The Journal of Bone & Joint Surgery最新文献

{"title":"Migration of Cemented and Uncemented Implants in Total Knee Arthroplasty with an Asymmetrical Tibial Component: A Randomized Controlled Trial with a 2-Year Model-Based Radiostereometric Analysis Follow-up.","authors":"Müjgan Yilmaz Altun,Gunnar Flivik,Thomas Lind,Anders Odgaard,Christina Enciso Holm,Michael Mørk Petersen","doi":"10.2106/jbjs.24.00835","DOIUrl":"https://doi.org/10.2106/jbjs.24.00835","url":null,"abstract":"BACKGROUNDAseptic loosening remains a main complication following total knee arthroplasty (TKA), requiring revision surgery. Radiostereometric analysis (RSA) can assess the risk of aseptic loosening. This study evaluated the migration and segmental motion of cemented and uncemented femoral and asymmetrical tibial Persona components (Zimmer Biomet) with model-based RSA.METHODSWe conducted a randomized controlled trial with 63 patients (22 male patients and 41 female patients, with a mean age of 62 years) and compared patients who underwent TKA with cemented and uncemented Persona components. The primary outcome measure was the maximal total point motion (MTPM) after 2 years. The Mann-Whitney U test was used to compare groups. Migration was visualized by plotting the mean and 95% confidence interval (CI).RESULTSAfter 3 months, femoral components demonstrated an MTPM of 0.41 mm (95% CI, 0.35 to 0.48 mm) in the cemented group and 0.65 mm (95% CI, 0.50 to 0.80 mm) in the uncemented group. Subsequently, a stabilization occurred, and the MTPM after 24 months was 0.51 mm (95% CI, 0.41 to 0.61 mm) in the cemented group and 0.83 mm (95% CI, 0.65 to 1.02 mm) in the uncemented group. There was a significant difference between fixation types at 3 months (p = 0.04), 6 months (p = 0.03), 12 months (p = 0.02), and 24 months (p = 0.02). At 3 months postoperatively, the tibial component demonstrated an MTPM of 0.70 mm (95% CI, 0.53 to 0.88 mm) in the cemented group and 0.76 mm (95% CI, 0.61 to 0.91 mm) in the uncemented group. A stabilization was then observed, and migration after 24 months was 0.72 mm (95% CI, 0.55 to 0.89 mm) for cemented components and 0.78 mm (95% CI, 0.64 to 0.92) for uncemented components.CONCLUSIONSTKA with cemented and uncemented Persona components showed migration values within acceptable ranges, suggesting successful long-term fixation; however, significant differences in mean MTPM between cemented and uncemented femoral components were found.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":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144737403","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":"Efficacy and Safety of Osteobiologics for Lumbar Spinal Fusion: A Systematic Review and Network Meta-Analysis.","authors":"Luca Ambrosio,Jordy Schol,Shota Tamagawa,Sathish Muthu,Daisuke Sakai,Rocco Papalia,Gianluca Vadalà,Vincenzo Denaro","doi":"10.2106/jbjs.24.01205","DOIUrl":"https://doi.org/10.2106/jbjs.24.01205","url":null,"abstract":"BACKGROUNDLumbar spinal fusion (LSF) is a common surgical procedure for treating lumbar degenerative conditions. The use of osteobiologics to enhance fusion has emerged as a promising alternative to address the limitations of autologous iliac crest bone graft (AICBG), but their comparative efficacy and safety remain unclear. This systematic review and network meta-analysis (NMA) aimed to assess the fusion rates, safety profiles, and clinical outcomes of the use of osteobiologics in LSF.METHODSPubMed/MEDLINE and Scopus databases were searched for randomized controlled trials (RCTs) comparing different osteobiologics to AICBG in LSF. Data on fusion rates, complications, pain, disability, blood loss, operative time, and length of stay (LOS) were extracted. The risk of bias was evaluated using the Cochrane Risk of Bias-2 tool, and the certainty of evidence was assessed using the GRADE framework. The NMA was performed using a frequentist random-effects model to compare the efficacy and safety of various osteobiologics, along with associated perioperative and clinical outcomes.RESULTSForty-three RCTs including a total of 3,823 patients were identified. The use of rhBMP-2 (recombinant human bone morphogenetic protein-2) significantly improved fusion rates (odds ratio [OR]: 3.71; 95% confidence interval [CI]: 2.59 to 5.32; p < 0.0001) and reduced complications (OR: 0.30; 95% CI: 0.13 to 0.68; p < 0.0001) compared with AICBG, with moderate certainty of the evidence. Other osteobiologics, including ABM/P-15 (anorganic bone matrix/15-amino acid peptide fragment) and allograft, demonstrated reduced complication rates, although the quality of the evidence was low to very low. No significant differences were observed for pain, disability, or LOS. The use of rhBMP-2, autologous local bone, and silicate-substituted calcium phosphate was associated with decreased operative time, with rhBMP-2 additionally associated with lower intraoperative blood loss.CONCLUSIONSUse of rhBMP-2 was associated with significantly higher fusion and lower complication rates compared with AICBG, as well as decreased operative time and blood loss. Other osteobiologics may also offer benefits, but the supporting evidence is low-quality and limited by the notable underrepresentation of these materials in the published literature.