JBJS Open Access最新文献

{"title":"Direct Healthcare Cost of Fracture-related Infection Treatment.","authors":"Nike Walter, Ines Neubauer, Susanne Baertl, Volker Alt, Markus Rupp","doi":"10.2106/JBJS.OA.24.00133","DOIUrl":"10.2106/JBJS.OA.24.00133","url":null,"abstract":"<p><strong>Background: </strong>Fracture-related infections (FRIs) pose significant clinical and economic challenges in trauma surgery. Despite advancements in treatment modalities, the economic burden of managing FRIs remains substantial. However, cost analyses are scarce. Therefore, the aim of this study was to analyze the direct healthcare costs associated with FRI treatment compared with initial fracture treatment across various fracture types in a level 1 trauma center in Germany.</p><p><strong>Methods: </strong>A retrospective analysis of 95 patients treated for fractures and FRIs between 2013 and 2020 was conducted. Patients were categorized based on the fracture location: femur, tibia, ankle, and foot. Data collected included fracture characteristics, and costs related to both initial fracture treatment and FRI management. Costs were analyzed using diagnosis-related group (DRG) reimbursement data. The mean DRG reimbursement for initial fracture treatment and FRI treatment was compared to determine the economic impact of FRIs.</p><p><strong>Results: </strong>The study revealed significant increases in costs for FRI treatment across all fracture types. For femur fractures, the mean reimbursement for initial treatment was €17,617.66, while FRI treatment costs were €31,731.49, resulting in a difference of €14,113.83 and a 1.8-fold increase in costs. Tibia fractures showed an increase from €10,327.70 to €28,024.38 (difference of €17,696.68, 2.7-fold increase of costs). Ankle fractures had a cost increase from €3,790.38 to €17,940.90 (difference of €14,150.52, 4.7-fold increase of costs), and foot fractures showed an increase from €6,557.95 to €23,272.48 (difference of €16,714.53, 3.5-fold increase of costs).</p><p><strong>Conclusions: </strong>The costs for FRI treatment are substantially higher than those for initial fracture management across all fracture types studied. These findings emphasize the need for effective preventive measures and efficient management protocols to reduce the incidence and financial impact of FRIs.</p><p><strong>Level of evidence: </strong>Level III. See Instructions for Authors for a complete description of levels of evidence.</p>","PeriodicalId":36492,"journal":{"name":"JBJS Open Access","volume":"10 3","pages":""},"PeriodicalIF":3.8,"publicationDate":"2025-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12367026/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144972547","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 Impact of Preference Signaling on Interview Invitations and Match Outcomes in the 2023 to 2024 Orthopaedic Residency Cycle: A Retrospective Review.","authors":"Samir Alkhouri, Matthew Michelberger, Jay Parikh, Christopher J Fang, Cameron Harris, Karen Nelson, Sukanta Maitra, Brock Wentz","doi":"10.2106/JBJS.OA.25.00083","DOIUrl":"10.2106/JBJS.OA.25.00083","url":null,"abstract":"<p><strong>Background: </strong>Orthopaedic surgery is among the most competitive residency specialties with recent cycles seeing record application volumes and declining match rates. Therefore, the aim of this study was to examine the Electronic Residency Application Service (ERAS) signaling system's impact on interview invitations and outcomes in the 2023 to 2024 orthopaedic surgery residency application cycle, building on data from its inaugural use.</p><p><strong>Methods: </strong>Application and interview data were collected from official National Resident Matching Program reports, Association of American Medical Colleges (AAMC) Supplemental ERAS Application Report, and specialty-wide surveys. Statistical findings, including interview distributions and match rates, were extracted from previously published studies and AAMC database.</p><p><strong>Results: </strong>The 2023 to 2024 cycle had 1,492 applicants. On average, applicants submitted 86 applications (range: 12-198), with the majority submitting between 70 and 80 applications. Nearly all orthopaedic applicants (∼97%) participated in preference signaling. Applicants received more interview invitations from programs they signaled than from programs not signaled. Signaled programs accounted for the majority (∼79%) of interview offers. Only 19% to 20% of interview offers were extended by programs that applicants did not signal. Of matched applicants, the majority (90%) matched at a program they had signaled, and the remaining (10%) matched at programs, they did not signal. Furthermore, the majority of applicants (63%) who matched were matched at programs where they had completed an away rotation. Although signaling aimed to reduce excessive applications, the overall volume per applicant remained high. While 45% of applicants reported feeling incentivized to apply more selectively, many still submitted broad applications.