The Journal of Bone & Joint Surgery最新文献

{"title":"Acing the Base in Adult Spinal Deformity: Commentary on an article by Benjamin Elder, MD, PhD, et al.: \"Placement of Triangular Titanium Implants Suprajacent to Pelvic Fixation Screws Reduces Pelvic Fixation Failure in Multilevel Spinal Fusion Surgery. Results of a Randomized Controlled Trial\".","authors":"Reuben C C Soh","doi":"10.2106/jbjs.26.00263","DOIUrl":"https://doi.org/10.2106/jbjs.26.00263","url":null,"abstract":"","PeriodicalId":22625,"journal":{"name":"The Journal of Bone & Joint Surgery","volume":"72 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148539245","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 Prescribing Caps: Advancing Opioid Stewardship After Total Joint Arthroplasty.","authors":"Ahmed Siddiqi,Paul B Jacob,Andrew Wickline,Khalid Yousuf","doi":"10.2106/jbjs.26.00412","DOIUrl":"https://doi.org/10.2106/jbjs.26.00412","url":null,"abstract":"","PeriodicalId":22625,"journal":{"name":"The Journal of Bone & Joint Surgery","volume":"4 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148539254","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":"Peptide Therapeutics in Orthopaedics: Current Evidence and Future Directions.","authors":"Kenneth L Urish,Samuelson E Osifo,Jonathan D Steckbeck","doi":"10.2106/jbjs.26.00785","DOIUrl":"https://doi.org/10.2106/jbjs.26.00785","url":null,"abstract":"➢ Peptides lack a rigid tertiary structure, allowing them to adopt a variety of conformations, and can be engineered for specific targets. This article examines the design principles underlying orthopaedic peptide applications, from preclinical candidates to clinically validated drugs.➢ The use of peptides in orthopaedics began with naturally occurring agents, such as bone morphogenetic proteins, and has evolved toward rationally engineered synthetics.➢ Teriparatide, a synthetic parathyroid hormone-derived peptide, is used for bone regeneration; PLG0206, a fully engineered antimicrobial peptide, has demonstrated activity against biofilm-forming and multidrug-resistant organisms that conventional antibiotics cannot eradicate, and is advancing through Phase-II and III clinical evaluations.➢ Peptide engineering has produced candidates with potential for cartilage-penetrating, sustained local drug delivery, although no peptide-based disease-modifying osteoarthritis drug has yet achieved clinical validation.➢ Artificial intelligence-driven peptide design is accelerating discovery, but the translation of computationally designed sequences to clinical efficacy remains an active challenge.","PeriodicalId":22625,"journal":{"name":"The Journal of Bone & Joint Surgery","volume":"49 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148539244","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":"Impact of T4-L1-Hip Axis Normalization on Outcomes and Complications in Adult Spinal Deformity.","authors":"Sarthak Mohanty,Zeeshan M Sardar,Justin L Reyes,Fthimnir M Hassan,Michael P Kelly,Josephine R Coury,Elisabeth Geraghty,Nathan J Lee,Justin K Scheer,Steven G Roth,Chun Wai Hung,Ronald A Lehman,Joseph M Lombardi,Lawrence G Lenke","doi":"10.2106/jbjs.25.01263","DOIUrl":"https://doi.org/10.2106/jbjs.25.01263","url":null,"abstract":"BACKGROUNDIn asymptomatic adults, a harmonious T4-L1-hip axis requires a T4-pelvic angle (T4PA) within 4° of the L1-pelvic angle (L1PA). We evaluated whether T4PA-L1PA mismatch is associated with mechanical complications (MCs) and patient-reported outcomes (PROs) after long-segment surgery for adult spinal deformity (ASD).METHODSThis single-center retrospective study involved a cohort of patients with ASD undergoing >6-level posterior spinal fusion (PSF) for spinal deformity. T4PA - L1PA was assessed at 6 weeks and followed for ≥2 years. The primary outcome was MCs (implant-related reoperations, with a particular focus on proximal junctional failure [PJF]) events. Multivariable logistic regression included linear and quadratic terms for T4PA - L1PA, adjusted for the Charlson Comorbidity Index (CCI), preoperative alignment, upper instrumented vertebra (UIV), pelvic fixation, and correction magnitude. Predicted probability curves depicted MC risk across the T4PA - L1PA spectrum. Secondary outcomes were attainment of