JBJS Open Access最新文献

{"title":"The Effects of Antibiotic-Impregnated Spacers on Bone Healing in an Animal Model of the Induced Membrane Technique: Healing of a Critical-Size Femoral Defect in a Rat Model.","authors":"Hening Sun, Charles Godbout, Gareth Ryan, Ikran Ali, James Higgins, Graeme Hoit, Jeremy Hall, Mansur Halai, Amir Khoshbin, Emil H Schemitsch, Aaron Nauth","doi":"10.2106/JBJS.OA.24.00059","DOIUrl":"10.2106/JBJS.OA.24.00059","url":null,"abstract":"<p><strong>Background: </strong>Surgeons performing the induced membrane technique (IMT) often incorporate antibiotics into the spacer at the first stage of the surgical procedure to prevent or treat infection. However, the effect of antibiotic use on subsequent bone healing is not clear. This study aimed to investigate if antibiotic-impregnated spacers impact subsequent bone healing in a rat model of the IMT.</p><p><strong>Methods: </strong>Inbred male rats (Fischer 344) were randomly divided into 3 groups according to the antibiotic dose in the spacer: (1) control (no antibiotics), (2) low-dose (1.2 g tobramycin and 1.0 g vancomycin per 40 g of polymethylmethacrylate [PMMA]), and (3) high-dose (3.6 g tobramycin and 3.0 g vancomycin per 40 g of PMMA). We created a 5-mm segmental defect in the right femoral diaphysis. The bone was stabilized with a plate and screws, and the assigned spacer was inserted into the defect. Four weeks later, the spacer was removed and bone graft was placed within the defect. Radiographs made 12 weeks after grafting were scored according to union status and degree of bone healing. Micro-computed tomographic (CT) analysis and biomechanical testing were also performed at 12 weeks.</p><p><strong>Results: </strong>Full radiographic union was achieved in 10 (83%) of 12 control animals, 13 (100%) of 13 low-dose animals, and 8 (62%) of 13 high-dose animals (high-dose compared with low-dose: risk ratio, 11.0; p = 0.039). The control group demonstrated higher bone volume compared with the high-dose group (mean difference, 9.0 mm³; p = 0.039), and there was a trend toward higher bone volume in the low-dose group compared with the high-dose group (mean difference, 8.1 mm³; p = 0.06). The biomechanical results demonstrated that maximum stiffness was significantly higher in the low-dose group compared with the high-dose group (mean difference, 14.1 N*mm/degree; p = 0.009).</p><p><strong>Conclusions: </strong>Our results demonstrated that low doses of antibiotics in PMMA spacers used for the IMT did not impair bone healing. However, high doses of antibiotics demonstrated inferior bone healing.</p><p><strong>Clinical relevance: </strong>The addition of high-dose antibiotics to the PMMA spacers used for the IMT may result in impaired bone healing and should be used with caution.</p>","PeriodicalId":36492,"journal":{"name":"JBJS Open Access","volume":"10 1","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11841848/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143484174","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 Cost-Effectiveness Analysis of Intramedullary Nailing Versus External Fixation for Open Tibial Fractures in Tanzania.","authors":"Jamieson M O'Marr, Patricia Rodarte, Billy Haonga, Patrick Ngunyale, Heather Roberts, Saam Morshed, David Shearer","doi":"10.2106/JBJS.OA.24.00006","DOIUrl":"10.2106/JBJS.OA.24.00006","url":null,"abstract":"<p><strong>Background: </strong>Open tibial fractures are a cause of substantial orthopaedic morbidity in low- and middle-income countries. These injuries represent a substantial cost burden to both individual patients and society because of their high propensity for complications, such as infection, nonunion, and malunion. External fixation and intramedullary (IM) nailing are both utilized for definitive treatment of open tibial fractures, but given the differences in cost and lack of clear superiority of intramedullary nailing, cost-effectiveness becomes important to consider in low- and middle-income countries. The present study aimed to examine the cost-effectiveness of IM nailing versus external fixation within Tanzania.</p><p><strong>Methods: </strong>This study utilized data from a randomized controlled trial conducted at a single tertiary hospital in Dar es Salaam, Tanzania. Direct cost data were collected via an internal audit of operating costs and hospital staff time. Indirect costs data were collected from patients in a long-term follow-up study assessing total lost work. A Markov model was utilized to run the cost-effectiveness simulations. The primary outcome was the incremental cost-effectiveness ratio (ICER) over a lifetime time horizon. Both the payer and societal perspectives were considered. To account for uncertainty, both 1-way and probabilistic sensitivity analyses were performed.