JBJS Open Access最新文献

{"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}

{"title":"The Gut-Joint Axis in Hip Osteoarthritis: Distinct Articular Microbial Profiles and Metabolic Potential Compared With Nonarthritic Controls.","authors":"Pablo A Slullitel, Florencia A Lohmann, Agustín F Albani-Forneris, Martin Buljubasich, Agustín M García-Mansilla, Francisco Salagoity, Carlos M Lucero, Fernando Comba, Gerardo Zanotti, Tamara A Piñero, Martin A Buttaro","doi":"10.2106/JBJS.OA.26.00184","DOIUrl":"10.2106/JBJS.OA.26.00184","url":null,"abstract":"<p><strong>Background: </strong>Intestinal dysbiosis and systemic microbial translocation potentially contribute to chronic joint inflammation. However, the role of the gut-joint axis in the genesis of osteoarthritis still needs to be elucidated. This investigation characterized taxonomic signatures and proinflammatory metabolic pathways within the hip joint to define their contribution to the pathophysiology of osteoarthritis relative to nonarthritic controls.</p><p><strong>Methods: </strong>A prospective cohort of 48 patients undergoing hip arthroplasty was enrolled. Specimens including synovial fluid, articular cartilage, and acetabular fossa tissue were collected from patients with primary hip osteoarthritis (n = 20) and femoral neck fracture (n = 20). Metagenomic profiling was performed using 16S-rRNA gene sequencing (V3-V4 region). Alpha and beta diversity, taxonomic composition, and predicted functional pathways (PICRUSt2) were compared based on diagnosis (arthritis vs. fracture) and sample location.</p><p><strong>Results: </strong>Osteoarthritic samples demonstrated reduced alpha diversity evenness compared with fracture controls (p = 0.031). While beta diversity was primarily driven by specimen type rather than diagnosis, significant taxonomic differences were observed at the genus level. <i>Pseudomonas</i>, <i>Atopostipes</i>, and <i>Staphylococcus</i> showed significant differential abundance between groups, both by specimen location and diagnosis. Functional predictive analysis revealed a marked enrichment of the KDO2-lipid A biosynthesis pathway in osteoarthritic specimens, specifically within the genus <i>Pseudomonas</i>. Key genes involved in lipopolysaccharide biosynthesis and export, including lpxB, lpxL, and lpxM, exhibited significantly higher median abundances in osteoarthritic joints compared with controls (p < 0.00000001).</p><p><strong>Conclusions: </strong>Patients with hip osteoarthritis exhibited specific taxonomic and predicted lipopolysaccharide-related pathways differences compared with nonarthritic controls, consistent with microbial molecular signatures in a noninfectious inflammatory joint environment, despite the absence of major diagnosis-driven community-level differences.</p><p><strong>Level of evidence: </strong>Diagnostic 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":"2026-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13391134/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148563034","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":"Disparities in Industry Payments Between Orthopaedic Surgery and General Surgery Residents.","authors":"Cemil C Gedik, Claire Saltzman, Parker D Boyce, Jonathan R Dubin, An-Lin Cheng, Houssam Bouloussa, Akin Cil","doi":"10.2106/JBJS.OA.26.00029","DOIUrl":"10.2106/JBJS.OA.26.00029","url":null,"abstract":"<p><strong>Background: </strong>Industry funding may support surgical training but also raises conflict-of-interest concerns, particularly among financially vulnerable residents. This study examined whether the prevalence and magnitude of Centers for Medicare & Medicaid Services (CMS) Open Payments general payments differed between postgraduate year 5 (PGY-5) orthopaedic surgery (OS) and general surgery (GS) residents graduating in 2025, and whether these payments varied by institution type and geographic region.</p><p><strong>Methods: </strong>We performed a cross-sectional analysis of CMS Open Payments (2018-2024) for PGY-5 residents in OS and GS graduating in 2025. Residency programs were identified, and PGY-5 rosters were compiled from program websites. Residents were linked to Open Payments records. Payments were categorized as Consulting Fees/Grants/Charity, Travel/Education Support, and Hospitality. Payment prevalence and payment amounts were compared between specialties, with adjustment for institution type and geographic region.