JBJS Open Access最新文献

{"title":"An Analysis of Reoperations Following Proximal Femoral Varus Derotational Osteotomy in Children with Cerebral Palsy.","authors":"Sam P Wimmer, Natalie L Zusman, Tishya A L Wren, Rachel Y Goldstein, Robert M Kay","doi":"10.2106/JBJS.OA.23.00159","DOIUrl":"10.2106/JBJS.OA.23.00159","url":null,"abstract":"<p><strong>Background: </strong>Hip displacement is common in children with cerebral palsy (CP). The existing literature has focused on native-hip longevity in patients with CP. This study investigated the reoperation-free rate of hips in children with CP following index proximal femoral varus derotational osteotomy (VDRO).</p><p><strong>Methods: </strong>We conducted a retrospective cohort study of patients with CP who were <18 years of age and underwent VDRO surgery at a tertiary referral center between January 2004 and January 2022, and who were followed for at least 2 years after the index surgery. Two hundred and eighty-nine patients (518 hips) met the inclusion criteria. Any return to the operating room for a same-site procedure counted as a reoperation, apart from elective hardware removal undertaken while the patient underwent a distinctly separate procedure. Reoperation rates and odds ratios (ORs) were calculated. Analyses were carried out using logistic regression and Cox proportional hazard models.</p><p><strong>Results: </strong>We found a 29.2% rate of reoperation (151 reoperations among 518 hips). The reoperation rate was greatest for patients functioning at Gross Motor Function Classification System (GMFCS) level V (32.2% for level V, 27.8% for level IV, and 25.5% for level II/III), although the difference did not reach significance (p = 0.73). Hips in patients ≥6 years of age were significantly less likely to require reoperation than in those <6 years of age (23.1% versus 46.0%; p < 0.01). Bilateral index procedures (OR, 3.68 [95% confidence interval (CI), 1.68 to 8.04]; p < 0.01) significantly increased the risk of reoperation, regardless of operative side (31.1% right versus 32.3% left; p = 0.84). Additionally, operations on the left hip (OR, 1.24; 95% CI, 1.04 to 1.48; p = 0.02) had an increased risk of reoperation compared with those on the right.</p><p><strong>Conclusions: </strong>The frequency of reoperation in this large cohort was 29.2%, which is similar to previously published rates. An age of <6 years at the index surgery, operation on the left hip, and bilateral VDRO were the only significant risk factors for reoperation; however, there was a nonsignificant stepwise increase in the reoperation rate with increasing GMFCS level. These findings enhance a surgical team's ability to optimize counseling for families and patients with CP regarding the frequency and timing of additional hip surgery.</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":"10 1","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11905970/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143658973","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":"Prevalence of Osteochondromas in the Spine in Patients with Multiple Hereditary Exostoses.","authors":"Carlos Monroig-Rivera, Lauren Bockhorn, David Thornberg, Brenda Santillan, Karl E Rathjen","doi":"10.2106/JBJS.OA.24.00072","DOIUrl":"10.2106/JBJS.OA.24.00072","url":null,"abstract":"<p><strong>Background: </strong>Multiple hereditary exostoses (MHE) is an autosomal-dominant disorder characterized by the development of multiple cartilage-capped exostoses originating from the physis that are known as osteochondromas. The potential for these osteochondromas to impinge on the spinal cord is a clinical concern. The aim of our study was to determine the prevalence of osteochondromas in the spine in individuals with MHE. Additionally, we aimed to identify any risk factors for neural-impinging osteochondromas.</p><p><strong>Methods: </strong>We prospectively enrolled a cohort of patients and their family members with MHE at a single institution from 2010 to 2022. Demographics, osteochondroma location, and clinical outcomes were documented. Magnetic resonance imaging (MRI) scans were made and interpreted by a pediatric musculoskeletal radiologist. Patients were categorized based on osteochondroma location: no spinal involvement, on the spinal column, in the spinal canal but not impinging, or neural-impinging. We also noted when osteochondromas were present on the ribs and pelvis to assess if these were predictive of spinal involvement.