JBJS Open Access最新文献

{"title":"Atlantoaxial Rotatory Fixation: Current Challenges and Advances in Diagnosis and Management.","authors":"Zirui Ren, Qifeng Lan, Yinglun Tian, Nanfang Xu, Shenglin Wang","doi":"10.2106/JBJS.OA.26.00081","DOIUrl":"10.2106/JBJS.OA.26.00081","url":null,"abstract":"<p><p>» Atlantoaxial rotatory fixation (AARF), also known as atlantoaxial rotatory subluxation (AARS), is an uncommon cervical disorder that occurs predominantly in children and typically presents with painful torticollis in the characteristic \"cock-robin\" position. It is frequently associated with upper respiratory infections, minor trauma, or recent otolaryngologic procedures. » Computed tomography (CT) is the gold standard for diagnosing AARF because it provides accurate assessment of atlantoaxial alignment and rotational deformity. » Several classification systems have been proposed to characterize AARF, including the Fielding and Hawkins classification, the Pang-Li dynamic CT classification, and the PUTH classification, which incorporates reducibility to help guide treatment decisions. » Management strategies range from nonoperative treatments-such as cervical immobilization and traction-to more invasive nonoperative interventions, including manipulation under anesthesia or halo traction, depending on symptom duration and reducibility. » Surgical stabilization, most commonly posterior C1-C2 fusion using techniques such as the Goel-Harms construct, is generally reserved for irreducible deformities or cases that fail conservative management, highlighting the need for standardized diagnostic and treatment algorithms.</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/PMC13375065/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148473290","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 the Type, Impact, and Resolution of Complications Following Direct Anterior Versus Posterior Approach Total Hip Arthroplasty: A Multicenter Propensity-Weighted Analysis.","authors":"Sergio F Guarin Perez, Heather J Roberts, Diego J Restrepo, Abraham Babalola, Dirk R Larson, Cameron K Ledford, Joshua S Bingham, Mark W Pagnano, Robert T Trousdale, Michael J Taunton, Rafael J Sierra","doi":"10.2106/JBJS.OA.26.00172","DOIUrl":"10.2106/JBJS.OA.26.00172","url":null,"abstract":"<p><strong>Background: </strong>Prior studies have reported higher rates of periprosthetic fracture, superficial infection, and neurologic deficit with the direct anterior approach (DAA), and higher rates of dislocation with the posterior approach (PA) for total hip arthroplasty (THA). Despite these differences, the overall clinical burden of complications between approaches remains unclear. The purpose of this study was to compare the profiles, severity, impact, and resolution of 5 clinically important complications between DAA and PA THA.</p><p><strong>Methods: </strong>A retrospective review was conducted of 11,783 consecutive primary THAs performed between 2010 and 2021 across 3 centers within a single healthcare system, using either the DAA (n = 4,451) or the PA (n = 7,332). Complications assessed included dislocation, infection, periprosthetic fracture (PPFx), aseptic loosening, and neurologic deficit. Severity was graded using the Clavien-Dindo classification (I = minor, V = death). Impact was defined by reoperation burden, and outcomes were categorized as resolved or persistent. Kaplan-Meier survivorship and propensity-weighted Cox proportional hazards models were used to compare complication risk.</p><p><strong>Results: </strong>The overall 1-year risk of surgical complications did not differ between DAA and PA (hazard ratio [HR], 0.89; 95% confidence interval [CI], 0.75-1.06; p = 0.208). Dislocation occurred more frequently with PA THA than DAA THA (1.9% vs. 0.4%; HR, 5.20; 95% CI, 3.04-8.90; p < 0.001). Superficial infections were more frequent with the DAA (1.6% vs. 0.8%; HR, 2.43; 95% CI, 1.68-3.53; p < 0.001). The risk of deep infection, PPFx, aseptic loosening, and neurologic deficit did not differ significantly between approaches. Among patients with complications, the proportion classified as severe (Clavien-Dindo III-V) was similar, and adjusted analyses showed no difference in the odds of severe complications (adjusted odds ratio 1.34 for PA vs DAA; 95% CI, 0.95-1.91; p = 0.099). Complication impact and resolution were likewise comparable.