JBJS Open Access最新文献

{"title":"Tibial Fractures at High Risk of Infection Treated with Intramedullary Nailing: Do Nails with Antibacterial Coatings Make a Difference?","authors":"Nikolaos K Kanakaris, Vasileios P Giannoudis, Ritchie G Strain, Peter V Giannoudis","doi":"10.2106/JBJS.OA.25.00183","DOIUrl":"10.2106/JBJS.OA.25.00183","url":null,"abstract":"<p><strong>Background: </strong>Tibial fractures represent the most common model for studying complications of long-bone fracture treatment, particularly fracture-related infections (FRIs). One of the recently emerging FRI prevention strategies has been the use of coated intramedullary nails. The aim of this study was to evaluate the clinical effectiveness of 2 commercially available coated tibial nails (the ETN PROtect and the ZNN Bactiguard) in comparison with standard noncoated nails in clinical scenarios of high FRI risk.</p><p><strong>Methods: </strong>In-hospital and follow-up data for a minimum of 12 months were collected. High risk was defined as open injuries, fasciotomies, and fractures treated initially with a bridging external fixator or Oestern-Tscherne grade 2/3 soft tissue trauma. Statistical analysis was performed using Stata, with a significance level of p < 0.05.</p><p><strong>Results: </strong>Two hundred thirty-four high-risk tibial fractures were operated in different periods by the same team of senior surgeons. The PROtect nail was used in 102 fractures, the Bactiguard in 41, and the noncoated standard nail in 92. There were no statistically significant differences in epidemiological and comorbidity characteristics, severity of associated injuries, fracture types, severity of soft tissue trauma, time-to-definitive fixation, or soft tissue management between the coated nail groups. Overall, the incidence of FRIs was 9.4%: for the PROtect nails, 7.8%; for the Bactiguard nails, 4.9%; and 13.2% for the noncoated nails (p = 0.167). Staphylococcus was the most common species, whereas 11 (50%) samples were polymicrobial, and 18.8% were multidrug-resistant species. Uncomplicated union within 6 months was recorded in 64.7% vs. 65.9% vs. 53.8% and unplanned secondary interventions in 26.5% vs. 22% vs. 41.8%, respectively, (p = 0.009).</p><p><strong>Conclusions: </strong>The incidence of FRIs in these high-risk tibial fractures was 9.4%. Compared with noncoated intramedullary implants, both types of coated nails achieved a lower incidence of FRI. Larger-scale studies would provide more robust evidence to inform patient care and validate the role of coated implants in preventing FRI.</p><p><strong>Level of evidence: </strong>Level III, cohort study (nonrandomized comparative study). See Instructions for Authors for a complete description of levels of evidence.</p>","PeriodicalId":36492,"journal":{"name":"JBJS Open Access","volume":"10 3","pages":""},"PeriodicalIF":3.8,"publicationDate":"2025-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12448154/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145113560","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":"Impact of Posterior Spinal Fusion on Pulmonary Function in Patients With Severe Adolescent Idiopathic Scoliosis (Major Cobb Angle ≥90°).","authors":"Sin Ying Lee, Zhi Sean Teng, Chee Kuan Wong, Chee Kidd Chiu, Chris Yin Wei Chan, Mun Keong Kwan","doi":"10.2106/JBJS.OA.25.00169","DOIUrl":"10.2106/JBJS.OA.25.00169","url":null,"abstract":"<p><strong>Background: </strong>Curve severity is a recognized factor associated with impaired pulmonary function in patients with severe adolescent idiopathic scoliosis (AIS). Despite significant curve correction achieved after posterior spinal fusion, reports on the extent of potential pulmonary function improvement in these patients remain inconsistent. Therefore, we aimed to evaluate the changes in pulmonary function test (PFT) parameters in patients with severe AIS after posterior spinal fusion.