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":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144737404","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 Unifying Radiographic Description of Legg-Calvé-Perthes Disease at Skeletal Maturity: The Head, Acetabulum, Trochanter Classification.","authors":"John A Herring,Harry K W Kim,Chanhee Jo,William J Hadden","doi":"10.2106/jbjs.24.00471","DOIUrl":"https://doi.org/10.2106/jbjs.24.00471","url":null,"abstract":"BACKGROUNDWe revaluated the radiographic results of a 2004 landmark, multicenter prospective study of patients with Legg-Calvé-Perthes disease (LCP). In the current study, we developed a new classification to evaluate the femoral head, acetabulum, and greater trochanter in the hips of patients with LCP, to address what we found to be deficiencies in the Stulberg rating system, which is based mainly on femoral head shape.METHODSWe digitized and analyzed approximately 5,000 radiographs and related data sheets of 337 patients (345 hips) with LCP from the 2004 study. We found many unexpected abnormalities, including serious lesions of the femoral head, that had not been noted in that study. To record our findings in the femoral head, acetabulum, and greater trochanter, we developed a classification system that we termed the HAT (Head, Acetabulum, Trochanter) classification, which assigns the femoral head 1 to 5 points, the acetabulum 1 point if dysplastic, and the greater trochanter 1 point if elevated to or above the femoral head. The sum is the HAT score, which we compared with the Stulberg score, other predictive factors, and the Nonarthritic Hip Score (NAHS) from two 20-year follow-up studies of a number of patients from the 2004 study.RESULTSThe intraclass correlation coefficient (ICC) of the HAT score was 0.93 (95% confidence interval [CI]: 0.90 to 0.95), and the total HAT score correlated strongly with the NAHS. Forty-nine percent of all hips had acetabular dysplasia, which correlated with a worse NAHS. A HAT of ≤3 was considered a good result. The odds of a patient developing acetabular dysplasia at skeletal maturity were lower after surgical treatment than after nonoperative treatment. In addition, surgically treated patients had better HAT scores than nonoperatively treated patients, especially if their skeletal age was ≥6 years at LCP onset. Better outcomes were also associated with a favorable lateral pillar classification, a younger skeletal at onset, and male sex.CONCLUSIONSThe HAT classification is reproducible and allows a more comprehensive analysis of the radiographic outcomes of LCP. The system is flexible and would allow for different measures of its 3 components in future studies.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":"132 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144737400","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":"Is There a Difference in Postoperative Outcomes Between Kyphoplasty and Vertebroplasty in the Management of Vertebral Compression Fractures?: A Meta-Analysis of Randomized Controlled Trials.","authors":"Mohammad Daher,Marven Aoun,Andrew Xu,Alan H Daniels,Amer Sebaaly","doi":"10.2106/jbjs.24.01191","DOIUrl":"https://doi.org/10.2106/jbjs.24.01191","url":null,"abstract":"BACKGROUNDCement augmentation using vertebroplasty (VP) or kyphoplasty (KP) can be employed to manage vertebral compression fractures (VCFs). Randomized controlled trials (RCTs) have disagreed about the superiority of one technique over the other. Therefore, a meta-analysis of RCTs is warranted.METHODSPubMed, Cochrane, Embase, and Google Scholar were searched for articles from database inception to July 15, 2024. The inclusion criteria consisted of English and non-English-language RCTs comparing KP to VP in the management of VCFs. The studied outcomes were the risks of cement leakage and adjacent vertebral fractures (AVFs), operative time, the postoperative local kyphotic angle, and postoperative back pain.RESULTSA total of 11 RCTs were included, comprising 1,190 patients, of whom 600 (50.4%) underwent KP and 590 (49.6%) underwent VP. We found no difference in the risk of cement leakage (risk ratio [RR], 1.07; 95% confidence interval [CI], 0.68 to 1.69; p = 0.78) or AVFs (RR, 0.60; 95% CI, 0.29 to 1.23; p = 0.16) between the 2 groups. With the inclusion of additional trials, the KP group had a lower risk of AVFs (RR, 0.58; 95% CI, 0.34 to 0.98; p = 0.04). We found no difference in operative time (mean difference, 4.75 minutes; 95% CI, -7.34 to 16.84; p = 0.44) or postoperative pain (mean difference, -0.48; 95% CI, -1.91 to 0.95; p = 0.51) between the 2 groups. A lower postoperative kyphotic angle was observed in the KP group (standardized mean difference, -2.97; 95% CI, -5.62 to -0.32; p = 0.03).CONCLUSIONSThis meta-analysis revealed that KP was associated with a better postoperative local kyphotic angle and a lower risk of AVFs, with no difference in postoperative pain or cement leakage, compared with VP.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":"10 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144677965","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: Effects of Sustained Tensile Distraction on Vertebrae and Intervertebral Disc Growth.","authors":"Pooria Salari,Garrett W D Easson,Kaitlyn S Broz,Michael P Kelly,Simon Y Tang","doi":"10.2106/jbjs.er.24.00224","DOIUrl":"https://doi.org/10.2106/jbjs.er.24.00224","url":null,"abstract":"","PeriodicalId":22625,"journal":{"name":"The Journal of Bone & Joint Surgery","volume":"63 1","pages":"e78"},"PeriodicalIF":0.0,"publicationDate":"2025-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144640188","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":"Insights from 300 Periprosthetic Tibial Fractures: Where Do We Go from Here?: Commentary on an article by Evan M. Dugdale, MD, et al.: \"Three Hundred Periprosthetic Tibial Fractures Around a Total Knee Replacement. Classification and Outcomes from a Single Institution\".","authors":"Noah M Hodson,Phillip C McKegg,Michael A Charters","doi":"10.2106/jbjs.25.00234","DOIUrl":"https://doi.org/10.2106/jbjs.25.00234","url":null,"abstract":"","PeriodicalId":22625,"journal":{"name":"The Journal of Bone & Joint Surgery","volume":"2 1","pages":"e76"},"PeriodicalIF":0.0,"publicationDate":"2025-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144640194","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":"CARE Trial: Patient Education Reduces Opioid Use After ACL Reconstruction: Commentary on an article by Jonathan D. Packer, MD, et al.: \"Perioperative Opioid Counseling for Patients Undergoing Anterior Cruciate Ligament Reconstruction. A Randomized Controlled Trial\".","authors":"Bashir Ahmed Zikria,Jean Fleuriscar","doi":"10.2106/jbjs.25.00221","DOIUrl":"https://doi.org/10.2106/jbjs.25.00221","url":null,"abstract":"","PeriodicalId":22625,"journal":{"name":"The Journal of Bone & Joint Surgery","volume":"13 1","pages":"e75"},"PeriodicalIF":0.0,"publicationDate":"2025-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144640175","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":"Adequately Reduced Distal Radial Fractures in Elderly Patients: How Long Should We Immobilize?: Commentary on an article by A. Sala-Pujals, MD, et al.: \"Immobilization Time for Conservative Treatment of Distal Radial Fractures in Elderly Patients. A Randomized Controlled Trial\".","authors":"Dafang Zhang","doi":"10.2106/jbjs.25.00333","DOIUrl":"https://doi.org/10.2106/jbjs.25.00333","url":null,"abstract":"","PeriodicalId":22625,"journal":{"name":"The Journal of Bone & Joint Surgery","volume":"4 1","pages":"e77"},"PeriodicalIF":0.0,"publicationDate":"2025-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144640189","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":"Tension Band Wiring Versus Precontoured Plate Fixation for 2-Part and Multifragmented Olecranon Fractures: A Prospective Randomized Trial.","authors":"Kaare Sourin Midtgaard,Gunnar Birkeland Flugsrud,Kenneth B Jonsson,Greta Snellman,Marius Coucheron,Ane Djuv,Dag Grundel,Lars Gunnar Johnsen,Espen Laudal,Knut Erik Mjaaland,Tor Nicolaysen,Jan Erik Madsen,Frede Frihagen, ","doi":"10.2106/jbjs.24.01461","DOIUrl":"https://doi.org/10.2106/jbjs.24.01461","url":null,"abstract":"BACKGROUNDWe conducted a randomized controlled trial to compare the outcomes of tension band wiring and precontoured plate fixation for the treatment of 2-part and multifragmented isolated, displaced olecranon fractures.METHODSWe recruited 200 patients, 18 to 75 years of age, who had isolated, displaced olecranon fractures and randomly allocated them to tension band wiring (n = 100) or plate fixation (n = 100). The patients were followed at 6 weeks, 12 weeks, 12 months, and 24 months. The