Hss Journal最新文献

{"title":"The Safety and Feasibility of Oral Aspirin and Ketamine for Acute Pain Management After Total Knee Arthroplasty: A Pilot Study.","authors":"Daniel K Devine, Jacqueline Grubel, Steven B Haas, Amar S Ranawat, Amethia Joseph, Jawad Saleh, Fred D Cushner, Ellen M Soffin, Faye Rim, Michael P Ast","doi":"10.1177/15563316261468290","DOIUrl":"10.1177/15563316261468290","url":null,"abstract":"<p><strong>Background: </strong>Managing pain after total knee arthroplasty (TKA) without opioids remains a priority. Aspirin is often used after joint surgery for venous thromboembolism prophylaxis and is unique among non-steroidal anti-inflammatory drugs (NSAIDs) in providing this protection through irreversible cyclooxygenase inhibition. Oral ketamine has demonstrated analgesic benefit, but its combination with aspirin for postoperative pain control is not well established.</p><p><strong>Purpose: </strong>We sought to investigate the following: (1) Is combined administration of oral ketamine and aspirin safe in patients undergoing TKA? (2) What are the observed pain control outcomes and opioid requirements associated with this regimen?</p><p><strong>Methods: </strong>We conducted a single-institution pilot study of patients undergoing primary TKA to test the safety of a proprietary oral aspirin/ketamine combination; the study was funded by the manufacturer, Vitalis Pharmaceuticals. Eligible patients were prospectively identified from the operative schedules of 7 participating arthroplasty surgeons and approached at their preoperative office visits between February 2023 and March 2023. Patients were excluded from the study if they were age <18 or >80 years, if they had a primary diagnosis other than primary osteoarthritis, an allergy to aspirin or another NSAID, any contraindications to NSAID use, use of anti-coagulant or anti-thrombotic medication, recent active bleeding requiring a transfusion or hospitalization, or scheduled for same-day discharge. Twenty patients were included. Patients received oral ketamine (40 mg) and aspirin (162 mg) every 6 hours postoperatively until discharge. The primary outcome was safety, assessed using the Side Effect Rating Scale for Dissociative Anesthetics and the Richmond Agitation Sedation Scale (RASS). Secondary outcomes included a numeric rating scale for pain and morphine milligram equivalents (MME). Descriptive statistics were used.</p><p><strong>Results: </strong>Of the 20 patients in the final cohort, 14 patients completed the full 4-dose regimen during their 24-hour postoperative inpatient stays; 18 of the 20 patients reported no adverse effects. Two patients experienced mild dizziness after later doses, with no reported agitation or sedation on the RASS scale. Most patients (19/20) required rescue opioid doses; pain scores were similar, regardless. Mean 24-hour opioid consumption was 30.2 ± 20.4 MME.</p><p><strong>Conclusion: </strong>This single-institution pilot study observed that an oral aspirin/ketamine combination appeared to be safe after TKA, with minimal adverse effects. A future randomized controlled trial is needed to evaluate efficacy and opioid-sparing benefits.</p><p><strong>Level of evidence: </strong>Level IV, pilot study.</p>","PeriodicalId":35357,"journal":{"name":"Hss Journal","volume":" ","pages":"15563316261468290"},"PeriodicalIF":1.4,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13428807/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148664670","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Incidence and Risk Factors for Post-Dural Puncture Headache (PDPH) in Patients Receiving Neuraxial Anesthesia for Total Joint Arthroplasty: A Retrospective Case Series.","authors":"William P Qiao, Juliet E Rowe, Pa Thor, Maya Tailor, Bradley H Lee","doi":"10.1177/15563316261472867","DOIUrl":"10.1177/15563316261472867","url":null,"abstract":"<p><strong>Background: </strong>Post-dural puncture headache (PDPH) after unintended dural puncture is a known complication of neuraxial anesthesia, especially with puncture by 20 gauge or larger catheter or needle. PDPH can impact post-operative recovery; however, PDPH in patients undergoing total joint arthroplasty (TJA) is less well documented because the majority of studies address obstetric patients.</p><p><strong>Purposes: </strong>We sought to answer the following questions: What is the incidence of PDPH after unintended dural puncture in the TJA population? What are risk factors for PDPH? How is PDPH managed?