</p><p><strong>Conclusions: </strong>Preference signaling in orthopaedic surgery residency applications has markedly reshaped the match landscape by concentrating interview opportunities and match success predominantly within signaled programs. The authors recommend that medical students strategically research and prioritize programs when signaling, while residency programs should continue refining how they interpret signals to enhance holistic and equitable selection processes.</p>","PeriodicalId":36492,"journal":{"name":"JBJS Open Access","volume":"10 3","pages":""},"PeriodicalIF":3.8,"publicationDate":"2025-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12366994/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144972633","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":"Ganglion Formation After Steroid Injection for Stenosing Flexor Tenosynovitis.","authors":"Kazuhiro Kohata, Yutaka Morizaki, Takafumi Miyake, Kosuke Uehara, Ryota Sugimura, Yasuhide Iwanaga, Sayaka Komine, Sakae Tanaka","doi":"10.2106/JBJS.OA.25.00152","DOIUrl":"10.2106/JBJS.OA.25.00152","url":null,"abstract":"<p><strong>Background: </strong>The exact mechanism underlying flexor tendon sheath ganglion (FTSG) formation remains unclear. We hypothesized that steroid injections into the A1 pulley are a cause of FTSG. Therefore, this study aimed to evaluate the risk of FTSG after steroid injections in patients with stenosing flexor tenosynovitis.</p><p><strong>Methods: </strong>This prospective cohort study enrolled patients diagnosed with stenosing flexor tenosynovitis between August 2019 and May 2024. A total of 128 fingers in 114 patients with no history of injections within the past 6 months consented to participate in the study. An initial ultrasound of the A1 pulley was performed, and patients with preexisting FTSG were excluded. Based on patient preference, the injection group received a steroid injection (5 mg of triamcinolone + 0.5 ml of 1% lidocaine) into the flexor tendon sheath, followed by a follow-up ultrasound at 3 months. The control group underwent ultrasonography at the same time points without injections.</p><p><strong>Results: </strong>Three-month follow-up ultrasound evaluations were conducted on 53 fingers (43 patients) in the injection group and 22 fingers (21 patients) in the control group. The incidence of FTSG was significantly higher in the injection group, with 20 of 53 fingers (37.7%) developing FTSG compared with 1 of 22 fingers (4.5%) in the control group. The risk difference was 0.33 (95% confidence interval: 0.18-0.49; p < 0.01). Symptom improvement was observed in 93% of the injection group compared with 45% of the control group (p < 0.01), indicating more significant symptom relief in the injection group.</p><p><strong>Conclusions: </strong>This study concluded that small punctures caused by steroid injections for stenosing flexor tenosynovitis can lead to FTSG; however, further studies are required to fully elucidate the clinical significance of ganglion formation.</p><p><strong>Level of evidence: </strong>Level II. See Instructions for Authors for a complete description of levels of evidence.</p>","PeriodicalId":36492,"journal":{"name":"JBJS Open Access","volume":"10 3","pages":""},"PeriodicalIF":3.8,"publicationDate":"2025-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12366992/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144972555","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":"Trapeziectomy and Ligament Reconstruction Using a Reinforced Half-Slip of the Extensor Carpi Radialis Longus Tendon for Thumb Carpometacarpal Osteoarthritis.","authors":"Teiji Kato, Katsumasa Ideo, Takeshi Miyamoto","doi":"10.2106/JBJS.OA.25.00147","DOIUrl":"10.2106/JBJS.OA.25.00147","url":null,"abstract":"<p><strong>Background: </strong>Carpometacarpal (CM) joint osteoarthritis of the thumb is characterized by pain and impaired thumb function in terms of pinch and range of motion. Here, we newly adopted a trapeziectomy with a graft-augmented ligament reconstruction procedure, in which the reconstructed ligament is reinforced using a half-slip extensor carpi radialis longus (ECRL) tendon.</p><p><strong>Methods: </strong>From 2015 to 2022, 101 hands of 95 patients with CM joint osteoarthritis of the thumb underwent trapeziectomy with graft-augmented ligament reconstruction using the half-slip ECRL tendon to reconstruct the ligament. The reconstructed ligament was reinforced by wrapping 3 times with the half-slip ECRL tendon. All patients underwent a 1-year assessment, and 29 hands of 26 patients were followed up for >4 years postoperatively.