The Journal of Bone & Joint Surgery最新文献

{"title":"Effectiveness of a Structured Training Program in Pediatric Distal Radial Fracture Reduction for Orthopaedic Advanced Practice Providers.","authors":"Ambika Nair,Beverly Teti,Caroline Fay,Margaret A Bowen,Alexandra M Olson,Sulagna Sarkar,Akbar N Syed,John Todd R Lawrence","doi":"10.2106/jbjs.25.01466","DOIUrl":"https://doi.org/10.2106/jbjs.25.01466","url":null,"abstract":"BACKGROUNDTraining programs to prepare novice advanced practice providers (APPs) to reduce fractures have not been described or evaluated. The current study evaluated the effectiveness of a structured training program for APPs to deliver effective fracture care independently in emergency department settings.METHODSWe performed a retrospective review of the first 5 independent distal radial fracture reductions performed by each participant. Radiographic measurements and information regarding patient injury, loss of reduction, and the need for surgery due to failure of closed management were collected. Patients were treated by (1) APPs with structured training (APP group), (2) traditionally trained postgraduate year (PGY)-2 residents (TR2), (3) PGY-2 residents with additional simulation training (SR2), and (4) experienced PGY-4 residents (TR4).RESULTSWe identified 136 patients: 28 treated by the APP group; 24, by TR2s; 52, by SR2s; and 32, by TR4s. Significant differences were seen in post-reduction angulation and percent contact, with the APPs and TR4s achieving better initial reductions as indicated by the least residual angulation and greatest percent contact (all p < 0.05). At the time of follow-up, reductions by the APP group had more favorable outcomes, compared with those performed by residents, with respect to angulation on lateral radiographs (p = 0.047) and percent contact on anteroposterior (p = 0.036) and lateral (p = 0.004) radiographs. Reductions performed by the APP group also showed lower rates of loss of reduction (p < 0.001) and subsequent surgery (p = 0.005).CONCLUSIONSAPPs receiving structured training prior to independent care delivery achieved better reductions overall, placed better casts, and had lower rates of loss of reduction and subsequent surgery compared with junior orthopaedic residents.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":"62 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148415874","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 Century of Orthopaedic Excellence with Global Impact: Instituto de Ortopedia y Traumatología \"Carlos E. Ottolenghi\" at Hospital Italiano de Buenos Aires.","authors":"Martin Buttaro,Maximiliano Ranalletta,Pablo A Slullitel,Luciano A Rossi,Luis A Aponte,Miguel Á Ayerza,German Farfalli,Nicolás S Piuzzi,D Luis Muscolo","doi":"10.2106/jbjs.26.00554","DOIUrl":"https://doi.org/10.2106/jbjs.26.00554","url":null,"abstract":"➢ Argentine orthopaedics was shaped by the influence of Dr. Vittorio Putti (Rizzoli Institute, Bologna, Italy). Dr. Carlos E. Ottolenghi, one of Dr. Putti's most distinguished disciples, together with Dr. José Valls, founded the Instituto de Ortopedia y Traumatología at Hospital Italiano de Buenos Aires in 1926. Prof. Ottolenghi transformed the Orthopaedic Service into a leading academic center and pioneer of subspecialization, serving as a foundational driver of orthopaedic development in Argentina and Latin America, while establishing strong international academic connections and collaborations.➢ Major milestones include the establishment of one of the earliest institutional bone banks and the performance of one of the world's first reported massive bone allograft reconstructions (1948); the performance of the first Charnley total hip replacement in the Americas (1967) and the first total knee replacement in Argentina (1970); and the early adoption of intramedullary nailing (1972), knee arthroscopy (1976), and femoral bone impaction allografting (1987). These contributions helped to define modern orthopaedic practice across Latin America and influenced global reconstructive strategies.➢ Advances such as surgical navigation (2010) and augmented reality (2025) have strengthened its role as a regional and globally connected center of excellence, particularly in musculoskeletal oncology.➢ Over the past 25 years, 180 residents and 160 fellows have been trained in our institute, and more than 500 indexed publications have been produced in the last 10 years, with alumni holding leadership roles across major orthopaedic centers worldwide, amplifying our institute's global footprint.