</p><p><strong>Results: </strong>Ninety-four patients with MHE (50% female; 78% White; mean age, 23 years) were enrolled. Fifty (53%) had no spinal involvement. Twenty-two (23%) had osteochondromas located on the spinal column, 18 (19%) had osteochondromas in the spinal canal, and 4 (4%) had an osteochondroma causing neural impingement. Of the 4 with neural impingement, 2 displayed paraparesis requiring immediate surgical intervention. The remaining 2 patients were observed clinically and monitored with use of serial MRI scans. One patient developed symptoms and underwent surgical excision of the osteochondroma. The remaining patient remained stable throughout the follow-up period. Age, gender, and the presence of osteochondromas on the ribs and pelvis were not associated with spinal involvement, osteochondromas in the canal, or neural impingement.</p><p><strong>Conclusions: </strong>Although nearly half of the patients had spinal osteochondromas, neural impingement was rare (4%). Neither age, gender, nor the presence of rib and pelvic osteochondromas were associated with spinal involvement, osteochondromas in the canal, or neural impingement. This information can be used to guide clinical decision-making regarding the use of MRI scans for patient screening.</p><p><strong>Level of evidence: </strong>Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.</p>","PeriodicalId":36492,"journal":{"name":"JBJS Open Access","volume":"10 1","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11905973/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143658989","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":"Intraoperative Neuromonitoring During Periacetabular Osteotomy Provides Actionable Alerts.","authors":"Lukas G Keil, James D Bomar, Carolyn R Bower, Melanie H Venne, Patrick F Curran, Vidyadhar V Upasani","doi":"10.2106/JBJS.OA.24.00126","DOIUrl":"https://doi.org/10.2106/JBJS.OA.24.00126","url":null,"abstract":"<p><strong>Background: </strong>Bernese periacetabular osteotomy (PAO) for symptomatic acetabular dysplasia and femoroacetabular impingement has become increasingly common, with a corresponding increase in the incidence of adverse outcomes. The rate of major neurological injury (excluding lateral femoral cutaneous nerve injury) during PAO has been reported to be around 2%. Previous publications have recommended the use of intraoperative neuromonitoring (IONM) to mitigate risk of major neurological injury during PAO, but its use has not become universal among PAO surgeons as it has among spine surgeons. The purpose of this study was to report the incidence and clinical significance of IONM alerts in a single-surgeon, consecutive cohort of patients treated with Bernese PAO.</p><p><strong>Methods: </strong>After a permanent peripheral nerve injury during a PAO without IONM, IONM has been used at our institution in every PAO. Motor evoked potentials and somatosensory monitoring are performed throughout the procedure. We conducted a retrospective review of all PAOs performed after this practice change between 2017 and 2023. Medical records were reviewed for all IONM alerts, surgical team responses to alerts, and postoperative neurological status.</p><p><strong>Results: </strong>All 94 PAOs performed with IONM in 82 patients during the study period were included. The mean age was 19 years (range 11-38). Significant IONM alerts occurred in 10 of 94 PAOs (11%) in 10 patients. Of these 10 alerts, 6 resulted in action taken by the surgical team including adjustment of acetabular fragment correction, leg repositioning, or stockinette or boot loosening. The remaining 4 alerts were due to anesthetic or systemic causes or technical issues with the neuromonitoring electrodes. No patients had a detectable neurological deficit postoperatively.</p><p><strong>Conclusions: </strong>IONM may produce alerts in approximately 1 in 9 periacetabular osteotomies. These alerts are actionable and may improve patient safety and minimize the non-negligible risk of major nerve injury. This study provides additional evidence to support the utility of IONM in PAO.</p><p><strong>Level of evidence: </strong>Level III-retrospective cohort study. See Instructions for Authors for a complete description of levels of evidence.</p>","PeriodicalId":36492,"journal":{"name":"JBJS Open Access","volume":"10 1","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11896103/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143651242","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":"Arthroscopic Pectoralis Minor Release and Infraclavicular Brachial Plexus Decompression for Neurogenic Thoracic Outlet Syndrome: A Novel Treatment for an Old Problem.","authors":"Eric R Wagner, Thomas J McQuillan, Oluwakorede Omole, Sameer R Khawaja, Kevin R Cuneo, Zaamin B Hussain, Hayden L Cooke, Krishna N Chopra, Michael B Gottschalk, Robert L Bowers","doi":"10.2106/JBJS.OA.24.00203","DOIUrl":"https://doi.org/10.2106/JBJS.OA.24.00203","url":null,"abstract":"<p><strong>Background: </strong>Neurogenic thoracic outlet syndrome (nTOS) of infraclavicular etiology is a complex condition involving the compression of the brachial plexus through the interscalene triangle and costoclavicular, infraclavicular, and pectoralis minor space. New insight into nTOS of infraclavicular etiology and its association with scapular dyskinesia has enabled minimally invasive treatments: endoscopic pectoralis minor release (PMR) and infraclavicular brachial plexus neurolysis. The purpose of this study was to analyze clinical outcomes of this technique compared with historically published outcomes for open first rib resection (FRR) and/or scalenectomy.