The Journal of Bone & Joint Surgery最新文献

{"title":"Home Call and Sleep in Orthopaedic Surgeons: A Prospective, Longitudinal Study of the Effect of Home Call on Sleep in Orthopaedic Attending Surgeons and Residents.","authors":"Michelle M Lawson,Karalynn Lancaster,Colin Lipps,Gerard Slobogean,Jacqueline M Brady,Nathan O'Hara,Zachary M Working","doi":"10.2106/jbjs.24.01411","DOIUrl":"https://doi.org/10.2106/jbjs.24.01411","url":null,"abstract":"BACKGROUNDThe effect of home call on the sleep of orthopaedic residents and attending surgeons remains unquantified, despite known negative impacts of poor sleep on cognition, fine motor skills, and decision-making. We prospectively measured the impact of home call on orthopaedic surgery residents' and attending surgeons' sleep patterns (total sleep, slow-wave sleep [SWS], and rapid eye movement [REM] sleep), as well as on heart rate variability (HRV). We hypothesized that orthopaedic home call would negatively impact all phases of sleep and suppress post-call HRV.METHODSSixteen orthopaedic attending surgeons and 14 orthopaedic surgery residents taking home call at multiple Level-I trauma centers in a single program wore WHOOP 3.0 Straps. The WHOOP Strap objectively measures and quantifies total sleep, SWS, and REM sleep. Over a 13-month period, home call nights were prospectively recorded and matched with physiological data to compare on-call, post-call night 1 (PCN 1), and PCN 2 metrics. Fixed-effects regression models were used for statistical analysis.RESULTSOver 13 months, we observed 4,574 recorded nights of residents' sleep and 3,573 recorded nights of attending surgeons' sleep. The mean baseline (non-call night) sleep parameters were highly varied among individuals. Overall, the mean sleep time was significantly shorter (p < 0.001) for attending surgeons (6.0 hours) than for residents (6.7 hours). When on home call, residents' total sleep decreased by 20% from baseline (p < 0.001), REM sleep decreased by 12% (p < 0.001), and SWS decreased by 12% (p < 0.001). For attending surgeons, total sleep on call decreased by 10% from baseline (p < 0.001), REM sleep decreased by 7% (p < 0.001), and SWS decreased by 4% (p < 0.01).CONCLUSIONSOrthopaedic surgery residents and attending surgeons exhibited low baseline sleep, and taking home call reduced this further. This suggests that there is a previously unmeasured toll of home call on orthopaedic surgeons, upon which further research is required to ensure excellent patient care, maximize educational environments, and develop strategies for resilience.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":"24 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144930110","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":"Wearables and Other Innovative Technologies and Applications Are Tools, Rather Than a Strategy, To Improve Patient Care and Clinical Outcomes: Commentary on an article by Dane J. Brodke, MD, MPH, et al.: \"The Future Is Mobile: Pilot Validation Study of Apple Health Metrics in Orthopaedic Trauma\".","authors":"David N Bernstein","doi":"10.2106/jbjs.25.00526","DOIUrl":"https://doi.org/10.2106/jbjs.25.00526","url":null,"abstract":"","PeriodicalId":22625,"journal":{"name":"The Journal of Bone & Joint Surgery","volume":"15 1","pages":"e80"},"PeriodicalIF":0.0,"publicationDate":"2025-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144930112","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":"Navigating Total Knee Arthroplasty After Myocardial Infarction: Commentary on an article by Alejandro M. Holle, BS, et al.: \"Myocardial Infarction Prior to TKA Is Associated with Increased Risk of Medical and Surgical Complications in a Time-Dependent Manner\".","authors":"Mohamad J Halawi","doi":"10.2106/jbjs.25.00583","DOIUrl":"https://doi.org/10.2106/jbjs.25.00583","url":null,"abstract":"","PeriodicalId":22625,"journal":{"name":"The Journal of Bone & Joint Surgery","volume":"28 1","pages":"e79"},"PeriodicalIF":0.0,"publicationDate":"2025-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144930113","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":"Blurred Lines but Clear