➢ A merit-based, highly selective system based on excellence determines who becomes a staff surgeon. Currently, 85% of the actual staff surgeons completed residency training in our department, fostering a unique sense of institutional identity and perceived belonging. This experience reinforces the concept that excellence in orthopaedics transcends geographic boundaries and can emerge as a global reference from any setting committed to innovation, mentorship, and academic rigor.","PeriodicalId":22625,"journal":{"name":"The Journal of Bone & Joint Surgery","volume":"31 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148415872","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":"Intraoperative Surgical Smoke During Arthroplasty: Early Unhealthy-Level Exposure and Approach-Dependent Risk.","authors":"Ryuto Tsuchiya,Ryo Suzuki,Sei Yano,Sumio Ikenoue,Masaya Mimura,Hiroaki Sameda,Yukio Someya,Takeru Ohara,Seiji Ohtori","doi":"10.2106/jbjs.25.01585","DOIUrl":"https://doi.org/10.2106/jbjs.25.01585","url":null,"abstract":"BACKGROUNDSurgical smoke is a gaseous intraoperative byproduct that contains numerous toxic compounds, including fine particles with a diameter of ≤2.5 µm (PM2.5). However, intraoperative exposure during joint arthroplasty has not been well characterized. In this study, we aimed to quantify PM2.5 exposure during arthroplasty and to determine, by procedure and approach, how often it reached potentially harmful levels.METHODSWe conducted a single-center prospective study of 83 primary arthroplasties (20 bipolar hemiarthroplasties [BHAs] via a direct lateral approach, 35 total hip arthroplasties [THAs] via a direct anterior approach, and 28 total knee arthroplasties [TKAs]). Intraoperative PM2.5 concentrations were measured using a portable monitor and were mapped to Air Quality Index (AQI) categories. Summary metrics, including maximum and cumulative PM2.5 exposure, were calculated by procedure. Logistic regression was used to estimate odds ratios (ORs) for exceeding AQI thresholds.RESULTSIn BHA and TKA, PM2.5 concentrations increased sharply during field development, whereas they remained low throughout THA. The median maximum PM2.5 concentrations were 129.50 µg/m3 (interquartile range [IQR], 85.44 to 275.28 µg/m3) for BHA, 6.14 µg/m3 (IQR, 2.54 to 23.94 µg/m3) for THA, and 118.80 µg/m3 (IQR, 56.23 to 208.04 µg/m3) for TKA. The concentrations were significantly higher in BHA and TKA (both adjusted p < 0.001) than in THA. At 25% of the normalized surgical time, 80% of BHA cases and 71% of TKA cases reached an AQI of Unhealthy or worse, whereas most THA cases remained within the Good or Moderate categories. The adjusted ORs for reaching an AQI of Unhealthy or worse were 34.280 (95% confidence interval [CI], 7.479 to 215.044; p < 0.001) for BHA and 21.971 (95% CI, 6.011 to 101.814; p < 0.001) for TKA compared with THA.CONCLUSIONSBHA via a direct lateral approach and TKA generated substantially higher intraoperative PM2.5 concentrations than THA via a direct anterior approach, and many cases reached an AQI of Unhealthy or worse. Procedure and approach are not readily modifiable determinants of surgical smoke exposure, underscoring the need for comprehensive control strategies, including smoke evacuation and high-efficiency masks, in arthroplasty practice.CLINICAL RELEVANCEOperating room teams may be exposed to potentially harmful levels of surgical smoke during arthroplasty. Understanding the characteristics of this exposure may help to guide strategies to optimize the operating room environment.","PeriodicalId":22625,"journal":{"name":"The Journal of Bone & Joint Surgery","volume":"22 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-07-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148393725","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":"Timing of Vascular Endothelial Growth Factor Inhibitor Reinitiation and Risk of Wound Complications in Spinal Metastasis Surgery.","authors":"Chih-Chi Su,Yu-Ting Pan,Yen-Po Lin,Chin-Cheng Chou,Hung-Kuan Yen,Hsing-Chen Tsai,Hsiang-Chieh Hsieh,Wei-Hsin Lin,Ming-Hsiao Hu,Olivier Q Groot","doi":"10.2106/jbjs.26.00030","DOIUrl":"https://doi.org/10.2106/jbjs.26.00030","url":null,"abstract":"BACKGROUNDVascular endothelial growth factor inhibitors (VEGFi) are widely used for metastatic cancer management but are known to impair wound-healing. In spinal metastasis surgery, postoperative wound complications remain a clinical challenge, and the perioperative management of systemic antineoplastic therapies remains poorly defined. Current recommendations regarding postoperative VEGFi reinitiation are largely consensus-based and range from 28 to 40 days. The aims of this study were to evaluate the association between perioperative antineoplastic therapies and wound complications and to define the optimal timing of postoperative VEGFi reinitiation.METHODSThis retrospective cohort study included 1,164 Taiwanese patients (684 male and 480 female; median age, 60.7 years [interquartile range, 51.5 to 68.8 years]) who underwent spinal metastasis surgery at a single tertiary center between 2010 and 2022. The outcome was postoperative wound complications within 90 days. Multivariable logistic