</p><p><strong>Methods: </strong>All patients who underwent endoscopic surgical decompression for nTOS of infraclavicular etiology were retrospectively reviewed at a single institution. Surgical treatment included endoscopic PMR, subclavius release, and neurolysis of the infraclavicular brachial plexus. Patient-reported outcomes were collected prospectively and compared with prior research on FRR and scalenectomy. A subgroup analysis was performed on patients with prior open FRR or anterior cervical discectomy and fusion (ACDF).</p><p><strong>Results: </strong>Fifty-eight shoulders among 55 patients were included, with an average follow-up of 25.8 months (range: 12-52). Patients showed significant improvement in visual analog scale pain (7.0-2.1) and single alpha-numeric evaluation scores (37% to 84%). Overall, 90% of patients experienced good or excellent outcomes according to the Derkash classification. There were no major complications and only 2 minor ones (one wound infection and one case of adhesive capsulitis). Satisfaction and Derkash scores among patients undergoing endoscopic surgery were comparable with previously published studies on open FRR and scalenectomy, with lower rates of major complications and equivalent or improved clinical outcomes. Patients with prior ACDF or open FRR had worse postoperative American Shoulder and Elbow Surgeons; Quick Disabilities of the Arm, Shoulder, and Hand; and Derkash scores than the subgroup with no prior intervention.</p><p><strong>Conclusions: </strong>Endoscopic PMR and infraclavicular brachial plexus decompression is a viable and effective treatment option for nTOS of infraclavicular etiology driven by the pectoralis minor and associated scapular girdle dyskinesia. This cohort demonstrates improvements in clinical outcomes comparable with open scalenectomy and FRR with high patient satisfaction and no major neurologic, vascular, or thoracic complications.</p><p><strong>Level of evidence: </strong>Therapeutic Level IV-Case Series. See Instructions for Authors for a complete description of levels of evidence.</p>","PeriodicalId":36492,"journal":{"name":"JBJS Open Access","volume":"10 1","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11896109/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143651238","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":"Descriptive Epidemiology of Venous Thromboembolism in Pediatric Orthopedic Patients: A National, Multicenter Study.","authors":"Hillary Brenda Nguyen, Ryan M Sanborn, Danielle Cook, Benjamin J Shore","doi":"10.2106/JBJS.OA.24.00143","DOIUrl":"10.2106/JBJS.OA.24.00143","url":null,"abstract":"<p><strong>Background: </strong>Consensus regarding which children within orthopedics would benefit from venous thromboembolism (VTE) prophylaxis is lacking. Our objective was to explore the incidence and epidemiology of VTE within pediatric orthopedics through a multicenter review across the United States.</p><p><strong>Methods: </strong>Encompassing 13 pediatric centers nationwide, VTE incidence rates with 95% confidence interval (CIs) were determined for all pediatric nonorthopedic patients (PNOPs) in general (age 0-18 years) and compared with pediatric orthopedic patients (POPs) from both inpatient and outpatient settings between 2014 and 2017. Demographics, risk factors, presence of prophylaxis, treatment, and outcomes for POP VTEs were analyzed using descriptive statistics.</p><p><strong>Results: </strong>Of 10,040,937 total unique patients, the overall 4-year VTE incidence for PNOPs was 2.1 per 10,000 patients (CI 2.01-2.19). Of 141,545 POPs, the VTE incidence was 8.0 per 10,000 patients (CI 6.61-9.63). The weighted median age for POP VTEs was higher than that for PNOP VTEs (11.5 vs. 8.0 years, p = 0.001). Of the 113 POP VTEs, 97 eligible patients (median age 13.3 years, 56% male) with complete data were further analyzed: 85% (82/97) underwent orthopedic surgery for trauma, infection, or an elective procedure. Orthopedic procedures (49%), bacteremia (46%), central venous catheters (38%), and trauma (28%) were the most common risk factors associated with VTE development, mostly occurring during the initial hospitalization (65%). Thirty-four percent (33/97) of VTE cases had received prophylaxis, predominantly pharmacological (26/33, 79%), administered postoperatively. Ninety-seven percent (94/97) of POP VTEs were treated with anticoagulation, most frequently low-molecular-weight heparin (79%). Twenty-two percent of POP VTEs experienced complications, 2 (2%) of which were deaths, with one having received postoperative VTE prophylaxis.