JBJS Open Access最新文献

{"title":"An All-Female Study Quantifying Morphological Differences of the Hindfoot and Posterior Tibialis Muscle Between Patients with Progressive Collapsing Foot Deformity and Asymptomatic Controls.","authors":"Takuma Miyamoto, Rich J Lisonbee, Hiroaki Kurokawa, Akira Taniguchi, Yasuhito Tanaka, Amy L Lenz","doi":"10.2106/JBJS.OA.24.00215","DOIUrl":"10.2106/JBJS.OA.24.00215","url":null,"abstract":"<p><strong>Background: </strong>The posterior tibialis (PT) muscle and tendon could be a contributing factor in progressive collapsing foot deformity (PCFD). Still, the extent to which the function of the PT is related to PCFD progression is debated. Recently, statistical shape models (SSM) have been shown to provide more accurate and comprehensive morphological evaluations of musculoskeletal tissue. To enhance understanding of the PT in patients with PCFD, we used a 3D SSM to test the hypothesis that both the shape of the PT and alignment of the PT relative to the hindfoot bones are different in female patients with PCFD when compared with female asymptomatic controls.</p><p><strong>Methods: </strong>In this retrospective comparative study, 12 female patients presenting with PCFD and 19 female asymptomatic individuals were included. Computed tomography images were segmented to create 3D models of hindfoot bones and PT. We compared the shape of the PT and alignment of the PT with the hindfoot bones using SSM. The PT 3D model was also used to measure volume, tendon normalized length, and percentage fat of the PT muscle. Each measurement and SSM were compared between PCFD and asymptomatic controls.</p><p><strong>Results: </strong>SSM did not identify significant differences in the isolated shape of the PT between groups. However, the SSM showed significant differences in the alignment of PT tendon regarding the hindfoot bones. Tendon normalized length was significantly lower in PCFD than that in controls. Percent fat content was significantly higher in PCFD compared with controls. No significant differences were found for PT volume between both groups.</p><p><strong>Conclusion: </strong>Our results indicate that in female patients with PCFD, the PT does not differ significantly in shape and volume, only in tendon alignment relative to hindfoot bones, suggesting that the PT may be not always directly involved in the progression of PCFD.</p><p><strong>Clinical relevance: </strong>The application of SSM to assess bones and muscles simultaneously in female patients with PCFD is a new and novel approach to understanding the pathophysiology of this disease.</p><p><strong>Evidence level: </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":"2025-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12431736/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145065969","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":"Musculoskeletal Manifestations of Disseminated Fungal Infections.","authors":"Akash Koul, John Traversone, Jonathan J Light, Sudha Chaturvedi, Jency Daniel, Andrew Rosenbaum","doi":"10.2106/JBJS.OA.25.00095","DOIUrl":"10.2106/JBJS.OA.25.00095","url":null,"abstract":"<p><p>» Disseminated musculoskeletal fungal infections, though rare, present significant diagnostic and therapeutic challenges, affecting both immunocompromised and previously healthy individuals. » Ubiquitous species (spp.) such as <i>Candida</i>, <i>Aspergillus</i>, and <i>Cryptococcus</i> contrast with dimorphic fungi, including <i>Histoplasma capsulatum</i>, <i>Blastomyces</i> spp., and <i>Coccidioides</i> spp., which are endemic to specific regions. » These infections typically present insidiously, with non-specific symptoms such as fever, joint pain, and swelling that mimic autoimmune, bacterial, or viral diseases, often leading to delayed diagnosis. » Initial evaluation often includes radiographs, which may reveal lytic bone lesions, particularly in the metaphyses of long bones, as well as in less conspicuous sites such as the talus and cuboid. Even with this information, a definitive diagnosis still requires histological or microbiological evidence prior to initiating some antifungal treatments. » This review synthesizes current knowledge on disseminated musculoskeletal fungal infections, emphasizing their epidemiology, pathogenesis, clinical manifestations, diagnostic strategies, and treatment.