JBJS Open Access最新文献

{"title":"Reduction Quality Determines Failure Behavior in Stable Intertrochanteric Fractures: A Mesh-Free Simulation Comparing DHS and TFNA.","authors":"Si Jian Hui, Marilyn Janice Oentaryo, Sloan Kulper, Erica Ueda Boles, Christian Fang, Nazrul Nashi","doi":"10.2106/JBJS.OA.26.00131","DOIUrl":"10.2106/JBJS.OA.26.00131","url":null,"abstract":"<p><strong>Introduction: </strong>Stable 2-part intertrochanteric hip fractures (Arbeitsgemeinschaft für Osteosynthesefragen/Orthoapedic Trauma Association [AO/OTA] 31A1.2) are commonly treated with dynamic hip screw (DHS) or trochanteric fixation nail advanced (TFNA). Although nails are increasingly favored, superiority in stable patterns remains unproven with DHS remains widely used. This study applied mesh-free simulation to investigate construct mechanics and failure behavior in stable fracture models, with implant migration and construct stability as surrogate measures for cutout risk.</p><p><strong>Methods: </strong>Particle models of AO/OTA 31A1.2 fractures were obtained from cadaveric computed tomography scans with bone mineral density mapping. Using volumetric particle modelling (100-400 μm resolution), either DHS (316L stainless steel lag screw/barrel) or TFNA (Ti6Al4V extra low interstitial nail/blade) was inserted at a tip-apex distance of <25 mm. A standardized axial compression test approximating single-leg stance was simulated at 2 m/s along the Z-axis. Two implant conditions were tested: sliding (allowing screw/blade migration) and non-sliding (rigid). Two fracture reductions were modelled: anatomical (0 mm gap) and proximal gap (5 mm). Outcomes were maximum load, displacement at failure, load-displacement curves, and von Mises stress distribution.</p><p><strong>Results: </strong>With anatomical reduction, DHS and TFNA showed nearly identical curves up to 3-4 mm displacement; DHS resisted higher loads beyond. In non-sliding, DHS reached a maximum load of 4,066 N vs. 3,945 N for TFNA; in sliding, DHS reached 4,156 N vs. 3,790 N for TFNA. With gap, early performance was similar, but DHS reached higher loads (2,161-2,504 N) vs. TFNA (1,643-1,877 N). Displacement at failure was comparable (approximately 5 mm). DHS exhibited a more gradual postpeak decline, whereas TFNA showed a steeper loss of resistance.</p><p><strong>Conclusion: </strong>DHS and TFNA provide comparable initial stability but diverge with increasing displacement and reduction imperfection. Rather than establishing implant superiority, these findings highlight differences in construct mechanics and tolerance to suboptimal reduction.</p><p><strong>Clinical relevance: </strong>DHS may better tolerate reduction imperfections in stable intertrochanteric fractures, potentially guiding implant selection when anatomical reduction is challenging. Results should be interpreted as mechanistic insights requiring clinical validation.</p><p><strong>Level of evidence: </strong>No level of evidence. See Instructions for Authors for a complete description of levels of evidence.</p>","PeriodicalId":36492,"journal":{"name":"JBJS Open Access","volume":"11 3","pages":""},"PeriodicalIF":4.9,"publicationDate":"2026-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13542053/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148897609","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":"A Comparison of Clinical Outcomes Among Undenatured Collagen Type II, Glucosamine Sulfate, and Diacerein on Osteoarthritic Knee Treatment: A Randomized Clinical Trial.","authors":"Rapeepat Narkbunnam, Kit Awirotananon, Keerati Chareancholvanich, Chaiwat Achawakulthep, Nath Adulkasem, Swist Chatmaitri, Paphon Hirunyachoke, Chaturong Pornrattanamaneewong","doi":"10.2106/JBJS.OA.26.00225","DOIUrl":"10.2106/JBJS.OA.26.00225","url":null,"abstract":"<p><strong>Background: </strong>Knee osteoarthritis (OA) causes significant disability with limited effective treatments. Undenatured collagen type II (UC-II), prescription-grade crystalline glucosamine sulfate (pCGS), and diacerein have been proposed as alternatives to conventional analgesics, but their comparative efficacy remains uncertain. We hypothesized that each supplement would demonstrate superior efficacy over placebo in reducing total Western Ontario and McMaster Universities Arthritis Index (WOMAC) score at Week 24 in patients with mild-to-moderate knee OA.