JBJS Open Access最新文献

{"title":"Lessons Learned from Nonoperative Management of Greater Trochanter Fractures After Total Hip Arthroplasty.","authors":"Pai-Han Wang, Josh R Labott, Sergio F Guarin Perez, Diego J Restrepo, Charles P Hannon, Matthew P Abdel, Rafael J Sierra","doi":"10.2106/JBJS.OA.26.00168","DOIUrl":"10.2106/JBJS.OA.26.00168","url":null,"abstract":"<p><strong>Background: </strong>Greater trochanteric (GT) fractures after total hip arthroplasty (THA) are typically managed nonoperatively. However, outcome data for patient counseling remain limited. We evaluated the nonoperative results, focusing on fracture union rates and the presence of persistent limp in relation with fracture location, displacement magnitude, and direction.</p><p><strong>Methods: </strong>We retrospectively reviewed 82 postoperative GT fractures not associated with trochanteric osteolysis following primary THA performed between 1984 and 2020. The mean follow-up was 9 years. Fracture location was classified relative to the contralateral lesser trochanter as tip, waist, or base. Initial displacement, migration, final displacement, and bony union were assessed radiographically. Clinical outcomes included the presence of a persistent limp and Harris Hip Score. Multivariable analyses were performed to identify factors associated with nonunion and limp.</p><p><strong>Results: </strong>Fractures were classified as tip (n = 32), waist (n = 29), or base (n = 21). The mean initial displacement was 8.9 mm, with 43% displaced >10 mm. Initial displacement was significantly lower in base fractures (4.8 mm) compared with tip (10.1 mm) or waist (10.8 mm) fractures (p < 0.05). The mean final displacement was 14.6 mm. 45% of fractures achieved complete bony union, and 38% of patients demonstrated a persistent limp. In multivariable analysis, greater final displacement (>12 mm), and tip and waist fractures were independently associated with nonunion. Posterior fracture displacement was significantly associated with persistent limp.</p><p><strong>Conclusions: </strong>Outcomes following nonoperative management of GT fractures after THA depend on fracture morphology and displacement characteristics. Tip and waist fractures and fractures with final displacement >12 mm have a higher risk of nonunion, whereas posterior and superior displacement is associated with persistent limp. Greater than 20 mm of displacement is associated with both limp and nonunion. These findings may assist surgeons in counseling patients and in identifying fracture patterns at higher risk for adverse outcomes of nonoperative management.</p><p><strong>Level of evidence: </strong>Level III (Prognostic 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":"2026-07-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13349219/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148424953","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 Concomitant Spine Comorbidities on Patient-Reported Outcomes After Total Knee Arthroplasty.","authors":"Jisoo Lee, Heeyoon Chung, Won Seok Lee, Chong Bum Chang","doi":"10.2106/JBJS.OA.26.00180","DOIUrl":"10.2106/JBJS.OA.26.00180","url":null,"abstract":"<p><strong>Background: </strong>The impact of clinically symptomatic spine comorbidities on patient-reported outcomes after total knee arthroplasty (TKA) remains unclear. We hypothesized that patients with pre-TKA spine comorbidities would demonstrate inferior outcomes compared with those without spine comorbidities.</p><p><strong>Methods: </strong>We retrospectively reviewed 492 patients who underwent primary TKA performed between 2020 and 2022. Spine comorbidities were defined as a history of lumbar injection, spine surgery, low back pain, or radiating pain. Three propensity score-matched analyses were performed: (1) primary analysis comparing patients with pre-TKA spine comorbidities vs. controls (141 pairs; 1:1 matching), (2) secondary analysis excluding patients who developed post-TKA spine comorbidities to isolate the effect of preexisting spine conditions (127 pairs; 1:1 matching), and (3) subgroup analysis comparing patients with prior spine surgery vs. those without (47 vs. 138; 1:3 matching). The Knee injury and Osteoarthritis Outcome Score (KOOS) was assessed preoperatively and at 1 and 2 years postoperatively.