Manuscripts: AI-Based Support Is Inevitable and Possibly Preferable: Commentary on an article by Tucker Callanan, MD, et al.: \"Evaluating Artificial Intelligence-Based Writing Assistance Among Published Orthopaedic Studies. Detection and Trends for Future Interpretation\".","authors":"Prem N Ramkumar","doi":"10.2106/jbjs.24.01633","DOIUrl":"https://doi.org/10.2106/jbjs.24.01633","url":null,"abstract":"","PeriodicalId":22625,"journal":{"name":"The Journal of Bone & Joint Surgery","volume":"113 1","pages":"e81"},"PeriodicalIF":0.0,"publicationDate":"2025-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144930111","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":"Erratum: Radiographic Outcome Following Treatment of Residual Hip Dysplasia with Pemberton Versus Salter Osteotomy.","authors":"Daniel J Sucato,Case E Brabham,Adriana De La Rocha,David A Podeszwa,Lori A Karol","doi":"10.2106/jbjs.er.23.01346","DOIUrl":"https://doi.org/10.2106/jbjs.er.23.01346","url":null,"abstract":"","PeriodicalId":22625,"journal":{"name":"The Journal of Bone & Joint Surgery","volume":"12 1","pages":"e82"},"PeriodicalIF":0.0,"publicationDate":"2025-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144930114","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":"Effective Communication Strategies to Address Excessive Waste and Overconsumption in the Orthopaedic Operating Room.","authors":"Laura L Bellaire,Isabelle Freiling","doi":"10.2106/jbjs.25.00164","DOIUrl":"https://doi.org/10.2106/jbjs.25.00164","url":null,"abstract":"","PeriodicalId":22625,"journal":{"name":"The Journal of Bone & Joint Surgery","volume":"12 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144851016","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 Childhood Obesity on Capital Femoral Epiphysis Morphology: A Large-Scale, Automated 3D-CT Study and Potential Implications for SCFE Pathogenesis.","authors":"Eduardo N Novais,Mohammadreza Movahhedi,Pratik Pradhan,Nazgol Tavabi,Mallika Singh,Shanika De Silva,Sarah Bixby,Ata M Kiapour","doi":"10.2106/jbjs.24.01472","DOIUrl":"https://doi.org/10.2106/jbjs.24.01472","url":null,"abstract":"BACKGROUNDThe precise pathological mechanisms through which obesity increases the risk of slipped capital femoral epiphysis (SCFE) remain unclear. We aimed to investigate the impact of childhood obesity on the morphology of the capital femoral epiphysis in children and adolescents without hip disorders.METHODSWe performed a retrospective cross-sectional study that included 4,888 children and adolescents 7 to 19 years of age who underwent a hip or pelvic computed tomography (CT) scan, most for abdominal pain, between 2004 and 2022. Automated 3D-CT analysis assessed epiphyseal tubercle height, superior and anterior peripheral cupping, and epiphyseal tilt. Generalized additive models (GAMs) were used to examine the associations between epiphyseal morphology and age, stratified by obesity status, while adjusting for sex.RESULTSWe observed distinct age-related trajectories of femoral-head morphology related to obesity. Subjects with obesity demonstrated a larger femoral-head diameter from ages 7 to 15 years (obese versus normal-weight differences: 0.3 to 2.3 mm), smaller epiphyseal tubercle height after 9 years of age (normal-weight versus obese differences: 0.4% to 1.3%), and a more posteriorly tilted epiphysis, as assessed by a smaller axial tilt angle (normal-weight versus obese differences: 4° to 1°) from ages 7 to 15 years. In subjects with obesity, the superior epiphyseal cupping was larger before 11 years of age (obese versus normal-weight differences: 1.6% to 0.4%), but after 13 years of age, the superior epiphyseal cupping was smaller (normal-weight versus obese differences: 0.2% to 2%).CONCLUSIONSChildren with obesity demonstrated a smaller epiphyseal tubercle height, greater posterior epiphyseal tilt, and reduced superior cupping compared with children of normal weight. These anatomical differences may contribute to the increased risk of SCFE in patients with obesity and offer potential imaging markers for earlier identification and risk-stratification.