</p><p><strong>Methods: </strong>This 4-arm, randomized, double-blind, placebo-controlled trial enrolled 216 Thai adults with symptomatic knee OA (Kellgren-Lawrence grade 2-3). Participants received UC-II (40 mg once daily), pCGS (500 mg 3 times daily), diacerein (50 mg once to twice daily), or placebo for 24 weeks, with follow-up to 36 weeks. The primary outcome was total WOMAC score (22 items; pain, stiffness, and physical function; scored 0-220, higher = worse) at Week 24. Analyses followed intention-to-treat principles using multiple imputation by chained equations (m = 10) and linear mixed-effects models.</p><p><strong>Results: </strong>Of 216 randomized Thai participants, 208 (96.3%) completed follow-up (mean age 61.7 ± 7.1 years; 90.9% female; 73.6% Kellgren-Lawrence grade 2). At Week 24, no supplement demonstrated superiority over placebo. Between-group differences in total WOMAC score were as follows: UC-II -4.7 (95% CI -18.6 to 9.1), pCGS -8.1 (95% CI -21.8 to 5.7), and diacerein -12.3 (95% CI -25.9 to 1.3). All 95% CIs included zero, and all point estimates were at or below, and none clearly exceeded, the minimum clinically important difference threshold. At 36 weeks, results were consistent: UC-II -1.8 (95% CI -15.5 to 12.0), pCGS -4.8 (95% CI -18.4 to 8.7), and diacerein -1.3 (95% CI -14.9 to 12.3). Secondary outcomes including pain scores, joint space width, and functional performance showed no significant between-group differences. Adverse events were mild and comparable across groups; no serious adverse events occurred.</p><p><strong>Conclusions: </strong>Among Thai patients with mild-to-moderate knee OA, UC-II, pCGS, and diacerein did not demonstrate superiority over placebo in reducing pain or improving function at 24 weeks. These findings do not support their routine use as monotherapy for knee OA.</p><p><strong>Trial registration: </strong>Thailand Clinical Trial Registry (TCTR20210901003).</p><p><strong>Level of evidence: </strong>Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.</p>","PeriodicalId":36492,"journal":{"name":"JBJS Open Access","volume":"11 3","pages":""},"PeriodicalIF":4.9,"publicationDate":"2026-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13542060/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148897558","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":"Assessing the Work Relative Value Unit System in Orthopaedic Oncology: A Matched Cohort Analysis.","authors":"James O Gaston, Sydney Horenstein, Pietro M Gentile, Vineeth Romiyo, John Epoh Dibato, Richard D Lackman, Christina J Gutowski, Tae Won B Kim","doi":"10.2106/JBJS.OA.26.00229","DOIUrl":"10.2106/JBJS.OA.26.00229","url":null,"abstract":"<p><strong>Background: </strong>Benign and malignant bone and soft-tissue tumors have a broad range of clinical presentations. Operative management ranges from limited excision to complex resection and reconstruction. The work relative value unit (wRVU) is designed to quantify physician time, technical skill, and effort, but it is unclear whether current assignments adequately reflect the overall procedural demands of musculoskeletal orthopaedic oncology. The aim of this study was to compare wRVU generation between orthopaedic oncology procedures and matched nononcologic orthopaedic procedures after controlling for measures of physician time and intensity.</p><p><strong>Methods: </strong>A retrospective observational study was conducted using the American College of Surgeons' National Surgical Quality Improvement Program. Musculoskeletal orthopaedic oncology cases were stratified by Current Procedural Terminology (CPT) code according to tumor type. Mahalanobis distance matching was used to match orthopaedic oncology cases with nononcology orthopaedic controls. Total case wRVU generation was compared between groups.