JBJS Open Access最新文献

{"title":"Two-Stage Modular Intramedullary Knee Arthrodesis for Persistent Periprosthetic Joint Infection After Failed Total Knee Arthroplasty: Mid-Term to Long-Term Outcomes.","authors":"Avtar Singh Kamboj, Abhijit Das, Babaji Sitaram Thorat, Arcot Reddy Vamsi Krishna, Kshitij Srivastav, Arshid H Wani, Prabhat Mittal","doi":"10.2106/JBJS.OA.26.00203","DOIUrl":"10.2106/JBJS.OA.26.00203","url":null,"abstract":"<p><strong>Background: </strong>Persistent periprosthetic joint infection (PJI) after failed total knee arthroplasty (TKA) remains a challenging condition, particularly in patients with severe bone loss or compromised soft tissues. Modular intramedullary knee arthrodesis is a limb-salvage option; however, evidence on mid-term to long-term outcomes remains limited. This study evaluated infection control, functional outcomes, and complications following 2-stage modular intramedullary knee arthrodesis.</p><p><strong>Methods: </strong>A retrospective analysis of 30 patients who underwent 2-stage modular intramedullary knee arthrodesis for persistent PJI after failed TKA was performed, with a mean follow-up of 7.2 ± 1.8 years. Outcomes included infection recurrence, functional scores (Oxford Knee Score [OKS], Visual Analog Scale [VAS], and Functional Independence Measure [FIM]), time to weight bearing, and mechanical complications.</p><p><strong>Results: </strong>Among the 30 patients available for final analysis, no clinical or laboratory evidence of recurrent infection, or infection-related reoperation, was observed during follow-up. Functional outcomes improved significantly (p < 0.05), with mean OKS increasing from 14.3 ± 2.6 to 43.5 ± 1.3, mean VAS decreasing from 8.4 ± 1.2 to 1.1 ± 0.5, and FIM scores improved from 70.5 ± 3.12 to 121.3 ± 2.3. Early mobilization was achieved, with progression to full-weight bearing at a mean of 22 days. No mechanical or implant-related complications were observed.</p><p><strong>Conclusion: </strong>Two-stage modular intramedullary knee arthrodesis provides durable infection control, early mobilization, and improved functional outcomes at mid-term to long-term follow-up in patients with persistent PJI after failed TKA.</p><p><strong>Level of evidence: </strong>Level IV, therapeutic study. 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/PMC13502848/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148814428","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":"Representation of Hispanic and Latino Orthopaedic Surgery Trainees and Attendings in the United States: A Demographical Analysis.","authors":"Emmanuel Brito, Nathan Sherman, Guy Paiement","doi":"10.2106/JBJS.OA.25.00349","DOIUrl":"10.2106/JBJS.OA.25.00349","url":null,"abstract":"<p><strong>Introduction: </strong>In 2021, the US Hispanic and Latino (H&L) population made up 19% of the national population, an increase from 14% in 2006. There is limited literature assessing the trends of H&L representation among residents, fellows, and attending physicians in orthopaedic surgery. We sought to analyze their current representation in light of recent changes in national demographics.</p><p><strong>Methods: </strong>Demographic data for the US population was obtained from the decennial Censuses. Race and ethnicity data for in-training residents from 2006 to 2021 were extracted from the Graduate Medical Education Census from the American Medical Association. Similar data were obtained from the 2008 and 2018 AAOS (American Academy of Orthopedic Surgeons) Censuses of fully trained orthopaedic surgeons. Representation was analyzed for the following groups: H&L, Black, Asian, Native American, Multiracial, and White. H&L fellows representation per subspecialty (adult reconstruction, foot and ankle, hand, oncology, sports medicine, spine, trauma, and pediatrics) was also analyzed.</p><p><strong>Results: </strong>A total of 57,187 orthopaedic surgery residents were in training over the 15-year study period (2006-2021), 2,812 (4.9%) identified as H&L. Total number of orthopaedic residents in-training grew by 36% from 2006 to 2021 (3,305 to 4,616). H&L residents doubled from 118 to 281 to comprise 6.1% of trainees. Representation for H&L trained orthopaedic surgeons grew from 484 (1.9%) in 2008 to 663 (2.2%) in 2018, a 37% increase in absolute number and 16% as percentage of the orthopaedic workforce.</p><p><strong>Conclusion: </strong>Across the 15-year study period, H&L representation in orthopaedic surgery moderately increased at all levels but remained low relative to the H&L population. H&L resident representation relative to H&L national demographic weight is significantly low (p < 0.001) compared with other ethnic/racial groups. H&L residents were represented at a rate 3 times lower than White residents and almost 7 times lower than Asian residents when compared with the H&L national population.