</p><p><strong>Conclusion: </strong>Although the profile of complications differed between DAA and PA THA, the severity, early clinical impact, and resolution of complications appeared similar. Notably, DAA was associated with a lower risk of dislocation and a higher risk of superficial infection compared with PA THA.</p><p><strong>Level of evidence: </strong>Level III, Retrospective Comparative 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":"2026-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13375057/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148473315","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":"Trends in Treatment Decisions for Distal Radius Fractures: The Effect of a Guideline Change.","authors":"Ofir Vinograd, Erez Avisar, Jonathan Persitz, Ahmad Essa, Orna Tal, Adi Vinograd","doi":"10.2106/JBJS.OA.26.00061","DOIUrl":"10.2106/JBJS.OA.26.00061","url":null,"abstract":"<p><strong>Background: </strong>The 2022 American Academy of Orthopaedic Surgeons/American Society for Surgery of the Hand (AAOS/ASSH) guideline discourages routine operative fixation of distal radius fractures (DRF) in patients aged 65 years or older. This study examined the impact of this recommendation on operative management patterns in this population.</p><p><strong>Methods: </strong>A retrospective, quasi-experimental before-after study was conducted, including all DRF diagnoses among patients aged 65 years or older at a tertiary medical center during 2012 to 2024. Annual age-standardized and sex-standardized DRF incidence and surgery rates were estimated. Multivariable logistic regression evaluated postguideline versus preguideline odds of surgery and model-based projection compared expected with observed postguideline surgery rates.</p><p><strong>Results: </strong>During the study period, 3,137 DRF cases were diagnosed with stable incidence. Surgery rates significantly increased among patients aged 65 to 69 years from 9% to 16% after guideline publication, whereas rates were unchanged in patients aged 70 years or older. Patients aged 65 to 69 years were nearly twice as likely to undergo operative management in the postguideline versus preguideline period. Model-based projection among patients aged 65 to 69 years predicted a postguideline surgery rate of 11%, whereas the observed rate of 16% represented a 44% relative increase.</p><p><strong>Conclusions: </strong>Despite a guideline discouraging operative management of DRF at ages ≥65 years, surgery rates did not decline, and increased in those aged 65 to 69 years, highlighting the limitations of an age-only treatment threshold.</p><p><strong>Level of evidence: </strong>Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.</p>","PeriodicalId":36492,"journal":{"name":"JBJS Open Access","volume":"11 3","pages":""},"PeriodicalIF":4.9,"publicationDate":"2026-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13375063/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148473079","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":"Treatment of Steroid-Induced Osteonecrosis of the Distal Femoral Condyle Using Structural Bone Grafting.","authors":"Dai Iwase, Yukie Metoki, Jun Aikawa, Manabu Mukai, Kensuke Fukushima, Kentaro Uchida, Gen Inoue, Masashi Takaso","doi":"10.2106/JBJS.OA.26.00089","DOIUrl":"10.2106/JBJS.OA.26.00089","url":null,"abstract":"<p><strong>Background: </strong>Steroid-induced osteonecrosis of the distal femoral condyle is an uncommon condition that predominantly affects young patients receiving high-dose corticosteroid therapy. Joint-preserving treatment options for precollapse lesions remain limited, particularly in cases with extensive subchondral involvement. The purpose of this study was to evaluate the clinical and radiological outcomes of structural bone grafting (SBG) using a bicortical iliac bone graft (autograft or allograft) for precollapse osteonecrosis of the distal femoral condyle.</p><p><strong>Methods: </strong>This retrospective case series included 11 knees in 8 patients with steroid-induced osteonecrosis of the distal femoral condyle who underwent SBG. All treated knees were classified as Association Research Circulation Osseous stage II. Clinical outcomes were assessed using the Japanese Orthopaedic Association (JOA) knee score, and radiological evaluation focused on graft incorporation and the presence of subchondral collapse or degenerative changes.