JBJS Open Access最新文献

{"title":"When is Growth the Greatest? Spine and Total Body Growth in Idiopathic Scoliosis Through Sanders Maturation Stages 2, 3A, 3B, and 4.","authors":"Yusuke Hori, Bryan Menapace, Norihiro Isogai, Sadettin Ciftci, Burak Kaymaz, Luiz Carlos Almeida da Silva, Kenneth J Rogers, Petya K Yorgova, Peter G Gabos, Suken A Shah","doi":"10.2106/JBJS.OA.24.00189","DOIUrl":"https://doi.org/10.2106/JBJS.OA.24.00189","url":null,"abstract":"<p><strong>Background: </strong>Sanders maturation stages (SMS) 2 to 4 represent periods of rapid growth and are considered ideal candidates for growth modulation surgery, such as anterior vertebral body tethering. A detailed assessment of spine growth during these stages is essential but limited. This study aimed to clarify the differences in growth rates for spine and total body height across SMS 2, 3A, 3B, and 4, as well as to assess cumulative growth until skeletal maturity for these stages.</p><p><strong>Methods: </strong>This single-center, retrospective, case-control longitudinal study evaluated consecutive patients with idiopathic scoliosis staged SMS 2 to 4. T1-S1 spine height, total body height, and curve magnitude were measured at each visit. Monthly growth rates for spine and total body height were calculated between baseline and first follow-up visit (6-12 months). In a subset followed to skeletal maturity, cumulative spine and total body height gain were assessed. To account for height loss due to scoliosis, spine and total body height were adjusted for curve magnitude using validated formulas. Multivariate linear regression models were employed to evaluate the relationship between SMS and growth, adjusting for confounding factors.</p><p><strong>Results: </strong>A total of 517 patients (68% female) were included. Spine height growth was highest in patients at SMS 3A, approximately 1.4 times stage 2, 1.5 times stage 3B, and 1.8 times stage 4. Total body height growth rates were comparable between SMS 2 and 3A, both significantly exceeding SMS 3B and 4. Among 314 patients followed to skeletal maturity, cumulative growth in spine and total body height was greatest in patients at SMS 2.</p><p><strong>Conclusions: </strong>This study demonstrated that spinal growth was most pronounced in patients at SMS 3A, while total body height growth was greatest during SMS 2 and 3A. Less mature patients exhibited greater cumulative growth potential in both spine and total body height. These findings provide crucial insights for determining the optimal timing of growth modulation surgery.</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 2","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12055122/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144015462","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":"Unicompartmental Knee Arthroplasty Offers More Natural Feeling Joints Compared with Total Knee Arthroplasty: A Systematic Review and Meta-Analysis.","authors":"Mohammad Poursalehian, Yashar Khani, Rezvan Ghaderpanah, Sanam Mohammadzadeh, Amir Mehrvar, Sina Hajiaghajani","doi":"10.2106/JBJS.OA.25.00011","DOIUrl":"https://doi.org/10.2106/JBJS.OA.25.00011","url":null,"abstract":"<p><strong>Background: </strong>Unicompartmental knee arthroplasty (UKA) preserves healthy cartilage and may provide a more \"natural-feeling\" joint compared with total knee arthroplasty (TKA). The Forgotten Joint Score (FJS) is increasingly used to assess joint awareness. We aimed to systematically compare FJS outcomes in patients undergoing UKA versus TKA.</p><p><strong>Methods: </strong>Following Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines, we searched PubMed, Embase, Scopus, and Web of Science. We included studies reporting FJS in UKA vs. TKA, assessed risk of bias using the Newcastle-Ottawa Scale, and Cochrane RoB-2, and conducted random-effects meta-analyses to calculate pooled mean differences (MD), and sensitivity analyses were performed to assess the robustness of the findings.</p><p><strong>Results: </strong>Ninteen studies (16 cohort, 3 randomized clinical trials; 4,500 knees) were included. Overall, the pooled MD in FJS favored UKA by 8.45 points (95% CI: 6.03-10.88; p < 0.001), indicating lower joint awareness. However, heterogeneity was high (I² = 96.24%) and publication bias was detected. Sensitivity analyses, including a leave-one-out analysis and an analysis restricted to randomized controlled trials, confirmed the consistency of the results, with no single study disproportionately influencing the findings.</p><p><strong>Conclusion: </strong>Despite substantial heterogeneity, these findings suggest that UKA may offer superior joint awareness compared with TKA.