</p><p><strong>Results: </strong>Among 2,138,294 orthopaedic cases, 6,700 were musculoskeletal orthopaedic oncology cases (mean age 48 years, 45% female, 61% White, 9.6% Black, 5.0% Asian, 1.4% Other, and 23% unknown/not reported). After matching, oncology cases had 19.0% lower average wRVU (16.2 vs. 20.0) than matched controls despite similar operative times and case characteristics. The mean total case wRVUs were lower for benign soft-tissue tumors (9.7 vs. 15.8, -38.6%), benign bone tumors (11.0 vs. 15.8, -30.6%), and malignant soft-tissue tumors (18.1 vs. 26.3, -31.1%) compared with matched orthopaedic controls. By contrast, malignant bone tumors generated higher mean total case wRVUs than matched controls (43.9 vs. 37.0, +18.9%). Using a standardized workload of 675 operative hours per year, orthopaedic oncology procedures were estimated to generate 6,883 annual wRVUs vs. 8,570 for matched controls, corresponding to $56,167 lower annualized Medicare-based procedural value.</p><p><strong>Conclusions: </strong>Musculoskeletal orthopaedic oncology procedures generated fewer wRVUs than matched nononcologic orthopaedic procedures. We advocate for hospital and department leaders to consider this discrepancy within the wRVU model and account for it when designing compensation models for orthopaedic oncologists.</p><p><strong>Level of evidence: </strong>Economic and Decision Analysis Level IV. See Instructions for Authors for a complete description of levels of evidence.</p>","PeriodicalId":36492,"journal":{"name":"JBJS Open Access","volume":"11 3","pages":""},"PeriodicalIF":4.9,"publicationDate":"2026-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13542050/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148897606","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":"Cost-Effectiveness of Timely Surgery and Timely Inpatient Rehabilitation for the Management of Hip Fracture.","authors":"Zheng Jing Hu, Lawrence Mbuagbaw, Gerhard Fusch, Salhab El Helou, Judith Versloot, Lehana Thabane, Walter Wodchis","doi":"10.2106/JBJS.OA.26.00200","DOIUrl":"10.2106/JBJS.OA.26.00200","url":null,"abstract":"<p><strong>Background: </strong>Evidence-based and quality-of-care guidelines for hip fracture have recommended providing timely surgery and postacute rehabilitation. We sought to evaluate the cost-effectiveness of providing early surgery (within 24 hours of emergency department admission) and immediate admission to inpatient rehabilitation postacute discharge, or a combination of both for the management of hip fracture patients in Ontario, Canada.</p><p><strong>Methods: </strong>We used a Markov state transition model to compare early surgery and immediate rehabilitation to surgery beyond 24 hours and no postacute rehabilitation or receiving it beyond 24 hours postacute discharge. Costs and Quality-adjusted life-years (QALYs) were estimated in a 5-year horizon for elderly patients, from the perspective of the (public) insurance payer in Ontario, using linked administrative data sets. Transition probabilities and costs were obtained from regression models fitted using linked administrative data sets. EuroQoL 5-Dimension (EQ-5D) utility values were obtained from an international prospective observational study. We performed base-case and probabilistic sensitivity analysis using 5,000 simulations for willingness-to-pay thresholds from $0-$300,000 Canadian Dollars (CAD).</p><p><strong>Results: </strong>The incremental cost-effectiveness ratio of timely rehabilitation, for both timely surgery and rehabilitation, compared with neither were $124,162 and $83,714 per QALY, respectively. Timely surgery alone was an absolute advantage strategy (Δ Cost = -$2,387, Δ QALY = 0.06). Five-year base-case costs ranged from $130,747 to $156,848 and QALYs from 2.13 to 2.37. Timely surgery alone had the highest probability of being cost-effective up to a willingness-to-pay threshold of $128,000 per QALY, whereas combined surgery and rehabilitation was favored above $130,000 per QALY. Results were qualitatively similar for common diagnoses and procedure modalities.</p><p><strong>Conclusion: </strong>Our population data and modelling results indicate that timely surgery can improve patients' quality of life while reducing costs. Adding inpatient rehabilitation yields greater QALYs but at higher cost.</p><p><strong>Level of evidence: </strong>Economic Level IV. See Instructions for Authors for a complete description of levels of evidence.