to simulate 12 virtual TOA scenarios: lateral rotation to achieve a lateral center-edge angle (LCEA) of 30°, 35°, and 40° combined with anterior rotation of 0°, 5°, 10°, and 15°. Joint contact pressure (CP) on the acetabular cartilage during a single-leg stance and simulated hip range of motion without osseous impingement were calculated. The optimal acetabular position was defined as satisfying both normal joint CP and the required range of motion for activities of daily living. Multivariable logistic regression analysis was used to identify preoperative morphological predictors of osseous impingement after virtual TOA with adequate acetabular correction.RESULTSThe prevalence of hips in the optimal position was highest (65.2%) at an LCEA of 30°, regardless of the amount of anterior rotation. While the acetabular position minimizing peak CP varied among patients, approximately 80% exhibited normalized peak CP at an LCEA of 30° and 35° with 15° of anterior rotation, which were the 2 most favorable configurations among the 12 simulated scenarios. In this context, the preoperative head-neck offset ratio (HNOR) at the 1:30 clock position (p = 0.018) was an independent predictor of postoperative osseous impingement within the required range of motion. Specifically, an HNOR of <0.14 at the 1:30 clock position predicted limitation of required range of motion after virtual TOA (sensitivity, 57%; specificity, 81%; and area under the receiver operating characteristic curve, 0.70).CONCLUSIONSAcetabular reorientation to an LCEA of between 30° and 35° with an additional 15° of anterior rotation may serve as a biomechanics-based target zone for surgeons performing TOA in most patients with hip dysplasia. However, patients with a reduced HNOR at the 1:30 clock position may experience limited range of motion in activities of daily living postoperatively.CLINICAL RELEVANCEThis study provides a biomechanics-based target for refining acetabular reorientation strategies during TOA while considering morphological factors that may limit the required range of motion.","PeriodicalId":22625,"journal":{"name":"The Journal of Bone & Joint Surgery","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142449340","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: Moving Orthopaedic Patient Care Forward: Tips for Successful Systems Improvement.","authors":"David N Bernstein,Robert Kaspar Wagner,Jacob S Borgida,Mitchel B Harris,Thuan V Ly","doi":"10.2106/jbjs.24.00698","DOIUrl":"https://doi.org/10.2106/jbjs.24.00698","url":null,"abstract":"","PeriodicalId":22625,"journal":{"name":"The Journal of Bone & Joint Surgery","volume":"218 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142329266","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":"No Discernible Difference in Revision Rate or Survivorship Between Posterior Cruciate-Retaining and Posterior Cruciate-Substituting TKA.","authors":"Young-Hoo Kim,Jang-Won Park,Young-Soo Jang,Eun-Jung Kim","doi":"10.2106/jbjs.24.00007","DOIUrl":"https://doi.org/10.2106/jbjs.24.00007","url":null,"abstract":"BACKGROUNDMany authors and the data of multiple registries have suggested that the use of posterior cruciate-substituting (posterior stabilized [PS]) total knee arthroplasty (TKA) leads to a higher risk of revision compared with the use of posterior cruciate-retaining (CR) TKA. The aim of the present prospective, randomized, long-term study was to compare PS and CR TKA with regard to the clinical, radiographic, and computed tomography (CT) results; the prevalence of osteolysis; revision rate; and survivorship.METHODSThis study included a consecutive series of 300 patients (mean age [and standard deviation], 63.6 ± 6 years) who underwent simultaneous, bilateral TKA in the same anesthetic session. Each patient received a NexGen CR-Flex prosthesis on 1 side and a NexGen LPS-Flex prosthesis on the contralateral side. The mean follow-up period was 18 years (range, 17.5 to 19.5 years).RESULTSThere were no significant differences between the NexGen CR and LPS-Flex TKA groups at the latest follow-up with regard to the mean Knee Society knee score (93 versus 92 points, respectively); the Western Ontario and McMaster Universities Osteoarthritis Index score (19.1 points for both); the University of California Los Angeles activity score (6.1 points for both); range of motion (125° ± 6.1° versus 126° ± 6.5°); radiographic and CT results; and revision rate (6.0% versus 6.3%). No knee had osteolysis. The estimated survival rate at 19.5 years was 94% (95% confidence interval [CI], 91% to 100%) for the NexGen CR-Flex prosthesis and 93.7% (95% CI, 91% to 100%) for the LPS-Flex prosthesis, with revision or aseptic loosening as the end point.CONCLUSIONSThe findings of the present, long-term (minimum follow-up of 17.5 years) clinical study showed that NexGen CR-Flex and NexGen LPS-Flex implants produced excellent clinical and radiographic results. There was no notable clinical advantage of a NexGen CR-Flex implant over a NexGen LPS-Flex implant.