</p><p><strong>Results: </strong>From the payer perspective, the cost of external fixation ($396 USD) was lower than that of IM nailing ($529), primarily because of shorter operative times. However, IM nailing was associated with more quality-adjusted life-years (QALYs). From the payer perspective, the ICER was $499 per QALY with a donated nail and $701 per QALY with a purchased locally available nail. From the societal perspective, the ICER was lower among patients undergoing IM nailing, at $70 per QALY, largely because of shorter recovery times.</p><p><strong>Conclusions: </strong>From both the payer and the societal perspective, IM nailing is considered highly cost-effective on the basis of the World Health Organization willingness-to-pay thresholds. This finding was consistent whether the IM nail was donated or purchased from local suppliers. These results are likely generalizable to other tertiary referral centers in low- and middle-income countries.</p><p><strong>Level of evidence: </strong>Economic Level II. See Instructions for Authors for a complete description of levels of evidence.</p>","PeriodicalId":36492,"journal":{"name":"JBJS Open Access","volume":"10 1","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11841853/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143484160","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: Perception of Residency Program Diversity Is Associated With Vulnerability to Race and Gender Stereotype Threat Among Minority and Female Orthopaedic Trainees.","authors":"Risa T Reid, Susan M Odum, Patrick J Rosopa, Jaysson T Brooks, Brian P Scannell, Selina Poon, Tyler Williams, Joshua C Patt, Gabriella E Ode","doi":"10.2106/JBJS.OA.ER.24.00084","DOIUrl":"10.2106/JBJS.OA.ER.24.00084","url":null,"abstract":"<p><p>[This corrects the article DOI: 10.2106/JBJS.OA.24.00084.].</p>","PeriodicalId":36492,"journal":{"name":"JBJS Open Access","volume":"10 1","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11838151/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143469437","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":"Risk of Fracture at External Fixator Pin Hole After Lateral Tibial Plateau Fracture Plating: A Biomechanical Comparison of Different Screw Configurations.","authors":"Patrick A Massey, Wayne Scalisi, Chloe Duval, Michael Lowery, Brad Chauvin, Giovanni F Solitro","doi":"10.2106/JBJS.OA.24.00094","DOIUrl":"10.2106/JBJS.OA.24.00094","url":null,"abstract":"<p><strong>Background: </strong>External fixation of tibial plateau fractures commonly provides temporary stabilization before definitive fixation with plate and screws. The purpose of this study was to determine if an external fixator pin hole distal to a tibial plate in a synthetic fracture model would increase the risk of fracture after fixation. Another objective was to determine the ideal configuration when placing tibial plate screws near an external fixator pin hole.</p><p><strong>Methods: </strong>Thirty synthetic tibiae were tested and evenly divided into 5 groups. Tibial plateau plates were placed with 4 different screw configurations for the distal-most screw near the external fixator pin hole. The 5 groups tested were control (fixation with no external fixator hole), unicortical (distal fixation with a unicortical locking screw), bicortical (distal fixation with a bicortical locking screw), oblique (distal fixation with an oblique cortical screw angled 30° proximally from the external fixator hole), and hole-bridging (hole-bridging fixation in which the plate was placed bridging the external fixator hole). The bone surrogates were potted and tested using an Instron 8874 Testing System.</p><p><strong>Results: </strong>There was a significant difference in failure load among the 5 groups (p = 0.005). The mean peak loads were 1,259 N (control), 835 N (unicortical), 831 N (bicortical), 943 N (oblique), and 993 N (hole-bridging). There was a higher failure load in the control group compared with the bicortical group (p = 0.007) and the unicortical group (p = 0.007). There was no difference in failure load between the control group and the hole-bridging group (p = 0.16) and the oblique group (p = 0.067).</p><p><strong>Conclusions: </strong>External fixator pin holes distal to a tibial plateau plate may increase the risk of tibial fracture through the pin hole. This risk may be mitigated by placing the distal screw oblique and angled proximally away from the external fixator pin hole or by placing the external fixator pin proximally with subsequent bridging of the external fixator pin hole with the plate.</p>","PeriodicalId":36492,"journal":{"name":"JBJS Open Access","volume":"10 1","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11778079/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143123834","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":"Does Resident Gender or Race/Ethnicity Affect Orthopaedic Surgery Case Volume During Residency Training?","authors":"Parisun Shoga, Ann Van Heest, S Elizabeth Ames, Sean O Hogan, Eric Holmboe, Mary Klingensmith, Yoon Soo Park, Corey Parker, Erik Solberg, Kimberly Templeton","doi":"10.2106/JBJS.OA.24.00146","DOIUrl":"10.2106/JBJS.OA.24.00146","url":null,"abstract":"<p><strong>Introduction: </strong>Disparities in case volumes have been reported in some surgical specialties. The objective of this study was to evaluate whether gender or racial/ethnicity disparities exist during orthopaedic surgery residency surgical case log volume.