</p><p><strong>Results: </strong>There were 282 patients (141 pairs) in the primary analysis cohort (mean age, 72 years; 85% female). KOOS Sport showed the most consistent between-group differences across analyses. In the primary analysis, KOOS Sport was significantly lower in the spine comorbidity group at 2 years after false discovery rate (FDR) correction (mean, 43.4 vs. 53.9; mean difference, -10.5; Cohen's d = -0.45). KOOS Total showed nominally lower scores, although this did not remain significant after multiplicity adjustment. In the secondary analysis, KOOS Symptoms (71.2 vs. 78.0), Sport (44.1 vs. 56.5), and Total scores (66.4 vs. 72.9) were significantly lower at 2 years after FDR correction. In the subgroup analysis, patients with prior spine surgery showed lower KOOS scores in unadjusted comparisons at 2 years, although none of these differences remained significant after FDR correction.</p><p><strong>Conclusions: </strong>Pre-TKA spine comorbidities are associated with inferior KOOS outcomes, most consistently in high-demand activities. Awareness of these coexisting conditions may be helpful when counseling patients undergoing TKA about realistic expectations for postoperative functional recovery.</p><p><strong>Level of evidence: </strong>Level III, Therapeutic Study. See Instructions for Authors for a complete description of levels of evidence.</p>","PeriodicalId":36492,"journal":{"name":"JBJS Open Access","volume":"11 3","pages":""},"PeriodicalIF":4.9,"publicationDate":"2026-07-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13349222/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148424973","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":"SPAIRE Approach Versus Direct Anterior Approach in Hemiarthroplasty for Displaced Femoral Neck Fractures: A Randomized Controlled Trial.","authors":"Stein H Ugland, Oystein T Fagerberg, Terje O Ugland, Knut E Mjaaland, Are H Pripp, Lars Nordsletten","doi":"10.2106/JBJS.OA.26.00171","DOIUrl":"10.2106/JBJS.OA.26.00171","url":null,"abstract":"<p><strong>Background: </strong>Several surgical approaches are used for hemiarthroplasty (HA) in femoral neck fractures (FNF). The Sparing Piriformis and Obturator Internus, Repair Externus (SPAIRE) approach, introduced in the Norwegian Hip Fracture Register in 2019, is gaining popularity, accounting for 18% of HAs in Norway in 2024. However, supporting evidence remains limited. This randomized controlled trial (RCT) aimed at comparing the SPAIRE and direct anterior (DA) approaches in patients with FNF treated with HA.</p><p><strong>Methods: </strong>158 patients with a displaced FNF operated with HA were from January 2022 to June 2024 included in this RCT at Sorlandet Hospital Kristiansand and Sorlandet Hospital Arendal and randomized to the SPAIRE (n = 79) or the DA approach (n = 79) and followed for 12 months. The mean age was 79 years (70-90), and 59% were women. Physiotherapists blinded to allocation collected functional outcomes and patient-reported outcome measures postoperatively and at 3 and 12 months.</p><p><strong>Results: </strong>158 patients were included and 126 were assessed at final follow-up. All patients received the allocated treatment, and the randomization groups were similar. The duration of surgery was 52 min in the SPAIRE group vs. 63 minutes in the DA group (mean difference 9 minutes, 95% confidence interval [CI] 8-15; p < 0.01). At 12 months, the mean Harris Hip Score was 86 and 88, respectively (mean difference 2.3, 95% CI -2.7 to 7.3; p = 0.365). We did not find clinically relevant differences in patient-reported outcome measures between the groups at any time point. Nine complications requiring reoperation were recorded in 8 patients.</p><p><strong>Conclusion: </strong>No significant differences in clinical outcomes were found between patients operated with the DA or SPAIRE approach. SPAIRE approach may be an alternative for posterior approach surgeons performing HA on FNF patients. However, larger studies are warranted to establish the clinical implications of the approach.