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":"22 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142329267","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":"Review of the Influences of Sex Differences on Health and Disease: What Is the Role of Journals?","authors":"Judith G Regensteiner,Kimberly Templeton","doi":"10.2106/jbjs.24.00297","DOIUrl":"https://doi.org/10.2106/jbjs.24.00297","url":null,"abstract":"➢ Sex-based differences are understudied, which has potential consequences for the health of everyone.➢ Women's health is particularly affected given a lack of sex-specific data across many disease states.➢ Journals do not consistently require the inclusion of both sexes and the disaggregation of data by sex in cell, animal model, and human studies.➢ Instructions for investigators and journals regarding the inclusion of sex-specific data are found in guidelines such as those by the Sex and Gender Equity in Research (SAGER) group, but these guidelines are underutilized.➢ Consistency in the inclusion of both sexes in studies (except in studies on diseases affecting only 1 sex), as well as in the disaggregation and reporting of results by sex, has the potential to improve health for all people.","PeriodicalId":22625,"journal":{"name":"The Journal of Bone & Joint Surgery","volume":"53 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142328903","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: Breaking Bread Together, Finding an Extracurricular Pursuit.","authors":"Stephen P Maier","doi":"10.2106/jbjs.24.00718","DOIUrl":"https://doi.org/10.2106/jbjs.24.00718","url":null,"abstract":"","PeriodicalId":22625,"journal":{"name":"The Journal of Bone & Joint Surgery","volume":"45 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142328897","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":"Sagittal Fragment Rotation and Ogden Type-I Classification Are Hallmarks of Combined Tibial Tubercle Fracture and Patellar Tendon Injury.","authors":"Rebecca J Schultz,Jason Z Amaral,Matthew J Parham,Raymond L Kitziger,Tiffany M Lee,Scott D McKay,Basel M Touban","doi":"10.2106/jbjs.24.00300","DOIUrl":"https://doi.org/10.2106/jbjs.24.00300","url":null,"abstract":"BACKGROUNDTibial tubercle fractures (TTFs) are uncommon injuries, comprising <3% of all proximal tibial fractures. These fractures occasionally occur in conjunction with a patellar tendon injury (PTI). We aimed to identify risk factors associated with combined TTF and PTI.METHODSA retrospective review was performed of patients presenting to a single, tertiary children's hospital with TTF between 2012 and 2023. Demographic data, operative details, radiographs, and injury patterns were analyzed. Radiographs were assessed for the epiphyseal union stage (EUS), Ogden classification, and fracture patterns. Multiple logistic regression models were used to assess the impact of body mass index, comminution, fracture fragment rotation, EUS, bilateral injury, and Ogden classification on injury type.RESULTSWe identified 262 fractures in 252 patients (mean age, 13.9 ± 1.31 years). Of the patients, 6% were female and 48% were Black. Of the 262 fractures, 228 (87%) were isolated TTFs and 34 (13%) were TTFs with PTI. Multivariable analysis demonstrated fragment rotation on lateral radiographs (p < 0.0001) and Ogden Type-I classification (p < 0.0001) to be the most predictive risk factors for a combined injury. Rotation was associated with a substantial increase in the odds of a combined injury, with an odds ratio of 22.1 (95% confidence interval [CI], 6.1 to 80.1). Ogden Type-I fracture was another significant risk factor, with an odds ratio of 10.2 (95% CI, 3.4 to 30.4).CONCLUSIONSThe Ogden classification and fragment rotation are the most useful features for distinguishing between isolated TTF and combined TTF with PTI. This is the first study to identify risk factors for TTF combined with PTI. Surgeons may use this information to aid in preoperative planning.