study was designed as a noninferiority trial. The primary outcome measure was the Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) score at 12 months.RESULTSMore patients in the tension band wiring group were classified as ASA (American Society of Anesthesiologists) grade I; otherwise, the randomization groups were similar. Two patients in the tension band wiring group and 3 in the plate fixation group did not receive the allocated treatment. The duration of the surgical procedure was 64 and 88 minutes in the tension band wiring and plate fixation groups, respectively (p < 0.01). After 12 months, the median QuickDASH score was 5 for both groups, and the median of the differences was 0 (95% 1-sided confidence interval [CI], 2.3). There were no clinically relevant differences between the groups at any time point. In addition, there were no differences in outcomes in subgroup analyses of 2-part and multifragmented olecranon fractures. Complications and secondary surgical procedures were analyzed on the basis of the treatment received (tension band wiring = 101 patients, plate fixation = 99 patients). Sixty-four complications were recorded in 52 patients (tension band wiring, 30 patients; plate fixation, 22 patients; relative risk [RR], 1.20 [95% CI, 0.88 to 1.58]; p = 0.23). In the tension band wiring and plate fixation groups, 49 and 34 patients (RR, 1.33 [95% CI, 1.01 to 1.74]; p = 0.04) required at least 1 additional surgical procedure, respectively. Hardware-related irritation was the most reported indication of secondary surgery.CONCLUSIONSWhen treating isolated, displaced 2-part and multifragmented olecranon fractures, tension band wiring was noninferior compared with plate fixation. The surgical procedure was quicker for tension band wiring, but the frequency of secondary surgical procedures was higher. The majority of secondary surgical procedures were removal of symptomatic hardware.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":"23 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144611520","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 Utility of a Prediction Model Using Neurological Examination Findings for Diagnosing Degenerative Cervical Myelopathy.","authors":"Masahiro Funaba,Hiroaki Nakashima,Lindsay Tetreault,Hidenori Suzuki,Yasutsugu Yukawa,Norihiro Nishida,Kazuhiro Fujimoto,Kiyoshi Ichihara,Sadayuki Ito,Naoki Segi,Jun Ouchida,Shiro Imagama,Takashi Sakai","doi":"10.2106/jbjs.24.00098","DOIUrl":"https://doi.org/10.2106/jbjs.24.00098","url":null,"abstract":"BACKGROUNDThe diagnostic accuracy of neurological examination findings for identifying degenerative cervical myelopathy (DCM) is not apparent, given the paucity of studies with appropriate control groups. In order to address this knowledge gap, we conducted a community cervical spine screening project and examined subjects without DCM or evidence of myelopathy on cervical magnetic resonance imaging (MRI).METHODSThis study included a total of 229 patients diagnosed with DCM, based on MRI evidence of spinal cord compression and improvement after surgery, and 807 controls without DCM (40 to 79 years of age) enrolled in the screening project. Neurological examination was performed on each subject, including the assessment of deep tendon reflexes at the biceps, triceps, patella, and Achilles tendon and the Hoffmann reflex, Babinski sign, sensory disturbance, and 10-second grip-and-release test. Multiple logistic regression analysis was performed to build a diagnostic model for DCM based on the neurological examination findings.RESULTSUsing a stepwise multiple logistic regression analysis method, an almost perfect diagnostic model was designed that comprised sex, age, 10-second grip-and-release test, patellar tendon reflex, Hoffmann reflex, Babinski sign, and sensory disturbance (area under the curve [AUC] in the receiver operating characteristic curve analysis, 0.994). However, given that the last 2 parameters are less commonly evaluated in routine practice, an alternative reduced model was developed for practical use and consisted of sex, age, Hoffmann reflex, patellar tendon reflex, and 10-second grip-and-release test. The reduced model yielded a nearly equivalent AUC of 0.956.CONCLUSIONSBoth diagnostic prediction models demonstrated excellent accuracy in distinguishing patients with DCM from subjects without DCM, highlighting the importance of combining specific neurological signs and performance measures when evaluating patients with suspected DCM.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":"3 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144603857","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}