</p><p><strong>Results: </strong>Motion pain, as assessed by visual analogue scale, was significantly improved from 56.9 ± 20.6 preoperatively to 4.2 ± 10.1 at the 1-year assessment (p < 0.001). Radial and palmar abduction also increased significantly from 46.0° ± 11.0° and 49.7° ± 8.8° preoperatively, respectively, to 58.4° ± 6.4° (p < 0.001) and 59.5° ± 6.3° (p < 0.001), respectively, at 12 months postoperatively. Both male and female tip pinch increased significantly from 4.2 ± 1.8 and 3.0 ± 1.4 preoperatively, respectively, to 6.1 ± 1.9 (p = 0.002) and 4.3 ± 1.4 (p < 0.001) at the 1-year postoperative evaluation. We observed no impingement of the first metacarpal and scaphoid bones due to sinking of the first metacarpal bone, and repeat surgery due to rupture of the reconstructed ligament or fractures at the bone hole, was not needed for the 101 hands followed for approximately 1 year and the 29 hands followed over 4 years.</p><p><strong>Conclusions: </strong>Trapeziectomy combined with graft-augmented ligament reconstruction, using a reinforced half-slip ECRL tendon wrapped 3 times, may serve as an effective treatment option for primary thumb carpometacarpal osteoarthritis. This approach offers significant pain relief, improved range of motion and pinch strength, and prevents postoperative impingement of the first metacarpal across all Eaton stages in the short - medium term.</p><p><strong>Level of evidence: </strong>Therapeutic Level Ⅳ. See Instructions for Authors for a complete description of levels of evidence.</p>","PeriodicalId":36492,"journal":{"name":"JBJS Open Access","volume":"10 3","pages":""},"PeriodicalIF":3.8,"publicationDate":"2025-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12367041/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144972623","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":"Use of a \"Fascial-Sock\" Technique to Manage the Stump and Stoma After Insertion of an Osseointegrated Implant in Transfemoral Amputees.","authors":"Norbert V Kang, Alexander C S Woollard, Yazan Al-Ajam","doi":"10.2106/JBJS.OA.25.00080","DOIUrl":"10.2106/JBJS.OA.25.00080","url":null,"abstract":"<p><strong>Introduction: </strong>We describe a new surgical technique to improve the stability of the peristomal skin around an osseointegrated implant in transfemoral amputees. As a secondary effect, the technique makes it easier to shape the residual limb into a cone and reduces the need for more complex revision surgery in the years after surgery.</p><p><strong>Methods: </strong>We compared outcomes in 2 groups of unilateral, transfemoral amputees by 18 months after insertion of an osseointegrated prosthetic limb implant. In Group 1, the soft tissues were managed using a standard muscle-platform technique. In Group 2, the soft tissues were managed using a fascial-sock technique. Rates of peristomal infection requiring treatment with oral antibiotics, rates of peristomal enthesopathy pain, surgical revision rates, and effectiveness of peristomal skin adhesion to the underlying bone were assessed.</p><p><strong>Results: </strong>Rates of peristomal skin infection were 50% lower in Group 2. Rates of treatment for enthesopathy pain were 50% lower in Group 2. Surgical revision rates were the same in both groups. However, the need to revise the stoma specifically was 50% lower in Group 2 and the nature of the revision procedures in Group 2 were less complicated (mainly for soft-tissue overhangs). By contrast, the need for bony debridement as part of the revision procedure was 4 X greater in Group 1 compared with Group 2. Finally, we were 1.8 X more likely to achieve a dry and stable stoma by 18 months using a fascial sock approach.</p><p><strong>Conclusion: </strong>Use of a fascial sock approach appears to be associated with improved rates of stability of the peristomal soft tissues, leading to decreased morbidity from this area at 18 months after treatment with an OI implant.</p><p><strong>Level of evidence: </strong>Level III. See Instructions for Authors for a complete description of levels of evidence.</p>","PeriodicalId":36492,"journal":{"name":"JBJS Open Access","volume":"10 3","pages":""},"PeriodicalIF":3.8,"publicationDate":"2025-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12366893/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144972588","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":"Comparison of Chronological, Greulich-Pyle, and Modified Fels Skeletal Ages in Patients with Unilateral Infantile and Adolescent Blount Diseases.","authors":"Marina R Makarov, Chan-Hee Jo, Raymond W Liu, John G Birch","doi":"10.2106/JBJS.OA.25.00151","DOIUrl":"10.2106/JBJS.OA.25.00151","url":null,"abstract":"<p><strong>Background: </strong>We sought to determine the relationship between Greulich and Pyle (G-P) and modified Fels (mFels) skeletal age in infantile and adolescent Blount diseases, where skeletal age (SA) is often advanced relative to chronological age (CA). We also sought to determine whether there was a difference between affected and unaffected extremity mFels SA in unilateral cases.