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":"85 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142328899","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":"Do Half of Orthopaedic Surgeons Change Jobs within Their First 2 Years?: An Analysis Using the American Board of Orthopaedic Surgery Database.","authors":"Jonathan D McKeeman,Dustin A Greenhill,Akhil Sharma,John J Harrast,David F Martin,Douglas W Lundy","doi":"10.2106/jbjs.24.00040","DOIUrl":"https://doi.org/10.2106/jbjs.24.00040","url":null,"abstract":"BACKGROUNDThe claim that \"50% of orthopaedic surgeons leave their first job within 2 years\" did not originate from evidence. The purpose of this study was to investigate practice change rates among board- eligible orthopaedic surgeons using the American Board of Orthopaedic Surgery (ABOS) database.METHODSWe utilized information provided by orthopaedic surgeons taking the ABOS Part II Examination across 6 different years. Surgeons who trained outside of the United States and members of the uniformed services of the U.S. were excluded. Move rates within 2 years of starting practice and before the candidate's Part II examination were determined. All surgeons were then subcategorized as having followed a traditional or nontraditional certification timeline based on whether they took Part II of the examination within 2 practice years after becoming board-eligible. Candidate-specific variables were analyzed according to whether the surgeon did or did not change practices.RESULTSAmong 3,784 orthopaedic surgeons, 215 (5.7%) left their first practice within 2 years. On average, candidates sat for the Part II examination at a mean (and standard deviation) of 2.1 ± 1.1 years (range, 0.7 to 31.9 years) after reporting their first practice location. Seventy-six percent of surgeons took the Part II examination within a traditional timeframe. On average, nontraditional candidates left their first practice at a significantly higher rate than traditional candidates (20.5% versus 1.3%; p < 0.001), changed practices more often (1.5 versus 1.2 moves; p = 0.021), and moved farther (500.1 versus 304.4 miles; p = 0.023). Fellowship training and/or Part II examination subspecialty were not strongly associated with a surgeon leaving his or her first practice.CONCLUSIONSWhile it is possible that >5.7% of orthopaedic surgeons leave their first job during their early career, it is unlikely that many relocate within 2 years. This is especially true among orthopaedic surgeons pursuing ABOS certification within a traditional timeframe.","PeriodicalId":22625,"journal":{"name":"The Journal of Bone & Joint Surgery","volume":"25 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142328896","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: Equitable Orthopaedic Care for Patients with Disabilities.","authors":"Uma Balachandran,Brocha Z Stern","doi":"10.2106/jbjs.24.00470","DOIUrl":"https://doi.org/10.2106/jbjs.24.00470","url":null,"abstract":"","PeriodicalId":22625,"journal":{"name":"The Journal of Bone & Joint Surgery","volume":"7 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142328902","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":"Association of Technology Usage and Decreased Revision TKA Rates for Low-Volume Surgeons Using an Optimal Prosthesis Combination: An Analysis of 53,264 Primary TKAs.","authors":"Michael McAuliffe,Ibrahim Darwish,Jon Anderson,Alex Nicholls,Sophie Corfield,Dylan Harries,Christopher Vertullo","doi":"10.2106/jbjs.24.00539","DOIUrl":"https://doi.org/10.2106/jbjs.24.00539","url":null,"abstract":"BACKGROUNDTechnology (navigation and robotics) usage during total knee arthroplasty (TKA) is often supported by literature involving high-volume surgeons and hospitals, but the value of technology for lower-volume surgeons is uncertain. This study aimed to determine if there was a relationship among surgeon volume, technology usage, and revision rate when using an optimal prosthesis combination (OPC).METHODSAustralian Orthopaedic Association National Joint Replacement Registry (AOANJRR) data were obtained from January 1, 2008, to December 31, 2022, for all primary TKA procedures performed for osteoarthritis using an OPC by a known surgeon ≥5 years after their first recorded procedure. The interaction between surgeon volume and conventional-instrumentation (CV) versus technology-assisted (TA) TKA was assessed. The cumulative percent revision (CPR) was determined