</p><p><strong>Results: </strong>The mean follow-up duration was 150.5 months (48-288 months). No procedure-related complications were observed. Radiological graft incorporation was confirmed in all treated knees, and no progression to subchondral collapse or degenerative changes was identified during the observation period. The mean JOA knee score improved, and no deterioration was observed; 2 knees showed no change, 3 demonstrated modest improvement, and 6 showed greater improvement (15-40 points).</p><p><strong>Conclusions: </strong>SBG using a bicortical iliac bone graft provided favorable long-term clinical and radiological outcomes in this series of patients with precollapse steroid-induced osteonecrosis of the distal femoral condyle.</p><p><strong>Clinical relevance: </strong>This technique may be useful for carefully selected patients with early-stage disease and extensive subchondral involvement.</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/PMC13375068/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148473022","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":"Study of Total Ankle Arthroplasty and Ankle Arthrodesis Complications and Costs Based on Surgeon Specialty.","authors":"Devon Nixon, Brook I Martin, Hyunkyu Ko","doi":"10.2106/JBJS.OA.26.00169","DOIUrl":"10.2106/JBJS.OA.26.00169","url":null,"abstract":"<p><strong>Background: </strong>Total ankle arthroplasty (TAA) and ankle arthrodesis (AA) remain viable treatment options for end-stage ankle arthritis. Both procedures are performed by orthopaedic surgeons and podiatric surgeons. The literature comparing outcomes based on surgeon specialty is sparse. In this study, we studied postoperative outcomes for both TAA and AA based on surgeon specialty in a Medicare cohort of both fee-for-service and health maintenance organization claims. Our primary outcome was surgical complications, and secondary outcome was 90-day episode-of-care costs, based on surgeon specialty.</p><p><strong>Methods: </strong>We performed a retrospective analysis of Medicare claims from 2016 to 2021 for beneficiaries aged 65 years or older who underwent either TAA or AA. Surgeon specialty was identified using specialty taxonomy codes submitted with claims. Multivariate regressions were performed to compare complication rates and costs between specialty, adjusted for patient age, sex, race, Charlson Comorbidity Index, dementia, year, presence of a surgeon assistant, surgery setting, and Medicare plan type. To account for inflation, costs from prior years were inflated to 2021 equivalents based on the gross domestic product (GDP) implicit price deflator.</p><p><strong>Results: </strong>Adjusted infection rates were higher among podiatric surgeons compared with orthopaedic surgeons for both TAA and AA. For TAA, the difference was +3.7 percentage points (ppts; 95% CI: 2.5-4.9) at 90 days and +4.1 ppts (95% confidence interval [CI]: 2.7-5.5) at 1 year. For AA, the difference was +3.8 ppts (95% CI: 2.1-5.5) at 90 days and +5.3 ppts (95% CI: 3.1-7.5) at 1 year. Most episode-of-care costs were higher when procedures were performed by podiatric surgeons.</p><p><strong>Discussion: </strong>Among Medicare beneficiaries, we observed an increased risk of postoperative complications-most notably infection-among podiatric surgeons relative to orthopaedic surgeons for both TAA and AA. Higher costs were seen with podiatric surgeons, though the clinical significance of these cost findings is unclear. With an aging population and expanding utilization of TAA, further investigations should continue to explore the impact of surgeon specialty on postoperative complication rates to best identify the optimal care for patients with ankle arthritis.</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/PMC13375097/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148472941","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":"Impact of New Orthopaedic Surgery Residency on Hip Fracture Time to Fixation at Rural Level 1 Trauma Center.","authors":"Justin MacDonald, William Wardell, Oliver Sogard, Joseph Yee, Carter Whittemore, Jeffrey Lutton, Robert Behm","doi":"10.2106/JBJS.OA.25.00029","DOIUrl":"10.2106/JBJS.OA.25.00029","url":null,"abstract":"<p><strong>Introduction: </strong>Hip fractures are among the most common orthopaedic injuries and are a vital element of orthopaedic surgery residency training. Multiple studies have examined resident involvement on surgical time, length of stay (LOS), cost, and outcomes. This study compared the time from orthopaedic hip fracture consultation to operative fixation before and after implementation of a new orthopaedic residency at a rural community hospital.