</p><p><strong>Methods: </strong>We reviewed databases of patients treated for subjects meeting inclusion criteria of unilateral infantile or adolescent Blount disease and concurrent interpretable hand and knee films. SA using the G-P atlas and of both knees by mFels method was compared with each other and CA.</p><p><strong>Results: </strong>Twenty subjects with infantile Blount and 36 with adolescent Blount met inclusion criteria. Overall, there was no difference in mFels between affected and unaffected sides in either of these conditions (p = 0.6). SA was advanced by both methods in patients with both types of Blount disease, ranging from 5 to 18 months, depending on sex and diagnosis (p < 0.01). mFels was less advanced than G-P in both infantile and adolescent Blount diseases, but the differences were statistically significant only in boys with adolescent Blount disease (mean 10 months, p < 0.01).</p><p><strong>Conclusions: </strong>Our study confirmed relatively advanced SA in patients with both forms of Blount disease. mFels SA was generally comparable in affected and unaffected extremities in these conditions. Given the epiphysial distortion typical of infantile Blount disease, comparability of affected/unaffected sides was an unexpected finding and should be validated by a larger cohort. Nevertheless, we recommend familiarization with and use of the mFels SA determination in these conditions.</p><p><strong>Level of evidence: </strong>Level III, controlled case series. See Instructions for Authors for a complete description of levels of evidence.</p>","PeriodicalId":36492,"journal":{"name":"JBJS Open Access","volume":"10 3","pages":""},"PeriodicalIF":3.8,"publicationDate":"2025-08-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12348382/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144875553","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":"Relationship Between Blurred Boundary and Neurological Deficits in Extension-Type Pediatric Supracondylar Humeral Fractures.","authors":"Takuji Yamamoto, Yoshifumi Ueshin, Hikaru Ogawa, Yasuharu Nakashima","doi":"10.2106/JBJS.OA.25.00153","DOIUrl":"10.2106/JBJS.OA.25.00153","url":null,"abstract":"<p><strong>Background: </strong>Supracondylar humeral fractures are common in children and are associated with nerve damage. However, the primary complaint may be unclear due to pain, and examination can be difficult in young children. This study aimed to introduce and validate the blurred boundary (BB) as a new radiographic measure.</p><p><strong>Methods: </strong>This retrospective study analyzed extension-type pediatric supracondylar humeral fractures treated surgically at Mizoguchi Hospital between January 2017 and October 2023, with a minimum postoperative follow-up of 60 days. Data collected included age, sex, height, weight, body mass index, fracture type (Wilkins-modified Gartland classification), surgical method, neurological injury status, and recovery period. BB positivity was defined as the absence or blurring of a clear line between the muscle and subcutaneous fat on lateral elbow x-rays. Type IIB and Type III cases, which are at high risk of nerve injury, were included in the statistical analysis of this study and were classified into 2 groups based on the presence or absence of nerve injury. Univariate and multivariate logistic regression analyses were performed to identify risk factors.</p><p><strong>Results: </strong>Neurological injuries were observed in 30 patients (16.0%), of which 18 cases (60%) were diagnosed preoperatively and 12 cases (40%) were not diagnosed before surgery. The fracture distribution included 43 cases of Type IIB (37.7%) and 71 cases of Type III (62.3%). BB was positive in 52.6% of these cases, with a higher prevalence in the nerve injury group (76.7% vs. 44.0%, p = 0.003). Multivariate analysis identified BB positivity (odds ratio [OR]: 4.15, 95% confidence interval [CI]: 1.52 to 11.30, p = 0.005) as an independent risk factor for nerve injury. BB demonstrated a sensitivity of 76.7%, which was higher than the proportion of cases diagnosed preoperatively. The specificity, positive predictive value, and negative predictive value were 56.0%, 38.3%, and 87.0%, respectively, with an overall accuracy of 61.4%.</p><p><strong>Conclusions: </strong>BB was closely associated with the presence of nerve injury, suggesting that BB may be a useful adjunct in identifying patients at higher risk of neurological injury, particularly to augment the limited sensitivity of clinical examination in pediatric cases.