</p><p><strong>Results: </strong>Across 150 institutions (120 GS programs, 117 OS programs), 1,591 residents were analyzed. Overall, 861 of 1,591 residents (54%) had ≥1 payment; OS residents had higher prevalence than GS (57% vs. 52%; OR 1.25, 95% confidence interval [CI]: 1.03-1.53; p = 0.03). Unadjusted mean payments were $3,176 (OS) versus $798 (GS) (p < 0.0001). Adjusted mean payments remained higher for OS ($3,202) than GS ($653), a 4.90-fold difference (p < 0.0001), with significant interactions by institution type and region.</p><p><strong>Conclusions: </strong>Over half of PGY-5 GS and OS residents receive industry payments, although OS receive substantially more overall. These payments are highly concentrated at the top tier of recipients. Training programs, governing bodies, and other key stakeholders should consider developing a structured approach that capitalizes on the industry financial support while minimizing bias in resident education and delivering a more equitable distribution to all residents.</p><p><strong>Level of evidence or clinical relevance: </strong>Level III (cross-sectional observational study); clinically relevant to graduate medical education policy and conflict-of-interest oversight. 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/PMC13391125/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148563113","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":"Femoral Stem Version in Primary Hip Arthroplasty: Challenges and Advances in 3D Planning.","authors":"Angelika Ramesh, Johann Henckel, Alister Hart, Anna Di Laura","doi":"10.2106/JBJS.OA.25.00300","DOIUrl":"10.2106/JBJS.OA.25.00300","url":null,"abstract":"<p><p>» Native femoral version (NFV) demonstrates inconsistent correlation with prosthetic femoral version (PFV) and should not be relied upon in isolation for femoral version planning in cementless total hip arthroplasty (THA). » Final stem version is strongly influenced by intramedullary canal morphology, fixation mechanics, and stem design philosophy. Straight, tapered wedge, and diaphyseal-engaging stems demonstrate greater variability in PFV, whereas anatomic and calcar-guided short stems may better preserve NFV. » Current planning methods inadequately characterise three-dimensional canal anatomy and fail to simulate canal-stem interaction, limiting accurate prediction of PFV. » Intraoperative estimation methods remain inconsistent and highly dependent on surgeon experience. Robotic-assisted THA enables real-time PFV measurements and supports femur-first strategies to optimise combined anteversion, although current systems still rely on computed tomography templating without true canal-stem interaction modelling. » Reliable PFV prediction will likely require next-generation planning platforms integrating internal canal anatomy, statistical shape modelling and artificial intelligence-driven modelling into planning workflows.</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/PMC13391145/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148563088","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":"Association Between Peripheral Nerve Blocks and Cardiovascular Outcomes in Older Adults with Hip Fractures: An Analysis of the Premier Healthcare Database.","authors":"Arissa M Torrie, Gerard P Slobogean, Flavia K Borges, John Jun, Chih Chun Tung, Robert V O'Toole, Anthony D Harris, Nathan N O'Hara","doi":"10.2106/JBJS.OA.26.00173","DOIUrl":"10.2106/JBJS.OA.26.00173","url":null,"abstract":"<p><strong>Background: </strong>Hip fractures in older adults carry substantial perioperative risk, with cardiovascular complications being a major concern. The dual physiologic stress from fracture and surgical repair activates neuroendocrine pathways and creates sympathovagal imbalance. While peripheral nerve blocks are established for analgesia in hip fracture management, their potential to attenuate the surgical stress response and reduce cardiovascular complications remains unclear. This study evaluated the association between peripheral nerve blocks and cardiac events in older adults undergoing hip fracture surgery.