</p><p><strong>Methods: </strong>This study involved 18 severe AIS patients with major main thoracic curves (<i>major Cobb angle ≥90°</i>), who underwent posterior spinal fusion between 2019 and 2023, with a minimum 24-month follow-up. Primary PFT parameters measured preoperatively and at the most recent observation postoperatively were forced vital capacity (FVC), forced expiratory volume in one second (FEV₁), and total lung capacity (TLC). Moderate to severe pulmonary impairment (<i>MSPI</i>) is defined as a predicted FVC/FEV₁ of ≤65%. Patients were classified into having <i>normal pulmonary function/mild pulmonary impairment</i> (<i>normal/mild PI</i>) and <i>MSPI</i>. Postoperatively, patients were further categorized into having <i>improved pulmonary function</i> or <i>stable pulmonary function</i> based on the transition of their pulmonary function classification.</p><p><strong>Results: </strong>The mean final follow-up duration was 37.9 ± 15.1 months. The major Cobb angle improved from 101.5° (93.0°-115.3°) to 45.0° (35.0°-58.0°) postoperatively (<i>p</i> < 0.001). There were increments of 14.7 ± 8.3% in predicted FVC and 15.2 ± 9.6% in predicted FEV₁ postoperatively. The predicted FVC and FEV₁ increased from 53.6 ± 11.9% and 50.1 ± 13.4% (preoperative) to 68.3 ± 7.9% and 65.3 ± 10.5% (postoperative), respectively (<i>p</i> < 0.001). Seven patients (50.0%) (<i>based on FVC classification</i>) and 6 patients (40.0%) (<i>based on FEV</i> _<i>1</i> <i>classification</i>) with <i>MSPI</i> showed postoperative improvement in pulmonary function by transitioning to <i>normal/mild PI</i>. The remaining patients exhibited stable pulmonary function, and none experienced deterioration.</p><p><strong>Conclusions: </strong>Patients with severe AIS demonstrated significant improvements in pulmonary function parameters after posterior spinal fusion. None experienced postoperative deterioration, whereas approximately 40.0% to 50.0% of those with <i>MSPI</i> improved to the <i>normal/mild PI</i> category.</p><p><strong>Level of evidence: </strong>Level III. See Instructions for Authors for a complete description of levels of evidence.</p>","PeriodicalId":36492,"journal":{"name":"JBJS Open Access","volume":"10 3","pages":""},"PeriodicalIF":3.8,"publicationDate":"2025-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12448169/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145114364","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":"Effectiveness of Teriparatide (rhPTH) in Enhancing Functional Recovery After Arthroscopic Rotator Cuff Repair: A Triple-Blind Randomized Clinical Trial.","authors":"Mohammad Reza Guity, Amir Human Hoveidaei, Ali Soltani Farsani, Mohammad Poursalehian, Maryam Okhovat, Rezvan Ghaderpanah, Reza Sattarpour, Sina Afzal, Shahabaldin Beheshti Fard","doi":"10.2106/JBJS.OA.25.00035","DOIUrl":"10.2106/JBJS.OA.25.00035","url":null,"abstract":"<p><strong>Background: </strong>Rotator cuff tears are common musculoskeletal injuries frequently requiring surgical intervention, yet retears occur at a notable rate. Teriparatide (recombinant human parathyroid hormone, rhPTH) has shown promise in animal studies for enhancing bone and tendon healing. However, limited human data exist on its clinical benefits when used adjunctively in arthroscopic rotator cuff repairs.</p><p><strong>Purpose: </strong>To investigate whether the systemic administration of teriparatide improves functional outcomes following arthroscopic rotator cuff repair in a triple-blind, randomized controlled trial (RCT).</p><p><strong>Methods: </strong>Fifty adult patients (aged 50-80 years) with degenerative rotator cuff tears were randomized (1:1) to receive daily subcutaneous injections of either teriparatide (20 μg) or placebo for 3 months after arthroscopic repair. Blinded evaluators assessed participants at baseline, 6 months, and 1 year. The primary outcome was the American Shoulder and Elbow Surgeons (ASES) score. Secondary outcomes included range of motion (ROM), Visual Analog Scale (VAS) for pain, nighttime pain, painkiller use, and magnetic resonance imaging (MRI) assessment of tendon integrity (Sugaya classification).