</p>","PeriodicalId":36492,"journal":{"name":"JBJS Open Access","volume":"11 3","pages":""},"PeriodicalIF":4.9,"publicationDate":"2026-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13472662/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148762207","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 Clubfoot Affect Sports Ability and Participation in Children?","authors":"Michelle Mo, Megan Hannon, Patricia E Miller, Winnie Lin, Matthew Rauseo, Shawn Cameron, Akossiwa Assignon, Maria F Canizares, William Meehan, Susan T Mahan","doi":"10.2106/JBJS.OA.26.00209","DOIUrl":"10.2106/JBJS.OA.26.00209","url":null,"abstract":"<p><strong>Background: </strong>Patients and families of school children with unilateral corrected talipes equinovarus (TEV, idiopathic clubfoot) have anecdotally noted a difference in sporting function from the unaffected side to the clubfoot. The purpose of this study was to assess difference in strength, balance, performance, and patient perception of their sporting ability using contemporary sports research technology.</p><p><strong>Methods: </strong>Following Institutional Review Board approval, 27 unilateral Ponseti-treated patients with clubfoot (ages 8-15) enrolled in a cross-sectional study. Demographics and patient-reported outcomes (Patient Reported Outcomes Measurement Information System [PROMIS] and Oxford Ankle Foot Questionnaire for Children [OxAFQ-C]) were collected. Strength, range of motion, and functional mechanics were measured using dynamometry, markerless motion capture, and forceplates, respectively (VALD ForceFrame, HumanTrak, and ForceDecks). Comparisons between affected and unaffected limbs were conducted using paired Student's <i>t</i> tests.</p><p><strong>Results: </strong>Mean evaluation age was 11.2 years (30% male); mean initial Dimeglio score was 10.5. Most (78%) participated in >2 sports. PROMIS Physical Activity mean score was 52.3 (SD 6.6), and mean OxAFQ-C Physical score was 81.5 (SD 17.5). Comparing TEV and unaffected limbs in range of motion and strength found differences in ankle dorsiflexion force (mean 58.4N [SD 20.8] vs. 68.6N [28.1]; p = 0.02) and lateral spine tilt during lunge stance (-0.2° [2.6] vs. -1.5° [2.4]); p = 0.04). No significant differences were noted with most performance measures, with small differences noted in single leg stand on the clubfoot limb (1005 mm vs. 781 mm), and mean velocity (67 mm/s vs. 52 mm/s; p < 0.001), jump height (1.6 in vs. 2.2 in; p < 0.001), and peak power (749W vs. 808W; p = 0.02).</p><p><strong>Conclusions: </strong>Children with unilateral TEV report favorably on standardized reports of patient-reported and functional assessments including sports participation. Although differences were noted with decreased balance with flexibility, single leg stance, and jump height on the clubfoot limb, overall, the magnitude of these differences was generally small, and their clinical significance remains uncertain given the lack of established minimal clinically important differences (MCIDs) for this population.</p><p><strong>Level of evidence: </strong>Prognostic Level IV (cross-sectional, small sample size). 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":"2026-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13472657/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148762837","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":"Redefining Success and Characterizing Midterm Growth Modulation: Analysis of Radiographic Outcomes in 2 Years Following Vertebral Body Tethering.","authors":"Qiuya Li, Lijuan Ren, Prudence Wing Hang Cheung, Jason Pui Yin Cheung","doi":"10.2106/JBJS.OA.26.00198","DOIUrl":"10.2106/JBJS.OA.26.00198","url":null,"abstract":"<p><strong>Background: </strong>Vertebral body tethering (VBT) offers fusionless correction for idiopathic scoliosis, yet midterm growth modulation remains poorly characterized. This study established a clinically relevant success criterion and characterized growth modulation kinetics with associated predictors.</p><p><strong>Methods: </strong>This multicenter prospective study enrolled patients with idiopathic scoliosis with Sanders stage ≤7A, preoperative fulcrum-bending flexibility rate ≥50%, and ≥2-year follow-up after VBT. Parameters were collected before surgery and at 7 postoperative time points. Two-year success was defined as Cobb angle <35° (group 1) and correction rate (CR) ≥50% without overcorrection (Group 2). Group 3 included cases with an instrumented Cobb angle <35° but CR <50%. Curves were further classified as undercorrection (CR <50%), overcorrection (negative curve), and short-term clinical success (same as group 2) at 2 years postoperatively.