JBJS Open Access最新文献

{"title":"An Algorithmic Approach to Understanding Osteoarthritic Knee Pain.","authors":"Brandon G Hill,&nbsp;Travis Byrum,&nbsp;Anthony Zhou,&nbsp;Peter L Schilling","doi":"10.2106/JBJS.OA.23.00039","DOIUrl":"10.2106/JBJS.OA.23.00039","url":null,"abstract":"<p><strong>Background: </strong>Osteoarthritic knee pain is a complex phenomenon, and multiple factors, both within the knee and external to it, can contribute to how the patient perceives pain. We sought to determine how well a deep neural network could predict osteoarthritic knee pain and other symptoms solely from a single radiograph view.</p><p><strong>Methods: </strong>We used data from the Osteoarthritis Initiative, a 10-year observational study of patients with knee osteoarthritis. We paired >50,000 weight-bearing, posteroanterior knee radiographs with corresponding Knee Injury and Osteoarthritis Outcome Score (KOOS) pain, symptoms, and activities of daily living subscores and used them to train a series of deep learning models to predict those scores solely from raw radiographic input. We created regression models for specific score predictions and classification models to predict whether the modeled KOOS subscore exceeded a range of thresholds.</p><p><strong>Results: </strong>The root-mean-square errors were 15.7 for KOOS pain, 13.1 for KOOS symptoms, and 14.2 for KOOS activities of daily living. Modeling was performed to predict whether pain was above or below given pain thresholds, and was able to predict extreme pain (KOOS pain < 40) with an area under the curve (AUC) of 0.78. Notably, the system was also able to correctly predict numerous cases where the Kellgren-Lawrence (KL) grade assigned by the radiologist was 0 but patient pain was high, and cases where the KL grade was 4 but patient pain was low.</p><p><strong>Conclusions: </strong>A deep neural network can be trained to predict the osteoarthritic knee pain that a patient experienced and other symptoms with reasonable accuracy from a single posteroanterior view of the knee, even using low-resolution images. The system can predict pain and dysfunction that the traditional KL grade does not capture. Deep learning applied to raw imaging inputs holds promise for disentangling sources of pain within the knee from aggravating factors external to the knee.</p><p><strong>Level of evidence: </strong>Diagnostic Level III. See Instructions for Authors for a complete description of levels of evidence.</p>","PeriodicalId":36492,"journal":{"name":"JBJS Open Access","volume":"8 4","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/df/97/jbjsoa-8-e23.00039.PMC10545400.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41158998","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Outcomes of Humeral Allograft-Prosthetic Composites with Plate Fixation in Revision Total Elbow Arthroplasty.","authors":"Adnan N Cheema, Ryan T Conyer, Jacob J Triplet, Shawn W O'Driscoll, Mark E Morrey, Joaquín Sanchez-Sotelo","doi":"10.2106/JBJS.OA.22.00136","DOIUrl":"10.2106/JBJS.OA.22.00136","url":null,"abstract":"<p><strong>Background: </strong>Traditionally, the reconstruction of severe distal humeral bone loss at the time of revision total elbow arthroplasty (TEA) has used allograft-prosthetic composites (APCs) stabilized with cerclage wires or cables. We have migrated to plate fixation when revision TEA using a humeral APC is performed. This study shows the outcomes of patients treated with a humeral APC with plate fixation during revision TEA.</p><p><strong>Methods: </strong>Between 2009 and 2019, 41 humeral APCs with plate fixation of distal humeral allograft to the native humerus were performed in the setting of revision TEA. There were 12 male patients (29%) and 29 female patients (71%), with a mean age of 63 years (range, 41 to 87 years). The mean allograft length was 12 cm. All elbows had a minimum follow-up of 2 years (mean follow-up, 3.3 years). Patients were evaluated for visual analog scale pain scores, range of motion, the ability to perform select activities of daily living, and the Mayo Elbow Performance Score (MEPS). Outcomes including reoperations, complications, and revisions were noted. The most recent radiographs were evaluated for union at the allograft-host interface, failure of the plate-and-screw construct, or component loosening.