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":"27 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144851012","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":"Conversion of Fused Knees to Total Knee Arthroplasty: The 21 to 31-Year Clinical Results and Patient Satisfaction.","authors":"Young-Hoo Kim,Jang-Won Park,Young-Soo Jang,Eun-Jung Kim","doi":"10.2106/jbjs.25.00149","DOIUrl":"https://doi.org/10.2106/jbjs.25.00149","url":null,"abstract":"BACKGROUNDThere are limited long-term data on the results of conversion of a surgically or spontaneously fused knee to a total knee arthroplasty (TKA) in the literature. The purpose of this study was to determine the long-term (minimum, 21-year) results of TKA in a fused knee.METHODSWe reviewed the results of 95 TKAs in the fused knees of 93 patients (mean age, 41.9 ± 9.4 years; range, 23 to 62 years) using a TKA system. The mean follow-up was 25.1 years (range, 21 to 31 years).RESULTSThe mean Knee Society score was 88 points (range, 56 to 96 points) at the final follow-up. The mean range of motion was 76.4° (range, 0° to 105°). Nine knees (9%) required revision for aseptic loosening of TKA components. One knee (1%) was revised for pyogenic infection, and another knee was revised for recurrent tuberculous infection. Approximately 80% of patients were satisfied with the TKA. Approximately 67% of patients reported that their quality of life improved greatly after TKA. Kaplan-Meier survivorship, with revision for failure as the end point, was 88.4% (95% confidence interval, 83% to 97%) at 25.1 years postoperatively.CONCLUSIONSConversion of a fused knee to TKA resulted in good long-term fixation and high satisfaction.LEVEL OF EVIDENCETherapeutic 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":"54 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144851013","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 Extra-Articular Subtalar Arthrodesis for Valgus Deformity of the Hindfoot in Patients with Cerebral Palsy: A Radiographic and Pedobarographic Study.","authors":"Byoung Kyu Park,Sharkawy Wagih Abdel-Baki,Isaac Rhee,Kun-Bo Park,Hoon Park,Kyeong-Hyeon Park,Hyun Woo Kim","doi":"10.2106/jbjs.24.01611","DOIUrl":"https://doi.org/10.2106/jbjs.24.01611","url":null,"abstract":"BACKGROUNDExtra-articular subtalar arthrodesis generally has been recommended for treating severe valgus deformities of the hindfoot in patients with cerebral palsy (CP). However, it is unknown whether restricted subtalar joint motion affects the shape of the foot during continued growth in children. The purpose of the present study was to evaluate the effectiveness and longevity of extra-articular subtalar arthrodesis in ambulatory patients with spastic CP, with a specific focus on its impact on the final foot shape and plantar pressure distribution.METHODSThe present retrospective study included 99 feet in 60 children with a mean age (and standard deviation) of 7.6 ± 2.1 years at the time of surgery and 16.6 ± 4.7 years at the latest follow-up. Radiographic changes were analyzed both during the early postoperative period and at extended follow-up. At the latest follow-up, the feet were classified into 3 categories (hindfoot valgus, neutral, or varus) on the basis of the valgus/varus index obtained from dynamic pedobarographs.RESULTSAll radiographic parameters improved at 6 months after surgery. However, at the latest follow-up, all measurements except for the lateral talocalcaneal angle indicated overcorrection of the hindfoot valgus deformity. The overall valgus/varus index decreased from 0.54 ± 0.25 before surgery to -0.29 ± 0.35 at the latest follow-up. Five feet (5.1%) were classified as hindfoot valgus, 41 feet (41.4%) as neutral, and 53 feet (53.5%) as varus. Patients with hindfoot varus were younger at the time of surgery, and a lower anteroposterior talus-first metatarsal angle at 6 months after surgery was found to be the only significant radiographic predictor of the development of hindfoot varus. Revision procedures were performed on 22 feet (41.5%) in the varus group.CONCLUSIONSExtra-articular subtalar arthrodesis is associated with a high risk of progressive hindfoot varus deformity in patients with CP. Our findings highlight the need to reevaluate traditional surgical indications for correcting hindfoot valgus deformity, which have largely been based on the severity of the deformity observed on radiographs. Decision-making also should account for growth-related changes associated with restricted subtalar motion and the intraoperative position of the hindfoot and forefoot.