</p><p><strong>Results: </strong>Thirty-eight patients (50 curves, mean age 11.9 ± 1.17 years; 89.5% female) were analyzed. Coronal CR was 63.2% at 24 months. T2-12 kyphosis (p = 0.637), thoracolumbar kyphosis (p = 0.104), lumbar lordosis (p = 0.869), and sacral slope (p = 0.091) remained unchanged. While pelvic obliquity improved at 12 months (2.1° vs. 1.6°, p = 0.001) and trended toward recurrence at 24 months (2.1° vs. 1.8°, p = 0.142), the difference was below the minimally clinically important difference. Apical (11.3° vs. 6.8°) and upper end vertebral (8.5° vs. 2.8°) rotation improved significantly, while lower end vertebral rotation remained unchanged. Although no significant differences were found between group 1 (n = 39) and group 2 (n = 25) in CR and postoperative revisions, among curves under group 1 but not group 2 (group 3, n = 14), a significantly higher revision rate was observed compared with group 2 (28.6% vs. 4.0%, p = 0.047). Eighty-four percent of successful operations under the new criterion remained successful at the 3.4-year follow-up. The change in correction (Δcorrection) diverged at 3 to 6 months postoperatively. Overcorrection was associated with greater flexibility, a younger Risser sign, lower body mass index (14.5 ± 0.86 kg/m²), and higher immediate CR (84.9%).</p><p><strong>Conclusion: </strong>VBT effectively corrects coronal and axial deformity. A short-term success criterion based on a Cobb angle CR ≥ 50% without overcorrection better reflects a favorable biological response than the <35° benchmark at 2 years. Skeletally immature, lean patients with high flexibility and continued correction beyond 6 months may signal overcorrection risk.</p><p><strong>Level of evidence: </strong>Prognostic Level II. 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":"2026-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13472660/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148764804","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 Immunothrombotic Phenotype: Early Inflammatory and Hematologic Markers that Identify Children at Increased Risk of Avascular Necrosis Following Septic Arthritis.","authors":"Maria F Canizares, Benjamin J Shore, Julia S Sanders, Patricia E Miller, Jonathan G Schoenecker","doi":"10.2106/JBJS.OA.26.00196","DOIUrl":"10.2106/JBJS.OA.26.00196","url":null,"abstract":"<p><strong>Background: </strong>Avascular necrosis (AVN) is a devastating complication of pediatric septic arthritis (SA). While traditionally attributed to increased intra-articular pressure, emerging evidence suggests that the host's systemic response to infection may contribute to ischemic injury. We hypothesized that an immunocoagulopathic phenotype characterized by extreme inflammation and platelet consumption would identify children at the highest risk of developing AVN.</p><p><strong>Methods: </strong>Following institutional review board approval, children aged younger than 18 years diagnosed with SA between 2010 and 2016 were retrospectively identified from a multicenter database. The primary outcome was the development of AVN. Demographic, clinical, microbiologic, and early laboratory variables were collected. Multivariable logistic regression using Firth's penalized likelihood method was used to account for rare events. Subgroup-level predicted risks of AVN were calculated based on combinations of dichotomized laboratory markers.</p><p><strong>Results: </strong>Among 616 children with SA, 23 developed AVN (incidence, 3.7%). Patients with AVN demonstrated greater early inflammatory burden, including higher C-reactive protein (CRP) levels, lower platelet counts, and more frequent positive blood and tissue cultures. In multivariable analysis, extreme CRP elevation (>160 mg/L) and relative thrombocytopenia (<245 × 10³/µL) were each associated with nearly 7-fold increased odds of AVN, while elevated admission white blood cell count (>9.3×10³/µL) and erythrocyte sedimentation rate (>60 mm/h) were associated with approximately threefold increased odds. A prediction model using these markers demonstrated excellent discrimination (area under the curve, 0.85), with an estimated AVN risk of 43% in the highest-risk group.</p><p><strong>Conclusions: </strong>In this multicenter cohort, AVN occurred in 3.7% of children with SA. The development of AVN was strongly associated with an immunocoagulopathic phenotype, defined by extreme inflammation (CRP >160 mg/L) and coagulopathy (relative thrombocytopenia <245 × 10³/µL). These findings support the hypothesis that pathological immunothrombosis, rather than mechanical pressure alone, drives ischemic injury in SA. Early recognition of this profile identifies patients who may benefit from heightened surveillance and aggressive perfusion-sparing management.