</p><p><strong>Methods: </strong>Accreditation Council for Graduate Medical Education Case Log Database for orthopaedic surgery residents for 9 years of cohorts graduating in academic years 2013-2014 to 2021-2022 were analyzed to compare case logs between men and women, as well as race/ethnicity, defined by Association of American Medical Colleges as underrepresented in medicine (URiM) and non-URiM groups.</p><p><strong>Results: </strong>Longitudinal analyses of total required minimum type cases indicate significant gender differences among the initial graduating cohorts with women trainees reporting 33 cases fewer than men; in the most recent years of this study period, women trainees reported 5 cases fewer than men per year. URiM trainees reported 29 cases fewer at baseline, while in the most recent years, there were no significant differences. Significant differences exist for 8 of the 15 case minimum types with fewer women cases at baseline; in the most recent years, women had fewer cases in anterior cruciate ligament Reconstruction, Ankle Fracture Fixation, Closed Reduction Forearm Fracture, Total Hip Arthroplasty, and Total Knee Arthroplasty. There were significant differences for 3 of 15 case minimum types at baseline for URiM trainees with no significant differences in most recent years. Hand was the only anatomic area with women reporting significantly more cases than men, both initially and over the 9 years of study period.</p><p><strong>Conclusion: </strong>Significant differences exist in case volume and case types during orthopaedic surgery residency based on gender for the initial cohort, albeit lessening in most recent years. Although initial differences in cases volumes based on race/ethnicity exist, no significant differences persist in most recent years of the study period.</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 1","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11778099/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143123830","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":"Robot-Assisted Retrograde Elastic Intramedullary Nailing Versus ORIF with a Plate for Displaced Midshaft Clavicular Fractures.","authors":"Yufu Zhang, Jie Tan, Xigong Zhang, Xiao Han, Yanchao Li, Maoqi Gong, Qiang Huang, Junqiang Wang, Xieyuan Jiang","doi":"10.2106/JBJS.OA.24.00071","DOIUrl":"https://doi.org/10.2106/JBJS.OA.24.00071","url":null,"abstract":"<p><strong>Background: </strong>The objective of this study was to compare the clinical outcomes of robot-assisted retrograde elastic intramedullary nailing and open reduction and internal fixation (ORIF) with a plate for displaced midshaft clavicular fractures.</p><p><strong>Methods: </strong>All patients diagnosed with displaced midshaft clavicular fractures between November 1, 2022, and June 30, 2023, in our level-III hospital (most advanced level) were enrolled in this retrospective study; a total of 116 patients met the inclusion criteria. Patients were divided into 2 groups on the basis of treatment: robot-assisted retrograde elastic intramedullary nailing (RAN group) and ORIF with a plate (plate group). Operations in the RAN group were carried out using the novel TIANJI Robot system (TINAVI Medical Technologies) for navigation and planning of the optimal retrograde intramedullary nailing trajectory. Patient demographics, perioperative parameters, and complications were documented. Patients were followed at the trauma clinic for clinical and radiographic assessment.</p><p><strong>Results: </strong>There were 74 patients in the RAN group and 42 patients in the plate group. The RAN group exhibited a significantly shorter total operative time (mean, 52.20 ± 20.76 versus 86.83 ± 27.42 minutes), less blood loss (mean, 7.38 ± 5.54 versus 59.05 ± 30.11 mL), shorter incision length (mean, 1.28 ± 0.85 versus 9.79 ± 1.63 cm), and shorter duration of hospital stay (mean, 3.38 ± 0.73 versus 5.50 ± 1.99 days) (all p < 0.05). Nail treatment was also associated with a significantly shorter time to bone union (mean, 7.92 ± 2.46 versus 16.79 ± 5.18 weeks), a higher SCAR score (mean, 9.77 ± 0.51 versus 5.74 ± 1.15), a shorter time to return to sports (mean, 12.70 ± 2.35 versus 20.10 ± 4.10 weeks), and a shorter time to regain full range of shoulder motion (mean, 9.46 ± 2.35 versus 12.05 ± 2.95 weeks) (all p < 0.05). At the final follow-up, the Constant-Murley shoulder score was significantly higher in the RAN group (mean, 97.57 ± 2.77 versus 93.29 ± 7.63) (p < 0.05). Compared with the RAN group, the plate group had more complications (p < 0.05).