</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/PMC12431750/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145066068","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":"Practical Considerations for Liposomal Bupivacaine Use in Orthopaedic Surgery: A Clinical and Economic Analysis.","authors":"Daniel E Goltz, Eoghan T Hurley, Jonathan Gustafson, Paul Sethi, Karl Koenig, Grant Garrigues","doi":"10.2106/JBJS.OA.25.00114","DOIUrl":"10.2106/JBJS.OA.25.00114","url":null,"abstract":"<p><p>» Opioid-related dependence remains a major concern following surgery in the United States, driving increased interest in non-opioid, multimodal pain control strategies within orthopaedic surgery. » Liposomal bupivacaine is an extended-release anesthetic approved for specific nerve blocks and offers the potential to prolong analgesia without the need for post-operative catheters. » Liposomal bupivacaine is currently approved for use in interscalene brachial plexus blocks, sciatic nerve blocks in the popliteal fossa, and adductor canal blocks. » Despite mixed clinical trial results compared to unencapsulated bupivacaine, liposomal formulations may provide clinical and economic advantages in selected orthopaedic settings.</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/PMC12431757/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145066015","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":"Medicare Reimbursement for Revision Arthroplasty Procedures Decrease Over 20+ Years, a Concerning Trend for Arthroplasty Subspecialists and Their Patients.","authors":"Timothy W Kouo, Coltin R Gerhart, David N Shau","doi":"10.2106/JBJS.OA.25.00081","DOIUrl":"10.2106/JBJS.OA.25.00081","url":null,"abstract":"<p><strong>Background: </strong>Numerous studies have highlighted a rise in procedure volume and fall in physician reimbursement for various primary arthroplasty procedures. The aim of our study was to investigate these same trends in revision hip, knee, ankle, elbow, shoulder, and wrist arthroplasty from 2000 to 2021.</p><p><strong>Methods: </strong>The Medicare Part B National Summary Data File was analyzed for Current Procedural Terminology (CPT) codes related to revision knee, hip, shoulder, wrist, ankle, and elbow arthroplasty. For each code and year, the total number of procedures and total amount billed and reimbursed was collected. Monetary values were adjusted to the 2021 US Dollar.</p><p><strong>Results: </strong>All procedures had full data from 2000 to 2021 except codes associated with rTSA and rTEA which only had data from 2013 to 2021. When comparing the first and last year of the study period, all codes had a percent increase in procedure volume except 27137 and 24370, which decreased by -51.6% and -5.3%, respectively. All codes had a percent decrease in reimbursement except 24370, which increased by 8.0%.</p><p><strong>Conclusion: </strong>Orthopedic surgeons are performing more revision arthroplasty procedures while receiving lower inflation-adjusted reimbursement. This reduction reflects reimbursement not keeping pace with inflation rather than true cuts in absolute payment per procedure. Exceptions to this general trend include code 27137, which had a decrease in both metrics, as well as 24370, with a decrease in volume and increase in reimbursement. These developments should urge policymakers to reassess current reimbursement policies and how it may affect access to quality arthroplasty care.</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":"2025-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12431729/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145066017","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":"Faculty Diversity Associated With Decreased Orthopaedic Surgery Resident Attrition.","authors":"Xi Chen, Hiroko Matsumoto, Lee S Haruno, Melodie F Metzger, Carol A Lin, Milton T M Little, Selina C Poon","doi":"10.2106/JBJS.OA.24.00135","DOIUrl":"10.2106/JBJS.OA.24.00135","url":null,"abstract":"<p><strong>Introduction: </strong>Underrepresented minority (URM) and female orthopaedic surgical residents have an increased risk of attrition. The purpose of this study was to investigate the relationship between orthopaedic faculty demographic diversity and resident attrition.</p><p><strong>Methods: </strong>Demographic data for full-time faculty in departments or divisions of Orthopaedic Surgery at accredited medical schools in the United States and demographic and attrition data for 13,785 affiliated orthopaedic residents were sourced from the Association of American Medical Colleges. Faculty diversity was defined by the number of female and/or URM faculty at medical school affiliated with residency. The faculty per year (FPY) was calculated by dividing the total number of female and URM faculty by the number of years in residency for each resident. The average FPY across all programs was calculated to assess whether programs had above-average FPY (greater faculty diversity) or below-average FPY. This stratification was used to investigate the relationship between faculty diversity and resident attrition. Diverse faculty was defined as the aggregate of URM and female faculty. A p-value of <0.05 was considered statistically significant.