</p><p><strong>Methods: </strong>A retrospective review of electronic medical records was performed for patients who underwent surgical fixation of a hip fracture from July 2019 to June 2023. July 2019 to June 2021 represented the period before orthopaedic residents, and July 2021 to June 2023 represented the period with orthopaedic resident involvement. The primary outcome was time from hip fracture consult order to patient entry into the operating room (OR) before and after resident involvement. Secondary outcomes included LOS, 30-day readmission rate, and 90-day return to the emergency department.</p><p><strong>Results: </strong>In total, 821 hip fractures underwent operative fixation between July 2019 and June 2023: 387 (47.1%) were performed before resident involvement and 434 (52.9%) were performed after initiation of the orthopaedic residency. There was no statistically significant difference in time to OR from consult before and after resident involvement (28.3 vs. 27.8 hours, p = 0.786), LOS (6.4 vs. 6.1 days, p = 0.33), 30-day readmission rate (12.1% vs. 9.9%, p = 0.362), or 90-day return to the emergency department (26.1% vs. 27.4%, p = 0.728).</p><p><strong>Conclusion: </strong>Timely hip fracture fixation within 24 to 48 hours is essential for optimal patient outcomes. This study demonstrates that the introduction of orthopaedic surgery residents does not compromise timely operative fixation, LOS, or readmission rates in patients with hip fractures.</p><p><strong>Level of evidence: </strong>Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.</p>","PeriodicalId":36492,"journal":{"name":"JBJS Open Access","volume":"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/PMC13375053/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148473243","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":"Growth-Friendly Surgery Improves Diaphragm Positioning, Thoracic Dimensions, and Patient-Reported Outcomes in Neuromuscular Scoliosis.","authors":"Zaid Elsabbagh, William ElNemer, Peter G Gabos, Gregory J Redding, Paul D Sponseller","doi":"10.2106/JBJS.OA.26.00097","DOIUrl":"10.2106/JBJS.OA.26.00097","url":null,"abstract":"<p><strong>Background: </strong>Neuromuscular scoliosis (NMS) can displace the diaphragm into the thorax, reducing lung volume and impairing respiration. As an alternative to posterior spinal fusion, growth-friendly surgery (GFS) allows thoracic growth while correcting deformity. We evaluated associations of GFS with thoracic dimensions and diaphragm positioning, hypothesizing that GFS would alleviate respiratory constraints in pediatric NMS.</p><p><strong>Methods: </strong>We reviewed data from 45 patients who underwent GFS for NMS at a mean age of 8 years, from 2003 to 2022. Radiographic measures were lung volume, space available for lung (SAL) ratio, diaphragm intrusion index (DII), diaphragm vertebral level (DVL), T1-T12 height, and T1-S1 height, assessed preoperatively, postoperatively, and at 2-year follow-up. We also analyzed Early-Onset Scoliosis 24-item Questionnaire (EOSQ-24) outcomes related to lung function. A \"latest follow-up\" time point was included for patients with extended data (mean: 7.2 years; range: 2.0-18.5). Paired <i>t</i> tests compared preoperative and follow-up values. Alpha = 0.05.</p><p><strong>Results: </strong>Mean lung volume increased from 1,992 cm³ preoperatively to 2,917 cm³ postoperatively and 3,210 cm³ at 2 years (p < 0.001), remaining stable (3,590 cm³) at latest follow-up. SAL ratio improved from 0.79 preoperatively to 0.91 postoperatively and 0.89 at 2 years, with no change at final follow-up. DII improved from 0.59 (right) and 0.56 (left) preoperatively to 0.69 (right) and 0.70 (left) at 2 years, with no decline thereafter (p < 0.001). DVL showed bilateral descent by approximately 1.3 vertebral levels through 2 years and remained stable. T1-T12 and T1-S1 heights increased to 21 and 34 cm, respectively, at 2 years (p < 0.001). EOSQ-24 scores improved postoperatively, with further gains by 2 years in energy (from 55 to 83), pulmonary function (from 69 to 94), and fatigue (from 48 to 19).</p><p><strong>Conclusions: </strong>GFS was associated with improvements in thoracic dimensions, diaphragm position, lung volume, and respiratory-related quality of life in pediatric NMS, underscoring the potential of GFS to address deformity and long-term respiratory health in this population.