</p><p><strong>Conclusions: </strong>Although relatively rare, the true incidence of pediatric orthopedic-related VTE may be greater than that of nonpediatric orthopedic VTE, with child mortality occurring in a small minority of cases. In children diagnosed with VTE, one third had received VTE prophylaxis. Identifying at-risk children undergoing orthopedic surgery and establishing best practice safety protocols for VTE prevention are critical to prevent associated morbidity and mortality.</p><p><strong>Level of evidence: </strong>Level III-Retrospective comparative study. See Instructions for Authors for a complete description of levels of evidence.</p>","PeriodicalId":36492,"journal":{"name":"JBJS Open Access","volume":"10 1","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11896105/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143651240","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":"Anatomic Study of Hip Pericapsular Muscle Arrangement on the Joint Capsule.","authors":"Masahiro Tsutsumi, Akimoto Nimura, Hajime Utsunomiya, Masahiro Ikezu, Yasuhiko Iizuka, Shintarou Kudo, Keiichi Akita","doi":"10.2106/JBJS.OA.24.00153","DOIUrl":"https://doi.org/10.2106/JBJS.OA.24.00153","url":null,"abstract":"<p><strong>Background: </strong>Despite the recognized importance of pericapsular muscles in hip stability, their specific roles in stability remain debated. For anatomically elucidating how the pericapsular muscles can act on the femoral head and neck through the joint capsule, this study aimed to investigate pericapsular muscle arrangement on the joint capsule with a positional relation to the femoral head and neck and their histological relationships.</p><p><strong>Methods: </strong>Eight hips of 7 anatomic donors (average age, 72.5 years) fixed with 8% formalin were analyzed. Five hips were macroscopically assessed to determine the arrangement of the pericapsular muscles (iliopsoas, gluteus minimus, gemelli muscles, obturator internus, and externus) on the joint capsule, and 3 were analyzed histologically.</p><p><strong>Results: </strong>When viewed from the side of the greater trochanter (posterolateral aspect), the pericapsular muscles were macroscopically arranged spirally and ran clockwise around the femoral neck axis on the joint capsule of the right hip. The gluteus minimus had histological continuity to the joint capsule through the tendon. The other pericapsular muscles, including the iliopsoas, obturator externus, and complex of the obturator internus, had histological continuity to the joint capsule through their perimysium.</p><p><strong>Conclusions: </strong>The pericapsular muscles were arranged on the joint capsule in a spiral pattern, with histologically close continuity to the joint capsule through the perimysium or tendon.</p><p><strong>Clinical relevance: </strong>The contraction force of the pericapsular muscles may be generated spirally with their centripetal force because they maintain their spiral running course through histological continuity. The pericapsular muscles may be vital in maintaining the centric position of the femoral head by balancing their centripetal forces through the joint capsule.</p>","PeriodicalId":36492,"journal":{"name":"JBJS Open Access","volume":"10 1","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11896106/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143651236","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":"Timely Surgical Intervention for Hip Fractures is Essential to Reinstate Ambulatory Function on Discharge: Propensity Score Matching.","authors":"Hirotaka Kawakami, Hiromi Sasaki, Junichi Kamizono, Yuki Yasutake, Yusuke Fujimoto, Noboru Taniguchi","doi":"10.2106/JBJS.OA.24.00037","DOIUrl":"https://doi.org/10.2106/JBJS.OA.24.00037","url":null,"abstract":"<p><strong>Background: </strong>Timely surgical intervention for hip fractures extends postoperative survival and alleviates potential complications. However, the extent to which individuals can restore their mobility after undergoing hip fracture surgery remains unclear. We aimed to investigate the effect of timely surgical management, defined as intervention within 48 hours of injury, on postoperative ambulatory function in patients with hip fractures.</p><p><strong>Methods: </strong>We included 320 patients who underwent bipolar hemiarthroplasty for hip fractures at our institution between April 2017 and March 2023. Patients were divided into 2 groups based on the postinjury timing of the surgical intervention: the \"early group\" (within 48 hours) and the \"delay group\" (after 48 hours). We applied propensity score matching to address confounders in this retrospective observational study.