</p><p><strong>Results: </strong>Overall resident attrition was 3.2%. Female and URM residents had attrition rates of 6.2% and 6.3%, respectively. The average URM FPY for all orthopaedic surgery departments was 2.0; the average female FPY was 5.8; and the average diverse FPY was 7.5. Residents in programs with above-average female and URM FPY had a decreased risk of attrition (relative risk [RR] = 0.25, p < 0.001; RR = 0.23, p < 0.001, respectively). Programs with below-average female, URM, and diverse FPY significantly increased the risk of all resident attrition by 82% (RR = 1.82, p < 0.001), 47% (RR = 1.47, p < 0.001), and 88% (RR = 1.88, p < 0.001), respectively.</p><p><strong>Conclusions: </strong>Programs with increased racial and gender faculty diversity are associated with lower resident attrition, regardless of resident race or sex. Below-average faculty diversity is associated with the greatest risk of attrition among female and URM residents.</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/PMC12431768/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145065978","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":"ChatGPT-4o is Not a Reliable Study Source for Orthopaedic Surgery Residents.","authors":"Neil Jain, Caleb Gottlich, John Fisher, Travis Winston, Kristofer Matullo, Dustin Greenhill","doi":"10.2106/JBJS.OA.25.00112","DOIUrl":"10.2106/JBJS.OA.25.00112","url":null,"abstract":"<p><strong>Background: </strong>The use of artificial intelligence platforms by medical residents as an educational resource is increasing. Within orthopaedic surgery, older Chat Generative Pre-trained Transformer (ChatGPT) models performed worse than resident physicians on practice examinations and rarely answered questions with images correctly. The newer ChatGPT-4o was designed to improve these deficiencies but has not been evaluated. This study analyzed (1) ChatGPT-4o's ability to correctly answer Orthopaedic In-Training Examination (OITE) questions and (2) the educational quality of the answer explanations that it presents to our orthopaedic surgery trainees.</p><p><strong>Methods: </strong>The 2020 to 2022 OITEs were uploaded into ChatGPT-4o. Annual score reports were used to compare the chatbot's raw score with that of ACGME-accredited orthopaedic residents. ChatGPT-4o's answer explanations were then compared with those provided by the American Academy of Orthopaedic Surgeons (AAOS) and categorized based on (1) the chatbot's answer (correct/incorrect) and (2) the chatbot's answer explanation when compared with the explanation provided by AAOS subject-matter experts (classified as consistent, disparate, or nonexistent). Overall ChatGPT-4o response quality was then simplified into 3 groups. An \"ideal\" response combined a correct answer with a consistent explanation. \"Inadequate\" responses provided a correct answer but no explanation. \"Unacceptable\" responses provided an incorrect answer or disparate explanation.</p><p><strong>Results: </strong>ChatGPT-4o scored 68.8%, 63.4%, and 70.1% on the 2020, 2021, and 2022 OITEs, respectively. These raw scores corresponded with ACGME-accredited postgraduate year-5 (PGY-5), PGY2-3, and PGY-4 resident physicians. Pediatrics and Spine were the only subspecialties whereby ChatGPT-4o consistently performed better than a junior resident (≥PGY-3). The quality of responses provided by ChatGPT-4o was ideal, inadequate, or unacceptable in 58.7%, 6.9%, and 34.4% of questions, respectively. ChatGPT-4o scored significantly lower on media-related questions when compared with nonmedia questions (60.0% versus 73.1%, p < 0.001).</p><p><strong>Conclusions: </strong>ChatGPT-4o performed inconsistently on the OITE. Moreover, the responses it provided trainees were not always ideal. Its limited performance on media-based orthopaedic surgery questions also persisted. The use of ChatGPT by resident physicians while studying orthopaedic surgery concepts remains unvalidated.</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":"2025-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12417002/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145030870","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":"Do Open Fracture Classification Systems Predict Functional Outcomes in a Low-Income Country?: A Prospective Study of 287 People with Open Tibia Fractures in Malawi.","authors":"Alexander Thomas Schade, Vincent Mkochi, Nohakhelha Nyamulani, Maureen Sabawo, Kaweme Mwafulirwa, Chikumbutso Clara Mpanga, Leonard Banza Ngoie, Andrew John Metcalfe, William Jim Harrison, Peter MacPherson","doi":"10.2106/JBJS.OA.25.00090","DOIUrl":"10.2106/JBJS.OA.25.00090","url":null,"abstract":"<p><strong>Background: </strong>Open fractures are common and severe injuries that are associated with poor functional outcomes and quality of life, and high societal costs. Several classifications systems have been developed to characterize these injuries, predict prognosis and plan treatment. We aimed to assess the agreement between open fracture classification and patient-reported function, fracture-related infection, and amputation.