</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 2","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12055126/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143988352","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":"Socioeconomic Deprivation Influences Failure to Attend Arranged Orthopaedic Outpatient Appointments as Well as Access to and Engagement With Health Care: A Cohort Study.","authors":"V Badial, S F Turner, H Jeffrey, R Barter, E Hayter, R E Anakwe","doi":"10.2106/JBJS.OA.24.00238","DOIUrl":"https://doi.org/10.2106/JBJS.OA.24.00238","url":null,"abstract":"<p><strong>Background: </strong>We undertook this study to examine the \"did-not-attend\" (DNA) rate for the orthopaedic outpatient clinic at a large tertiary center, to understand the influencing factors and reasons from the patient perspective and to determine the impact of socioeconomic deprivation.</p><p><strong>Methods: </strong>We reviewed all scheduled outpatient attendances to our trauma and orthopaedic surgery service over a 12-month period and demographic information for each patient, including the Index of Multiple Deprivation. We studied the rate and predictors for nonattendance in the outpatient clinic and the influence of socioeconomic deprivation. We undertook a secondary study to evaluate the reasons patients gave for nonattendance, their perception of the accessibility, usefulness, and format of the outpatient model and any relationship with socioeconomic deprivation.</p><p><strong>Results: </strong>Eighteen thousand thirty-three patients attended 58,396 outpatient appointments over the 12-month study period. 2060 patients \"did not attend\" at least one arranged orthopaedic outpatient appointment over the 12 months of the study period. Men and more socioeconomically deprived patients were more likely to not attend. The most common reasons given for not attending were that patients did not feel that the appointment was useful for them. Patients from socioeconomically deprived groups were more likely to reference transport difficulties as a reason for not attending (p < 0.001). Socioeconomically deprived and disadvantaged patients reported poorer satisfaction scores regarding how able they felt to access orthopaedic help and services when they needed to and how able they felt to access orthopaedic help and services in a way that suits them.</p><p><strong>Conclusions: </strong>Socioeconomic deprivation affects health and access to health care. Patients who are more socioeconomically deprived are more likely to not attend, and they report poorer satisfaction with access to orthopaedic outpatient care. DNA rates may reflect underlying health disparities.</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 2","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12055086/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144022623","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":"Surgical Outcomes of Single-Stage Correction Using Cervical Pedicle Screw Fixation Rather Than Lateral Mass Fixation in NF1-Associated Pediatric Cervical Kyphosis: A Retrospective Study with a Minimum 2-Year Follow-Up.","authors":"Zeki Boğa, Semih Kıvanç Olguner, Tolga Türkmen, Ümit Kara, Ali Arslan, Mehmet Özer, Ahmet Hamit Çınkı, Yurdal Gezercan","doi":"10.2106/JBJS.OA.24.00252","DOIUrl":"https://doi.org/10.2106/JBJS.OA.24.00252","url":null,"abstract":"<p><strong>Background: </strong>Neurofibromatosis type 1 (NF-1) can cause severe kyphosis in the cervical vertebrae. There is no consensus on the optimal surgical treatment for this rare condition, although long-segment fixation and combined approaches are generally preferred. To our knowledge, this study is the first to report the clinical outcomes of patients with NF-related cervical kyphosis who underwent stand-alone posterior pedicle fixation surgery.</p><p><strong>Methods: </strong>The outcomes of 14 patients who underwent surgery using the pedicle screw were retrospectively examined between 2015 and 2022. Only patients with at least 2 years of follow-up were included. For each patient, the following parameters were recorded and evaluated at 1 month postoperatively and at the end of the follow-up period: cervical lordosis (CL), local kyphosis angle (LKA), T1 slope, cervical sagittal vertical axis, visual analog score for neck pain, modified Japanese Orthopedic Association score, and Neck Disability Index. Complications, surgical duration, blood loss, levels of instrumentation, and length of hospital stay were also recorded.