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":"14 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144851239","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":"Behavioral Intervention to Foster Healthy Lifestyle Physical Activity After Complex Lumbar Surgery: A Randomized Controlled Trial.","authors":"Carol A Mancuso,Roland Duculan,Manuela C Lafage,Frank P Cammisa,Andrew A Sama,Alexander P Hughes,Darren R Lebl,Federico P Girardi","doi":"10.2106/jbjs.24.01180","DOIUrl":"https://doi.org/10.2106/jbjs.24.01180","url":null,"abstract":"BACKGROUNDPersistent sedentary lifestyles are prevalent after complex lumbar surgery. Inactivity often is due to habit, is not necessary, and results in both adverse general health and adverse spine health. We tested a multicomponent behavioral intervention administered in surgical practices to increase lifestyle walking after recuperation from surgery involving ≥3 lumbar levels or fusion. This analysis reports the main objective of measuring change in physical activity; subsequent analysis will address the additional objective of measuring change in disability due to lumbar pain.METHODSAt 3 months postoperatively, patients were interviewed in person, completed the self-reported Paffenbarger Physical Activity and Exercise Index measuring energy expenditure in kcal/week from walking and total activity, and were randomized to the control or a behavioral intervention. Patients in the intervention group made a contract to increase walking and received a pedometer and information about activity benefits, followed by telephone contacts over 1 year to reinforce the intervention and assess activity change. Controls received only information about activity benefits and fewer telephone contacts to assess activity change. The primary outcome was the difference in within-patient change in kcal/week from walking (as measured by the Paffenbarger Index) from enrollment to 4 months later. Additional assessments and outcomes included changes in the total Paffenbarger Index from enrollment to 4 and 12 months and changes in the walking domain to 12 months.RESULTSAmong 250 patients (mean age, 63 years; 53% men; 96% White patients and 6% Latino patients), 123 received the intervention and 127 were controls. The mean energy expenditure from walking increased from enrollment to 4 months for patients in the intervention group (1,437 to 2,582 kcal/week; p &lt; 0.0001) and for controls (1,320 to 1,870 kcal/week; p &lt; 0.0001), with a greater difference for the intervention group (1,165 compared with 600 kcal/week; p = 0.03). At 12 months, the effectiveness of the intervention was sustained (estimated effect, 588 kcal/week [95% confidence interval (CI), 119 to 1,056 kcal/week]; p = 0.01) when accounting for new events that potentially affect activity, such as another lumbar surgery (estimate, -1,396 kcal/week [95% CI, -2,116 to -676 kcal/week]; p = 0.0002) and new arthroplasty or foot or ankle surgery (estimate, -701 kcal/week [95% CI, -1,212 to -189 kcal/week]; p = 0.007). Similar results were obtained for changes in total activity. Retention in this study was 92%; 72% of all patients reported that being in the study did not affect spine symptoms, and 28% reported that being in the study made symptoms better. No adverse events were associated with the trial.CONCLUSIONSA behavioral intervention was effective in increasing lifestyle walking after recuperation from complex lumbar surgery. These findings support integrating counseling about physical activity into routine postopera","PeriodicalId":22625,"journal":{"name":"The Journal of Bone & Joint Surgery","volume":"174 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144802505","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}