</p><p><strong>Methods: </strong>In this prospective cohort study, we enrolled adults with open tibia fractures in 6 hospitals across Malawi. Radiographs and clinical photographs were classified according to the Gustilo-Anderson, Orthopaedic Trauma Society (OTS), Muller and Tscherne classification by an orthopaedic surgeon. Participants' function (using the Short Musculoskeletal Assessment Score), and risk of fracture-related infection and amputation were assessed by face-to-face interviews at 6 weeks, 3 months, 6 months, and 1 year postinjury. The Kendall rank correlation coefficient with 95% bootstrapped confidence intervals investigated correlation between fracture classifications and patient outcomes.</p><p><strong>Results: </strong>Two hundred eighty-seven participants were recruited with 252 of 287 photographs (88%) and 274 of 287 radiographs (95%) available for review. The Kendall correlation with function score 1 year after injury was 0.34 for OTS classification, 0.18 for Gustilo, 0.17 for Tscherne, and -0.02 for Muller. For correlation with fracture-related-infection at 1 year, this was 0.34 for the Orthopaedic Trauma Society, 0.31 for Gustilo, 0.24 for Tscherne, -0.02 for Muller. For amputation, correlation was 0.39 for OTS, 0.24 for Gustilo, 0.24 for Tscherne, and 0.12 for Muller.</p><p><strong>Discussions: </strong>Most open fracture classification systems had negligible or weak correlation with subsequent patient function, fracture-related infection, or amputation in Malawi. Treatment factors and other confounders may have a greater influence on outcomes, but classification systems must still account for this variability to remain useful. More research in low or middle income countries needs to be conducted to develop appropriate and relevant open fracture classifications to improve and standardize the management of open fractures.</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":"2025-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12417000/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145030878","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":"Modeling Musculoskeletal Combat Casualty Care: NATO Trauma System Performance in Large Scale Combat Operations.","authors":"Mark P Cote, Kaitlyn E Holly, Roman J Schoenfeld, Matthew R Bryan, Malina O Hatton, Mitchel B Harris, Tracey P Koehlmoos, Andrew J Schoenfeld","doi":"10.2106/JBJS.OA.25.00194","DOIUrl":"10.2106/JBJS.OA.25.00194","url":null,"abstract":"<p><strong>Background: </strong>It is unclear whether the current North Atlantic Treaty Organization (NATO) trauma system will be effective in the setting of Large-Scale Combat Operations (LSCO). We sought to model the efficacy of the NATO trauma system in the setting of LSCO. We also intended to model novel scenarios that could better adapt the current system to LSCO.</p><p><strong>Methods: </strong>We developed a discrete-event simulation model for patients with combat musculoskeletal injuries treated within the standard NATO system. The primary outcome of the model was survival. The model's health states were characterized as stable, hypovolemia, sepsis, shock, or death. The model simulated combat intensity by increasing the number of casualties up to 192 casualties per 24 hours. We explored how an augmented system (FC) and Field Hospital (FH) moved closer to the battlefront would change performance.</p><p><strong>Results: </strong>Mortality rates rose precipitously from a 10% baseline to 61% at 12 casualties per 24 hours in the base model. This performance was not significantly different from that of the FC model at any casualty rate. Successful evacuation of casualties was significantly more for the FH model versus the base model at 12 casualties/24 hours (47.5% vs. 39%; p = 0.046), 48 casualties/24 hours (45.5% vs. 33%; p = 0.008), and 192 casualties/24 hours (25% vs. 15.5%; p = 0.02).</p><p><strong>Conclusions: </strong>The current NATO model experiences high rates of mortality in LSCO. The most effective modification entails situating Field Hospitals within one-hour of ground transport from the battlefront.</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":"2025-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12417006/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145030808","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":"Inaccuracies in Orthopaedic Research Fellowship Applications: A Study on Authorship Misrepresentations.","authors":"Antonio Fernandez-Perez, Jonathan M Stern, Natalia Cruz-Ossa, Victor H Hernandez, Michele R D'Apuzzo, Colin A McNamara","doi":"10.2106/JBJS.OA.25.00074","DOIUrl":"10.2106/JBJS.OA.25.00074","url":null,"abstract":"<p><strong>Background: </strong>Academic integrity is a cornerstone of scientific research. However, increasing competition may cause applicants seeking competitive positions to report their research contributions inaccurately. An orthopaedic research fellowship offers substantial value for medical students and recent medical graduates to strengthen their applications for a residency position. Misrepresented authorship and publication history may distort applicant evaluations and compromise the credibility of the selection process.