</p><p><strong>Results: </strong>In terms of radiographic parameters, all patients achieved lordosis, with the cervical LKA improving from an average of 76.7° preoperatively to an average of 20.4° in the early postoperative period. At the 2-year follow-up, the postoperative CL significantly improved compared with preoperative values (p < 0.001) with only approximately 4° correction loss. Moreover, by the end of the follow-up, all postoperative symptoms showed improvement compared with the preoperative symptoms. The average surgical duration was 211.86 ± 49.83 min. During the follow-up, junctional kyphosis was observed in 4 patients all of whom required revision surgery. C5 palsy was detected in 3 patients. Infection-related complications occurred in 6 patients, with wound infection in only 1 patient.</p><p><strong>Conclusion: </strong>Cervical pedicle screw fixation is an effective treatment for NF-1-related cervical kyphosis. Although this technique is considered difficult and dangerous to apply by several spine surgeons, it exerts a positive effect on clinical improvement and provides optimal correction.</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 2","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12055176/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144039291","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":"Analysis of Tumor and Tumor-Like Entities Tested on the Orthopaedic In-Training Examination From 2012 to 2023.","authors":"Sean Kelly, Braden Goldberg, Eli Bryk, Vincent Vigorita","doi":"10.2106/JBJS.OA.24.00250","DOIUrl":"https://doi.org/10.2106/JBJS.OA.24.00250","url":null,"abstract":"<p><strong>Background: </strong>The Orthopaedic In-Training Examination (OITE) is used by orthopaedic residency training programs to evaluate the knowledge base of orthopaedic surgery trainees and to predict future performance on the American Board of Orthopaedic Surgery (ABOS) certifying exams. The pathology section of the OITE has changed over the years, both in terms of the content assessed and the format of the questions. This study aims to describe such trends.</p><p><strong>Methods: </strong>This study analyzed OITE questions from 2012 to 2023, focusing on tumors and tumor-like conditions of bone and soft tissue to guide resident preparation and core curriculum design. Questions were categorized by histologic photomicrographs, preferred responses, possible options, and implied entities. Additionally, questions were classified into four domains: diagnosis, treatment, next step, and multifactorial.</p><p><strong>Results: </strong>Tumor-related questions constituted 10-16% of each OITE, with an equal number of questions concerning benign and malignant entities. Bone tumor questions averaged nine per year, while soft tissue tumor questions averaged four. The most frequently tested bone tumors were osteosarcoma and giant cell tumor, while pleomorphic sarcoma and liposarcoma were the most frequently tested malignant soft tissue tumors. Metabolic bone diseases such as osteoporosis, osteomalacia, and osteonecrosis were also frequently tested. Histologic photomicrographs were included in 120 questions over the study period, with osteosarcoma being the most depicted. A shift in question focus was observed, with diagnosis questions declining in favor of treatment and next-step management questions in recent years.</p><p><strong>Conclusion: </strong>These findings provide a comprehensive overview of tumor-related content on the OITE, highlighting trends in question composition and format. This information can guide program directors in designing curricula that align with tested material, ensuring residents are well-prepared for both the OITE and ABOS exams. Emphasizing highyield topics and adapting to evolving question patterns can optimize educational outcomes and improve board pass rates.</p>","PeriodicalId":36492,"journal":{"name":"JBJS Open Access","volume":"10 2","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12040059/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144050913","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":"Preoperative and Postoperative Residual Urine in 796 Men Older than 65 Years Undergoing Elective Orthopaedic Surgery in Denmark: A Single-Center Cohort Study.","authors":"Inger Markussen Gryet, Charlotte Graugaard-Jensen, Asger Roer Pedersen, Simon Toftgaard Skov","doi":"10.2106/JBJS.OA.24.00180","DOIUrl":"https://doi.org/10.2106/JBJS.OA.24.00180","url":null,"abstract":"<p><strong>Background: </strong>Postvoid residual urine (PVR) can be an unknown chronic disorder, or it can occur after surgery. A pilot study led to development of a flowchart suggesting performing preoperative and postoperative bladder scans and recommending men with PVR further diagnostic work-up. This study aimed to determine the prevalence of preoperative and postoperative PVR in men older than 65 years undergoing major elective orthopaedic surgery and also to determine risk factors and possibility of prediction.