</p>","PeriodicalId":36492,"journal":{"name":"JBJS Open Access","volume":"10 3","pages":""},"PeriodicalIF":3.8,"publicationDate":"2025-08-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12348379/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144875555","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cost Drivers for Single-Tendon Rotator Cuff Repair: Day-of-Surgery Time-Driven Activity-Based Costing Analysis.","authors":"Haley D Puckett, Rebekah M Kleinsmith, Mariah N Norling, Adam M Schweitzer, Stephen A Doxey, Adam E Hadro, Allison J Rao, Alicia K Harrison, Gary Fetzer, Bradley J Nelson, Brian P Cunningham","doi":"10.2106/JBJS.OA.25.00146","DOIUrl":"10.2106/JBJS.OA.25.00146","url":null,"abstract":"<p><strong>Background: </strong>The purpose of this study was to determine the patient-driven and surgical characteristics that drive day-of-surgery (DOS) costs for repair of isolated supraspinatus tears.</p><p><strong>Methods: </strong>All patients who underwent primary rotator cuff repair (RCR) for isolated supraspinatus tears within one health care system from 2016 to 2022 were inclusion eligible. Exclusion criteria included concomitant tear of infraspinatus, teres minor, or subscapularis; previous RCR or fractures of affected shoulder; diagnosis of rheumatoid arthritis; and incomplete baseline or 1-year patient-reported outcomes. Patient demographic information, injury characteristics, surgical technique/supplies, operative time stamps, symptomatic retear, and reoperation rates data were extracted from patients' electronic medical records and retrospectively reviewed. Time-driven activity-based costing was derived from direct and indirect DOS cost of care.</p><p><strong>Results: </strong>A total of 236 patients who underwent primary RCR for isolated supraspinatus tears from 2016 to 2022 were included. The average DOS cost was $2,443 ± $832. The average implant cost was $1,066 ± $654, accounting for 87% of variation in DOS costs. Upon univariate analysis, depression (p = 0.045), full-thickness tears (p < 0.001), double-row repair (p < 0.001), subacromial decompression (p < 0.001), distal clavicle excision (p = 0.003), biceps tenodesis (p < 0.001), number of suture anchors (p < 0.001), and operating surgeon (p < 0.001) were associated with higher DOS costing. Multivariable linear regression analysis using characteristics that demonstrated statistical significance on univariate analysis revealed that depression, full-thickness tears, double-row repairs, subacromial decompression, distal clavicle excision, biceps tenodesis, and number of suture anchors were significant predictors of cost (p < 0.05).</p><p><strong>Conclusions: </strong>Significant predictors of DOS costing for isolated supraspinatus RCRs include depression, full-thickness tear, double-row repair, subacromial decompression, distal clavicle excision, biceps tenodesis, number of suture anchors, and operating surgeon. Providing surgeons with this information can enable greater cost-transparency and, in conjunction with clinical judgement and patient preference, better equip them to deliver high-quality value-based care.</p><p><strong>Level of evidence: </strong>Level IV. See Instructions for Authors for a complete description of levels of evidence.</p>","PeriodicalId":36492,"journal":{"name":"JBJS Open Access","volume":"10 3","pages":""},"PeriodicalIF":3.8,"publicationDate":"2025-08-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12348393/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144875554","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":"Cruciate-Retaining Implants Do Not Provide a More Natural Joint Feeling Than Cruciate-Substituting Implants in Total Knee Arthroplasty: A Systematic Review and Meta-Analysis.","authors":"Yashar Khani, Amir Mehrvar, Sadra Mohebbi, Mohammadhossein Hefzosseheh, Mahya Aliakbari, Fateme Mansouri Rad, Mohammad Poursalehian","doi":"10.2106/JBJS.OA.25.00136","DOIUrl":"10.2106/JBJS.OA.25.00136","url":null,"abstract":"<p><strong>Background: </strong>The Forgotten Joint Score (FJS) is a patient-reported outcome measure developed to assess joint awareness, potentially differentiating between \"good\" and \"excellent\" outcomes. Prosthetic designs, specifically cruciate-retaining (CR) and cruciate-substituting (cruciate sacrificing/substituting [CS]) implants, may influence joint awareness due to differences in posterior cruciate ligament (PCL) preservation. Our objective was to compare the joint awareness outcomes, measured by the FJS, between CR and CS implants in total knee arthroplasty (TKA).</p><p><strong>Methods: </strong>A systematic review and meta-analysis were conducted following PRISMA guidelines. Scopus, PubMed, Embase, and Web of Science were searched up to March 2024 without date or language restrictions. Studies comparing CR and CS implants reporting FJS outcomes were included. Data extracted included study characteristics, patient demographics, intervention details, follow-up durations, and FJS scores. Risk of bias was assessed using the Risk of Bias in Nonrandomized Studies of Intervention-I tool. A random-effects meta-analysis using Hedges g was performed, with sensitivity analyses and meta-regression to explore heterogeneity.