</p><p><strong>Conclusions: </strong>Robot-assisted retrograde elastic intramedullary nailing is a safe and minimally invasive treatment option for displaced midshaft clavicular fractures that promotes rapid healing, good cosmesis, excellent functional outcomes, and fewer complications compared with ORIF with a plate.</p><p><strong>Level of evidence: </strong>Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.</p>","PeriodicalId":36492,"journal":{"name":"JBJS Open Access","volume":"10 1","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11771674/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143068407","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":"Functional Improvements by Controlled Suture Tension in Arthroscopic Rotator Cuff Repair.","authors":"Shinji Imai","doi":"10.2106/JBJS.OA.24.00031","DOIUrl":"10.2106/JBJS.OA.24.00031","url":null,"abstract":"<p><strong>Background: </strong>Although a certain degree of tension in bridging sutures is required for proper tendon healing following suture-bridge rotator cuff repair, excessive suture tension may be detrimental to tendon healing. This study aimed to investigate the effects of bridging suture tension on clinical outcomes and tendon healing. We hypothesized that fixed, low tension of the bridging sutures would improve the tendon healing rate and clinical outcomes compared with maximum manual tensioning.</p><p><strong>Methods: </strong>A group of 39 patients with a rotator cuff tear were treated with arthroscopic suture-bridge rotator cuff repair, in which the bridging sutures were uniformly tensioned to 20 N (group A). A separate group of 37 patients was treated with the same suture construct, but the sutures were tensioned by maximum manual pulling (mean tension, 36.1 N; group B). The visual analog scale (VAS) score for pain, active anterior elevation, external and internal rotation, and Constant score were compared between the groups preoperatively and at 1, 3, and 6 months and 1 and 2 years postoperatively. Anatomical healing was evaluated using magnetic resonance imaging (MRI) at 1 year after surgery.</p><p><strong>Results: </strong>At 6 months postoperatively, all clinical values had improved in both groups. The Constant score (p < 0.001), VAS pain score (p < 0.001), and anterior elevation (p = 0.004) were significantly better in group A than in group B. Two years postoperatively, there was no significant difference between groups A and B in the Constant score (p = 0.847), VAS pain score (p = 0.991), and anterior elevation (p = 0.855). Group A demonstrated a significantly lower retear rate (3 of 39, 7.7%) than group B (9 of 37, 24.3%) (p = 0.0467).</p><p><strong>Conclusions: </strong>Double-row suture-bridge repairs with fixed, low tension led to superior clinical outcomes at 6 months and a superior tendon healing rate at 1 year compared with repairs with higher suture tension. However, the clinical outcomes did not differ significantly at 2 years between the 2 tensioning methods.</p><p><strong>Level of evidence: </strong>Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.</p>","PeriodicalId":36492,"journal":{"name":"JBJS Open Access","volume":"10 1","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11749655/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143030013","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: Expanding the Pipeline: Exposure and Female Mentorship Increase Interest in Orthopaedic Surgery Among Female Premedical Undergraduate Students: Erratum.","authors":"Victoria E Bergstein, Jessica Schmerler, Alexandra H Seidenstein, Dawn M LaPorte","doi":"10.2106/JBJS.OA.ER.24.00142","DOIUrl":"10.2106/JBJS.OA.ER.24.00142","url":null,"abstract":"<p><p>[This corrects the article DOI: 10.2106/JBJS.OA.24.00142.].</p>","PeriodicalId":36492,"journal":{"name":"JBJS Open Access","volume":"10 1","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11737502/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143013037","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":"An Updated Demographic Profile of Orthopaedic Surgery Using a New ABOS Data Set.","authors":"Lindsey S Caldwell, Natalie Glass, Gregory P Guyton, David W Elstein, Charles L Nelson","doi":"10.2106/JBJS.OA.24.00122","DOIUrl":"10.2106/JBJS.OA.24.00122","url":null,"abstract":"<p><strong>Introduction: </strong>The orthopaedic surgery physician workforce is predominately White and male and has been identified as the least diverse medical specialty. Increasing efforts toward diversification within orthopaedic surgery are underway. Evaluating the effectiveness of these programs requires a thorough understanding of the current demographic profile of the profession.