</p>","PeriodicalId":36492,"journal":{"name":"JBJS Open Access","volume":"11 3","pages":""},"PeriodicalIF":4.9,"publicationDate":"2026-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13542062/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148897614","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":"Safety and Effectiveness of Placental Connective Tissue Matrix Allograft Versus Corticosteroid Injection in Adhesive Capsulitis: A Double-Blinded Prospective Randomized Study.","authors":"Olivia C Nembhard, Janice M Pogoda, James M Helm, James M Gregory, Jessica Waters, Ajai Sambasivan, Evan Meeks, Paul Shupe, Eric F Berkman","doi":"10.2106/JBJS.OA.26.00080","DOIUrl":"10.2106/JBJS.OA.26.00080","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Adhesive capsulitis causes significant pain and functional limitation, with limited effective treatment options. Current standard-of-care treatments, such as corticosteroid injections, may offer short-term symptom relief but are associated with limited long-term efficacy and potential side effects. Regenerative therapies using extracellular matrix-based products derived from placental tissue have shown promise in treating musculoskeletal injuries due to their anti-inflammatory and tissue-healing properties. Clinical data supporting their use in adhesive capsulitis remains limited. The objective of this study was to compare the safety and effectiveness of a flowable placental connective tissue matrix allograft (PCTMA) vs. corticosteroid injection for adhesive capsulitis.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Hypothesis: &lt;/strong&gt;We hypothesized that intra-articular injection of a placental connective tissue allograft would result in superior clinical outcomes compared with corticosteroid injection for adhesive capsulitis of the shoulder.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Study design: &lt;/strong&gt;Randomized controlled clinical trial.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;This double-blinded prospective study randomized patients with adhesive capsulitis to receive either intra-articular PCTMA (1 cc) with lidocaine (study group, n = 25) or corticosteroid injection with triamcinolone 20 mg and lidocaine (control group, n = 27). Inclusion criteria included ages 18 to 75 years, clinical diagnosis of adhesive capsulitis, shoulder pain &gt;6 weeks, and MRI confirmation without other shoulder pathology. The primary end point was change from baseline in Shoulder Pain and Disability Index (SPADI) score. Secondary end points included Visual Analog Scale (VAS), American Shoulder and Elbow Surgeons (ASES) score, and passive range of motion. Assessments occurred at 4, 12, and 24 weeks postinjection.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Both groups improved over time. At 24 weeks, mean SPADI improvement was similar between groups [PCTMA: -40.4 (SD 18.81) vs. corticosteroid: -37.7 (SD 30.12)] (p = 0.73), but post hoc responder analyses favored PCTMA: SPADI responders 88% vs. 63% (p = 0.04), VAS responders 80% vs. 56% (p = 0.06), and ASES responders 88% vs. 56% (p = 0.01). One serious adverse event unrelated to the study intervention was reported.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;Flowable intra-articular PCTMA demonstrated a favorable safety profile and comparable improvements in pain and disability to corticosteroid injection at 24 weeks. A post hoc responder analysis favored PCTMA, suggesting potential for more sustained clinical benefit warranting further investigation.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Clinical relevance: &lt;/strong&gt;This study provides the first randomized controlled comparison of PCTMA vs. corticosteroid injection for adhesive capsulitis, offering preliminary evidence to guide treatment selection and informing the design of future, larger-scale trials investigating biologic therapies for th","PeriodicalId":36492,"journal":{"name":"JBJS Open Access","volume":"11 3","pages":""},"PeriodicalIF":4.9,"publicationDate":"2026-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13502745/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148814437","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":"Three-dimensional Computed Tomography Mapping of Talar Body Fractures.","authors":"Erika Roddy, Ian Engstrom, Erik Magnusson, Soshana Goldstein, Madeleine Jackson, Scott Telfer, Michael Githens","doi":"10.2106/JBJS.OA.26.00208","DOIUrl":"10.2106/JBJS.OA.26.00208","url":null,"abstract":"<p><strong>Background: </strong>Three-dimensional (3D) fracture mapping has improved the ability to understand and classify complex orthopaedic injuries including scapula body and tibial plafond fractures. Talar body fractures are another complex injury. The most used classification of talar body fractures is based on a series of 51 patients, using radiographs alone. The purpose of this study was to use modern techniques to further understand the morphology of talar body fractures.