The Journal of Bone & Joint Surgery最新文献

{"title":"Colorado Limb Donning-Timed Up and Go (COLD-TUG) Test in Lower-Extremity Amputation: Less Donning Time with Osseointegrated Bone-Anchored Prosthetic Limb.","authors":"Mohamed E Awad,Guy Lev,Danielle H Melton,Kylie G Shaw,Peter B Thomsen-Freitas,Brecca M M Gaffney,Cory L Christiansen,Jason W Stoneback","doi":"10.2106/jbjs.24.00871","DOIUrl":"https://doi.org/10.2106/jbjs.24.00871","url":null,"abstract":"BACKGROUNDOsseointegration of a bone-anchored limb (BAL) establishes a direct skeletal interface for prosthesis attachment, simplifying the donning/doffing process. The Timed Up and Go (TUG) test reliably assesses mobility in individuals with lower-extremity amputation who use socket prostheses, but it does not account for the time required to don a prosthetic limb. The aim of this study was to develop and examine the reliability and validity of the Colorado Limb Donning-Timed Up and Go (COLD-TUG) test. This test combines the time required for donning a prosthesis with the time to complete the TUG test in lower-extremity amputees using a prosthesis.METHODSParticipants with a unilateral lower-extremity amputation were enrolled in this study; participants were divided into 2 groups: socket prosthesis users (n = 15) and BAL users (n = 22). The COLD-TUG test measured the time (in seconds) required to don the prosthesis, get up from a standard chair, walk 3 m, turn around, walk back to the chair, and sit down again. Group differences as well as the intrarater reliability and concurrent validity of the test were analyzed.RESULTSThere were no significant differences between the 2 groups in terms of baseline characteristics. The intrarater reliability of the COLD-TUG test was excellent (intraclass correlation coefficient [ICC] = 0.94; p = 0.001). The concurrent validity between the COLD-TUG test and the TUG test in BAL patients was good (r = 0.712; p = 0.006). Participants in the BAL group had a significantly shorter mean COLD-TUG time (16.6 ± 5.6 seconds) compared with participants in the socket-prosthesis group (85.3 ± 61.4 seconds) (p < 0.001).CONCLUSIONSThe COLD-TUG test accurately measures prosthesis-donning burden in the context of functional mobility, thus providing valuable insights into functional abilities and quality of life. Use of a BAL was associated with a shorter donning time compared with use of a socket prosthesis.LEVEL OF EVIDENCEPrognostic 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":"35 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143945253","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 Future of Private Equity in Orthopaedics.","authors":"Sudheer C Reddy,Gary Herschman","doi":"10.2106/jbjs.24.00937","DOIUrl":"https://doi.org/10.2106/jbjs.24.00937","url":null,"abstract":"","PeriodicalId":22625,"journal":{"name":"The Journal of Bone & Joint Surgery","volume":"58 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143932418","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":"Kienböck Disease: Recent Advances in Understanding and Management.","authors":"David M Lichtman,William F Pientka","doi":"10.2106/jbjs.24.01090","DOIUrl":"https://doi.org/10.2106/jbjs.24.01090","url":null,"abstract":"➢ An at-risk lunate (due to anatomic factors) subjected to a trigger event (axial load, embolism, hypercoagulability) leads to the development of lunate osteonecrosis.➢ Children, adolescents, and elderly patients with Kienböck disease respond well to nonoperative treatments, and this should be considered before any surgical intervention.➢ For disease limited to the lunate, treatment decisions should be driven by the condition of the cartilage; intact lunate cartilage can be treated with joint leveling or core decompression, whereas disrupted cartilage surfaces should be bypassed with scaphocapitate or scaphotrapeziotrapezoid arthrodesis. Newer surgical procedures such as wrist arthroscopy and the introduction of contrast-enhanced magnetic resonance imaging have expanded the treatment options for these patients.➢ Once disease extends outside of the lunate, reconstruction with proximal row carpectomy or partial or total wrist arthrodesis should be considered on the basis of which articular surfaces are affected.➢ The new unified classification system and treatment are applicable to almost all patients with Kienböck disease.","PeriodicalId":22625,"journal":{"name":"The Journal of Bone & Joint Surgery","volume":"69 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143926296","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 New High-Tech, Low-Calorie Adventure in Joint Arthroplasty: Commentary on an article by Michael W. Seward, MD, et al.: \"Weight Loss Before Total Joint Arthroplasty Using a Remote Dietitian and a Mobile Application. A Multicenter Randomized Controlled Trial\".","authors":"Philippe Hernigou","doi":"10.2106/jbjs.24.01576","DOIUrl":"https://doi.org/10.2106/jbjs.24.01576","url":null,"abstract":"","PeriodicalId":22625,"journal":{"name":"The Journal of Bone & Joint Surgery","volume":"25 1","pages":"e44"},"PeriodicalIF":0.0,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143914997","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":"Re-Evaluating the Impact of Including Patients with Bilateral Conditions in Orthopaedic Clinical Research Studies: When 1 + 1 Does Not