</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":"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/PMC13349216/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148424981","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":"Pre-Residency Research Engagement and Subsequent Publication Output Among Orthopaedic Surgery Applicants.","authors":"Ben Setaro, Evan London, Siddarth Dasari, Dominic M Farronato, A Bobby Chhabra, Wendy Novicoff, Charles A Su","doi":"10.2106/JBJS.OA.26.00158","DOIUrl":"10.2106/JBJS.OA.26.00158","url":null,"abstract":"<p><strong>Introduction: </strong>Competition for orthopaedic surgery residency positions has intensified in recent years, coinciding with the shift of the United States Medical Licensing Examination Step 1 and many medical schools' curricula to pass/fail grading. Consequently, residency programs have placed greater emphasis on applicants' research productivity. The average number of research items listed on applications has quadrupled since 2011. However, it is unclear whether preresidency research productivity predicts long-term research output. This study evaluates the association between preresidency research productivity and future publication output.</p><p><strong>Methods: </strong>A retrospective cohort of 822 applicants to a single US orthopaedic surgery residency program during the 2010 application cycle was evaluated. Electronic Residency Application Service (ERAS) data collected included the number and total hours of research experiences, total research items, oral/poster presentations, and manuscript publications. Each publication was cross-referenced using Scopus and PubMed to determine citation counts and publication in a top-15 orthopaedic journal. Applicants were matched to publicly available Scopus profiles to assess post-ERAS submission research productivity. The primary outcome was the number of post-ERAS publications. The 309 applicants without Scopus records were excluded from the study. Associations between variables were analyzed using Spearman's correlation, with statistical significance set at p < 0.05.</p><p><strong>Results: </strong>Post-ERAS publication count was significantly correlated with the number of poster/oral presentations (P = 0.023) and publication in a top-15 orthopaedic journal (P = 0.027). However, post-ERAS publication count was not significantly associated with the number of research experiences (P = 0.129), research hours (P = 0.501), total research items (P = 0.571), manuscript count (P = 0.713), or cumulative citations from application manuscripts (P = 0.308).</p><p><strong>Discussion: </strong>Poster/oral presentations and publication in a top-15 orthopaedic journal were the only ERAS metrics associated with postapplication publication output. Total research items, manuscripts, and citations were not correlated with continued productivity. Qualitative indicators of research engagement, such as presentations and publication quality, were associated with continued publication output, whereas quantitative metrics were not. These findings suggest that meaningful research involvement, rather than volume alone, better predicts long-term publication output.</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/PMC13349220/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148424901","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":"Declining Medicare Work Relative Value Unit Reimbursement in Orthopaedic Surgery: A Cross-Specialty Analysis from 2000 to 2025, with Projections to 2030.","authors":"Owen Falkenberg, Omar Badr, Davis Le, Cyrus Wong, Nicholas Smith, David Shau","doi":"10.2106/JBJS.OA.26.00064","DOIUrl":"10.2106/JBJS.OA.26.00064","url":null,"abstract":"<p><strong>Background: </strong>Inflation-adjusted Medicare reimbursement has declined over the past 2 decades, raising concerns about the sustainability of procedural practice and patient access to care. Prior trend analyses are often limited to single specialties or use aggregate payments, which can obscure changes in the valuation of surgeon work. We sought to assess reimbursement trends of orthopaedic surgery and compare with other surgical specialties, using work Relative Value Units (wRVUs).</p><p><strong>Methods: </strong>Using the Centers for Medicare & Medicaid Services Physician Fee Schedule and the Medicare Physician & Other Practitioners by Provider and Service data set, we identified 10 of the most performed procedures in 2023 for orthopaedic surgery, neurosurgery, general surgery, and urology. Reimbursement was calculated from wRVUs using annual conversion factors, inflation-adjusted to January 2025 US dollars, and evaluated from 2000 to 2025 with projections to 2030.