</p><p><strong>Methods: </strong>The American Board of Orthopaedic Surgery (ABOS) is the leading board certification organization for orthopaedic surgeons in the United States. The ABOS began collecting self-reported race/ethnicity and sex/gender data of its examinees and diplomates in 2017. This new data set of ABOS was analyzed to describe both the current demographic profile of orthopaedic surgery and trends over time. Underrepresented minority (URM) was defined as a group that is less well represented in orthopaedic surgery than in US census data and includes female, American Indian or Alaska Native, Black or African American, Hispanic/Latino, and Native Hawaiian or Other Pacific Islander categories.</p><p><strong>Results: </strong>Of the 21,025 currently practicing ABOS diplomates with time-limited ABOS certificates (issued since 1986), 19,912 (94.7%) provided sex/gender data, and 19,876 (94.5%) provided race/ethnicity data. Approximately 84.78% selected male and 8.43% female. The majority identified as White (73.67%), whereas 16.35% selected a URM race/ethnicity category. There have been significant increases in the proportions of female (odds ratio [OR] = 4.72, 95% confidence interval [CI] = 3.64-6.11, p < 0.001) and URM (OR = 2.31, 95% CI = 1.80-2.96, p < 0.0001). Diplomates among orthopaedic surgeons attaining ABOS board Diplomates from 1989 to present. Among the subspecialties, pediatric orthopaedics reported the highest percentage of females (30.4%). Spine had both the lowest percentage of females (2.63%) and the highest percentage of URMs (8.97%). Sports had the lowest percentage of URMs at 5.63%.</p><p><strong>Conclusion: </strong>Orthopaedic surgery in 2023 remains largely White and male. However, there have been promising trends toward diversification of orthopaedic surgery both in terms of gender and race/ethnicity. Specialties within orthopaedics have a wide variety of demographic profiles.</p><p><strong>Level of evidence: </strong>Level IV Retrospective Cohort Study. See Instructions for Authors for a complete description of levels of evidence.</p>","PeriodicalId":36492,"journal":{"name":"JBJS Open Access","volume":"10 1","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11737504/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143012773","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":"ASA Class Is a Stronger Predictor of Early Revision Risk Following Primary Total Knee Arthroplasty than BMI.","authors":"Christopher J Wall, Richard N de Steiger, Christopher J Vertullo, Dylan Harries, Srinivas Kondalsamy-Chennakesavan","doi":"10.2106/JBJS.OA.24.00064","DOIUrl":"10.2106/JBJS.OA.24.00064","url":null,"abstract":"<p><strong>Background: </strong>Although there is a known correlation between obesity and revision risk following total knee arthroplasty (TKA), there is an ongoing debate regarding the appropriateness of denying TKA solely based on the body mass index (BMI) of a patient. Our aim was to determine whether a patient's American Society of Anesthesiologists (ASA) class predicts their risks of early all-cause revision and revision for periprosthetic joint infection (PJI) following primary TKA, independent of their BMI.</p><p><strong>Methods: </strong>Data from the Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR) were obtained regarding all patients who underwent primary TKA for osteoarthritis in Australia from January 1, 2015, to December 31, 2022. Estimated hazard ratios of all-cause revision and revision for PJI, as well as predicted risks of revision within 3 months, 1 year, and 2 years, as a function of patient ASA class and BMI, were calculated with use of multivariable Cox proportional hazards models.</p><p><strong>Results: </strong>A total of 274,786 primary TKAs (54.5% female; mean age, 68.3 years) were included in the study, of which 5,401 were revised during the study period. Compared with BMI, ASA class was a stronger predictor of the risks of all-cause revision and revision for PJI following primary TKA. Patients with an ASA class of 3 to 4 had higher risks of all-cause revision and revision for PJI at multiple time points after TKA compared with patients with an ASA class of 1 to 2, regardless of BMI.</p><p><strong>Conclusions: </strong>Although ASA class and BMI are theoretically interrelated variables, we found that a patient's ASA class was more strongly associated with their risks of early all-cause revision and revision for PJI following primary TKA than their BMI. Employing a BMI threshold in isolation when assessing fitness for TKA may be inappropriate, and surgeons should give greater weight to the other medical comorbidities and general perioperative fitness of the patient. Patients with poorly controlled comorbidities should be referred for medical optimization prior to TKA.</p><p><strong>Level of evidence: </strong>Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.</p>","PeriodicalId":36492,"journal":{"name":"JBJS Open Access","volume":"10 1","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11737488/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143013011","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}