Equal 2.","authors":"Patrick M Carry,Carson Keeter,Harry Smith,Kaleb Taylor,Nancy Hadley-Miller,David R Howell","doi":"10.2106/jbjs.24.01234","DOIUrl":"https://doi.org/10.2106/jbjs.24.01234","url":null,"abstract":"BACKGROUNDOrthopaedic studies frequently include subjects with bilateral conditions. Failure to account for bilateral conditions can lead to spurious associations. The performance of different methods for addressing this issue, especially in populations that include subjects with unilateral and bilateral conditions, has not been rigorously evaluated. The purpose of the present study was to test 3 different methods for analyzing bilateral data: (1) analyzing all limbs as independent subjects (naïve), (2) randomly selecting 1 limb per subject (random), and (3) accounting for correlation between limbs with use of a linear mixed model (LMM).METHODSWe simulated a hypothetical randomized controlled trial in which Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores were collected at a baseline and a 2-year visit. We simulated 2 scenarios: Scenario 1 (in which there was truly no difference between groups [mean difference = 0]) and Scenario 2 (in which there was truly a difference between groups [mean difference = 10]). We varied the prevalence of bilateral involvement from 10% to 100% within each scenario. We evaluated method performance on the basis of bias (difference from the simulated true effect), power (1 - type-II error), type-1 error rate, and 95% confidence interval (CI) coverage.RESULTSBias (difference from simulated true effect) was similar across all methods. In Scenario 2 (true difference between groups), CI coverage was lowest with use of the naïve method (median, 87.8%; range, 85.3% to 93.5%) relative to the random method (median, 95.1%; range, 94.5% to 95.6%) and the LMM method (median, 95.1%; range, 94.5% to 95.5%). In Scenario 1 (no difference between groups), the type-1 error rate was highest for the naïve method (median, 11.3%; range, 6.7% to 14.7%) relative to the LMM method (median, 4.9%; range, 4.5% to 5.3%) and the random method (median, 5.0%; range, 4.5% to 5.2%).CONCLUSIONSFailure to account for bilateral conditions led to biased CIs and an increased type-1 error rate. Due to the fact that bias was similar across the methods, decreased model performance using the naïve method was likely attributable to underestimation of the standard error. Orthopaedic studies involving subjects with bilateral conditions warrant special considerations that can be addressed using simple (random) or more complex (LMM) methods.CLINICAL RELEVANCEAdherence to robust methodological practices is an essential but underappreciated component of the translation of evidence into clinical practice. Our work is meant to be educational, providing clinical researchers with the knowledge and skills to address a common challenge within the field.","PeriodicalId":22625,"journal":{"name":"The Journal of Bone & Joint Surgery","volume":"58 1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143921119","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":"Boosting Endogenous BMP2 Levels Accelerates Fracture Healing: Commentary on an article by Govindaraj Ellur, PhD, et al.: \"4-Aminopyridine Promotes BMP2 Expression and Accelerates Tibial Fracture Healing in Mice\".","authors":"Elizabeth W Bradley","doi":"10.2106/jbjs.24.01528","DOIUrl":"https://doi.org/10.2106/jbjs.24.01528","url":null,"abstract":"","PeriodicalId":22625,"journal":{"name":"The Journal of Bone & Joint Surgery","volume":"1 1","pages":"e45"},"PeriodicalIF":0.0,"publicationDate":"2025-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143915001","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":"Can We Reduce the Rate of Rotator Cuff Repair Failure with the Local Supplementation of an Amino Acid?: Commentary on an article by Haoyuan Wang, MD, et al.: \"Glutamine Promotes Rotator Cuff Healing by Ameliorating Age-Related Osteoporosis\".","authors":"Jason E Hsu","doi":"10.2106/jbjs.24.01482","DOIUrl":"https://doi.org/10.2106/jbjs.24.01482","url":null,"abstract":"","PeriodicalId":22625,"journal":{"name":"The Journal of Bone & Joint Surgery","volume":"47 1","pages":"e46"},"PeriodicalIF":0.0,"publicationDate":"2025-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143915000","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":"How Big Data Can Improve Real-World Patient Care: Commentary on an article by Devon R. Pekas, MD, MS, et al.: \"Factors That Influence Returning to Driving Following Primary Total Knee Arthroplasty. A Prospective Investigation\".","authors":"Daniel H Williams","doi":"10.2106/jbjs.24.01613","DOIUrl":"https://doi.org/10.2106/jbjs.24.01613","url":null,"abstract":"","PeriodicalId":22625,"journal":{"name":"The Journal of Bone & Joint Surgery","volume":"39 1","pages":"e47"},"PeriodicalIF":0.0,"publicationDate":"2025-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143915139","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 of Transfibular Total Ankle Arthroplasty: Clinical and Radiographic Analysis of 130 Cases with Minimum 5-Year Follow-up.","authors":"Jonathan Day,Amanda N Fletcher,Morgan Motsay,Maggie Manchester,Mark Arthur,Zijun Zhang,Lew C Schon","doi":"10.2106/jbjs.24.00983","DOIUrl":"https://doi.org/10.2106/jbjs.24.00983","url":null,"abstract":"BACKGROUNDWhile most