</p><p><strong>Methods: </strong>A retrospective chart review was performed for patients undergoing TJA surgeries under neuraxial anesthesia between January 1, 2016, and April 30, 2023, at a single high-volume orthopedic hospital. Cases with documented dural puncture with 20 gauge epidural catheter, 18 gauge Weiss epidural needle, or 17 gauge Weiss epidural needle were identified and reviewed for PDPH.</p><p><strong>Results: </strong>Among 77 586 patients who received neuraxial anesthesia of any kind (spinal, epidural, combined spinal/epidural), 640 patients (0.8%) experienced unintended dural puncture and were included in the analysis. Among those with unintended dural puncture, 29 (4.5%) patients subsequently developed PDPH. The final logistic regression identified older age and higher body mass index (BMI) as protective and associated with reduced risk of PDPH. Among the 29 PDPH cases, non-steroidal anti-inflammatory drugs were employed in 86.2% of patients, and acetaminophen was used in 93.1%. Seven patients (24.1%) required an epidural blood patch, and 3 (10.3%) reported long-term sequelae.</p><p><strong>Conclusions: </strong>This large retrospective case series of TJA patients at a single institution found that the incidence of PDPH after unintended dural puncture was low (4.5%). Lower age and lower BMI were risk factors associated with higher odds of being diagnosed with PDPH.</p><p><strong>Level of evidence: </strong>Level IV: retrospective case series.</p>","PeriodicalId":35357,"journal":{"name":"Hss Journal","volume":" ","pages":"15563316261472867"},"PeriodicalIF":1.4,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13428810/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148664688","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Epidemiology of Injuries in Softball Pitchers: Does Pitch Count Matter?","authors":"Megan Carlson","doi":"10.1177/15563316261473914","DOIUrl":"10.1177/15563316261473914","url":null,"abstract":"","PeriodicalId":35357,"journal":{"name":"Hss Journal","volume":" ","pages":"15563316261473914"},"PeriodicalIF":1.4,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13428808/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148664644","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Return-to-Play for the Injured Baseball Pitcher: From Subjective to Objective, Multi-Domain Assessment.","authors":"Terrance Sgroi, Nicholas Jiacopello, Shane Morales","doi":"10.1177/15563316261471902","DOIUrl":"10.1177/15563316261471902","url":null,"abstract":"","PeriodicalId":35357,"journal":{"name":"Hss Journal","volume":" ","pages":"15563316261471902"},"PeriodicalIF":1.4,"publicationDate":"2026-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13428809/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148664668","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Elbow Medial Ulnar Collateral Ligament Repair Versus Reconstruction Versus Augmented Reconstruction: Where Do We Stand?","authors":"Sophia Mavrommatis, Rakan R Alshaibi, Joshua S Dines, Christopher L Camp","doi":"10.1177/15563316261472449","DOIUrl":"10.1177/15563316261472449","url":null,"abstract":"<p><p>Medial ulnar collateral ligament (MUCL) injuries of the elbow have increased over the past 2 decades, particularly among adolescent and young adult overhead throwing athletes. Over time, operative techniques for MUCL injuries have evolved, with the goals of improving time to return and rates of return to sport and meeting athlete-specific demands. The purpose of this review is to evaluate the state of surgical management of MUCL injuries, assessing indications, techniques, and outcomes. Surgical techniques reviewed included MUCL-augmented repair with internal bracing, traditional reconstruction, reconstruction augmented with internal bracing, and revision MUCL reconstruction. While MUCL reconstruction has been the gold standard of treatment, augmented reconstruction and repair techniques have shown promising outcomes; these strategies emphasize anatomic restoration, preservation of native tissue, and individualized patient selection.