The Journal of Bone & Joint Surgery最新文献

{"title":"Primary Total Knee Arthroplasty in Patients with BMI of ≥50 kg/m2: A Cohort Study with Long-Term Follow-up.","authors":"Christiaan H Righolt,Maxwell Luke Armstrong,Thomas R Turgeon,Eric R Bohm,Jhase Sniderman","doi":"10.2106/jbjs.24.01060","DOIUrl":"https://doi.org/10.2106/jbjs.24.01060","url":null,"abstract":"BACKGROUNDThe obesity epidemic has given rise to an orthopaedic patient subgroup with a body mass index (BMI) of ≥50 kg/m2. Without sound evidential guidance, arthroplasty surgeons and anesthesiologists do not know whether they can push the limits of the surgical feasibility of total knee arthroplasty (TKA) without risks of harm.METHODSIn a retrospective cohort study of patients who had undergone primary TKA for degenerative arthritis at our academic center (n = 10,389; 6,821 women, 4,070 men, and 38 unknown), we compared the outcomes between patients with a BMI of ≥50 kg/m2 (n = 627) and patients in other weight classes. The average patient follow-up was 8.6 years. We used Cox proportional hazards models to estimate the association between BMI and revision risk, using overweight patients (BMI = 25 to 29.99 kg/m2) as the reference group while adjusting for patient age and sex. Patient satisfaction, pain scores on a visual analogue scale (VAS), and the Oxford Knee Score (OKS) were compared among groups preoperatively and at 1, 5, and 10 years postoperatively.RESULTSIn the first year after surgery, the adjusted hazard ratio (HR) for revision TKA for patients with a BMI of ≥50 kg/m2 was 3.7 (95% confidence interval [CI] = 1.9 to 7.2), with overweight patients as the reference. There was virtually no difference between patients with a BMI of 35 to 39.99 kg/m2 and those with a BMI of 40 to 49.99 kg/m2. After the first year, the HR was 1.2 (95% CI = 0.7 to 2.4) for revision TKA for patients with a BMI of ≥50 kg/m2. Those patients reported worse preoperative function of the knee, with a median OKS of 15 versus 23 for overweight patients. For obese patients, each additional unit of BMI corresponded with an additional OKS improvement of 0.07 point (95% CI = 0.04 to 0.10) at 1 year.CONCLUSIONSOur study confirms the increased risk of failure of TKA in patients with a BMI of ≥50 kg/m2 in the first year after surgery, but we found no evidence of worse outcomes in the 40 to 49.99 kg/m2 group compared with the 35 to 39.99 kg/m2 group. The increase in the revision risk in the ≥50 kg/m2 group was found only in the first postoperative year and plateaued afterwards. Despite worse function and higher failure rates, patients with a BMI of ≥50 kg/m2 reported benefits and high satisfaction with TKA.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":"46 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144130707","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":"Acute Interpositional Fat Autograft Does Not Protect Against Bar Formation in Physeal Fractures.","authors":"Mikhail S Tretiakov,Christine L Farnsworth,Garrett E Rupp,Kelly E Gordon,Kortney A Ponce,David B Berry,Suzanne M Tucker,Eric W Edmonds","doi":"10.2106/jbjs.24.01261","DOIUrl":"https://doi.org/10.2106/jbjs.24.01261","url":null,"abstract":"BACKGROUNDLong-bone fractures in children can lead to premature physeal bar formation and growth disturbance. Bar excision has been studied, but data on prophylactic tissue interposition into physeal fractures are limited. This study used an established animal model to evaluate acute placement of fat autograft. The number of animals was selected to give 80% power on the basis of pilot data on induction of radiographic bars in physeal fractures.METHODSProximal tibial fractures were created in 30 rabbits by placing pins in the epiphysis and levering the distal tibia, propagating the fracture through the physis. Twenty fracture sites had interposed fat autograft (fat group), and 10 did not (fracture group). The 30 untreated contralateral limbs were the control group. Radiographs were assessed preoperatively and immediately, 10 days, and 6 weeks following fracture. Radiographic measurements were compared using repeated-measures analysis of variance. Micro-computed tomography (microCT) 3D reconstructions and histologic analysis further characterized the healing and control tibial physes.RESULTSFat and fracture groups were similar (age, weight, body length, surgical duration, and weight and body length increases over 6 weeks). No difference was observed in the probability of radiographic bar formation between the fat (12 of 20) and fracture (7 of 10) groups (p = 0.702). On the basis of the medial-lateral side difference, fat (0.66 ± 1.64 mm) and fracture (0.53 ± 1.36 mm) groups demonstrated increased valgus growth compared with controls (-0.74 ± 1.16 mm) (p = 0.002 and p = 0.04). Six weeks following fracture, tibial length was less in the fat group compared with the control group (fat: 101.4 ± 3.1 mm, control: 103.7 ± 2.6 mm, p = 0.02). MicroCT 3D reconstructions demonstrated no difference in bone bridging between fat and fracture groups, and the fat group having more bone bridging than controls (83 ± 102 versus 11 ± 49, p = 0.004). Histologic analysis showed disorganized tissue without evidence of physeal cartilage preservation for most limbs in both treatment groups.CONCLUSIONSFat autograft interposition did not reliably prevent radiographic bar formation or angular deformity when placed during physeal fracture reduction. 