</p><p><strong>Methods: </strong>All skeletally mature patients with operatively treated isolated shear-type talar body fractures and preoperative computed tomography (CT) scans from 2008 to 2020 at a single level 1 academic trauma center were eligible for inclusion. 3D fracture lines and intact bone fragments were identified and subsequently mapped onto a common template talus model to generate 3D fracture maps depicting the spatial distribution and relative frequency of fractures and comminution.</p><p><strong>Results: </strong>A total of 124 talar body fractures were included. The average age was 37 years (SD 10, range 17-69). Eighty-eight patients (71%) were male. There was a dominant oblique fracture pattern originating from the anteromedial talar body and extending posterolaterally, involving a variable amount of the talar dome and posterior facet. This fracture pattern was present in 71% of cases, whereas the typical coronal shear pattern was present in only 18% and the classic sagittal shear pattern was present in only 8% of cases. Ninety percent of fractures had the presence of comminution or articular impaction, which typically occurred at the plantar-medial talus and involved the medial subtalar joint.</p><p><strong>Conclusions: </strong>This CT-based 3D fracture mapping study of 124 talar body fractures demonstrated that these fractures occur in certain patterns with high frequency. An obliquely oriented, anteromedial-to-posterolateral fracture line involving a variable amount of the posterior facet and talar dome was present in the majority of cases. These results may help guide treatment planning including surgical approach and fixation strategies.</p><p><strong>Level of evidence: </strong>Level IV, prognostic. See Instructions for Authors for a complete description of levels of evidence.</p>","PeriodicalId":36492,"journal":{"name":"JBJS Open Access","volume":"11 3","pages":""},"PeriodicalIF":4.9,"publicationDate":"2026-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13502746/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148814461","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: Fifteen-Year Results of Cementless Medial Oxford Unicompartmental Knee Arthroplasty: Reliable Long-Term Fixation.","authors":"Nisrina Widari, Cathy Jenkins, Christopher Dodd, Stephen Mellon, David Murray","doi":"10.2106/JBJS.OA.ER.26.00140","DOIUrl":"10.2106/JBJS.OA.ER.26.00140","url":null,"abstract":"<p><p>[This corrects the article DOI: 10.2106/JBJS.OA.26.00140.].</p>","PeriodicalId":36492,"journal":{"name":"JBJS Open Access","volume":"11 3","pages":""},"PeriodicalIF":4.9,"publicationDate":"2026-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13502805/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148814434","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":"Effect of Patient-Surgeon Sex Concordance on Total Joint Arthroplasty Outcomes.","authors":"Tanya Watarastaporn, Mark C Duggan, Elizabeth W Paxton, Ronald A Navarro, Christopher D Grimsrud, Ajinkya A Rane, Kanu Okike","doi":"10.2106/JBJS.OA.26.00219","DOIUrl":"10.2106/JBJS.OA.26.00219","url":null,"abstract":"<p><strong>Introduction: </strong>In fields outside of orthopaedics, patient-physician sex concordance has been linked to improved rapport, better quality of care, and decreased mortality. However, the effects of sex concordance have yet to be evaluated in orthopaedic surgery. This study examined whether patient-surgeon sex concordance was associated with outcomes following total joint arthroplasty (TJA).