</p>","PeriodicalId":35357,"journal":{"name":"Hss Journal","volume":" ","pages":"15563316261472449"},"PeriodicalIF":1.4,"publicationDate":"2026-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13423937/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148654614","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A New Column and New Frontiers for the HSS Journal.","authors":"Charles N Cornell","doi":"10.1177/15563316261469468","DOIUrl":"10.1177/15563316261469468","url":null,"abstract":"","PeriodicalId":35357,"journal":{"name":"Hss Journal","volume":" ","pages":"15563316261469468"},"PeriodicalIF":1.4,"publicationDate":"2026-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13395971/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148585271","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"AI Use in Orthopedic Publishing: A Shared Accountability.","authors":"Joy Jacobson, Charles N Cornell","doi":"10.1177/15563316261469568","DOIUrl":"10.1177/15563316261469568","url":null,"abstract":"","PeriodicalId":35357,"journal":{"name":"Hss Journal","volume":" ","pages":"15563316261469568"},"PeriodicalIF":1.4,"publicationDate":"2026-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13385154/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148550880","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Role of Scapular Dyskinesis in Shoulder Injuries and Rehabilitation Approaches: Commentary.","authors":"Jill A Manners, Aaron D Sciascia","doi":"10.1177/15563316261468356","DOIUrl":"10.1177/15563316261468356","url":null,"abstract":"","PeriodicalId":35357,"journal":{"name":"Hss Journal","volume":" ","pages":"15563316261468356"},"PeriodicalIF":1.4,"publicationDate":"2026-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13385153/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148550816","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Assessment of Hip Joint Articular Cartilage Composition in People with Marfan Syndrome Utilizing T1ρ and T2 Mapping.","authors":"Grayson L Shuck, Mariana V Jacobs, Aaron D Fain, Anthony A Mangino, Mary B Sheppard, Michael A Samaan","doi":"10.1177/15563316261466677","DOIUrl":"10.1177/15563316261466677","url":null,"abstract":"<p><strong>Background: </strong>People with Marfan syndrome (MFS) exhibit a high incidence of hip joint pain and earlier onset of osteoarthritis than those without MFS. Imaging-related biomarkers of hip joint health that provide an earlier indication of hip cartilage degeneration in the MFS population have yet to be assessed.</p><p><strong>Purpose: </strong>We sought to determine whether people with MFS exhibit biochemical alterations of proteoglycan content and collagen structure within the hip joint cartilage compared to individuals without MFS as documented by quantitative magnetic resonance imaging (MRI) including both T1ρ and T2 mapping.</p><p><strong>Methods: </strong>Fourteen individuals with MFS and 14 healthy, asymptomatic controls matched for age, sex, and body mass index underwent radiographic imaging and unilateral hip quantitative MRI including both T1ρ and T2 mapping to evaluate cartilage proteoglycan content and collagen structure.</p><p><strong>Results: </strong>People with MFS showed significantly higher T1ρ values in the anterior superior acetabular cartilage compared to the asymptomatic controls. No significant between-group differences were noted in the femoral T1ρ values or in any of the T2-related values.</p><p><strong>Conclusion: </strong>This cross-sectional, observational study found elevated anterior superior acetabular cartilage T1ρ values, indicating a lower proteoglycan content within this specific sub-region, in individuals with MFS. The anterior superior acetabular cartilage may be prone to degeneration and may contribute to the high rates of early onset osteoarthritis observed in the MFS population. Our results suggest T1ρ cartilage imaging may be a potential biomarker of early cartilage degradation in the MFS population. Clinically, T1ρ imaging may allow for better informed decisions regarding interventional timing to prevent the onset and progression of hip osteoarthritis in individuals with MFS.</p><p><strong>Level of evidence: </strong>Level III, prognostic study.</p>","PeriodicalId":35357,"journal":{"name":"Hss Journal","volume":" ","pages":"15563316261466677"},"PeriodicalIF":1.4,"publicationDate":"2026-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13372799/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148473163","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ethical Considerations in Disclosing Orthopedic Implant Failures to Patients.","authors":"Daniel Alsoof, Alan H Daniels","doi":"10.1177/15563316261466680","DOIUrl":"10.1177/15563316261466680","url":null,"abstract":"","PeriodicalId":35357,"journal":{"name":"Hss Journal","volume":" ","pages":"15563316261466680"},"PeriodicalIF":1.4,"publicationDate":"2026-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13354596/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148424427","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}