</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":"2026-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13472669/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148766519","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 1-Month Oral Oxycodone on Postoperative Pain Following Total Knee Arthroplasty.","authors":"Mohammad Poursalehian, Seyed Hadi Kalantar, Mohammadreza Razzaghof, Mahboobeh Tajvidi, Sina Esmaeili, Maziar Nafisi, Abdolsalam Razzaghi, Mohammad Ali Mansournia, Hirad Farajidavar, Fatemeh Hashemipour, Mohammad Ayati Firoozabadi, Seyed Mohammad Javad Mortazavi","doi":"10.2106/JBJS.OA.26.00170","DOIUrl":"10.2106/JBJS.OA.26.00170","url":null,"abstract":"<p><strong>Background: </strong>Opioid stewardship is a priority after total knee arthroplasty (TKA). Although scheduled, outpatient oxycodone adds clinically meaningful benefit to contemporary multimodal, nonopioid analgesia remains uncertain.</p><p><strong>Methods: </strong>We conducted a phase-II, single-center, triple-blind, randomized, placebo-controlled trial. Adults undergoing primary TKA received immediate-release oral oxycodone (5 mg twice daily) or matching placebo for 1 month in addition to a standardized multimodal regimen (acetaminophen, celecoxib, pregabalin). The primary outcome was knee pain on the Visual Analog Scale (VAS) on postoperative days 1, 7, and 30. Secondary outcomes were hospital length of stay, Knee Injury and Osteoarthritis Outcome Score (KOOS), Oxford Knee Score (OKS), Pittsburgh Sleep Quality Index (PSQI), patient satisfaction, and adverse events through 6 months. Analyses followed the intention-to-treat principle.</p><p><strong>Results: </strong>Between July 2023 and July 2024, 190 patients were randomized (95 per group); 2 placebo recipients died of myocardial infarction before the 6-month visit. Baseline characteristics were balanced. On postoperative day 1, the mean VAS pain was 6.7 ± 1.5 (mean ± SD) with oxycodone and 7.2 ± 1.5 with placebo (mean difference, 0.48 cm; 95% confidence intervals, 0.06-0.92; P = 0.015); the difference did not reach the minimal clinically important difference (MCID) (1.0 cm). No between-group differences were observed on day 7 or day 30. Length of stay was reduced by 0.2 days (1.7 vs. 1.9 days, P = 0.047), a statistically significant but clinically modest difference. KOOS, OKS, PSQI, and patient satisfaction were comparable at 1 or 6 months. Minor adverse events were similar between groups; no serious events were attributed to the study drug.</p><p><strong>Conclusions: </strong>In patients undergoing primary TKA with optimized multimodal, nonopioid analgesia, a fixed 1-month course of oral oxycodone produced small improvements in day 1 pain and length of hospital stay that were statistically significant but below established MCID thresholds. These findings support individualized prescribing through shared decision making rather than routine scheduled oxycodone use after TKA.</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":"2026-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13472667/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148760939","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":"Suture Tape Augmentation in Anterior Cruciate Ligament Reconstruction: A Meta-Analysis of Prospective and Matched Retrospective Studies.","authors":"Jad Mansour, Michel Estephan, Matthew Nakouzi, Amer Sebaaly, Alan H Daniels, Mohammad Daher","doi":"10.2106/JBJS.OA.26.00107","DOIUrl":"10.2106/JBJS.OA.26.00107","url":null,"abstract":"<p><strong>Background: </strong>Previous biomechanical studies have shown that suture tape augmentation (STA) in anterior cruciate ligament reconstruction (ACLR) can improve the graft which can translate to reduced failure rate in a clinical setting. Previous meta-analysis did not show benefits to STA in patients undergoing ACLR. However, the included studies were retrospective and are subject to heterogeneity which can result in confounding bias. By including only prospective and matched retrospective studies, this meta-analysis will assess the benefits of STA in patients undergoing ACLR.</p><p><strong>Methods: </strong>Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, PubMed, Cochrane, and Google Scholar were accessed and explored until November 2025. The extracted data consisted of the risk arthrofibrosis, graft failure, return to sports (RTS), time to RTS, and postoperative functional outcomes (The Knee Injury and Osteoarthritis Outcome Score [KOOS] subscales and The International Knee Documentation Committee [IKDC] scale).