</p><p><strong>Methods: </strong>This was a single-center cohort study. The patients were consecutively included for 1 year from April 2022. Data were extracted from the electronic patient files: age, lower urinary tract symptoms (LUTS), comorbidity, type of surgery and anesthesia, opioid use, and preoperative and postoperative PVR which was defined as ≥150 ml.</p><p><strong>Results: </strong>A total of 796 men were eligible for inclusion: 316 knee, 276 hip, and 26 shoulder arthroplasties and 178 lower back spinal surgeries. Preoperative bladder scans were acquired in 95% of the eligible patients, and PVR was found in 15% (confidence interval [CI] 12-18). There was a higher risk of preoperative PVR in men reporting LUTS, OR 1.97 (1.28-3.03); neurological disease, OR 3.09 (1.41-6.74); and the risk increased with higher age, OR 1.08 per year (1.04-1.12). PVR was found in 9% of the men without risk factors. A postoperative bladder scan was performed in 72% of the men. Among men without preoperative PVR, 15% (CI 12-19) had postoperative PVR de novo. The highest risk for PVR postoperative was PVR preoperatively.</p><p><strong>Conclusions: </strong>Preoperatively, 15% had PVR. Neurological disease, LUTS, and higher age were identified as risk factors, but PVR was found in 9% of the men without risk factors. In men without preoperative PVR, 15% had postoperative PVR de novo. It is not possible to conclude whether PVR is transient or chronic, and it is unclear whether a PVR of 150 ml is associated with complications or if the threshold should be higher. This study highlights the importance of awareness regarding voiding issues before and after surgery.</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 2","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12040042/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144037638","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":"Comparison Between Septic Arthritis Alone and Coexisting with Other Bone and Joint Infections in Pediatric Patients: A Retrospective Review.","authors":"Nicolas Makoto Favre, Giacomo De Marco, Oscar Vazquez, Amira Chargui, Anne Tabard-Fougère, Blaise Cochard, Christina Steiger, Romain Dayer, Dimitri Ceroni","doi":"10.2106/JBJS.OA.24.00200","DOIUrl":"https://doi.org/10.2106/JBJS.OA.24.00200","url":null,"abstract":"<p><strong>Background: </strong>It is unclear whether coexisting septic arthritis and osteomyelitis (CSAO) differs from septic arthritis (SA) alone in terms of susceptible age groups, clinical and paraclinical presentations, and prevalence. This study aimed to compare patients with isolated SA with those presenting with CSAO, determine the efficacy of different parameters used to distinguish those diagnoses, and investigate the prevalence of CSAO due to <i>Kingella kingae</i>.</p><p><strong>Methods: </strong>The study retrospectively included all patients treated for SA over a 17-year period at Geneva University Hospitals. Clinical, biological, and bacteriological data were analyzed. Magnetic resonance imaging (MRI) was reviewed for all patients to identify those with coexisting osteomyelitis. Comparisons between patients with isolated SA and those with CSAO were performed using the unpaired Mann-Whitney <i>U</i> for continuous outcomes (reported with median [interquartile range]) and the Pearson χ² tests for dichotomous outcomes (reported with n [%]).</p><p><strong>Results: </strong>Of 247 patients with osteoarticular infections, 177 with SA fulfilled our inclusion criteria. Of these, 124 had SA alone, and 53 (29.9%) had a CSAO. There were no statistically significant differences between the 2 groups regarding sex, age, and clinical and paraclinical results. When coexisting osteomyelitis was present, 51% of cases were acute and 49% were subacute. Bone infection was found in the metaphyses of 21 patients (39.6%), the epiphyses of 11 (20.8%), and was transphyseal in 10 (18.9%). Whatever the infection location, <i>K. kingae</i> was the most common pathogen found in both groups (48% of SA, 43% of CSAO, p = 0.651).</p><p><strong>Conclusions: </strong>This study showed that CSAO is common in children, especially among those younger than 4 years, with an unexpectedly high prevalence of subacute osteomyelitis. This should encourage caregivers to use MRI more extensively in diagnostic processes. Clinical and paraclinical data did not contribute to differentiate CSAO from SA. The widespread presence of <i>K. kingae</i> as a pathogen in both groups supports the advice to systematically use polymerase chain reaction techniques in children younger than 4 years of age.