regression was used to identify independent risk factors. The association between the timing of postoperative VEGFi reinitiation and wound complications was assessed using receiver operating characteristic curve analysis and the Fisher exact test.RESULTSWound complications occurred in 301 patients (25.9%). Multivariable analysis identified diabetes mellitus (odds ratio [OR] = 4.58; p < 0.001), poor performance status (Eastern Cooperative Oncology Group score ≥2; OR = 3.07; p = 0.002), perioperative use of VEGFi (OR = 4.12; p < 0.001), and perioperative use of antimetabolites (OR = 2.24; p = 0.04) as independent risk factors. Patients reinitiating VEGFi within 40 days had higher complication rates than both nonusers and those reinitiating VEGFi after 40 days, with the former comparison reaching statistical significance.CONCLUSIONSOne-quarter of the patients undergoing spinal metastasis surgery experienced postoperative wound complications. Perioperative use of VEGFi was an independent predictor, and our results suggest that there should be a postoperative cessation interval of 40 days to reduce wound-related risk. Clinicians should balance the oncologic benefits of early VEGFi reinitiation against the heightened risk of complications.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":"61 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-07-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148393726","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":"Osteochondral Autograft Transfer for Focal Osteochondral Defects of the Knee: Indications, Technique, Outcomes, and Future Directions.","authors":"John T Strony,Jason G Ina,John M Apostolakos,Jacob G Calcei,Michael R Karns,Gabriella E Ode,Michael J Salata,James E Voos,Scott A Rodeo,Riley J Williams Rd","doi":"10.2106/jbjs.25.01562","DOIUrl":"https://doi.org/10.2106/jbjs.25.01562","url":null,"abstract":"➢ Osteochondral autograft transfer (OAT) restores hyaline cartilage and subchondral bone in a single stage, offering a durable joint-preserving option for focal full-thickness articular cartilage defects in young, active patients.➢ Optimal candidates have unipolar femoral condyle, patellofemoral, or tibial plateau lesions measuring 1 to 4 cm2; outcomes become less predictable once the defect size exceeds 3 cm2. Outcomes are further influenced by age, activity level, sex, alignment, instability, and meniscal deficiency, with older, lower-demand patients and those with larger lesions demonstrating comparatively inferior results.➢ Technical success requires meticulous recipient-site preparation, perpendicular graft harvest, and flush implantation; both arthroscopic and open approaches achieve reliable results.➢ OAT demonstrates high return-to-sport rates (often >85% within 6 months), significant functional improvements, and superiority over microfracture. Outcomes may be comparable or superior to cellular resurfacing or allograft techniques in appropriately selected patients.➢ Emerging biologic adjuncts, recess-filling strategies, and donor-site substitutes may enhance graft integration and reduce morbidity, although long-term clinical benefits remain unproven.","PeriodicalId":22625,"journal":{"name":"The Journal of Bone & Joint Surgery","volume":"36 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-07-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148393704","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":"Do Younger Patients Undergoing Transfibular Total Ankle Arthroplasty Achieve Outcomes Comparable with Those of Older Patients? Interpreting Nonsignificant Differences in Clinical Research: Commentary on an article by Kevin A. Schafer, MD, et al.: \"Clinical and Radiographic Outcomes at a Mean of 7 Years Following Primary Transfibular Total Ankle Arthroplasty in Younger and Older Patients\".","authors":"Yuki Tochigi","doi":"10.2106/jbjs.26.00460","DOIUrl":"https://doi.org/10.2106/jbjs.26.00460","url":null,"abstract":"","PeriodicalId":22625,"journal":{"name":"The Journal of Bone & Joint Surgery","volume":"66 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148365361","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":"Stacked-Cone Constructs for Extensive Tibial and/or Femoral Bone Loss in Complex Primary and Revision TKA: A Multicenter Analysis of 84 Cases.","authors":"Pranit Kumaran,Sahil S Telang,McKenzie Culler,Ryan C Palmer,Donald B Longjohn,Daniel A Oakes,Lucas A Anderson,Yale A Fillingham,Jesse I Wolfstadt,Nathanael D Heckmann","doi":"10.2106/jbjs.26.00165","DOIUrl":"https://doi.org/10.2106/jbjs.26.00165","url":null,"abstract":"BACKGROUNDStacked metaphyseal cone constructs can be used to address extensive metaphyseal and metadiaphyseal bone loss encountered during complex primary or revision total knee arthroplasty (TKA). Our study reports the 5-year outcomes of a multicenter cohort of stacked-cone constructs used to manage