</p><p><strong>Results: </strong>Final analyses included 43 participants (rhPTH group = 23, control group = 20). Both the rhPTH and control groups demonstrated significant within-group improvements in ASES scores, ROM, and pain scores from baseline to 1 year (p < 0.0001). However, no significant between-group differences were observed at the 6-month or 1-year follow-up for the ASES score (p = 0.87), ROM in all planes, or VAS pain scores. MRI evaluations at 1 year showed comparable retear rates (8.7% vs. 10%, p = 0.94), indicating no significant advantage of teriparatide in promoting tendon integrity.</p><p><strong>Conclusion: </strong>In this triple-blind RCT, teriparatide did not confer additional benefits over placebo in improving functional outcomes or reducing retear rates 1 year after arthroscopic rotator cuff repair. Larger RCTs that include a broader patient population are required to fully clarify the role of teriparatide in enhancing rotator cuff repair outcomes.</p><p><strong>Level of evidence: </strong>Level II. See Instructions for Authors for a complete description of levels of evidence.</p>","PeriodicalId":36492,"journal":{"name":"JBJS Open Access","volume":"10 3","pages":""},"PeriodicalIF":3.8,"publicationDate":"2025-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12448177/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145114390","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":"Extended Trochanteric Osteotomy Combined with Medial Reduction Corticotomy to Correct Femoral Deformity at the Time of Revision Total Hip Arthroplasty.","authors":"Diego J Restrepo, Sergio F Guarin Perez, Ta-Wei Tai, Matthew P Abdel, Daniel J Berry, Rafael J Sierra","doi":"10.2106/JBJS.OA.25.00193","DOIUrl":"10.2106/JBJS.OA.25.00193","url":null,"abstract":"<p><strong>Background: </strong>An extended trochanteric osteotomy (ETO) is commonly used to improve exposure and facilitate femoral component removal in revision total hip arthroplasty (THA). An additional medial corticotomy may be used in conjunction with an ETO to correct a femoral deformity, particularly varus remodeling in association with a failed femoral component. This study evaluated the outcomes of combining an ETO with a medial corticotomy in revision THA, with emphasis on implant fixation, femoral alignment, bone union, and clinical outcomes.</p><p><strong>Methods: </strong>Of the 612 ETOs performed between 2003 and 2013, 13 patients (9 men and 4 women) underwent ETO combined with a medial corticotomy to correct varus remodeling, representing 2% of all ETOs during that period. The average follow-up was 8 ± 3.5 years. The mean age at surgery was 67 ± 13.5 years. The mean body mass index was 32 ± 7.7 kg/m². Radiographs were reviewed to measure preoperative and postoperative femoral deformity, time to consolidation, and femoral fixation. Clinical outcomes were evaluated using the Harris Hip Score (HHS).</p><p><strong>Results: </strong>All patients had preoperative varus femoral deformity (mean 16.3° ± 5.7°). The mean postoperative alignment was 4.3 ± 1.6° varus achieving an average correction of 12° (95% CI -15.7 to -8.3, p < 0.0001). Both the ETO and the medial corticotomy consolidated in 10 of 11 patients (91%) with available 1-year radiographs at a mean of 11 ± 7.7 months. The mean HHS improved significantly from 42 preoperatively to 82 at 5-year follow-up (p = 0.0002). Complications related to the ETO and corticotomy occurred in 4 patients (30%), including 1 intraoperative fracture, 1 postoperative greater trochanteric fracture, 1 nonunion of the medial corticotomy, and 1 postoperative wound-hematoma. All femoral components remained well fixed at final follow-up.</p><p><strong>Conclusion: </strong>The combination of ETO and medial corticotomy in revision THA effectively corrected femoral alignment in patients with a preoperative varus deformity and was associated with significant functional improvement at the final follow-up.