</p><p><strong>Results: </strong>The early and delay groups each comprised 127 patients. We assessed the Functional Independence Measure (FIM) (walking/wheelchair) score on discharge. For preinjury Functional Ambulation Category (FAC) 3, there was a notable contrast between the early (FIM: 3.44) and delay groups (FIM: 2.31) (p = 0.005). Similarly, regarding the Gross Muscle Test (GMT) (unaffected side) score on discharge, there was a significant between-group difference at FAC 3 (early group, GMT score = 3.56; delay group, GMT score = 3.18 [p = 0.01]). Except for FAC 3, there were no significant between-group differences in either FIM or GMT scores for the other categories. Multiple regression analysis revealed that the regression coefficient for the FIM (locomotion) score on the \"time from injury to surgery\" was -0.28 (p = 0.03).</p><p><strong>Conclusions: </strong>Patients who underwent surgery at >48 hours after sustaining an injury faced increased difficulties in achieving postoperative ambulatory function, especially if their mobility had been compromised before the injury, as indicated by a low preinjury FAC score. Disparities in the restoration of ambulatory function were associated with muscle weakness.</p><p><strong>Level of evidence: </strong>Level III, Case-control study. See Instructions for Authors for a complete description of levels of evidence.</p>","PeriodicalId":36492,"journal":{"name":"JBJS Open Access","volume":"10 1","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11896104/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143651327","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":"Intramedullary Nail Versus Locking Plate for Displaced 3- and 4-Part Fractures of the Proximal Humerus: Two-Year Results From a Semidouble-Blind Randomized Trial.","authors":"Annette Konstanse Bordewich Wikerøy, Hendrik Frølich Stange Fuglesang, Rune Bruhn Jakobsen, Owen Matthew Truscott Thomas, Per-Henrik Randsborg","doi":"10.2106/JBJS.OA.24.0078","DOIUrl":"10.2106/JBJS.OA.24.0078","url":null,"abstract":"<p><strong>Background: </strong>This is a semidouble-blind randomized controlled trial comparing the clinical and radiographic outcomes of fixation of displaced 3- and 4-part proximal humerus fractures with an intramedullary nail versus a locking plate.</p><p><strong>Methods: </strong>Seventy-nine patients aged 45 to 81 years (mean 66.5 years) were randomized to open reduction and osteosynthesis with either locking nails or plates. The primary outcome was the Disabilities of the Arm, Shoulder, and Hand (DASH) score at 2 years after surgery. The secondary outcomes were the Constant score (CS), Oxford shoulder score (OSS), visual analog scale for pain at rest and during activity, and complication and reoperation rates. The patients were assessed at 6 weeks, 12 weeks, 6 months, 1 year, and 2 years after inclusion. Physiotherapists who were blinded to the choice of implant performed assessments at 6 months and 2 years. Patients were also blinded to the choice of implant.</p><p><strong>Results: </strong>Three patients were lost to follow-up, leaving data from 38 patients in each group available for analysis. There were no statistically significant differences in the DASH score, CS, OSS, or pain score at any time. The DASH score at 2 years was 12.7 (95% confidence interval [CI] 8.8-17.0) for the nail group and 10.0 (95% CI 5.6-16.1) for the plate group (p = 0.48). Twelve (32%) patients underwent reoperation in the nail group, whereas 2 (5%) patients underwent reoperation in the plate group (p = 0.006). Fourteen (37%) patients in the nail group and 4 (11%) patients in the plate group experienced complications (p = 0.05).</p><p><strong>Conclusions: </strong>There were no statistically significant differences in patient-reported outcomes or function 2 years after surgery for fixation of displaced 3- and 4-part part proximal humerus fractures with nails or plates. However, there were more complications and reoperations in the nail group.</p><p><strong>Level of evidence: </strong>Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.</p>","PeriodicalId":36492,"journal":{"name":"JBJS Open Access","volume":"10 1","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11884838/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143587373","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":"Periprosthetic Joint Infection Surrounding Lower-Extremity Endoprostheses After Tumor Resection: Causative Microorganisms, Effectiveness of DAIR, and Risk Factors for Treatment Failure.","authors":"Philip Sanders, Henk Scheper, Robert van der Wal, Michiel van de Sande, Mark de Boer, Pieter Durk Sander Dijkstra, Michael Bus","doi":"10.2106/JBJS.OA.23.00119","DOIUrl":"10.2106/JBJS.OA.23.00119","url":null,"abstract":"<p><strong>Background: </strong>Periprosthetic joint infection (PJI) surrounding an endoprosthesis after reconstruction of a lower extremity following tumor resection is a common complication, and the treatment of these infections is challenging and often requires multiple surgical interventions or even implant removal. Because there has been limited evidence to support treatment strategies and understanding of the epidemiology of the causative microorganisms, we analyzed the effectiveness of debridement, antibiotics, and implant retention (DAIR), risk factors for the failure of DAIR, and causative microorganisms in patients with a PJI surrounding a lower-extremity endoprosthesis after tumor resection.