</p><p><strong>Results: </strong>The mean postoperative flexion was 124° (range, 60° to 150°) and the mean postoperative extension was 26° (range, 0° to 90°); the mean arc of motion was 99° (range, 30° to 150°). The mean MEPS was 58 points (range, 10 to 100 points). Two surgical procedures were complicated by neurologic deficits. The overall reoperation rate was 14 (34%) of 41. Of the 33 patients with complete radiographic follow-up, 12 (36%) had evidence of nonunion at the allograft-host interface with humeral component loosening, 1 (3%) had evidence of partial union, and 1 (3%) had ulnar stem loosening.</p><p><strong>Conclusions: </strong>Revision TEA with a humeral APC using compression plating was successful in approximately two-thirds of the elbows. Further refinement of surgical techniques is needed to improve union rates in these complex cases.</p><p><strong>Level of evidence: </strong>Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.</p>","PeriodicalId":36492,"journal":{"name":"JBJS Open Access","volume":"8 4","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/66/01/jbjsoa-8-e22.00136.PMC10545412.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41145164","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Labral Reconstruction via Capsular Augmentation Maintains Perfusion to the Acetabular Labrum and Locally Transferred Autograft: An in Vivo Laser Doppler Flowmetry Analysis.","authors":"Nathan J Cherian,&nbsp;Christopher T Eberlin,&nbsp;Michael P Kucharik,&nbsp;Paul F Abraham,&nbsp;Mark R Nazal,&nbsp;Michael C Dean,&nbsp;Scott D Martin","doi":"10.2106/JBJS.OA.23.00026","DOIUrl":"https://doi.org/10.2106/JBJS.OA.23.00026","url":null,"abstract":"<p><strong>Background: </strong>The purpose of the present study was to examine the effects of arthroscopic labral repair with capsular augmentation on blood flow in vivo with use of laser Doppler flowmetry (LDF) to measure microvascular perfusion of the labrum and autograft tissue.</p><p><strong>Methods: </strong>The present prospective case series included patients ≥18 years old who underwent arthroscopic acetabular labral repair with capsular augmentation; all procedures were performed by a single surgeon between 2018 and 2022. The LDF probe measured microvascular blood flow flux within 1 mm³ of the surrounding labral and capsular tissue of interest. Mean baseline measurements of flux were compared with readings immediately following capsular elevation and after completing labral augmentation. Blood flux changes were expressed as the percent change from the baseline measurements.</p><p><strong>Results: </strong>The present study included 41 patients (24 men [58.5%] and 17 women [41.5%]) with a mean age (and standard deviation) of 31.3 ± 8.4 years, a mean BMI of 24.6 ± 3.4 kg/m², a mean lateral center-edge of angle 35.3° ± 4.9°, a mean Tönnis angle of 5.8° ± 5.8°, and a mean arterial pressure of 93.7 ± 10.9 mm Hg. Following capsular elevation, the mean percent change in capsular blood flow flux was significantly different from baseline (-9.24% [95% confidence interval (CI), -18.1% to -0.04%]; p < 0.001). Following labral augmentation, the mean percent change in labral blood flow flux was significantly different from baseline both medially (-22.3% [95% CI, -32.7% to -11.9%]; p < 0.001) and laterally (-32.5% [95% CI, -41.5% to -23.6%]; p = 0.041). There was no significant difference between the changes in medial and lateral perfusion following repair (p = 0.136).</p><p><strong>Conclusions: </strong>Labral repair with capsular augmentation sustains a reduced blood flow to the native labrum and capsular tissue at the time of fixation. The biological importance of this reduction is unknown, but these findings may serve as a benchmark for other labral preservation techniques and support future correlations with clinical outcomes.</p><p><strong>Level of evidence: </strong>Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.</p>","PeriodicalId":36492,"journal":{"name":"JBJS Open Access","volume":"8 3","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/7c/54/jbjsoa-8-e23.00026.PMC10516391.