</p><p><strong>Results: </strong>Orthopaedic surgery demonstrated the greatest absolute reimbursement decline, decreasing an average of $526.47 per procedure (50.27%). The remaining declines were $454.14 (52.31%, neurosurgery), $298.94 (46.47%, general surgery), and $242.47 (52.01%, urology), with negative compound annual growth rates across all fields. Projections suggest continued decline through 2030, with General Surgery and orthopaedic surgery exhibiting the largest projected proportional reduction (65.46% and 64.67%, respectively) but orthopaedic surgery demonstrating the greatest projected absolute reimbursement decline by 2030, exceeding $150 per procedure.</p><p><strong>Conclusions: </strong>The valuation of surgeon work has eroded broadly across procedural medicine with orthopaedic surgery experiencing the worst reimbursement reductions, emphasizing the need for collaboration and advocacy among surgical proceduralists. These system-wide trends raise concerns about workforce sustainability, access to complex surgical care, and the effectiveness of specialty specific advocacy efforts to reimbursement policy.</p><p><strong>Level of evidence: </strong>Level IV, economic. 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/PMC13349212/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148424822","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 Effect of Bearing Surface On the Survival of Cementless and Hybrid Total Hip Arthroplasty: An Analysis of Linked National Joint Registry and Hospital Episode Statistics Data.","authors":"Edward T Davis, Maria Raikou, Alistair J McGuire, Joseph Pagkalos","doi":"10.2106/JBJS.OA.25.00286","DOIUrl":"10.2106/JBJS.OA.25.00286","url":null,"abstract":"<p><strong>Background: </strong>Crosslinked polyethylene-based bearings have led to marked improvements in total hip arthroplasty (THA) survival. Antioxidant highly crosslinked polyethylene bearings are the latest addition to the bearing options. Previous reports were limited by low numbers and short follow-up in this category therefore limiting comparisons.</p><p><strong>Methods: </strong>We combined the UK National Joint Registry data set with polyethylene manufacturing characteristics to classify polyethylene as crosslinked (XLPE) or conventional polyethylene. The Hospital Episode Statistics data set was used to link ipsilateral surgical procedures for the treatment of periprosthetic hip fractures. The effect of bearing surface on THA survival was analyzed through estimating cause-specific cumulative incidence functions to allow for competing risks. This was followed by regression analysis that fitted a Fine-Gray proportional subdistribution hazards model for reoperation.</p><p><strong>Results: </strong>A total of 696,013 THAs and 17,468 reoperations were included in this analysis. Average follow-up time was estimated to be between 4.83 and 9.64 years depending on the bearing combination while the maximum follow-up was 19.1 years across all bearings. The estimated cause-specific cumulative incidence functions allowing for competing risks revealed that Ceramicised Metal on XLPE (CMoXLPE) and Ceramic on Antioxidant XLPE (CoAoXLPE) had the lowest probability of reoperation by the end of the follow-up period. The regression analysis (all ages) with Metal on Polythelene (MoP) as the reference bearing adjusted for age, sex, and stem fixation showed CMoXLPE to be associated with the lowest risk of revision for any reason (HR = 0.64, 95% CI = 0.58-0.72) followed by CoAoXLPE XLPE (HR 0.65, 95% CI = 0.57-0.74).</p><p><strong>Conclusion: </strong>This analysis, which includes fixations as well as revisions in defining reoperation for periprosthetic fracture, covers a longer follow-up period compared with earlier reports. Regression analysis in a model including all ages, all bearings, with MoP as the reference revealed the lowest risk of revision for any reason in THAs using CMoXLPE and CoAoXLPE.