the minimal clinically important difference (MCID) for the Scoliosis Research Society (SRS)-22r and Oswestry Disability Index (ODI).RESULTSThe study included 427 patients (mean age, 61.16 ± 14.82 years; 285 [66.7%] female; mean of 12.50 ± 4.16 instrumented levels), with 78.7% undergoing pelvic fixation; 66 (15.5%) underwent MC-related reoperations. In multivariable analysis (area under the curve [AUC] = 0.72, p < 0.001), higher CCI (OR = 1.21, p = 0.029), pelvic fixation (OR = 2.78, p = 0.022), and greater (T4PA - L1PA)2 (OR = 1.01, p < 0.001) independently predicted MCs; the modeled risk suggested that both under- and overcorrection increased the risk of MCs. (T4PA - L1PA)2 was not associated with MCID attainment for the PROs.CONCLUSIONSConstruct- and patient-related factors-particularly pelvic fixation-were associated with MCs. T4PA-L1PA deviation conferred additional nonlinear (U-shaped) risk: normalization was associated with fewer MCs, undercorrection was associated with implant-related failure, and overcorrection was associated with proximal junctional complications. Normalization was not associated with PRO improvement or attainment of the MCIDs for the SRS-22r and ODI.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":"297 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148539078","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 Update.","authors":"Michael A Mont,Chase W Smitterberg,Lynne C Jones,Stuart B Goodman,Jay R Lieberman,Javad Parvizi,Edward Y Cheng","doi":"10.2106/jbjs.25.01621","DOIUrl":"https://doi.org/10.2106/jbjs.25.01621","url":null,"abstract":"➢ Nontraumatic osteonecrosis of the femoral head should be suspected in patients who are <50 years of age who have persistent hip pain despite normal radiographs.➢ Bilateral involvement is common; magnetic resonance imaging (MRI) of the contralateral hip is recommended.➢ MRI is the most sensitive modality for detecting early disease.➢ Femoral head sphericity is assessed on anteroposterior, lateral, and 30º view radiographs.➢ Small pre-collapse lesions have the best prognosis. Large lateral lesions and subchondral collapse predict rapid progression.➢ Systemic risk factors and multifocal disease should be actively evaluated.➢ Joint-preserving procedures are most effective before structural collapse.➢ Total hip arthroplasty remains the most reliable treatment after femoral head collapse.","PeriodicalId":22625,"journal":{"name":"The Journal of Bone & Joint Surgery","volume":"11 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148522335","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":"Traumatic Posterior Dislocation Is Associated with Posterior Acromial Morphology.","authors":"Jean-David Werthel,Alexander Vervaecke,Matteo Petit,Omid Jamei-Martel,Christian Gerber","doi":"10.2106/jbjs.26.00036","DOIUrl":"https://doi.org/10.2106/jbjs.26.00036","url":null,"abstract":"BACKGROUNDTraumatic posterior shoulder dislocation is rare, and the role of posterior acromial morphology in acute traumatic posterior dislocation is unknown. We compared posterior acromial morphology in first-time traumatic posterior versus first-time traumatic anterior dislocations.METHODSIn this retrospective comparative cohort study, 34 consecutive patients with a first-time acute traumatic posterior shoulder dislocation were compared with 34 consecutive patients with a first-time acute traumatic anterior shoulder dislocation. The posterior dislocation cohort included 26 males and 8 females, with a mean age of 43.4 ± 16.5 years, and the anterior dislocation cohort included 29 males and 5 females, with a mean age of 41.3 ± 15.4 years. Posterior acromial tilt (PAT), posterior acromial coverage (PAC), posterior acromial height (PAH), and the critical shoulder angle (CSA) were measured on standardized radiographs. Comparisons between the groups were performed, and logistic regression analyses were used to assess associations between acromial morphology parameters and posterior dislocation. Interobserver and intraobserver reliability were assessed using intraclass correlation coefficients.RESULTSCompared with the anterior dislocation group, patients with posterior dislocation demonstrated a significantly higher PAT (65.8° ± 6.7° versus 58.9° ± 8.4°, p < 