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41177133","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Development of an Endoscopic Spine Surgery Program: Overview and Basic Considerations for Implementation.","authors":"Benjamin K Stone,&nbsp;Ria Paradkar,&nbsp;George M Anderson,&nbsp;Alan Daniels,&nbsp;Sravisht Iyer,&nbsp;Peter B Derman,&nbsp;Albert E Telfeian,&nbsp;Bryce Basques","doi":"10.2106/JBJS.OA.22.00152","DOIUrl":"https://doi.org/10.2106/JBJS.OA.22.00152","url":null,"abstract":"<p><p>Endoscopic spine surgery (ESS) is an innovative technique allowing for minimally invasive, direct visualization of spinal abnormalities. The growth of ESS in the United States has been stunted by high start-up costs, low reimbursement rates, and the steep learning curve associated with mastering endoscopic techniques. Hergrae, we describe the current state and future direction of ESS and provide key action items for ESS program implementation.</p>","PeriodicalId":36492,"journal":{"name":"JBJS Open Access","volume":"8 3","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/ca/2f/jbjsoa-8-e22.00152.PMC10508372.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41136743","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Radiographic Outcomes of the Short and Intensive Rehabilitation (SHAiR) Program in Patients with Dropped Head Syndrome.","authors":"Norihiro Isogai,&nbsp;Ken Ishii,&nbsp;Tatsuya Igawa,&nbsp;Kentaro Ideura,&nbsp;Yutaka Sasao,&nbsp;Haruki Funao","doi":"10.2106/JBJS.OA.23.00016","DOIUrl":"https://doi.org/10.2106/JBJS.OA.23.00016","url":null,"abstract":"<p><strong>Background: </strong>The radiographic outcomes of nonoperative treatment of dropped head syndrome are still unknown. The purpose of the present study was to assess the change in sagittal spinopelvic radiographic parameters after the short and intensive rehabilitation (SHAiR) program in patients with dropped head syndrome.</p><p><strong>Methods: </strong>This study included 48 consecutive patients with dropped head syndrome who presented with an inability to maintain horizontal gaze and who underwent the SHAiR program during the period of 2018 to 2019. Patients were divided into 2 groups according to their ability to maintain horizontal gaze at the time of final follow-up: those who had regained horizontal gaze (the \"effective\" group) and those who had not regained horizontal gaze (the \"noneffective\" group). Sagittal radiographic parameters including the sagittal vertical axis (SVA), the C2-7 angle, the C2-7 SVA, T1 slope, thoracic kyphosis of T1-5 and T5-12, lumbar lordosis, pelvic tilt, pelvic incidence, sacral slope, and curve flexibility, and demographic data and clinical outcomes were compared between the 2 groups using an unpaired t test, chi-square test, and Fisher exact test, as appropriate.</p><p><strong>Results: </strong>Thirty-five patients in the effective group and 13 patients in the noneffective group were analyzed. The rate of response in regaining horizontal gaze with the SHAiR program was 73%. The C2-7 angle, the C2-7 SVA, T1 slope, and thoracic kyphosis (T1-5) demonstrated significant correction in the effective group (p < 0.05). There were no significant changes in other parameters below the mid-thoracic spine-i.e., the thoracolumbar and lumbar spine and pelvis-following the SHAiR program. Scores of the Neck Disability Index and visual analog scale for pain improved significantly in both groups.</p><p><strong>Conclusions: </strong>The SHAiR program improved horizontal gaze among a large percentage of our patients and reduced cervical pain among patients overall. The correction of thoracic kyphosis (T1-5) might be an important treatment target to restore the appropriate T1 tilt in patients with dropped head syndrome.</p><p><strong>Level of evidence: </strong>Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.</p>","PeriodicalId":36492,"journal":{"name":"JBJS Open Access","volume":"8 3","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/09/71/jbjsoa-8-e23.00016.PMC10519487.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41180166","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluating ChatGPT Performance on the Orthopaedic In-Training Examination.","authors":"Justin E Kung, Christopher Marshall, Chase Gauthier, Tyler A Gonzalez, J Benjamin Jackson","doi":"10.2106/JBJS.OA.23.00056","DOIUrl":"10.2106/JBJS.OA.23.00056","url":null,"abstract":"<p><strong>Background: </strong>Artificial intelligence (AI) holds potential in improving medical education and healthcare delivery. ChatGPT is a state-of-the-art natural language processing AI model which has shown impressive capabilities, scoring in the top percentiles on numerous standardized examinations, including the Uniform Bar Exam and Scholastic Aptitude Test. The goal of this study was to evaluate ChatGPT performance on the Orthopaedic In-Training Examination (OITE), an assessment of medical knowledge for orthopedic residents.