</p><p><strong>Results: </strong>Six studies met the final inclusion criteria including 414 patients in the STA group with age ranging from 19 to 36 years and 450 patients in the control group with age ranging from 20 to 39 years. There was no difference between the 2 groups in arthrofibrosis, graft failure, RTS, and time to RTS. In addition, there were no differences in postoperative KOOS pain, symptoms, activities of daily living, sports, and quality of life subscales as well as IKDC.</p><p><strong>Conclusion: </strong>The results of this meta-analysis revealed that the systematic use of STA did not provide additional clinical benefits in patients older than 18 years undergoing ACLR.</p>","PeriodicalId":36492,"journal":{"name":"JBJS Open Access","volume":"11 3","pages":""},"PeriodicalIF":4.9,"publicationDate":"2026-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13472666/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148765080","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 Locally Executed Agentic Artificial Intelligence Framework for Deduplication, Screening, and Structured Data Extraction in Spine Surgery Systematic Reviews: A PRISMA-Transparent Reporting of Artificial Intelligence in Comprehensive Evidence Synthesis-Compliant Evaluation.","authors":"Sathish Muthu, Dhibin Vikash Kolarpatti Ponnusamy, Vibhu Krishnan Viswanathan, Sathish Kumar Rajappan Chandra, Khan Sharun","doi":"10.2106/JBJS.OA.26.00102","DOIUrl":"10.2106/JBJS.OA.26.00102","url":null,"abstract":"<p><p>Systematic reviews and meta-analyses remain time-consuming and labor-intensive. We developed and validated a locally executed agentic artificial intelligence (AI) framework for deduplication, screening, and structured data extraction in systematic reviews, reported following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA)-Transparent Reporting of AI in Comprehensive Evidence Synthesis (trAIce) guidelines. A multiagent pipeline of specialized agents for deduplication, title/abstract screening, structured data extraction, and verification was executed entirely locally to ensure data governance and reproducibility. Human-in-the-loop validation compared outputs against dual independent reviewers across 3 spine surgery systematic reviews, assessing accuracy, inter-rater agreement (Cohen's κ), time savings, and clinically critical error rates. Across 6,214 records, deduplication achieved near-perfect agreement with human reviewers (κ = 0.98), title and abstract screening yielded higher concordance than human screening (κ = 0.91) while reducing full-text review volume by 83%, and structured data extraction reached substantial agreement (κ = 0.87). The framework reduced reviewer time by 91.1% (90.8%-91.4%), a mean saving of 19.5 hours per review (p < 0.001). Clinically critical discrepancies were rare (<1%) and traceable, with no fabricated or hallucinated data introduced. A locally executed agentic AI framework has the potential to deliver accurate, efficient, and secure automation of systematic review tasks with human oversight, offering a reproducible pathway for trustworthy evidence synthesis under PRISMA-trAIce standards.</p>","PeriodicalId":36492,"journal":{"name":"JBJS Open Access","volume":"11 3","pages":""},"PeriodicalIF":4.9,"publicationDate":"2026-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13472668/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148762637","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":"Case Study in Education: Improving Resident Didactic Training: A Longitudinal Analysis of a Flipped Classroom Curriculum on Normalized Foot and Ankle OITE Scores.","authors":"Rohan Charles, Lindsey E Turner, Channon E Cordes Cole, Jonathan D Barlow, Daniel Ryssman, Alexander Vlasak, Norman S Turner","doi":"10.2106/JBJS.OA.26.00095","DOIUrl":"10.2106/JBJS.OA.26.00095","url":null,"abstract":"<p><strong>Introduction: </strong>Flipped classroom models, which use active, case-based discussion, have shown promise across graduate medical education. Previous literature demonstrates that transitioning to a flipped classroom model resulted in significant increases in overall Orthopaedic In-Training Examination (OITE) scores. This observational study retrospectively compares foot and ankle OITE scores for orthopaedic surgery residents before and after implementation of a flipped classroom curriculum.</p><p><strong>Methods: </strong>This retrospective study reviewed OITE scores for orthopaedic residents, comparing a lecture-based curriculum (n = 49) to a flipped classroom curriculum (n = 61). Residents who started their second year in July 2020 or later were defined as treated. The curriculum is given to the postgraduate year-2 (PGY2) residents only. Percentage of correct foot and ankle questions (F&A) were analyzed via mixed-effects models using random-subject intercepts. Fixed effects included PGY, overall performance on other sections, and flipped classroom status. All statistical analyses were performed in R version 4.4.1.