The Journal of Bone & Joint Surgery最新文献

{"title":"Validation of the Bone-RADS (Bone Reporting and Data System) Score for Predicting Risk of Malignancy","authors":"Alec Bigness,Guston Zervoudakis,Jon Raso,Conrad Stoy,Denise Kalos,David Joyce,G. Douglas Letson,Jamie Caracciolo,Alexander L. Lazarides,Odion Binitie","doi":"10.2106/jbjs.26.00278","DOIUrl":"https://doi.org/10.2106/jbjs.26.00278","url":null,"abstract":"Background: Bone-RADS (Bone Reporting and Data System) is a consensus guideline by the American College of Radiology to assist in the risk stratification of lytic bone lesions. A score is calculated using 5 radiographic factors and a history of primary malignancy. The purpose of this study was to externally validate the Bone-RADS scoring system. Methods: This retrospective review examined radiographs from January 1, 2021, to December 31, 2021. Radiographs were identified via a keyword search for “lucent,” “osteolytic,” or “lytic” in extremity radiograph reports. All radiographs were initially read by a musculoskeletal radiologist. Radiographs of skeletally immature patients, lesions in a bone other than a long bone, primary soft-tissue masses, and negative/normal radiographs were excluded. Radiographs were independently scored on the basis of the Bone-RADS system by 4 reviewers. In the absence of a biopsy, a lesion was considered benign if it remained stable for 2 years on radiographs. Scores were correlated with final diagnoses to calculate the rates of malignancy and malignant transformation. Results: Of 1,108 screened radiographs, 423 were eligible. The mean age of the patients was 62 years and 49% were male. A higher Bone-RADS score was associated with a malignant diagnosis (p < 0.001), with an odds ratio of 9.7 (95% confidence interval [CI], 6.2 to 14.9) per 1-unit increase in the score. A higher margin score (p < 0.001), endosteal erosion (p < 0.001), a pathologic fracture (p < 0.001), and a soft-tissue mass (p = 0.02) were associated with increased risk of malignancy. The mean inter-rater agreement (weighted kappa) was 0.52, the inter-rater mean absolute deviation (MAD) was 0.37, and the intra-rater MAD was 0.27. Sensitivity was 97.1% (CI, 94.4% to 98.5%), specificity was 67.4% (CI, 59.3% to 74.5%), positive predictive value was 85.2% (CI, 80.9% to 88.7%), and negative predictive value was 92.4% (CI, 85.7% to 96.1%). Conclusions: The Bone-RADS scoring system demonstrated moderate diagnostic performance for malignancy risk stratification of lytic bone lesions, with high sensitivity and reproducible binary classification of possibly benign versus malignant. Although inter-rater agreement for the 4-tier score was only moderate, clinically relevant benign-versus-malignant categorization demonstrated higher inter- and intra-rater agreement. These findings support Bone-RADS as a practical triage framework based on musculoskeletal imaging of lytic bone lesions. Level of Evidence: Diagnostic 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":"11 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149089370","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":"Global Projection of Revision Total Hip and Knee Arthroplasty Through 2060","authors":"Jakob Adolf,Taner Karlıdağ,Mustafa Citak","doi":"10.2106/jbjs.26.00772","DOIUrl":"https://doi.org/10.2106/jbjs.26.00772","url":null,"abstract":"Background: The expanding pool of primary hip and knee arthroplasty implants in situ will generate a growing burden of revision arthroplasty. Projections for several individual countries have been published, but heterogeneous methods and time horizons prevent direct aggregation. We used a uniform method to estimate annual revision total hip arthroplasty (rTHA) and revision total knee arthroplasty (rTKA) volumes through 2060 for 17 registry-equipped countries. Methods: Annual rTHA and rTKA counts were extracted from each country’s most recent register annual report or registry-based publications. Adult (≥25 years) population denominators were taken from the UN World Population Prospects 2024 medium variant. For each country and procedure, we fitted a log-linear Poisson generalized linear model with the year as a covariate and ln(population) as an offset; each fitted trend was partially pooled across countries, bounded at ±2.0% per year, and damped over the projection horizon. Three sensitivity analyses (demographic-only, half-trend Poisson, logistic saturation) were also performed to bracket modeling uncertainty. Results: In 2024, the modeled 17-country aggregate was 185,921 rTHA and 189,689 rTKA procedures. Under the primary capped Poisson model, the 2060 aggregate reached 243,404 rTHAs and 267,456 rTKAs, corresponding to increases of 31% and 41%, respectively, relative to 2024. Country-level volume trajectories were heterogeneous: the United States and People’s Republic of China drove most absolute growth, while Germany, the United Kingdom, and Sweden approached plateaus by mid-century and Japan was projected to have a decline. The 4 projection methods spanned 2060 combined volumes of ⁓461,000 (demographic-only) to ⁓511,000 (primary model) procedures. Conclusions: Across 17 countries that perform most of the world’s hip and knee arthroplasties, annual revision volumes are projected to grow by approximately one-third (36% in aggregate; 31% for rTHA and 41% for rTKA) by 2060 under the primary model. The United States and China account for the largest absolute growth; mature European systems flatten, and Japan declines. These projections have direct implications for revision-fellowship pipelines, perioperative infection-prevention programs, and registry infrastructure. Level of Evidence: Prognostic 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":"401 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149089371","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 Current Landscape of Fragility Fracture Care in the People’s Republic of China","authors":"Ronald Man Yeung Wong,Minghui Yang,Chunpeng Zhao,Chaoran Liu,Keith Yu Kin Cheng,Wing Hoi Cheung,Weiguo Xu,Jing Zhang,Xinyi Zhang,Sheung Wai Law,Xinbao Wu,Maoyi Tian","doi":"10.2106/jbjs.26.00865","DOIUrl":"https://doi.org/10.2106/jbjs.26.00865","url":null,"abstract":"➢ Robotic systems are an emerging technology for the treatment of fragility fractures. ➢ An emerging treatment paradigm is to manage fragility fractures of the acetabulum with acute total hip arthroplasty or a combined hip procedure. ➢ Multidisciplinary care and orthogeriatric comanagement are fundamental components of the management of fragility fractures of the hip. ➢ Sarcopenia is highly prevalent among patients with fragility fractures.","PeriodicalId":22625,"journal":{"name":"The Journal of Bone & Joint Surgery","volume":"12 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149049111","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":"Reclaiming Agency in the Business of Orthopaedics: The 22-Modifier as a Case Study in Surgeon-Led Inquiry","authors":"Benjamin Randolph Childs","doi":"10.2106/jbjs.26.00936","DOIUrl":"https://doi.org/10.2106/jbjs.26.00936","url":null,"abstract":"","PeriodicalId":22625,"journal":{"name":"The Journal of Bone & Joint Surgery","volume":"9 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149049100","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":"Is There a Role for Preference-Based Care in Randomized Trial Enrollment?","authors":"Anna M. Nolan,Morgan H. Jones,Benjamin C. Silverman,Jeffrey N. Katz","doi":"10.2106/jbjs.26.00842","DOIUrl":"https://doi.org/10.2106/jbjs.26.00842","url":null,"abstract":"","PeriodicalId":22625,"journal":{"name":"The Journal of Bone & Joint Surgery","volume":"67 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149049099","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":"Answering the Call: AOA Leading Orthopaedic Care for an Aging Population","authors":"Stephen L. Kates","doi":"10.2106/jbjs.26.01062","DOIUrl":"https://doi.org/10.2106/jbjs.26.01062","url":null,"abstract":"Stephen L. Kates, MD, presented this presidential address, entitled “Answering the Call: AOA Leading Orthopaedic Care for an Aging Population,” at the Annual Leadership Meeting of the American Orthopaedic Association (AOA) in Albuquerque, New Mexico, in May 2026. The speech highlights that the field of orthopaedic surgery is facing significant challenges presented by the demographics of an aging U.S. population, including an aging surgeon workforce. By 2030, an estimated 73 million Americans will be 65 years of age or older, resulting in an increased need for orthopaedic care. Multiple workforce studies have predicted a substantial shortage of orthopaedic surgeons by 2036. The AOA offers potential solutions to these