</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":"2026-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13322474/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148369867","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":"Patient-Specific Medial Patellofemoral Ligament Femoral Footprint Mapping Using Compressed Lateral and Sagittal Sequence MRI in Patients With Trochlear Dysplasia.","authors":"E Alonso Domenech, G Thürig, M Barrera Uso, R Panadero-Morales, J López-Pascual, M Tannast, J M Schwab, D Petek","doi":"10.2106/JBJS.OA.26.00118","DOIUrl":"10.2106/JBJS.OA.26.00118","url":null,"abstract":"<p><strong>Background: </strong>Accurate identification of the medial patellofemoral ligament (MPFL) femoral footprint is essential for successful MPFL reconstruction. Standard tunnel placement techniques, such as the Schöttle method, rely on fixed sagittal radiographic landmarks and may not account for morphological patient variability, particularly in patients with trochlear dysplasia. The Compressed Lateral and Sagittal Sequence (CLASS) magnetic resonance imaging (MRI) method has been validated for assessing the native MPFL insertion and has been used to map its location in normal knees. However, it has not yet been applied to assess anatomical variability in dysplastic knees. The objective of this study was (1) to determine whether the MPFL femoral footprint differs between knees with and without trochlear dysplasia and (2) to assess whether the position of the MPFL footprint in trochlear dysplasia differs from the Schöttle point.</p><p><strong>Methods: </strong>MRI data from 58 dysplastic knees and 80 control knees were analyzed. The femoral MPFL footprint was identified using the CLASS method and projected onto a 2D coordinate system defined by the posterior femoral cortex (<i>y</i>-axis) and a perpendicular line intersecting the most posterior point of Blumensaat's line (x-axis). Statistical comparisons were made between groups and relative to the Schöttle reference point. A p-value of less than 0.05 was considered as statistically significant.</p><p><strong>Results: </strong>The femoral MPFL footprint in trochlear dysplasia was more anterior (2.05 ± 3.61 mm vs. 0.83 ± 3.39 mm; <i>p</i> = 0.044) and distal (-1.84 ± 4.09 mm vs. 1.44 ± 2.66 mm; <i>p</i> < 0.001) compared with knees without dysplasia. When referenced to the Schöttle point, a distal deviation was observed (mean difference: 4.84 ± 4.09 mm; <i>p</i> < 0.001), while there was no anteroposterior difference (0.75 ± 3.61 mm; <i>p</i> = 0.119).</p><p><strong>Conclusion: </strong>Trochlear dysplasia alters the femoral MPFL footprint, producing a significant systematic distal displacement compared with both normal knees and the Schöttle point, with a mean distal difference of 3.28 mm vs. normal knees and 4.84 mm relative to Schöttle point, emphasizing the anatomical variability overlooked by standardized landmarks. This supports the use of the CLASS algorithm for individualized tunnel placement in MPFL reconstruction.</p><p><strong>Level of evidence: </strong>Level IV, 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":"2026-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13322477/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148370143","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":"Early Brace Treatment: The New Standard for Adolescent Idiopathic Scoliosis?","authors":"Karina A Zapata, J P Rathbun, Donald Virostek, Chan-Hee Jo, Megan E Johnson, Daniel J Sucato","doi":"10.2106/JBJS.OA.26.00072","DOIUrl":"10.2106/JBJS.OA.26.00072","url":null,"abstract":"<p><strong>Background: </strong>No direct comparison exists between early bracing of adolescent idiopathic scoliosis (AIS) at curve magnitudes of 15° to 24° vs. observation until the Scoliosis Research Society-recommended criteria of ≥25°. We compared curve improvement and progression between early bracing vs. standard treatment with bracing starting at ≥25°.</p><p><strong>Methods: </strong>A retrospective review was performed among patients Risser 0 to 1 with AIS curves 15° to 24° at initial visit who were followed until skeletal maturity or surgery. Patients prescribed rigid thoracolumbar sacral orthoses (TLSO) for curves 15° to 24° (early group) were compared with a control group observed until TLSO prescription at ≥25° (standard group). A subanalysis of open triradiate cartilage status (TRC) was performed. At final follow-up, patients were categorized into curve improvement ≥6°, stable (-5° to +5°), progression ≥6°, and progression to surgical magnitude (≥45°).</p><p><strong>Results: </strong>Among 414 patients (207 early, 207 standard) matched by skeletal maturity, the early group had greater curve improvement (19% vs. 1%, p < 0.001, odds ratio 16.3), greater stability (50% vs. 37%, p = 0.007), less progression ≥6° (31% vs. 62%, p < 0.001), and less progression to a surgical magnitude (6% vs. 14%, p = 0.014) than the standard group. Patients with open TRC highlighted these differences, with the early group demonstrating greater curve improvement (18% vs. 2%, p < 0.01), greater stability (42% vs. 21%, p < 0.001), less progression ≥6° (39% vs. 77%, p < 0.001), and less progression to a surgical magnitude (9% vs. 20%, p = 0.018) than the standard group, especially those with thoracic curves 20° to 24° at initial visit (13% vs. 43%, p = 0.001). The number needed to treat was 3.3.