</p><p><strong>Results: </strong>Seventeen cohort studies involving 4,245 patients were included. The meta-analysis demonstrated that CS implants were superior to CR implants in terms of FJS (Hedges g = -0.39; p = 0.018), indicating a small to medium effect size favoring CS designs. High heterogeneity was observed (I² = 95.69%). Sensitivity analyses yielded similar results, and meta-regression did not identify significant sources of heterogeneity.</p><p><strong>Conclusion: </strong>CS implants are associated with superior joint awareness compared with CR implants in TKA, as measured by the FJS. Despite the theoretical advantage of PCL preservation, CR implants did not demonstrate better joint awareness. The findings should be interpreted with caution due to study heterogeneity and limitations in study design. Further high-quality randomized controlled trials are necessary to confirm these results.</p>","PeriodicalId":36492,"journal":{"name":"JBJS Open Access","volume":"10 3","pages":""},"PeriodicalIF":3.8,"publicationDate":"2025-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12324053/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144800513","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":"Lost in Translation: Preoperative Orthopaedic Education Materials Significantly Exceed Recommended Reading Levels.","authors":"Maxwell Sahhar, Manjot Singh, Tanmay Mehta, Arjun Laud, Joseph E Nassar, Michael J Farias, Bassel G Diebo, Alan H Daniels","doi":"10.2106/JBJS.OA.25.00143","DOIUrl":"10.2106/JBJS.OA.25.00143","url":null,"abstract":"<p><strong>Background: </strong>National guidelines recommend that patient education materials are written at or below a 6th-grade reading level. Poor understanding of their care plan after orthopaedic surgery has been associated with worse outcomes, including lower surgical satisfaction and higher postoperative complications. This study evaluates the language availability and readability of orthopaedic patient education materials published by Elsevier and distributed via Epic, the most widely used electronic health record system in the United States.</p><p><strong>Methods: </strong>In March 2025, orthopaedic patient education documents, as well as their easy-to-read versions when available, were extracted from Epic in English and Spanish. Documents were summarized by type, subspecialty, and revision date. Readability was assessed using 5 validated English scoring systems and 2 Spanish systems. Comparisons with recommended grade levels and with their easy-to-read versions were analyzed using <i>t</i>-test, whereas trends over time were assessed using linear regression.</p><p><strong>Results: </strong>Among 806 patient education documents, English and Spanish versions were available for all documents, but other languages were available for less than 30% of the documents. The mean readability grade level was 8.6 for English and 5.8 for Spanish documents, with 100% and 27% exceeding the recommended 6th-grade level, respectively. Preoperative documents consistently demonstrated the highest grade levels, whereas rehabilitation documents demonstrated lower grade levels across both English and Spanish documents (p < 0.05). Furthermore, musculoskeletal oncology documents consistently had the highest grade levels across document subspecialties (p < 0.05). Easy-to-read versions were only available for 11% of documents and reduced grade level to 7.4 for English and 5.5 for Spanish documents, although 94% and 4% still exceeded the recommended 6th-grade level, respectively. No significant changes in readability were observed over time.</p><p><strong>Conclusions: </strong>Elsevier's orthopaedic patient education materials, specifically related to preoperative information, are frequently written above recommended reading levels. The scarcity of easy-to-read versions further restricts their availability accessibility. To improve patient comprehension and adherence, efforts should focus on increasing the availability of simplified materials and expanding translation efforts. Artificial intelligence driven solutions may offer a scalable approach to addressing these deficiencies.</p><p><strong>Level of evidence: </strong>Level III. See Instructions for Authors for a complete description of levels of evidence.</p>","PeriodicalId":36492,"journal":{"name":"JBJS Open Access","volume":"10 3","pages":""},"PeriodicalIF":3.8,"publicationDate":"2025-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12323961/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144800514","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}