0.001), lower PAC (55.6° ± 6.6° versus 59.5° ± 8.4°, p = 0.038), greater PAH (27.0 ± 4.2 versus 22.0 ± 6.7 mm, p < 0.001), and smaller CSA (32.9° ± 4.0° versus 35.5° ± 4.1°, p = 0.009). Logistic regression showed that higher PAH and PAT were most strongly associated with posterior dislocation. Measurement reliability was good to excellent for all parameters.CONCLUSIONSAcute traumatic posterior shoulder dislocation is associated with distinct posterior acromial morphology similar to that described in recurrent posterior instability.LEVEL OF EVIDENCEDiagnostic 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":"44 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148521983","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 Precision Medicine Framework to Improve Patient Care Using Orthobiologics.","authors":"Daniel de la Huerta Meza,Purva Singh,Miguel Otero,Jonathan S Kirschner,Scott A Rodeo","doi":"10.2106/jbjs.26.00694","DOIUrl":"https://doi.org/10.2106/jbjs.26.00694","url":null,"abstract":"The lack of consistent responses to treatment is a considerable challenge in the medical field, in part driven by the one-size-fits-all approach traditionally applied to developing and testing therapies. This approach has resulted in treatments that work for some patients but fail to work for others and has led to the development of precision medicine initiatives aiming to refine treatment allocation. This is of particular interest for orthopaedic conditions, for which patient populations are often heterogeneous. The rapid implementation of orthobiologics and their lack of consistent clinical efficacy, for which the heterogeneity and variability stem from both the patients and the treatments, further underline the need to implement precision medicine approaches in orthopaedics. This article will discuss proposed steps, challenges, and opportunities to enable the deployment of a precision medicine framework to improve patient care using orthobiologics.","PeriodicalId":22625,"journal":{"name":"The Journal of Bone & Joint Surgery","volume":"45 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148522336","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":"Full and Half Cup-Cage Reconstruction of Major Acetabular Defects: A Concise Follow-up, at 10 Years, of a Previous Report.","authors":"Galen E Berdis,Mason F Carstens,Dirk R Larson,Kevin I Perry,Michael J Taunton,Nicholas A Bedard,David G Lewallen,Matthew P Abdel","doi":"10.2106/jbjs.26.00065","DOIUrl":"https://doi.org/10.2106/jbjs.26.00065","url":null,"abstract":"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":"49 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148522337","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":"De-Implementation of Routine Radiographs in the Follow-up of Wrist and Ankle Fractures in Dutch Hospitals.","authors":"D A Vuijk,P Krijnen,N J Eggebeen,I B Schipper,L van Bodegom-Vos,M F Termaat, ","doi":"10.2106/jbjs.25.01663","DOIUrl":"https://doi.org/10.2106/jbjs.25.01663","url":null,"abstract":"BACKGROUNDDistal radial fractures (DRFs) and malleolar fractures (MFs) represent almost one-third of Dutch emergency room fractures. The WARRIOR trials showed that routine follow-up radiographs obtained >2 weeks post-injury were unnecessary in most cases and safe to omit. This study evaluated 2 strategies to reduce such imaging: dissemination of WARRIOR evidence and a tailored de-implementation strategy.METHODSThis multicenter retrospective observational study included adults with a DRF (OTA/AO 23A to 23C) or MF (Lauge-Hansen SA 2, SE 2 to 4, PE 1 to 4, or PA 1 to 3) treated at 5 hospitals in the West Netherlands region. Centers 1 and 2 (Level I) were participants in the WARRIOR trials; Centers 3 to 5 (Level II) were not. Exclusion criteria were open, pathological, high-energy, or SA 1 fractures. Three cohorts were compared: historical controls (n = 846; at Centers 1 and 2), after dissemination (n = 337; at Centers 1 to 5), and after de-implementation (n = 314; at Centers 1 to 5). The mean age was 55 years, and 67% were female. The de-implementation strategy included educational sessions, performance feedback, and updated guidelines. The primary outcome was the number of routine follow-up radiographs per patient; secondary