total ankle arthroplasty (TAA) procedures utilize an anterior approach for implantation, the Zimmer Biomet Trabecular Metal implant is unique in that it utilizes a lateral transfibular approach. We present the largest mid-term study to date to analyze the implant survivorship and clinical and radiographic outcomes of transfibular TAA at a minimum 5-year follow-up.METHODSWe retrospectively identified and evaluated 130 ankles (122 patients; mean age, 60.8 years; 50% female) with a mean follow-up of 5.9 years (range, 5.0 to 10.1 years) after primary TAA performed between October 2012 and December 2018. Patient-reported outcome measures (PROMs) included the 12-item Short Form Health Survey (SF-12) Physical Component Summary (PCS) and Mental Component Summary (MCS), Ankle Osteoarthritis Scale (AOS) for pain and disability, and visual analog scale (VAS) for pain. Radiographic measurements for range of motion, coronal and sagittal alignment, and implant subsidence were evaluated. The presence of periprosthetic radiolucency was determined using a 12-zone classification system. Adverse events were reported using the Canadian Orthopaedic Foot and Ankle Society (COFAS) Reoperation Coding System (CROCS).RESULTSThe cohort had mean postoperative values of 41.5 for the SF-12 PCS, 54.9 for the SF-12 MCS, 2.3 for VAS pain, 19.1 for AOS pain, and 28.5 for AOS disability. The postoperative tibiotalar range of motion was 7.5° of dorsiflexion and 17.3° of plantar flexion. A total of 42 valgus ankles (mean coronal tibiotalar angle, 10.4°; range, 1.0° to 25.3°) and 44 varus ankles (mean, -9.1°; range, -1.0° to -25.0°) were corrected to neutral. Twenty-six ankles (20%) had 1 zone of radiolucency, and none of the ankles had >7 zones. There were 3 cases of cysts (2.3%) and 0 cases of subsidence, septic or aseptic loosening, or fibular nonunion. Adverse events occurred in 47 ankles (36.2%) at a mean of 26.7 months, with the most common reoperation being medial gutter debridement (22 ankles; 16.9%). There were 2 ankles (1.5%) with acute infection treated with debridement, antibiotics, and polyethylene exchange with metal component retention. Overall implant survivorship, defined as retention of the metal components, was 100% at the time of final follow-up.CONCLUSIONSThe clinical and radiographic data in this study suggest that transfibular TAA is an effective and durable treatment option for end-stage ankle arthritis, with excellent mid-term implant survivorship. Periprosthetic radiolucency was limited and did not lead to implant subsidence or loosening. The most common reoperation was medial gutter debridement.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":"104 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143893221","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":"Unlike Acetabular Anteversion, Femoral Anteversion Is Not Associated with the Hip Coronal Morphotype: An Anatomic Basis for a New Hip Morphotype Classification at Total Hip Arthroplasty.","authors":"Elhadi Sariali,Sena Boukhelifa","doi":"10.2106/jbjs.24.00489","DOIUrl":"https://doi.org/10.2106/jbjs.24.00489","url":null,"abstract":"BACKGROUNDMost femoral stem designs used in total hip arthroplasty (THA) take into account the proximal femoral morphotype in terms of lateralization and neck-shaft angle (NSA) but not version. The objective of this study was to analyze the acetabular anteversion and femoral anteversion (FA) values in a large cohort according to the 3-dimensional (3D) morphotype of the proximal femur. Our hypothesis was that FA is an anatomic parameter independent of the coronal morphotype (varus, neutral, valgus).METHODSA retrospective study based on prospectively collected data included all patients who underwent, from January 2009 to December 2021, a THA planned on the basis of a low-dose computed tomographic (CT) scan 3D. The anatomic acetabular anteversion was calculated in the anterior pelvic plane. The 3D volume models were used to measure the NSA and the FA. We used a multivariable linear regression model to assess the relationship between the NSA and the other hip parameters.RESULTSThe study included 849 consecutive patients (430 women and 419 men), with a mean age of 62 ± 15 years and a mean body mass index of 26.8 ± 5.7 kg/m2. The etiology was primary osteoarthritis in 616 patients, osteonecrosis in 141 patients, and dysplasia in 92 patients. The mean NSA was 129° ± 7°. The femoral morphotype was vara in 112 cases and valga in 105 cases. Acetabular anteversion was significantly lower in the vara group (mean, 21° ± 9°) and higher in the valga group (mean, 26° ± 9°) compared with the neutral group (mean, 24° ± 8°) (p < 0.001). The FA did not vary significantly according to the femoral morphotype (mean, 20° ± 12°; p = 0.3), with no significant association found between the NSA and FA (β = -0.004 [95% confidence interval, -0.5 to 0.05]; p = 0.8).CONCLUSIONSThe FA was not associated with the NSA. A hip morphotype classification combining the NSA and FA is presented for use in guiding preoperative planning in THA. Customized patient-specific stems may be of interest in some morphotypes to accurately restore the hip anatomy.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":"51 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143889280","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}