</p><p><strong>Results: </strong>Residents in the flipped classroom cohort demonstrated a statistically significant increase in F&A questions answered correctly. The average increase was 7% (95% confidence interval: 4%, 10%; p < 0.001). This improvement trend became clearly visible in PGY3 and grew stronger in senior residents. Specifically, PGY3 residents improved their mean percentage correct from 62.26% to 66.07% (p = 0.16). PGY4 residents improved from 69.16% to 74.83% (p = 0.013), and PGY5 residents improved from 69.03% to 75.53% (p = 0.006). Historically, approximately 75% of traditional PGY5 residents scored lower on the F&A section than on the rest of the examination. Conversely, in the flipped classroom group, approximately 75% of PGY4 and PGY5 residents scored higher on the F&A section compared with other sections.</p><p><strong>Discussion: </strong>The implementation of a flipped classroom model was associated with a statistically significant improvement in resident performance on the F&A section of the OITE. The educational benefits of this curriculum appear cumulative over the course of residency, with the most substantial performance gains realized by senior residents in their fourth and fifth years of training.</p><p><strong>Level of evidence: </strong>Level III, Observational Study. 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":"2026-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13472659/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148762789","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":"Predictors of Postoperative Physical Therapy Utilization After Common Orthopaedic Procedures.","authors":"Neel Bhardwaj, Sahil Dadoo, Rachit Saggar, Derrick Lin, Siya Bhardwaj, Jonathan D Hughes","doi":"10.2106/JBJS.OA.26.00192","DOIUrl":"10.2106/JBJS.OA.26.00192","url":null,"abstract":"<p><strong>Background: </strong>Physical therapy (PT) is essential to recovery after orthopaedic surgery, yet predictors of postoperative PT utilization across procedure types remain poorly understood. This study aimed to identify demographic and clinical predictors of PT utilization after 8 common orthopaedic procedures using a diverse national cohort.</p><p><strong>Methods: </strong>Patients undergoing 8 orthopaedic procedures were identified from the National Institutes of Health All of Us Research Program. The primary outcome was PT utilization within 180 days of surgery. Sequential multivariable logistic regression evaluated predictors of PT utilization, adjusting for demographics, comorbidities, insurance, employment, preoperative PT, 0- to 14-day postoperative opioid prescriptions, and procedure type. Procedure-stratified analyses were performed. Statistical significance was set as p < 0.050.</p><p><strong>Results: </strong>Among 12,666 patients (59% female; mean age, 58 ± 13 years), including 1,531 (12%) Hispanic/Latino and 1,445 (11%) Black patients, overall postoperative PT utilization was 44%. Female sex was associated with lower odds of PT utilization compared with male sex (adjusted odds ratio [aOR], 0.85; 95% confidence interval [CI], 0.78 to 0.92; p < 0.001), an effect that persisted after full adjustment. Preoperative PT (aOR, 8.91; 95% CI, 7.75-10.23; p < 0.001) and 0- to 14-day postoperative opioid prescriptions (aOR, 1.66; 95% CI, 1.50-1.83; p < 0.001) were independently associated with higher PT utilization. The association between female sex and lower PT utilization reached statistical significance in the total knee arthroplasty subgroup only in procedure-stratified analyses (aOR, 0.78; 95% CI, 0.67-0.91; p = 0.001). PT utilization was associated with lower 90-day emergency department visits (aOR, 0.67; 95% CI, 0.59-0.76; p < 0.001).</p><p><strong>Conclusions: </strong>Preoperative PT and early postoperative opioid prescriptions were the strongest predictors of postoperative PT utilization. Female sex was associated with lower PT utilization after comprehensive adjustment, although structural and unmeasured factors may partially account for this finding. These findings identify factors associated with rehabilitation access after orthopaedic surgery. Preoperative PT engagement, equitable opioid-prescribing practices, and strategies to address insurance-related barriers warrant further investigation as potential approaches to improve postoperative rehabilitation access.</p><p><strong>Level of evidence: </strong>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":"2026-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13391136/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148563043","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}