</p><p><strong>Methods: </strong>OITE 2020, 2021, and 2022 questions without images were inputted into ChatGPT version 3.5 and version 4 (GPT-4) with zero prompting. The performance of ChatGPT was evaluated as a percentage of correct responses and compared with the national average of orthopedic surgery residents at each postgraduate year (PGY) level. ChatGPT was asked to provide a source for its answer, which was categorized as being a journal article, book, or website, and if the source could be verified. Impact factor for the journal cited was also recorded.</p><p><strong>Results: </strong>ChatGPT answered 196 of 360 answers correctly (54.3%), corresponding to a PGY-1 level. ChatGPT cited a verifiable source in 47.2% of questions, with an average median journal impact factor of 5.4. GPT-4 answered 265 of 360 questions correctly (73.6%), corresponding to the average performance of a PGY-5 and exceeding the corresponding passing score for the American Board of Orthopaedic Surgery Part I Examination of 67%. GPT-4 cited a verifiable source in 87.9% of questions, with an average median journal impact factor of 5.2.</p><p><strong>Conclusions: </strong>ChatGPT performed above the average PGY-1 level and GPT-4 performed better than the average PGY-5 level, showing major improvement. Further investigation is needed to determine how successive versions of ChatGPT would perform and how to optimize this technology to improve medical education.</p><p><strong>Clinical relevance: </strong>AI has the potential to aid in medical education and healthcare delivery.</p>","PeriodicalId":36492,"journal":{"name":"JBJS Open Access","volume":"8 3","pages":""},"PeriodicalIF":2.3,"publicationDate":"2023-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/39/fc/jbjsoa-8-e23.00056.PMC10484364.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10276562","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Adverse Events After Surgical Treatment of Adult Diaphyseal Forearm Fractures: a Retrospective Analysis of 470 Patients.","authors":"Henri Vasara, Samuli Aspinen, Jussi Kosola, Juha Sartanen, Tuomo Naalisvaara, Jan Myllykoski, Antti Stenroos","doi":"10.2106/JBJS.OA.22.00115","DOIUrl":"10.2106/JBJS.OA.22.00115","url":null,"abstract":"<p><strong>Background: </strong>The incidence of and risk factors for adverse events after internal fixation of diaphyseal forearm fractures have not been well defined in the current literature. The objective of this study was to estimate the incidence of adverse events after diaphyseal forearm fracture surgery in adults and explore potential risk factors for adverse events.</p><p><strong>Methods: </strong>We conducted a retrospective, multicenter, cohort study in which we evaluated all diaphyseal forearm fractures between 2009 and 2019 in patients presenting to 4 trauma hospitals in southern Finland. Patients <16 years of age and fracture-dislocations were excluded. There were 470 patients included in this study. Patient records were evaluated to identify and analyze adverse events.</p><p><strong>Results: </strong>There were 202 patients with both-bone fractures, 164 patients with isolated ulnar fractures, and 104 patients with isolated radial fractures. In total, 146 patients (31%) experienced an adverse event; 83 (18%) had major adverse events (persistent or requiring surgical intervention). The patients underwent procedures performed by 185 different surgeons. The median number of operations for a single surgeon was 2 (range, 1 to 12). The most common major adverse events were plate and screw-related issues (6%), nonunion (5%), persistent nerve injuries (4%), and refractures (4%). Higher body mass index, Gustilo-Anderson type-II open fractures, both-bone fractures, isolated radial fractures, and operations performed by junior residents were found to be risk factors for adverse events in the multivariable analysis.</p><p><strong>Conclusions: </strong>Adverse events after diaphyseal forearm fracture surgery are common. We recommend concentrating these operations in a limited team of surgeons and restricting inexperienced surgeons from operating on these fractures without supervision.</p><p><strong>Level of evidence: </strong>Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.