</p><p><strong>Level of evidence: </strong>Level IV. See Instructions for Authors for a complete description of levels of evidence.</p>","PeriodicalId":36492,"journal":{"name":"JBJS Open Access","volume":"10 3","pages":""},"PeriodicalIF":3.8,"publicationDate":"2025-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12443152/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145114380","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":"Erratum: Relationship Between Blurred Boundary and Neurological Deficits in Extension-Type Pediatric Supracondylar Humeral Fractures.","authors":"Takuji Yamamoto, Yoshifumi Ueshin, Hikaru Ogawa, Yasuharu Nakashima","doi":"10.2106/JBJS.OA.ER.25.00153","DOIUrl":"10.2106/JBJS.OA.ER.25.00153","url":null,"abstract":"<p><p>[This corrects the article DOI: 10.2106/JBJS.OA.25.00153.].</p>","PeriodicalId":36492,"journal":{"name":"JBJS Open Access","volume":"10 3","pages":""},"PeriodicalIF":3.8,"publicationDate":"2025-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12443150/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145087665","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":"The Impact of Formal Leadership Training Programs Offered by the American Orthopaedic Association.","authors":"Chista R Irani, Rithvik Vutukuri, Mia V Rumps, Shreya M Saraf, Mary K Mulcahey","doi":"10.2106/JBJS.OA.25.00100","DOIUrl":"10.2106/JBJS.OA.25.00100","url":null,"abstract":"<p><strong>Background: </strong>Leadership training programs are gaining popularity in orthopaedic surgery, yet only a few studies analyze how orthopaedic surgeons benefit from these programs. The purpose of this study was to investigate the impact of participating in 4 leadership programs offered by the American Orthopaedic Association (AOA). The secondary aims were to understand why orthopaedic surgeons want to participate in these programs, whether male and female surgeons benefit similarly, and what are the opportunities for improving future programs.</p><p><strong>Methods: </strong>An anonymous survey was distributed by the AOA to orthopaedic surgeons who participated in the Resident Leadership Forum, Emerging Leaders Program, AOA-Kellogg Leadership Series (2012-2022), and/or AOA-University of Southern California (USC) Apex Leadership Certificate Program (2019-2022). Data was analyzed across all participants and by gender.</p><p><strong>Results: </strong>One hundred and twenty-five responses were received. Eighty-six respondents (68.8%) obtained new leadership position(s) following participation in AOA programs. Ninety-seven respondents (77.6%) were self-motivated to seek leadership training. Over half (76, 60.8%) recommend future programs to include lessons on healthcare administration and business management. Female compared with male surgeons benefited from building professional networks and finding new mentors (81.5% vs. 70.4% and 66.7% vs. 54.1%, respectively). Conversely, male surgeons benefited by learning team management, vision planning, and organizational management (78.6% vs. 74.1%, 86.7% vs. 77.8%, and 83.7% vs. 74.1%, respectively). Both genders benefitted similarly in building their emotional intelligence and mentorship skills (80.6% vs. 81.5% and 81.6% vs. 81.5%).</p><p><strong>Conclusion: </strong>AOA leadership programs helped orthopaedic surgeons with career advancement and skill development. While female surgeons emphasized networking and mentorship, male surgeons benefited from learning team and organizational management and vision planning. Both genders benefited similarly in emotional intelligence and mentorship. Future leadership programs should prioritize teaching nonclinical leadership skills to support the growing responsibilities of surgeon-leaders outside of the operating room.</p><p><strong>Level of evidence: </strong>Level III. See Instructions for Authors for a complete description of levels of evidence.