</p><p><strong>Materials and methods: </strong>A retrospective cohort analysis was conducted on all applications received during the previous two consecutive application cycles (2024 and 2025) by our adult reconstruction research fellowship located in an academic medical center. Data were collected from all curriculum vitae received, which were cross-referenced with indexed databases to verify publication status and author order. Misrepresentations were categorized into (1) publication discrepancies (nonexistent or withdrawn papers) and (2) exaggerated authorship positions. Descriptive statistics and comparative analysis were performed.</p><p><strong>Results: </strong>A total of 87 applications were included in our analysis. Of the 87 applications, 15 (17.2%) were found to have either a publication discrepancy or an exaggerated authorship position. Publication discrepancies occurred in 8 applications (9.2%), while 9 applications (10.3%) demonstrated exaggerated authorship position(s). There were no significant differences between medical student versus medical graduate applicants nor among US medical applicants versus international medical graduate applicants, for number nor types of misrepresentations found.</p><p><strong>Discussion: </strong>The increasing competitiveness of orthopaedic surgery residency programs has led applicants to emphasize research productivity as a key component of their applications. However, discrepancies in self-reported research output highlight the potential for misrepresentation. These findings raise ethical concerns regarding honesty in academic reporting. Even minor misrepresentations can undermine the integrity of the application process, diminish trust among reviewers, and compromise the fairness of candidate evaluation. Implementing systems such as Open Researcher and Contributor ID could enhance transparency, ensure accurate attribution, and mitigate inconsistencies in research reporting, ultimately improving the research fellowship application process.</p>","PeriodicalId":36492,"journal":{"name":"JBJS Open Access","volume":"10 3","pages":""},"PeriodicalIF":3.8,"publicationDate":"2025-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12417005/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145030857","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 Cell Salvage for Revision Hip Arthroplasty: A 24-Year Study of Transfusion Requirements.","authors":"D Huntley, T J Walton, S L Whitehouse, A D Ross, M J W Hubble, J R Howell, M J Wilson, J Davies, E Thomas, A M Kassam","doi":"10.2106/JBJS.OA.24.00204","DOIUrl":"10.2106/JBJS.OA.24.00204","url":null,"abstract":"<p><strong>Background: </strong>Revision hip arthroplasty is associated with significant blood loss and a subsequent need for blood transfusion. Intraoperative cell salvage (ICS) is a method of recovering a patient's blood for autologous transfusion. This potentially reduces the need for allogenic blood transfusion (ABT), thus avoiding associated risk and expense. This study assessed the impact of the use of ICS on the need for ABT in revision hip arthroplasty in a tertiary referral center over a 24-year period.</p><p><strong>Materials and methods: </strong>Retrospective analysis of prospectively collected data of revision hip arthroplasties performed between November 1996 and May 2020 was undertaken. ABT and ICS use for each procedure was collated and analyzed.</p><p><strong>Results: </strong>Two thousand six hundred thirty-nine revision hip operations were included, of which 755 (28.6%) used ICS. Significantly less patients in the ICS group required ABT, 218 patients (28.9%) compared with 923 (49.0%) in the control group, p < 0.001, χ² test. Patients who had ICS required significantly fewer units of ABT per person (ICS group: 0.73 units/person (554/755, SD 1.4); control group 1.36 units/person (2,574/1884, SD 1.9) (p < 0.001, <i>t</i>-test)).</p><p><strong>Discussion: </strong>The use of ICS in revision hip surgery significantly reduces the risk of requiring postoperative ABT and reduces the volume of allogenic blood required. This reduces the known risks associated with ABT, with associated cost saving benefits of reduced transfusion rates and reduced use of the precious resource of allogenic blood. We advise the use of ICS in all patients undergoing revision hip surgery and, in particular, those patients with higher bleeding risks outlined in the study.</p>","PeriodicalId":36492,"journal":{"name":"JBJS Open Access","volume":"10 3","pages":""},"PeriodicalIF":3.8,"publicationDate":"2025-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12416996/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145030896","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}