3D reconstructions and histology indicated that the fat was converted to bone just as readily as if a disrupted physis had no interposition, yet with a reduction in the surface area of bone bar formation that did not reach significance.CLINICAL RELEVANCEGiven these findings, we do not necessarily advocate for acute prophylactic fat interposition into physeal fractures for bar prevention in pediatric fractures.","PeriodicalId":22625,"journal":{"name":"The Journal of Bone & Joint Surgery","volume":"59 3 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144122087","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 Photovoice Study on Life After Traumatic Brachial Plexus Injury: \"There Is Somebody Out There Who Knows What You're Going Through\".","authors":"Amanda M Faust,Katherine M Gerull,Jean Hunleth,David M Brogan,Christopher J Dy","doi":"10.2106/jbjs.24.01349","DOIUrl":"https://doi.org/10.2106/jbjs.24.01349","url":null,"abstract":"BACKGROUNDBrachial plexus injury (BPI) leads to a variety of life-altering changes, both physically and mentally. While tremendous effort has been dedicated to improving patients' upper-extremity function through surgical and rehabilitation advances, patients' life experiences after BPI are largely understudied and poorly understood. Our study aims were to qualitatively assess the patient experience after BPI through the use of a photojournalism method known as photovoice, a community-based participatory research methodology centered on participant photograph-taking, and to trial the use of photovoice as a novel qualitative method within the field of orthopaedics.METHODSWe utilized both photovoice and qualitative methods to highlight the experiences of 7 participants living with a traumatic BPI (5 male and 1 female, 4 White and 2 Black, plus 1 not stated). The study was conducted in 6 phases with a mix of 1-on-1 and focus group discussions. Over the course of 10 weeks, the group met to generate photography prompts, analyze photographs (in 1-on-1 meetings with researchers), and discuss the meaning of photographs as a group. The research team analyzed transcripts from all 1-on-1 and group discussions to create 2 editions of e-magazines, which included quotes from transcribed data layered with photographs from each participant, to serve as patient-facing support materials for future patients with BPI. In the final phase, the research team shared the e-magazines with the participants in a group discussion.RESULTSThe participant-selected topics highlighted in the e-magazines ranged from pain after injury to tips and tricks for living with BPI. Photovoice was effective in building community among patients with BPI and creating meaningful patient-facing support materials. Our findings demonstrate the utility of using participant-generated photography as a tool to encourage meaningful conversation and develop community among participants.CONCLUSIONSParticipant-led methodologies, such as photovoice, provide opportunities for patients to convey their life experiences to their community and to their health-care providers in a unique way. Our study also demonstrates the potential for photovoice to improve the patient experience by generating a sense of community, allowing patients to express themselves, and inspiring others.","PeriodicalId":22625,"journal":{"name":"The Journal of Bone & Joint Surgery","volume":"31 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144122131","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":"Litigation Patterns of Acute Compartment Syndrome: Distinctions Between Orthopaedic and Non-Orthopaedic Cases and Factors Predicting Successful Defense.","authors":"Haad A Arif,Jose A Morales,Emmanuel Brito,Simon T Moore,Carol A Lin","doi":"10.2106/jbjs.24.01213","DOIUrl":"https://doi.org/10.2106/jbjs.24.01213","url":null,"abstract":"BACKGROUNDAcute compartment syndrome (ACS) is a medical emergency and a cause of medical litigation across multiple specialties. We sought to compare the characteristics and outcomes of ACS-related litigation levied against surgeons in orthopaedics compared with other specialties.METHODSThe Westlaw database was queried for ACS-related cases filed within the United States between 1980 and 2023 using the search term \"compartment syndrome.\" Inclusion criteria were defined as all jury verdicts or settlements tied to alleged medical malpractice concerning ACS of the spine and extremities. ACS cases of the abdomen were excluded.RESULTSOf 755 cases, 358 cases met inclusion criteria, 150 (42%) of which listed an orthopaedic surgeon as a defendant. A defendant verdict was reached in 203 cases (57%), a plaintiff verdict was reached in 88 cases (25%), and 67 cases (19%) were settled. The mean payout in orthopaedic cases was $3,219,519. Compared with non-orthopaedic practitioners, orthopaedic surgeons were significantly more likely to be named in cases in which ACS was due to surgery or fracture (both, p < 0.001) and in which the basis of litigation was alleged improper cast or splint application (p < 0.001). Orthopaedic surgeons were significantly less likely to be named in ACS cases when the basis of litigation was alleged negligent medication administration (p < 0.001). Only 3 cases (0.8%) mentioned documentation of compartment checks and intracompartmental pressures, and no cases were levied because of unnecessary fasciotomy. Two cases described the use of postoperative regional anesthesia for pain control.CONCLUSIONSACS-related litigation is associated with a considerable financial burden in the wake of substantial morbidity and mortality. Lawsuits against orthopaedic surgeons more commonly involve fractures and cast or splint application, whereas those against non-orthopaedists more commonly involve medication or fluid infiltration. Documentation of close monitoring for symptoms specifically related to ACS and intracompartmental pressure measures may be a valid method to mitigate associated medicolegal risk. Prophylactic fasciotomies have not historically been a source of litigation.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":"57 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144122130","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 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}