problems. The AOA offers leadership training at all career levels with the Resident Leadership Forum, the Emerging Leaders Program, and offerings for practicing orthopaedic surgeons. Strong support for orthopaedic residency programs is provided by the Council of Orthopaedic Residency Directors. The AOA is addressing the critical issues facing the profession through the Critical Issues/Educational Programming Committee and its symposia and publications. Targeted direct patient care to proactively manage bone health is promoted through the AOA Own the Bone Program. Lastly, the AOA provides guidance to late-career orthopaedic surgeons who wish to remain engaged in patient care, teaching, or mentoring junior colleagues as an alternative to complete retirement. Through these potential solutions, the AOA will “answer the call” in helping to address the significant challenges that the specialty will face over the next decade.","PeriodicalId":22625,"journal":{"name":"The Journal of Bone & Joint Surgery","volume":"47 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149020639","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":"Extra-Articular Malunions and Nonunions of the Scapular Body and Neck","authors":"Peter A. Cole,Jessica L. Xu,Alejandra A. Huaco,Michael C. LaRoque,Jeffrey D. Winter","doi":"10.2106/jbjs.26.00294","DOIUrl":"https://doi.org/10.2106/jbjs.26.00294","url":null,"abstract":"Background: Malunions and nonunions of scapular neck and body fractures can cause considerable pain and disability. This study reports outcomes regarding functional measures, range of motion, and strength before and after reconstruction. Methods: This retrospective case series at a Level-1 trauma center between 2003 and 2024 identified 50 consecutive patients (mean age, 50.3 years; 82% male; 80% White) with symptomatic malunion or nonunion of a scapular neck and/or body fracture who were referred to a single surgeon. Medial-lateral displacement and angular deformity were corrected through surgical reconstruction and malunion osteotomy. The Disabilities of the Arm, Shoulder and Hand (DASH) score, range of motion, strength, and postoperative procedures requiring a return to the operating room were recorded. Results: Fifty patients were included in the study; 5 patients were lost to follow-up before 12 months, leaving 45 patients (40 with malunion and 5 with nonunion) with >1-year outcomes. Eleven patients underwent reconstruction between 6 weeks and 3 months after injury because of the severity of the injury, their symptoms, and/or the necessity of an osteotomy. The median time from injury to reconstruction was 10 months (interquartile range [IQR] width, 16 months), and the median follow-up was 28.9 months (IQR width, 23.2 months). All patients achieved radiographic evidence of union. No intraoperative complications occurred. There was a mean 30.7-point improvement between the preoperative and final postoperative DASH scores (p < 0.001). The mean postoperative DASH score was 14.1 in patients who underwent reconstruction between 6 weeks and 3 months and was 23.2 in those who underwent reconstruction after 3 months. Forward flexion and abduction demonstrated significant increases in both range of motion and strength from preoperatively to postoperatively. External rotation range of motion and strength showed no significant increases. Subsequent procedures were performed in 12 patients: 8 patients underwent symptomatic implant removal (1 also underwent concurrent manipulation under anesthesia), 1 patient underwent open reduction and internal fixation for a new fracture, 2 patients underwent implant revision (1 also underwent concurrent manipulation under anesthesia), and 1 patient underwent manipulation under anesthesia for shoulder contracture. Conclusions: Extra-articular scapular malunions and nonunions can be associated with considerable pain and disability. Deformity correction improved range of motion and strength and reduced disability in this cohort. A principled reconstruction can be successful in addressing the sequelae of displaced scapular fractures. Level of Evidence: Therapeutic 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":"53 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149020640","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":"Prevention of Periprosthetic