</p><p><strong>Methods: </strong>A retrospective cohort study was conducted in a tertiary referral center for orthopaedic oncology. All patients treated between 2000 and 2018 for PJI surrounding a lower-extremity endoprosthesis after tumor resection were included. Treatment outcomes and risk factors for failure were analyzed in patients primarily treated with DAIR. Causative microorganisms were recorded. The minimum follow-up period was 2 years.</p><p><strong>Results: </strong>Of the 337 patients who underwent endoprosthetic reconstruction of a lower extremity after tumor resection, 67 patients (20%) developed a PJI surrounding the endoprosthesis. Of those patients, 55 were primarily treated with DAIR. The functional cure rate of DAIR was 65% (36 of 55). A median of 2 debridements per patient was needed. Chemotherapy (odds ratio [OR], 3.1 [95% confidence interval (CI), 1.0 to 9.3]) and an erythrocyte sedimentation rate of >50 mm/hr at diagnosis (OR, 4.5 [95% CI, 1.3 to 15.4]) were associated with treatment failure. Nineteen patients (28%) had a polymicrobial infection.</p><p><strong>Conclusions: </strong>Although sequential procedures are often needed, DAIR has acceptable clinical outcomes and should be considered, dependent on expected survival and the risk factors for treatment failure noted in this study.</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":"10 1","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11841843/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143484164","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":"Ten to 15-Year Outcomes of Monoblock Uncemented Dual Mobility Cups: Excellent Survival Rate and Outcome in Primary Total Hip Arthroplasty.","authors":"Cécile Batailler, Sébastien Lustig, Emmanuel Balot, Frédéric Farizon, Michel Henri Fessy, Rémi Philippot","doi":"10.2106/JBJS.OA.24.00074","DOIUrl":"10.2106/JBJS.OA.24.00074","url":null,"abstract":"<p><strong>Background: </strong>Dual mobility cups (DMCs) have effectively prevented dislocations after total hip arthroplasty (THA). However, use of these cups in primary THAs remains controversial, especially in young patients. This study aimed to determine the long-term survival rate and functional outcomes of a contemporary DMC used in primary THA.</p><p><strong>Methods: </strong>This retrospective multicenter study identified a cohort of 614 primary THAs performed with the same uncemented monoblock DMC between 2007 and 2010. Survival analysis included 572 THAs, while clinical analysis involved 394 THAs at a minimal follow-up of 10 years. The mean follow-up was 11.1 ± 1.2 years. The mean age was 71.4 ± 11.7 years, with 4.2% of patients under 50 years old. The mean body mass index was 27.0 ± 5.3 kg/m². The 10-year Kaplan-Meier survival rate was calculated based on cup removal for any reason or cup revision for an aseptic reason as the end point. Harris hip scores were collected at the last follow-up.</p><p><strong>Results: </strong>The cup-revision-free survival rate was 98.6% at 10 years and 96.2% at 13 years. No cup revisions were reported due to aseptic loosening or dislocation. The cup revisions were due to infection (7 of 572; 1.2%), acetabular fracture (1 of 572; 0.17%), and psoas impingement due to cup malpositioning (n = 1 of 572; 0.17%). Only 3 dislocations (0.52%) were observed, and they did not require revision. The mean Harris hip score significantly improved from 54.1 ± 14.4 preoperatively to 88.0 ± 14.3 at the last follow-up (p < 0.0001). For patients under 50 years old at the time of surgery, the mean Harris hip score showed significant improvement from 53.0 ± 10.2 preoperatively to 89.7 ± 12.8 at the last follow-up (p < 0.0001), with no significant difference compared with the older patients (p = 0.50). No revision or complication was reported in the younger patient population at 13 years of follow-up.</p><p><strong>Conclusions: </strong>The monoblock uncemented DMC demonstrated excellent survival rates with no DMC-specific complications during a minimum 10-year follow-up. The dislocation rate was very low, and a younger age was not identified as a risk factor for failure. Therefore, monoblock cementless DMCs can be safely used, even in primary THA.</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":"10 1","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11841846/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143484169","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}