</p>","PeriodicalId":36492,"journal":{"name":"JBJS Open Access","volume":"8 3","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-08-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10424891/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10373752","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Dislocated and Dissociated Dual-Mobility Components Are Easily Missed and More Than Half Fail Closed Reduction: Six Tips to Aid Management.","authors":"Katherine E Mallett, Michael J Taunton, Matthew P Abdel, Rafael J Sierra","doi":"10.2106/JBJS.OA.22.00108","DOIUrl":"10.2106/JBJS.OA.22.00108","url":null,"abstract":"<p><p>Dual-mobility (DM) implants reduce the risk of dislocation in patients who have undergone total hip arthroplasty (THA); however, DM implants are at risk for large-head dislocation and intraprosthetic dissociation (IPD), where the inner femoral head dissociates from the outer polyethylene head. This study aimed to report the incidence of DM dislocation and IPD, evaluate the rate of recognition of IPD before and after reduction, investigate the outcomes of these complications, and provide treatment recommendations for their management.</p><p><strong>Methods: </strong>Between 2010 and 2021, 695 primary and 758 revision THAs were performed with DM constructs at a single institution. There were 44 large-head dislocations (3.0%) and 10 IPDs (0.7%). Four additional IPDs occurred during attempted closed reduction, increasing the IPD incidence to 0.96%. We reviewed prior instability history, dislocation management, success of reduction, recognition of IPD, and subsequent rates of revision and complications. The mean follow-up was 2.5 years.</p><p><strong>Results: </strong>Nine of 10 IPDs were missed at presentation and thus not treated as such. Sixty-three percent of attempted closed reductions in the emergency department failed and led to 4 IPDs and 1 periprosthetic fracture. Reduction success was associated with the following factors: use of general anesthesia with paralysis (p = 0.02), having the reduction performed by an orthopaedist (p = 0.03), and undergoing only 1 reduction attempt (p = 0.015). Two-thirds of dislocations required revision. The rate of redislocation was 33%, and 5 hips required subsequent revision at a mean of 1.8 years after the initial dislocation.</p><p><strong>Conclusions: </strong>We present an evaluation of DM-implant dislocation and dissociation along with management recommendations based on these data. Given the low success and high complication rates of attempted closed reduction and the need for eventual revision, we recommend that all patients with dislocated DM implants be brought to the operating room for closed reduction as well as potential revision if the reduction fails.</p><p><strong>Level of evidence: </strong>Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.</p>","PeriodicalId":36492,"journal":{"name":"JBJS Open Access","volume":"8 3","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/a7/de/jbjsoa-8-e22.00108.PMC10348735.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9831675","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Use of Preoperative CT Scans and Patient-Specific Instrumentation May Not Improve Short-Term Adverse Events After Shoulder Arthroplasty: Results from a Large Integrated Health-Care System.","authors":"Ronald A Navarro, Priscilla H Chan, Heather A Prentice, Michael Pearl, Frederick A Matsen Rd, Matthew D McElvany","doi":"10.2106/JBJS.OA.22.00139","DOIUrl":"10.2106/JBJS.OA.22.00139","url":null,"abstract":"<p><p>Ongoing innovation leads to a continuous influx of new technologies related to shoulder arthroplasty. These are made available to surgeons and marketed to both health-care providers and patients with the hope of improving outcomes. We sought to evaluate how preoperative planning technologies for shoulder arthroplasty affect outcomes.</p><p><strong>Methods: </strong>This was a retrospective cohort study conducted using data from an integrated health-care system's shoulder arthroplasty registry. Adult patients who underwent primary elective anatomic or reverse total shoulder arthroplasty (2015 to 2020) were identified. Preoperative planning technologies were identified as (1) a computed tomography (CT) scan and (2) patient-specific instrumentation (PSI). Multivariable Cox regression and logistic regression were used to compare the risk of aseptic revision and 90-day adverse events, respectively, between procedures for which technologies were and were not used.