Fractures","authors":"J.N. Lamb,M. Whitehouse","doi":"10.2106/jbjs.26.00882","DOIUrl":"https://doi.org/10.2106/jbjs.26.00882","url":null,"abstract":"➢ Periprosthetic fractures after total hip arthroplasties represent a growing surgical emergency with high associated morbidity and mortality. ➢ Projections from national joint registries indicate that the absolute number of these fractures will rise substantially over the coming decades as the volume of primary arthroplasties increases and the population with implants ages. ➢ The consequences for patients and health systems are severe: mortality following periprosthetic fractures rivals that following hip fragility fractures, reoperation rates are high, and implant survival after fixation is substantially compromised. Therefore, prevention must be considered an integral part of arthroplasty care. ➢ We examine the mechanisms and classification of periprosthetic fractures with a focus on periprosthetic proximal femoral fractures after a total hip arthroplasty. ➢ Arthroplasty surgeons must adopt a holistic, multidisciplinary approach to reduce harm to patients.","PeriodicalId":22625,"journal":{"name":"The Journal of Bone & Joint Surgery","volume":"6 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149020642","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":"Ability of Deep Learning to Predict Surgical Recommendations for Distal Radial Fractures","authors":"Omar Shareef,Hailey Huddleston,Seong Jun Jang,Emma Smolev,Duretti T. Fufa","doi":"10.2106/jbjs.25.01693","DOIUrl":"https://doi.org/10.2106/jbjs.25.01693","url":null,"abstract":"Background: Distal radial fractures (DRFs) are extremely common, and decisions regarding operative intervention rely on clinical judgment and radiographic parameters at and after injury. Understanding whether a recommendation will be made for operative versus nonoperative management in an initial point-of-care setting can assist in patient counseling and reinforce timely follow-up with general orthopaedic or hand specialists. This study investigated the feasibility of using artificial intelligence (AI) to predict whether a fellowship-trained hand surgeon would recommend operative intervention using pre-reduction radiographs and clinical and demographic data. Methods: A convolutional neural network (CNN) model was trained on pre-reduction injury radiographs, and its outputs were combined with clinical and demographic data in a random forest (RF) model. The final model was evaluated on a hold-out test data set. To enhance interpretability, gradient-weighted class activation mapping (Grad-CAM) heatmaps and SHapley Additive exPlanations (SHAP) were employed to identify image regions and clinical features contributing to model predictions. Results: Of 1,040 included patients, 884 were used for training and 156 for testing model performance. On the test data set, the combined model achieved an accuracy of 87.14%, sensitivity of 97%, specificity of 73%, area under the receiver operating characteristic curve of 0.96, and Brier score of 0.10. Grad-CAM visualizations indicated that the CNN focused on clinically relevant features, such as fracture displacement, and SHAP analysis of the RF model highlighted age and lateral wrist radiographs as key contributors to predictions. Conclusions: This pilot study demonstrates the feasibility of using AI to predict the recommendations of a group of fellowship-trained hand surgeons at 1 institution regarding operative versus nonoperative treatment for a DRF on the basis of pre-reduction injury radiographs and clinical and demographic data. Future work will focus on external validation, expanding data sets, and incorporating additional imaging features to optimize performance and generalizability. Level of Evidence: Prognostic 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":"103 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149020643","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 Fragmented Aid to Coordinated Orthopaedic Humanitarian Trauma Response","authors":"Zina Smadi,Khaled J. Saleh","doi":"10.2106/jbjs.25.01656","DOIUrl":"https://doi.org/10.2106/jbjs.25.01656","url":null,"abstract":"","PeriodicalId":22625,"journal":{"name":"The Journal of Bone & Joint Surgery","volume":"2 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149020641","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}