</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":"11 3","pages":""},"PeriodicalIF":4.9,"publicationDate":"2026-07-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13349217/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148424836","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 Use of Intermittent Pneumatic Compression in Orthopaedic Surgery: An Umbrella Review and Meta-Analysis.","authors":"Michael Yayac, Tyler Konen, Javad Parvizi","doi":"10.2106/JBJS.OA.26.00048","DOIUrl":"10.2106/JBJS.OA.26.00048","url":null,"abstract":"<p><strong>Background: </strong>Venous thromboembolism (VTE), including deep vein thrombosis (DVT) and pulmonary embolism (PE), is a major complication following orthopaedic surgery, contributing to increased morbidity, mortality, and healthcare costs. Intermittent pneumatic compression (IPC) devices are widely used as a nonpharmacological prophylactic intervention, yet the evidence regarding their effectiveness remains varied across studies.</p><p><strong>Methods: </strong>An umbrella review of published meta-analyses was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Reviews comparing IPC devices to no prophylaxis, chemoprophylaxis, or combination regimens in orthopaedic surgery populations were identified through systematic searches of PubMed, Embase, and Cochrane databases. Data on DVT, PE, bleeding complications, and mortality were extracted. Study quality, overlap of primary studies, and reporting bias were evaluated. A meta-analysis of primary studies was performed.</p><p><strong>Results: </strong>IPC significantly reduced the risk of all DVT (odds ratio [OR] 0.40), proximal DVT (OR 0.58), distal DVT (OR 0.45), PE (OR 0.45), and bleeding complications (OR 0.57), with no effect on mortality. Subgroup analyses showed that IPC was effective across most surgery and intervention types, with particular benefit over aspirin and low molecular weight heparin. IPC alone performed comparably or better than chemoprophylaxis, especially for bleeding risk.</p><p><strong>Conclusion: </strong>IPC devices are effective in reducing the incidence of VTE and bleeding complications in patients undergoing orthopaedic procedures, with safety outcomes being more favorable compared with pharmacological agents. However, heterogeneity in existing evidence and methodological limitations highlight the need for standardized, high-quality randomized trials. These findings support the continued use of IPC, particularly in patients at high bleeding risk or when chemoprophylaxis is contraindicated.</p><p><strong>Level of evidence: </strong>Level IV, systematic review. 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":"2026-07-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13349225/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148424919","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":"Predicting Interval Pulmonary Metastasis in Extremity Soft Tissue Sarcoma Treated with Preoperative Radiotherapy: A Risk-Stratified Cohort Study of 378 Patients.","authors":"Sadegh Saberi, Alireza Talebi, Hamed Naghizadeh, Mohaddeseh Bahmani, Hadi Jahanbin, Seyyed Saeed Khabiri","doi":"10.2106/JBJS.OA.26.00034","DOIUrl":"10.2106/JBJS.OA.26.00034","url":null,"abstract":"<p><strong>Introduction: </strong>Preoperative radiotherapy (RT) is widely used in high-risk extremity soft tissue sarcoma (STS) because of its benefits in local control and functional preservation. However, the interval between diagnosis and definitive surgery raises concern regarding the potential development of interval distant metastases, particularly in aggressive tumors. Data defining the incidence and predictors of such progression remain limited.</p><p><strong>Methods: </strong>We conducted a retrospective cohort study of adult patients with nonmetastatic extremity STS treated with standardized preoperative RT followed by limb-sparing surgery between 2018 and 2024. All patients underwent baseline staging and mandatory preoperative chest computed tomography. The primary end point was new distant metastasis detected before surgery. Multivariable logistic regression was used to identify independent predictors, and a clinical risk score was developed.