by Kaplan-Meier estimates. Cox proportional-hazards methods were used to compare rates of revision by surgeon volume and by the interaction of volume and technology. Subanalyses were undertaken to examine major and minor revisions separately, and to assess the influence of technology on revision rates relative to those of a surgeon undertaking 100 TKA/year.RESULTSOf the 53,264 procedures that met the inclusion criteria, 31,536 were TA-TKA and 21,728 were CV-TKA. Use of technology reduced the all-cause revision rate for surgeons with a volume of <50 TKA/year and the rate of minor revisions for surgeons with a volume of <40 TKA/year. No interaction between surgeon volume and the rate of major revision surgery was found. With CV-TKA by a surgeon with a 100-TKA/year volume as the comparator, all-cause and major revision rates were significantly elevated for surgeons undertaking <50 and <100 TKA/year, respectively. In contrast, analysis of TA-TKA showed no difference in rates of all-cause or major revisions for surgeons undertaking <100 TKA/year compared with 100 TKA/year.CONCLUSIONSTA-TKA was associated with a decrease in the revision rate for lower-volume surgeons but no significant alterations in revision rate for higher-volume surgeons. Preferential use of TA-TKA by lower-volume surgeons should be considered.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":"108 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142328987","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":"Short-Term Complications of Arthroscopic Bristow or Latarjet Procedure with Screw Versus Suture-Button Fixation: A Prospective Study of 308 Consecutive Cases by a Single Surgeon.","authors":"Zhenxing Shao,Yanfang Jiang,Qingfa Song,Hangle Wang,Hao Luo,Xu Cheng,Guoqing Cui","doi":"10.2106/jbjs.23.00390","DOIUrl":"https://doi.org/10.2106/jbjs.23.00390","url":null,"abstract":"BACKGROUNDThis study aimed to investigate the short-term complications (minimum 1-year follow-up) after either an arthroscopic Bristow or Latarjet procedure for anterior shoulder instability utilizing screw or suture-button fixation.METHODSPatients undergoing arthroscopic Bristow or Latarjet procedures between November 2016 and April 2021 were enrolled. Data were collected at baseline, 3 months, 6 months, and every year after surgery. Risks of postoperative complications and unplanned reoperations were assessed. A multivariable regression model was used to identify risk factors for complications and to determine the association of complications with patient-reported outcomes.RESULTSA total of 412 patients (425 shoulders) undergoing arthroscopic Bristow or Latarjet procedures performed by a single surgeon between November 2016 and April 2021 were reviewed. Two hundred and ninety-nine patients (308 shoulders, 76.2% of 404 eligible) with a mean follow-up of 22.3 ± 4.2 months were included for analysis. Two hundred and sixty-nine shoulders (87.3%) underwent a Bristow procedure (165 with screw and 104 with suture-button fixation), while 39 (12.7%) underwent a Latarjet procedure (18 with screw and 21 with suture-button fixation). Eighty-two patients (83 shoulders) reported a total of 85 complications within 2 years after surgery, with an overall complication rate of 26.9%. The rates of recurrent dislocation or subluxation and infection were 1.9% and 0.6%, respectively, while a total of 4 (1.3%) of the shoulders had unplanned reoperations. The most common complications were graft-related (11.7%), followed by complications involving neurologic symptoms (10.7%). The overall, graft, and neurologic complication rates following Bristow or Latarjet procedures were 27.1% versus 25.6%, 12.3% versus 7.7%, and 10.0% versus 15.4%, respectively. Compared with the Bristow technique with screw fixation, Bristow with suture-button fixation yielded a lower risk of any complications (odds ratio [OR], 0.55; p = 0.04). Paying with rural insurance and poor sleep quality prior to surgery were associated with increased risk of any complications.CONCLUSIONSCompared with arthroscopic Bristow procedures with screw fixation, Bristow procedures with suture-button fixation resulted in a lower overall complication risk. Both patient demographic and implant-specific factors were associated with the development of a complication.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":"217 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142328895","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}