</p><p><strong>Methods: </strong>This retrospective cohort study used data from a US integrated healthcare system's TJA registry (2009-2020). Patients 18 years and older with hip or knee osteoarthritis who underwent primary total hip or knee arthroplasty were included. The primary outcome was all-cause revision, analyzed using accelerated failure time regression adjusted for potentially confounding variables, with patient-surgeon sex concordance as the exposure. Secondary outcomes included 90-day emergency department (ED) visits and readmissions, analyzed using logistic regression models also adjusted for confounders.</p><p><strong>Results: </strong>A total of 213,540 patients (median age 67.0 years, 59.9% female, 69.8% White) and 319 surgeons (18 female, 301 male) met the inclusion criteria. There were 70,883 total hip arthroplasty cases and 142,657 total knee arthroplasty cases. Sex concordance was not associated with all-cause revision for male patients (time ratio [TR] 1.18, 95% confidence interval (CI) 0.80-1.75, p = 0.40) or for female patients (TR 0.98, 95% CI 0.72-1.34, p = 0.92). Sex concordance was also not associated with 90-day readmission for male patients (odds ratio [OR] 0.99, 95% CI 0.84-1.16, p = 0.88) or for female patients (OR 0.99, 95% CI 0.86-1.14, p = 0.87). Both male and female patients had a lower likelihood of 90-day ED visit when treated by a female surgeon (OR 0.80, 95% CI 0.71-0.89, p < 0.001 and OR 0.86, 95% CI 0.79-0.94, p < 0.001, respectively).</p><p><strong>Conclusions: </strong>In this study of 213,540 TJA procedures performed within an integrated healthcare system, surgeon-patient sex concordance was not associated with all-cause revision or 90-day readmission. Ninety-day ED visits were less common among patients treated by female surgeons. Further research is required to determine if there are other aspects of TJA care, such as patient satisfaction or utilization, that could be more affected by patient-surgeon sex concordance.</p><p><strong>Level of evidence: </strong>Therapeutic Level III, prognostic. See Instructions for Authors for a complete description of levels of evidence.</p>","PeriodicalId":36492,"journal":{"name":"JBJS Open Access","volume":"11 3","pages":""},"PeriodicalIF":4.9,"publicationDate":"2026-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13502849/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148814425","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 Extended Intravenous Antibiotic Prophylaxis in Preventing Periprosthetic Joint Infection After Total Knee and Hip Arthroplasty: An Analysis of a Japanese Nationwide Database.","authors":"Shingo Kurihara, Chikamasa Ichita, Tadahiro Goto, Kazuhisa Hatayama, Kiyohide Fushimi, Sayuri Shimizu","doi":"10.2106/JBJS.OA.26.00212","DOIUrl":"10.2106/JBJS.OA.26.00212","url":null,"abstract":"<p><strong>Background: </strong>Although major international guidelines recommend discontinuing antibiotic prophylaxis within 24 hours after total joint arthroplasty, recent studies have suggested potential benefits of extended administration. The aim of this study was to evaluate the effectiveness of extended intravenous antibiotic prophylaxis in preventing periprosthetic joint infection (PJI).</p><p><strong>Methods: </strong>The Japanese Diagnosis Procedure Combination database was used to identify adults who underwent primary total knee arthroplasty (TKA) and total hip arthroplasty (THA) from April 2014 to March 2024. Based on the duration of postoperative intravenous antibiotic prophylaxis, patients were divided into the standard intravenous antibiotic prophylaxis (0-1 day) and extended intravenous antibiotic prophylaxis (2-3 days) groups. Patients who received any oral antibiotic prophylaxis during the intravenous prophylactic period were excluded. The outcome was PJI within 90 and 365 days after surgery, defined as surgical site infection requiring surgical intervention. Propensity score matching and subgroup analyses in high-risk patients were conducted (e.g., obesity, smoking, diabetes mellitus with chronic complications, kidney disease, hepatic disease, autoimmune disease, and oral corticosteroid use).