</p><p><strong>Results: </strong>The study sample included 8,117 procedures (in 7,372 patients) with an average follow-up of 2.9 years (maximum, 6 years). No reduction in the risk of aseptic revision was observed for patients having either preoperative CT scans (hazard ratio [HR] = 1.22; 95% confidence interval [CI] = 0.87 to 1.72) or PSI (HR = 1.44; 95% CI = 0.71 to 2.92). Patients having CT scans had a lower likelihood of 90-day emergency department visits (odds ratio [OR] = 0.84; 95% CI = 0.73 to 0.97) but a higher likelihood of 90-day venous thromboembolic events (OR = 1.79; 95% CI = 1.18 to 2.74). Patients with PSI use had a higher likelihood of 90-day deep infection (OR = 7.74; 95% CI = 1.11 to 53.94).</p><p><strong>Conclusions: </strong>We found no reduction in the risk of aseptic revision with the use of these technologies. Patients having CT scans and PSI use had a higher likelihood of venous thromboembolism and deep infection, respectively. Ongoing research with extended follow-up is being conducted to further examine the effects of these technologies on patient outcomes.</p><p><strong>Level of evidence: </strong>Diagnostic Level III. See Instructions for Authors for a complete description of levels of evidence.</p>","PeriodicalId":36492,"journal":{"name":"JBJS Open Access","volume":"8 3","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-07-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/1c/f0/jbjsoa-8-e22.00139.PMC10319369.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10164031","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Perceptions of Racial and Gender Microaggressions in an Academic Orthopaedic Department.","authors":"Marisa R Carino Mason,&nbsp;Shivani Pandya,&nbsp;Priyashma Joshi,&nbsp;Nathan Cai,&nbsp;Christopher J Murdock,&nbsp;Helen G Hui-Chou","doi":"10.2106/JBJS.OA.22.00150","DOIUrl":"https://doi.org/10.2106/JBJS.OA.22.00150","url":null,"abstract":"<p><p>Orthopaedic surgery consistently ranks last among all medical specialties in diversity and inclusion. While active efforts have recently been implemented to enact change, no study to date has explored the potential effects that social microaggressions have on an individual's career in orthopaedic surgery. The primary aim of this study was to investigate the influence of the perceived experiences of gender and race-based microaggressions on orthopaedic surgery residents, fellows, and attendings in their decision to pursue a career in orthopaedic surgery.</p><p><strong>Methods: </strong>A 34-question institutional review board-approved, modified version of the validated Racial and Ethnic Minorities Scale and Daily Life Experiences survey was sent to a total of 84 individuals at the University of Miami (UM) Department of Orthopaedics. Responses were anonymously collected from current UM orthopaedic residents, fellows, and attendings. Survey results were analyzed for the prevalence of microaggressions in the context of sex, race, ethnicity, academic goals, daily scenarios, and department support. p-Values less than 0.05 were considered statistically significant.</p><p><strong>Results: </strong>Fifty-four of 84 respondents (64%) completed the survey. Female respondents experienced significantly more gender-based microaggressions than male respondents. On average, male participants disagreed that their experiences with microaggressions made them doubt their ability to pursue a career in orthopaedic surgery while female participants responded they were neutral. In comparison with their White counterparts, non-White and Hispanic ethnicity participants demonstrated a statistically significantly greater frequency of race and ethnicity-based microaggressions.</p><p><strong>Conclusion: </strong>Our study demonstrates that female participants, non-White participants, and Hispanic minorities across all levels of training experience a higher frequency of microaggressions. The impact of these experiences on career decisions and goals for women and persons of color in orthopaedic surgery at this single institution is mixed. Experienced microaggressions should be further investigated as a potential barrier to recruitment and retention of under-represented minorities in orthopaedic surgery.</p><p><strong>Level of evidence: </strong>III.</p>","PeriodicalId":36492,"journal":{"name":"JBJS Open Access","volume":"8 3","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/c1/39/jbjsoa-8-e22.00150.PMC10405998.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10337573","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}