</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 2","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12039994/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143999977","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":"Long-Term Outcomes Following Reverse Total Shoulder Arthroplasty: A Systematic Review with a Minimum Follow-Up of 10 Years.","authors":"Matthias Biner, Stafan Klotz, Octavian Andronic, Daniel C Karczewski, Lukas Zingg, Wieser Karl, Philipp Kriechling","doi":"10.2106/JBJS.OA.25.00025","DOIUrl":"https://doi.org/10.2106/JBJS.OA.25.00025","url":null,"abstract":"<p><strong>Background: </strong>Reverse total shoulder arthroplasty (rTSA) is a crucial intervention for restoring shoulder function and alleviating pain. The aim of this review was to evaluate long-term clinical and radiological outcomes of rTSA patients with a minimum follow-up of 10 years.</p><p><strong>Methods: </strong>A systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines across PubMed, Web of Science, Embase, and Cochrane databases until September 2024. Studies in English or German with a minimum 10-year follow-up were included. Risk of bias was assessed using the Methodological Index for Non-Randomized Studies criteria. The study was registered with PROSPERO (CRD42024558828).</p><p><strong>Results: </strong>Of 673 studies, 7 retrospective case series with Level IV evidence met the inclusion criteria, totaling 469 rTSA procedures in 460 patients. The weighted mean age was 71 years, with 63% female patients. The mean follow-up was 12 years, with a 63% lost to follow-up. Four studies conducted all follow-ups in a clinical setting, while 3 used either outpatient visits (20 to 41%) or phone/mail interviews. The weighted mean reported revision-free implant survivorship reported in 5 studies was 88% at 10 years. Overall, the complication rate was 36% with need for further revision in 23% of patients. The revisions were primarily due to infection (8%), instability (7%), and glenoidal complications (3%). Significant functional improvements were noted across all studies. The absolute Constant score (CS) improved from 27 to 62 across 5 studies, and the relative CS improved from 37% preoperatively to 81% across 3 studies. The American Shoulder and Elbow Surgeons Score improved from 35 to 74 (p < 0.001) and the Single Assessment Numeric Evaluation from 23 to 73 (p < 0.001), in 1 study each. The Subjective Shoulder Value increased from 28% to 79% (p = 0.001) in 2 studies. Weighted mean range of motion improvements included active abduction of 54°, active anterior elevation of 52°, and active external rotation of 8°. Longitudinal outcomes were reported to be stable in the due course in 5 studies and deteriorated in 1. Scapular notching varied widely, with Nerot-Sirveaux grades I and II in 15% to 59% of cases, and grades III and IV in 7% to 47%.</p><p><strong>Conclusion: </strong>RTSA appears to provide substantial long-term improvements in shoulder function, clinical outcomes, and pain relief, albeit with significant complication and revision rates. However, caution is warranted when interpreting the data due to high lost-to-follow-up rates and limited data quality in the contemporary literature. Long-term registry data will be essential.</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 2","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12039979/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144064833","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":"Glenoid Bone Grafting During Primary Reverse Shoulder Arthroplasty: A Learning-Curve Analysis.","authors":"Zaamin B Hussain, Sameer R Khawaja, Musab Gulzar, Hayden L Cooke, Krishna N Chopra, Robert S Roundy, Michael B Gottschalk, Eric R Wagner","doi":"10.2106/JBJS.OA.24.00125","DOIUrl":"https://doi.org/10.2106/JBJS.OA.24.00125","url":null,"abstract":"<p><strong>Background: </strong>Reverse shoulder arthroplasty (RSA) with structural bone grafting of the glenoid utilizing an autograft from the resected humeral head is an effective strategy to address severe glenoid bone loss. Although learning curves have been established for RSA, RSA with bone grafting is more technically challenging, with relatively higher complication rates. The number of cases needed for proficiency and the optimal learning strategies have yet to be defined for RSA with bone grafting.