extensive bone loss encountered during primary or revision TKA.METHODSA retrospective review was conducted to identify patients who underwent primary or revision TKA with tibial and/or femoral stacked-cone constructs between July 2016 and September 2025 at 4 tertiary academic institutions. Demographic, operative, clinical, and radiographic data were obtained and analyzed. Five-year implant survivorship free from all-cause reoperation, all-cause revision, and stacked-cone construct revision for aseptic loosening was analyzed using Kaplan-Meier estimation.RESULTSEighty-four cases with a mean patient age of 67.3 years and a mean follow-up of 20.85 months were identified. Five-year survivorship was 56.5% (95% confidence interval [CI], 22.7% to 78.3%) free from all-cause reoperation, 65.2% (95% CI, 25.8% to 87.1%) free from all-cause revision, and 91.7% (95% CI, 52.5% to 99.8%) free from stacked-cone construct revision for aseptic loosening. Stacked-cone revision due to aseptic loosening was performed on the tibial side in 1 case (1.2%) at 3.6 years following the index surgery. Five other stacked cones were revised for periprosthetic joint infection (4 all femoral stacked-cone cases) and tibial implant fracture (1 tibial stacked-cone case).CONCLUSIONSStacked-cone constructs demonstrated excellent 5-year survivorship free from aseptic loosening. However, all-cause reoperations and revisions were common in this cohort, reflecting the complex nature of this patient population.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":"180 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148304687","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":"Measuring Pain and Function: Commentary on an article by Epaminondas Markos Valsamis, MB BChir, MA(Cantab), MRCS, PGCert, DPhil, et al.: \"Minimal and Substantial Improvement Thresholds for Oxford Scores Following Primary Hip and Knee Replacement Based on Patient Satisfaction\".","authors":"Daniel H Williams","doi":"10.2106/jbjs.26.00472","DOIUrl":"https://doi.org/10.2106/jbjs.26.00472","url":null,"abstract":"","PeriodicalId":22625,"journal":{"name":"The Journal of Bone & Joint Surgery","volume":"30 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148298845","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":"Early Periprosthetic Femoral Fracture After Total Hip Arthroplasty Is Not a Complication; It Is a Crisis: Commentary on an article by Alexander J. Acuña, MD, et al.: \"Alarmingly High Rates of Complications and Refracture Among Patients with Early Periprosthetic Femoral Fracture Within 30 Days After THA\".","authors":"Philip Linke","doi":"10.2106/jbjs.26.00128","DOIUrl":"https://doi.org/10.2106/jbjs.26.00128","url":null,"abstract":"","PeriodicalId":22625,"journal":{"name":"The Journal of Bone & Joint Surgery","volume":"25 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148298846","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":"Shaping Modern Practice in South Korea: A Centennial Review of Orthopaedics at Severance Hospital and Yonsei University College of Medicine.","authors":"Se-Han Jung,Sung-Hwan Kim,Insok Yeo,Seung Hwan Han,Kyung-Soo Suk,Si Young Park","doi":"10.2106/jbjs.26.00340","DOIUrl":"https://doi.org/10.2106/jbjs.26.00340","url":null,"abstract":"➢ This review commemorates the centennial of orthopaedic practice at Severance Hospital and Yonsei University College of Medicine by tracing its historical evolution and milestones in modern orthopaedic surgery in South Korea.➢ Chejungwon, the predecessor of Severance Hospital and Yonsei University College of Medicine, was founded in 1885 as Korea's first Western-style hospital and played a pivotal role in the introduction and institutionalization of modern medicine in Korea. This development was made possible through the efforts of American missionaries, who contributed to the early establishment of Western medical education and clinical practice.➢ Modern orthopaedic practice at Severance began in 1926 with the return of Yong-Seol Lee, the first Korean physician to receive structured orthopaedic training in the United States, marking the emergence of orthopaedics as a distinct specialty in Korea.➢ The establishment of an independent Department of Orthopaedic Surgery at Severance Hospital in 1953 further strengthened its academic and clinical foundations during a period characterized by war-related trauma, infectious diseases, and national reconstruction.➢ Over subsequent decades, the department has contributed to the development of orthopaedic subspecialties, clinical excellence, and academic research, while playing a central role in founding and leading the Korean Orthopaedic Association.","PeriodicalId":22625,"journal":{"name":"The Journal of Bone & Joint Surgery","volume":"76 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148304689","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}