</p>","PeriodicalId":36492,"journal":{"name":"JBJS Open Access","volume":"10 3","pages":""},"PeriodicalIF":3.8,"publicationDate":"2025-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12443149/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145113623","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":"Antibiotic-Loaded Bone Cement and Risk of Infection After Knee Arthroplasty in High-Risk Patients: A Register Based Meta-Analysis.","authors":"Tesfaye H Leta, Richard N Chang, Stein Atle Lie, Anne Marie Fenstad, Stein Håkon L Lygre, Martin Lindberg-Larsen, Alma B Pedersen, Annette W-Dahl, Ola Rolfson, Oskar Johansson, Liza N van Steenbergen, Rob Ghh Nelissen, Dylan Harries, Carl Holder, Peter Lewis, Richard de Steiger, Olav Lutro, Keijo Mäkelä, Mikko S Venäläinen, Jinny Willis, Chris Frampton, Michael Wyatt, Alexander Grimberg, Arnd Steinbrück, Yinan Wu, Håvard Dale, Christian Brand, Bernhard Christen, Joanne Shapiro, J Mark Wilkinson, Morgan Edwards, Geir Hallan, Jan-Erik Gjertsen, Ove Furnes, Art Sedrakyan, Heather A Prentice, Elizabeth W Paxton","doi":"10.2106/JBJS.OA.25.00061","DOIUrl":"10.2106/JBJS.OA.25.00061","url":null,"abstract":"<p><strong>Background: </strong>The use of antibiotic-loaded bone cement (ALBC) in primary total knee arthroplasty (TKA) is debated. Some argue that ALBC might only be justified in high-risk patients. This study assessed the effectiveness of ALBC vs. plain bone cement (PBC) in reducing risk of revision for periprosthetic joint infection (PJI) in TKA patients considered to have a high risk of infection.</p><p><strong>Methods: </strong>Cohort study of primary TKAs in 11 national or regional arthroplasty registries from 2010 to 2020. The 1-year risk of revision for PJI in TKAs with ALBC vs. PBC among patients with high American Society of Anesthesiologists (ASA) classification, body mass index (BMI), and/or diabetes was compared. Cumulative percent revision (1 minus Kaplan-Meier) based on 685,818 TKAs and Cox regression analyses (adjusted Hazard Rate Ratios [aHRRs]) were performed for TKAs with ALBC (reference) vs. PBC restricted to the following high-risk subgroups of patients: (1) ASA ≥3 (n = 335,612 vs. 35,997), (2) BMI ≥35 (n = 278,927 vs. 24,737), (3) ASA ≥3 and BMI ≥35 (n = 99,407 vs. 11,407), (4) diabetes (n = 38,341 vs. 21,838), and (5) ASA ≥3, BMI ≥35, and diabetes (n = 3,347 vs. 4,261). Advanced distributed meta-analyses were performed to combine all aggregate data and assess 1-year risk of revision for PJI.</p><p><strong>Results: </strong>Each registry reported a 1-year cumulative percent revision of ≤1.6% for PJI following TKAs both for ALBC and PBC in all high-risk subgroups. Similar 1-year risks of revision for PJI were found in TKAs with ALBC (reference) and PBC among patients with ASA ≥3 (aHRR: 1.09; 95% CI, 0.90-1.31); BMI ≥35 (1.06; 0.54-2.12); ASA ≥3 and BMI ≥35 (1.12; 0.83-1.50); diabetes (0.95; 0.74-1.20); and ASA ≥3, BMI ≥35, and diabetes (1.40; 0.86-2.29).</p><p><strong>Conclusions and relevance: </strong>Similar 1-year revision risk of PJI was found for TKAs with ALBC vs. PBC in high-risk patients. Confirmation of the efficacy of ALBC in high-risk TKA patients needs to be evaluated in clinical trials.</p><p><strong>Level of evidence: </strong>Level III. See Instructions for Authors for a complete description of levels of evidence.</p>","PeriodicalId":36492,"journal":{"name":"JBJS Open Access","volume":"10 3","pages":""},"PeriodicalIF":3.8,"publicationDate":"2025-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12443158/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145114416","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":"Increased Risk of Pulmonary Complications with Long Cephalomedullary Nails in Geriatric Intertrochanteric Femur Fractures: A Retrospective Review of 881 Patients.","authors":"Maaz Muhammad, Griffin Green, Wyatt G S Southall, Adam N Musick, Austin T Gregg, Robert K Wagner, Gregory S Hawk, Arun Aneja","doi":"10.2106/JBJS.OA.25.00170","DOIUrl":"10.2106/JBJS.OA.25.00170","url":null,"abstract":"<p><strong>Background: </strong>Despite extensive literature comparing short and long cephalomedullary nails (CMNs), the impact of CMN length on pulmonary complications in geriatric patients with intertrochanteric (IT) fractures is not well established. This study compared postoperative pulmonary complications in geriatric patients with IT fractures treated with short (<235 mm) or intermediate (235-240 mm) CMNs (SINs) versus long (≥300 mm) CMNs (LNs).