</p><p><strong>Methods: </strong>All patients who underwent primary, single-stage RSA with bone grafting for severe glenoid bone loss at our institution between November 2018 and February 2022 were identified. Perioperative data, including imaging, operative time, complications, revisions, postoperative functional data, and patient-reported outcomes, were recorded and analyzed. The learning curve for a fellowship-trained shoulder and elbow surgeon was analyzed using linear regression and cumulative sum (CUSUM) analysis. CUSUM analysis objectively evaluated differences in operative time over the course of the surgeon's practice and elucidated the completion of the learning curve.</p><p><strong>Results: </strong>A total of 32 patients (53% male and 47% female; mean age, 68 years) were included in the analysis. The mean follow-up was 28 months. The mean operative time was 127 minutes, and there was a linear decrease in operative time throughout the study. CUSUM analysis using operative times demonstrated that the surgeon's learning curve was 14 patients. When comparing patients among the first 14 cases and the last 18 cases, there was no difference in shoulder range of motion, American Shoulder and Elbow Surgeons (ASES) scores, and Subjective Shoulder Value (SSV), while visual analog scale (VAS) pain scores at the time of final follow-up were better for patients in the surgeon's proficiency phase compared with the learning phase.</p><p><strong>Conclusions: </strong>In this study, we found a significant linear decrease in operative time with the number of cases completed, without associated detriment to the postoperative outcome or complication rate. Our findings suggest that at least 14 cases may be required before proficiency is obtained with RSA using humeral head bone graft.</p><p><strong>Level of evidence: </strong>Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.</p>","PeriodicalId":36492,"journal":{"name":"JBJS Open Access","volume":"10 2","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12020699/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143999985","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":"Comparative Diagnostic Value of Serological and Synovial Tests for Periprosthetic Joint Infections: A Comprehensive Analysis.","authors":"Mars Yixing Zhao, Samuel Girgis, Thomas Goldade, Evan Parchomchuk, Michaela Nickol, Johannes M van der Merwe","doi":"10.2106/JBJS.OA.24.00206","DOIUrl":"https://doi.org/10.2106/JBJS.OA.24.00206","url":null,"abstract":"<p><strong>Background: </strong>Prompt diagnosis of periprosthetic joint infections (PJIs) is crucial for providing optimal care. Currently, there are no gold-standard tests available. An ideal test would be simple to implement, cost-effective, and readily available. We aimed to determine the best single or combined serological or synovial markers for diagnosing PJIs.</p><p><strong>Methods: </strong>There were 177 of 313 patients who had PJIs between April 2012 and March 2023 and a control group of 60 patients who were included in this retrospective review. The PJIs were diagnosed using Musculoskeletal Infection Society (MSIS) and European Bone and Joint Infection Society (EBJIS) criteria. Serum (C-reactive protein [CRP], white blood-cell [WBC] count, neutrophil-lymphocyte ratio [NLR], polymorphonuclear neutrophil percentage [PMN%]), and synovial fluid (WBC, NLR, PMN%) parameters were compared between the 2 groups. We determined the sensitivity, specificity, area under the curve (AUC), and cutoff values (COV) for each marker. We determined the best combination of markers to diagnose PJIs. There was no statistical significance between the demographic data of the control and treatment groups.</p><p><strong>Results: </strong>The S-CRP had the highest AUC of 0.912 with a COV of 16.15 mg/dL (Sensitivity 79.6%, Specificity 97.8%). The combination of tests, S-CRP, synovial fluid (SF-WBC), and S-NLR demonstrated the highest AUC of 0.946 (Sensitivity 93%, Specificity 90.9%). The COV for SF-WBC was 5.75 cells/μL (AUC 0.803; Sensitivity 70.3%, Specificity 97.1%); S-NLR COV was 3.659 (AUC 0.803; Sensitivity 67.3%, Specificity 88%).</p><p><strong>Conclusion: </strong>We found the combination of S-CRP, SF-WBC, and S-NLR to be valuable in diagnosing PJI with high sensitivities and specificities. It can be easily implemented by clinicians without additional cost or equipment. It is important to use this with a thorough clinical and physical examination as well as other modalities (i.e., MSIS/EBJIS criteria).</p><p><strong>Level of evidence: </strong>Retrospective Comparative Study-Level III evidence. See Instructions for Authors for a complete description of levels of evidence.</p>","PeriodicalId":36492,"journal":{"name":"JBJS Open Access","volume":"10 2","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12020709/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144031010","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}