</p><p><strong>Methods: </strong>This cohort study used the Premier Healthcare Database, including patients aged 65 years or older with hip fractures surgically treated in 2022 or 2023. Peripheral nerve block administration was identified through procedure codes and pharmacy records. Propensity score matching (1:1) balanced baseline characteristics between groups. The primary outcome was myocardial infarction during index hospitalization. Secondary outcomes included other cardiac events and noncardiac complications. All-cause 90-day readmission was an exploratory outcome.</p><p><strong>Results: </strong>Among 23,812 eligible patients, 3,299 (14%) received peripheral nerve blocks. After propensity matching, each group contained 3,299 patients (median age 81 years). Myocardial infarction showed a protective point estimate but did not reach statistical significance (risk ratio [RR] 0.64; 95% confidence interval [CI]:0.37-1.12; p = 0.12). Nerve blocks were associated with reduced acute congestive heart failure (RR 0.47; 95% CI: 0.31-0.72; p < 0.001) and cardiac arrest (RR 0.41; 95% CI: 0.19-0.90; p = 0.03). Nerve blocks were also associated with a reduced risk of 90-day hospital readmission (RR 0.82; 95% CI: 0.72-0.93; p = 0.003).</p><p><strong>Conclusions: </strong>Peripheral nerve blocks were associated with reduced cardiovascular complications in older adults undergoing hip fracture surgery. While myocardial infarction rates were similar between groups, nerve blocks were associated with reduced in-hospital acute congestive heart failure and cardiac arrest. These findings are hypothesis-generating for cardioprotective effects from peripheral nerve blocks.</p><p><strong>Level of evidence: </strong>Level III, Therapeutic. 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":"2026-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13375067/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148473300","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":"Proximal Femoral Varus Osteotomy Performed in the Early Stage of Legg-Calvé-Perthes Disease Increases Femoral Head Revascularization: A Serial Perfusion MRI Study.","authors":"Joonoh Lee, Ahan Mistry, Harry K W Kim","doi":"10.2106/JBJS.OA.26.00164","DOIUrl":"10.2106/JBJS.OA.26.00164","url":null,"abstract":"<p><strong>Background: </strong>Legg-Calvé-Perthes disease (LCPD) is idiopathic osteonecrosis of the femoral head. The effects of proximal femoral varus osteotomy (PFVO) on femoral head revascularization are unknown. We evaluated whether patients with early-stage LCPD treated with PFVO had a higher revascularization rate than those receiving nonoperative treatment with serial perfusion magnetic resonance imaging (pMRI).</p><p><strong>Methods: </strong>Forty-nine patients (49 hips) in early-stage LCPD with ≥2 pMRIs treated nonoperatively (n = 22) or with PFVO (n = 27) were retrospectively analyzed. The mean age of diagnosis was 8.2 ± 1.7 years (range: 5.3-12.2), median pMRI of 3 (IQR:2-4; range: 2-6), and Waldenström stage I (n = 37) or IIa (n = 12). The revascularization rate (%/month) was assessed in 4-month intervals. Time to Waldenström stage IIIb and full weight-bearing status (FWB) were compared.</p><p><strong>Results: </strong>Baseline characteristics (age, initial perfusion, Waldenström stage) were similar between groups. Perfusion was higher in the PFVO group at 4 to 8 (56 ± 20 vs. 80 ± 12%, p = 0.001) and 12 to 16 months (68 ± 25 vs. 91 ± 7%, p = 0.02) follow-ups. The PFVO group had significantly higher revascularization rates at 3 intervals: 4 to 8 (4.2 ± 2.7 vs. 7.0 ± 2.1%/month, p = 0.006), 8 to 12 (3.4 ± 1.7 vs. 6.1 ± 1.5%/month, p = 0.004), and 12 to 16 months (2.5 ± 1.3 vs. 4.9 ± 1.1%/month, p = 0.002). The PFVO group had a shorter time to Waldenström stage IIIb (22.7 ± 8.7 vs. 17.1 ± 6.9 months, p = 0.02) and was associated with earlier FWB (18.8 ± 6.5 vs. 13.1 ± 4.7 months, p = 0.008).</p><p><strong>Conclusions: </strong>The PFVO group had faster revascularization and a shorter time to the late-reossification stage.</p><p><strong>Significance: </strong>This study is the first to investigate the effects of PFVO on revascularization rate using serial pMRI. These findings provide novel insight into the biologic effect of PFVO on femoral head revascularization.</p><p><strong>Level of evidence: </strong>Level IV, therapeutic. 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":"2026-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13375058/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148472792","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}