</p><p><strong>Methods: </strong>Patients aged ≥65 years with AO Foundation/Orthopaedic Trauma Association (AO/OTA) 31A1-A3 fractures treated with SINs or LNs between 2008 and 2020 were retrospectively identified at a single Level 1 Trauma center. The primary outcome was inpatient postoperative pulmonary complications. Secondary outcomes included mortality, surgical duration, and other inpatient postoperative complications. Adjusted odds ratios (AORs) with 95% confidence intervals (CIs) were calculated using logistic regression to adjust for comorbidities (i.e., diabetes, hypertension, chronic) obstructive pulmonary disease, smoking status, age, AO/OTA classification, ASA ≥3, time to surgery, and surgical duration.</p><p><strong>Results: </strong>Overall, 881 patients were treated with either an SIN (n = 327) or an LN (n = 554). The SIN group was older (80.7 ± 9.1 years vs. 79.3 ± 8.4 years, p = 0.016), had a higher proportion of AO/OTA 31A1 fractures (p < 0.001), and included more patients with ASA ≥3 (89% vs. 84%, p = 0.035). In the SIN group, the median surgical duration was shorter (60 [interquartile range (IQR): 47-79] vs. 81 minutes [IQR: 62-106], p < 0.001), and rates of postoperative anemia (74% vs. 81%, p = 0.017) and transfusion (43% vs. 54%, p = 0.001) were lower. After adjusting for covariates, multivariable analysis demonstrated increased odds of postoperative pneumonia (AOR: 2.09, 95% CI: 1.01-4.71, p = 0.048), pulmonary embolism (AOR: 4.38, 95% CI: 1.09-29.5, p = 0.036), and transfusion (AOR: 1.38, 95% CI: 1.02-1.85, p = 0.034) in the LN group. There were no differences in mortality or other postoperative complications (p > 0.05).</p><p><strong>Conclusions: </strong>Geriatric patients with IT fractures treated with LNs had increased odds of inpatient postoperative pneumonia, pulmonary embolism, and transfusion. However, mortality and other postoperative complications were similar.</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 3","pages":""},"PeriodicalIF":3.8,"publicationDate":"2025-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12443157/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145113539","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":"Survivorship of Cemented Versus Cementless Metal on Metal Hip Resurfacing: A Match-Cohort Analysis at Minimum 5 Years.","authors":"Edoardo Viglietta, Simone Fenucci, Ariane Parisien, Andrew Tucker, George Grammatopoulos, Paul E Beaulé","doi":"10.2106/JBJS.OA.25.00180","DOIUrl":"10.2106/JBJS.OA.25.00180","url":null,"abstract":"<p><strong>Background: </strong>One of the most common causes of failure after metal-on-metal hip resurfacing (MoM HR) remains femoral neck fracture and aseptic loosening of the femoral component. The purpose of this study was to compare the survivorship of cemented and cementless femoral fixation metal on metal hip resurfacing.</p><p><strong>Methods: </strong>Five-hundred ninety patients' MoM HR performed through the Hueter-anterior approach with a minimum 5-year (mean age 50 years, body mass index (BMI) 29, 555 men and 35 women) follow-up were reviewed. One hundred and forty-three cementless (mean age 50 years, mean BMI 29, 136 men and 7 women) and 143 cemented MoM HR (mean age 52 years, mean BMI 29, 136 men and 7 women) were matched on age, sex, and BMI. Overall failures, femoral failures, adverse events, and complications were assessed. Acetabular cup inclination, neck-shaft angle (NSA), stem-shaft angles (SSA), Δ NSA-SSA, and neck narrowing were recorded.