outcomes were the number of treatment-phase radiographs, the total number of radiographs, and the proportion of patients without routine follow-up imaging. Operative and nonoperative fractures were analyzed jointly.RESULTSIn Centers 1 and 2, the mean number of routine radiographs per patient decreased by 1.41 (95% confidence interval, 1.10 to 1.72) after dissemination and by a further 0.26 (0.07 to 0.46) after de-implementation for MFs, and decreased by 0.71 (0.49 to 0.94) after dissemination but by only a nonsignificant further 0.09 (-0.08 to 0.26) after de-implementation for DRFs. The probability of no routine follow-up imaging increased by 44.2% (37.1% to 51.3%) after dissemination and by a further 13.2% (3.6% to 22.8%) after de-implementation for MFs, and increased by 41.9% (36.5% to 47.3%) after dissemination but changed by a nonsignificant -3.0% (-10.2% to 4.2%) after de-implementation for DRFs. In Centers 3 to 5, the mean number of routine radiographs per patient decreased after active de-implementation by 0.38 (0.18 to 0.57) for MFs, and by 0.30 (0.16 to 0.43) for DRFs, compared with the number after dissemination. The probability of no routine follow-up imaging increased after de-implementation by 11.4% (4.8% to 18.0%) for MFs, and by 21.9% (13.8% to 30.1%) for DRFs, compared with the rate after dissemination.CONCLUSIONSBoth research dissemination and a tailored de-implementation strategy substantially reduced routine follow-up radiographs for DRFs and MFs, supporting their use to decrease low-value radiographs in trauma care.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":"52 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148522338","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":"Placement of Triangular Titanium Implants Suprajacent to Pelvic Fixation Screws Reduces Pelvic Fixation Failure in Multilevel Spinal Fusion: Results of a Randomized Controlled Trial.","authors":"Benjamin D Elder,Gregory Mundis,Robert Eastlack,Paolo Arrigoni,Joerg Franke,Robert Lee,David Polly, ","doi":"10.2106/jbjs.25.01415","DOIUrl":"https://doi.org/10.2106/jbjs.25.01415","url":null,"abstract":"BACKGROUNDThe purpose of this study was to determine whether placement of triangular titanium implants (TTI) suprajacent to S2-alar-iliac (S2AI) pelvic fixation screws during multilevel spinal fusion surgery for adult spine deformity reduces pelvic fixation failures.METHODSThis prospective, multicenter, international, partially blinded randomized clinical trial included 222 patients scheduled for multilevel spinal fusion surgery with S2AI-based pelvic fixation. In the S2AI+TTI group, the mean age was 64.9 years, 54.1% were female, 3.7% were Hispanic, 5.5% were African American, and 1.8% were Asian. In the S2AI-alone group, the mean age was 64.8 years, 58.4% were female, 3.5% were Hispanic, 7.1% were African American, and 0.9% were Asian. Subjects were randomized to pelvic fixation using S2AI screws alone versus S2AI+TTI. Scheduled follow-up included a 24-month full-spine radiograph and a high-resolution computed tomography (CT) scan, which was independently interpreted.RESULTSThe primary composite radiographic end point (S2AI screw breakage, lucency, or pullout, or posterior spinal rod breakage distal to S1) occurred less frequently in the S2AI+TTI group than in the S2AI-alone group (11.0% versus 20.4%, p = 0.0415). Except for rod-screw dissociation and rod fracture distal to S1, all components of the primary composite end point occurred less frequently in the S2AI+TTI group. TTI placement did not affect sagittal or coronal spinal alignment parameters. The rate of rod fracture throughout the spinal construct was slightly higher in the S2AI+TTI group (9.2% versus 5.3%) but the difference was not significant (p = 0.197).CONCLUSIONSPlacement of TTI suprajacent to S2AI screws reduced the rate of pelvic fixation failure in patients undergoing multilevel spinal fusion with pelvic fixation.LEVEL OF EVIDENCETherapeutic Level I . See Instructions for Authors for a complete description of levels of evidence.","PeriodicalId":22625,"journal":{"name":"The Journal of Bone & Joint Surgery","volume":"118 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148462402","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}