</p><p><strong>Results: </strong>Among 506,710 eligible patients (244,156 TKA and 262,554 THA), the 90-day PJI incidence was 0.34% in TKA and 0.37% in THA. In propensity score-matched analysis, extended intravenous antibiotic prophylaxis was associated with a small reduction in 90-day PJI after TKA, with a risk difference (RD) of -0.07% (95% confidence interval [CI], -0.12% to -0.01%) and a corresponding risk ratio (RR) of 0.83 (95% CI, 0.72-0.96). In high-risk TKA patients, a stronger association was observed (RD, -0.13% [95% CI, -0.25% to -0.01%]; RR, 0.78 [95% CI, 0.63-0.98]). Similar findings were observed for 365-day PJI after TKA. No clear association was observed in THA, either in the overall cohort or in the high-risk subgroup.</p><p><strong>Conclusions: </strong>Extended intravenous antibiotic prophylaxis was associated with a marginal reduction in PJI within 90 and 365 days after TKA, with a greater effect in high-risk TKA patients. While routine extension is not supported for all patients, it may be considered in selected high-risk TKA cases.</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":"11 3","pages":""},"PeriodicalIF":4.9,"publicationDate":"2026-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13502880/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148814389","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 Persistent Preference for Traditional Bonesetting in Ethiopia: Risk Factors and Missed Opportunities.","authors":"Mengistu G Mengesha, Morgan Askew, Abdoulie Njai, Ephrem G Adem, Mario Keko, Sintayehu Bussa, Yisihak Zerihun, Mahamed Areis, Birlew T Alemayehu, Bekalu Wubshet, Moa C Jira, Mulugeta Bekelle, Claude Martin, William J Harrison, Kiran J Agarwal-Harding","doi":"10.2106/JBJS.OA.26.00199","DOIUrl":"10.2106/JBJS.OA.26.00199","url":null,"abstract":"<p><strong>Introduction: </strong>Many patients in Ethiopia prefer traditional bonesetting (TBS) over formal health services for musculoskeletal injuries, despite well-documented complications. We analyzed risk factors for initial and persistent TBS preference among patients who patronized TBS and subsequently presented to a tertiary hospital for definitive treatment.</p><p><strong>Methods: </strong>Over 15 months, we prospectively enrolled patients with musculoskeletal injuries who presented to 8 Ethiopian tertiary hospitals after patronizing TBS for the same injury. Multivariable regression evaluated associations between TBS preference and covariates including demographics, injury characteristics, reasons for seeking TBS, and hospitalization outcomes.</p><p><strong>Results: </strong>We enrolled 1,243 patients (mean age 27 ± 18.4 years; 67.6% male). Elbow (307, 24.7%) and leg/ankle/foot (245, 19.7%) injuries were most common; 978 (78.7%) were closed fractures/dislocations. At study enrollment, 1,003 (80.7%) patients had complications, most commonly stiffness/contracture (671, 54.0%) and malunion (346, 27.8%). Prolonged hospitalization (>7 days) occurred for 223 (17.9%) patients; 37 (3.0%) underwent amputation. TBS was initially preferred after injury by 808 (65.0%) patients, although 298 (24.0%) visited a health facility before TBS. Initial TBS preference was lower among patients with formal education (primary school: adjusted odds ratio [AOR] 0.64, [95% confidence interval [CI]: 0.41-0.99]; secondary school or above: AOR 0.56 [0.36-0.87]) and open fractures (AOR 0.41 [0.22-0.77]). For future injuries, 455 (36.6%) patients/guardians preferred TBS over health facility-based care. Controlling for initial TBS preference, future preference was associated with poverty (AOR 1.66, 95% CI 1.10-2.49, p = 0.015) and visiting a health facility before TBS (AOR 2.04, 95% CI 1.34-3.10, p < 0.001). Neither prolonged hospitalization (p = 0.734) nor amputation (p = 0.946) influenced future preference.</p><p><strong>Conclusion: </strong>More than one-third of patients preferred TBS for future injuries. Among patients in poverty, persistent TBS preference after reaching a tertiary hospital may reflect entrenched structural barriers to formal orthopaedic care. Initial health facility visits before TBS were associated with greater future TBS preference even after definitive hospital care, suggesting missed opportunities to build trust in formal care.</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":"11 3","pages":""},"PeriodicalIF":4.9,"publicationDate":"2026-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13502802/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148814459","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}