</p><p><strong>Results: </strong>Survivorship was 91% at a mean follow-up of 8.2 years (range 5-19). There were 14 failures (10% rate) in the cemented group and 12 failures (8% failure rate) in the cementless group (p > 0.05) with men at 92.7% and women at 74.9% (p = 0.019). In the male group, using isolated femoral reasons for revision survivorship was 96.5% for the cemented group and 98% for the cementless group (p > 0.05). Neck narrowing more than 10% was present in 11 patients (8%) in the cemented group and in 3 patients (2%) in the cementless group (p < 0.01). No significant correlation was found between any radiological parameter and the risk of failure.</p><p><strong>Conclusion: </strong>Both cementless and cemented MoM HR are associated with excellent survivorship, especially in men with cementless fixation having a lower incident of neck narrowing.</p>","PeriodicalId":36492,"journal":{"name":"JBJS Open Access","volume":"10 3","pages":""},"PeriodicalIF":3.8,"publicationDate":"2025-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12443159/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145113541","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":"The Prospective Randomized EValuation of Emerging Novel Treatments for Infection Prophylaxis in Total Joint Replacement (PREVENT-iT): Feasibility and Safety Study.","authors":"Thomas J Wood, Sameer Parpia, Isabelle Tate, Hassaan Abdel Khalik, Ernesto Muñoz-Mahamud, Michael Tanzer, Adam Hart, Anthony Albers, Qirui Hou, Mohit Bhandari","doi":"10.2106/JBJS.OA.25.00150","DOIUrl":"10.2106/JBJS.OA.25.00150","url":null,"abstract":"<p><strong>Background: </strong>Despite the success of total joint arthroplasty for end-stage hip and knee osteoarthritis, periprosthetic joint infection (PJI) remains a devastating complication and leading cause of revision surgery. Antiseptic irrigation solutions and topical antibiotics are promising and cost-effective strategies for the prevention of PJIs, though high-quality evidence assessing their efficacy is lacking. Therefore, this study investigates the feasibility of conducting a definitive trial to determine the optimal prophylactic treatment of PJIs using various irrigation solutions and topical antibiotics.</p><p><strong>Methods: </strong>Using a simple randomized 3 × 2 factorial trial, patients were randomized across 5 centers to 1 of 6 possible treatments (povidone-iodine, chlorhexidine-gluconate, or saline, with or without vancomycin). Nine criteria were assessed to evaluate feasibility including participant enrollment, administration of treatments, data collection methods, and protocol compliance. Adverse event rates were used to assess trial safety. Secondary outcomes included rates of PJI requiring reoperation and persistent wound drainage (PWD).</p><p><strong>Results: </strong>Four hundred and ninety-five participants were included in the pilot trial. Study participants were 56% female with a mean age of 67 years. Seven of the 9 criteria assessing feasibility indicated the trial was successful and no modifications needed. Two criteria, treatment contamination (8.5%) and completeness of patient follow-up (93.8%), were graded as requiring minor adjustment before conducting the definitive trial. There were 114 serious adverse events; none of which were deemed associated with the treatments. Overall, 9 (1.84%) presented with PJIs requiring reoperation, and 6 patients (1.12%) presented with PWD.</p><p><strong>Conclusion: </strong>This study demonstrates the feasibility and safety of prophylactic irrigation solutions and topical antibiotics. PREVENT-IT has received funding from the Canadian Institutes of Health Research toward the definitive, large, multicenter randomized controlled trial (NCT06126614).Ultimately, findings will directly affect clinical practice with the potential to positively influence global rates of PJI.</p><p><strong>Level of evidence: </strong>NA.</p>","PeriodicalId":36492,"journal":{"name":"JBJS Open Access","volume":"10 3","pages":""},"PeriodicalIF":3.8,"publicationDate":"2025-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12431753/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145065992","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}