</p><p><strong>Results: </strong>Among 378 patients, interval distant metastases occurred in 29 (7.8%), almost exclusively involving the lungs. Tumor size greater than 12 cm, synovial sarcoma histology, FNCLCC grade 3, and age 50 years or younger were independently associated with interval metastatic progression. A 4-factor risk score stratified patients into low, intermediate, and high-risk groups, with metastasis rates of 2.4%, 8.4%, and 25.6%, respectively.</p><p><strong>Discussion: </strong>Interval metastasis during preoperative RT is rare and linked to unfavorable baseline tumor biology. This supports the treatment's feasibility for most patients and highlights the need for routine preoperative chest restaging. Interval metastasis in a standardized preoperative RT protocol for extremity STS occurs mainly in patients with adverse tumor characteristics. Routine preoperative chest CT restaging is necessary, and a simple 4-factor risk score may identify patients needing enhanced surveillance and personalized counseling.</p><p><strong>Level of evidence: </strong>Prognostic Level IV.</p>","PeriodicalId":36492,"journal":{"name":"JBJS Open Access","volume":"11 3","pages":""},"PeriodicalIF":4.9,"publicationDate":"2026-07-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13349221/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148424916","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":"Acetabular Morphotype Is Associated with Change in Acetabular Orientation Between Supine and Standing.","authors":"Camille Vorimore, Jeroen C F Verhaegen, Chuan Kong, Eduardo Viglietta, Paul Beaulé, George Grammatopoulos","doi":"10.2106/JBJS.OA.26.00151","DOIUrl":"10.2106/JBJS.OA.26.00151","url":null,"abstract":"<p><strong>Background: </strong>Debate exists on which functional position (supine or standing) should form the basis of radiographic assessment of the native acetabulum. Pelvic tilt (PT) differs between positions influencing radiographic acetabular assessment. This study aims to (1) quantify PT changes from supine to standing amongst volunteers and patients; (2) assess changes in acetabular parameters between the postures; and (3) determine whether changes in acetabular parameters differ according to acetabular morphotype.</p><p><strong>Methods: </strong>This is a prospective, consecutive, cohort study of 105 asymptomatic volunteers (53% male; mean age 36.5 ± 13.6 years; body mass index [BMI] 25.0 ± 2.0 kg/m²) and 437 patients presenting to a hip preservation clinic without osteoarthritis (Tonnis ≤1) (40% male; mean age 35.7 ± 8.6 years; BMI 25.0 ± 2.0 kg/m²). All underwent standardized supine and standing anteroposterior pelvic radiographs. PT change was quantified using the sacrofemoral-pubic (SFP) angle. Acetabular morphology was evaluated in detail to characterize morphotype according to the Ottawa classification (lateral dysplasia, anterior dysplasia, posterior dysplasia), pincer or \"normal.\" Changes between supine and standing were compared between cohorts and morphotypes.</p><p><strong>Results: </strong>The mean SFP decreased by -3.7° (IC95% 4.0-3.5) from supine to standing. Acetabular measurements demonstrated no differences in change between volunteers and symptomatic patients when transitioning between supine to standing. Measurements of lateral coverage changed minimally between supine (volunteers: 30.7° ± 6.1°; symptomatics: 27.3° ± 8.3°) and standing (volunteers: 30.3° ± 5.7°; symptomatics: 26.1° ± 8.1°), whereas measurements reflecting anteroposterior coverage changed significantly (ΔAWI volunteers: -0.10 ± 0.08 and symptomatics: -0.09 ± 0.07; p < 0.001 and ΔPWI volunteers: 0.09 ± 0.08 and symptomatics: 0.09 ± 0.07; p < 0.001). Patients with anterior dysplasia demonstrated smaller ΔSFP (-1.5° ± 2.5° vs. -3.7° ± 2.9°; p = 0.004) compared with the rest of the cohort. By contrast, posterior dysplasia showed greater ΔSFP (-4.5° ± 2.7° vs. -3.6° ± 2.9°; p = 0.128) than the rest.</p><p><strong>Conclusions: </strong>Groups demonstrated comparable changes in PT and acetabular parameters between positions. The magnitude and direction of change was associated with acetabular morphology uncoupling compensatory mechanisms. Standing radiographs may be preferred to supine, as they account for compensatory mechanisms.</p><p><strong>Level of evidence: </strong>Level II, diagnostic. 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":"2026-07-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13349223/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148424830","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}