</p><p><strong>Conclusion: </strong>Early brace treatment of AIS curves 15° to 24° is superior to observation until brace initiation at 25°, with a 16-fold increased likelihood of improving curves and reducing progression to a surgical threshold by >50%.</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":"11 3","pages":""},"PeriodicalIF":4.9,"publicationDate":"2026-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13322468/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148370093","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":"Prevalence and Implications of Incidental Findings on Computed Tomography Scans Performed for Mako Robotic Arm-Assisted Joint Arthroplasty.","authors":"Tim Cheok, Veronica Pajnic, Julie F Vermeir, Yvana Toh, Alex Wu, Tasnim Zaman, Simon Perkins, Anthony M Silva","doi":"10.2106/JBJS.OA.25.00245","DOIUrl":"10.2106/JBJS.OA.25.00245","url":null,"abstract":"<p><strong>Background: </strong>Robotic arm-assisted joint arthroplasty has seen an increase in its popularity internationally. Image-based systems, such as the Mako robotic arm-assisted system, require a preoperative computed tomography (CT) scan to be performed. These scans may detect incidental findings, which can place additional burden on both patients and healthcare providers.</p><p><strong>Methods: </strong>A retrospective cohort study was performed to quantify the prevalence and significance of orthopaedic and nonorthopaedic incidental findings on CT scans obtained using the Mako CT protocol. All preoperative CT scans performed using this protocol between December 2018 and December 2024 for patients undergoing elective primary joint arthroplasty at the institution were included. Clinically significant findings were defined as any new and unexpected results which required invasive workup, surgical management, or had a direct negative impact on life expectancy.</p><p><strong>Results: </strong>Of 1,446 CT reports reviewed, 738 (51.0%) contained 1 or more incidental findings. Rates were highest in the total hip arthroplasty (THA) cohort (71.1%), followed by the unicompartmental knee arthroplasty cohort (51.4%) and total knee arthroplasty (TKA) cohort (42.7%). Only 4 (0.3%) incidental findings were deemed clinically significant, all within the TKA cohort. These findings led to surgical delay in 2 cases and cancellation in 1 case.</p><p><strong>Conclusion: </strong>Incidental findings are common in preoperative CT scans performed for Mako robotic arm-assisted joint arthroplasty, particularly in THA patients. However, clinically significant findings are rare and infrequently alter surgical time frames. Surgeons should remain aware of the potential ethical and medicolegal implications of these findings.</p><p><strong>Level of evidence: </strong>Level IV, 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":"2026-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13322469/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148369006","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":"Timing of Return to Driving After Volar Locking-Plate Fixation of Distal Radius Fractures Without Wrist Immobilization: A Prospective Driving Simulator Study.","authors":"Rikiya Shirato, Yuka Yamanaka, Wataru Goshima, Takashi Oda, Takuro Wada","doi":"10.2106/JBJS.OA.26.00013","DOIUrl":"10.2106/JBJS.OA.26.00013","url":null,"abstract":"<p><strong>Background: </strong>Studies examining return to driving after volar locking-plate fixation (VLP) for distal radius fractures (DRFs) have used heterogeneous postoperative immobilization protocols, resulting in widely varying recommendations for the timing of return to driving. The aim of this study was to determine the timing of return to driving in patients with DRFs treated with VLP managed without postoperative immobilization.</p><p><strong>Methods: </strong>Patients with DRFs treated with VLP and healthy controls who routinely drive were prospectively enrolled. Driving performance was evaluated at postoperative weeks 1, 2, 3, 4, 6, and 8 using a driving simulator (DS), administered as 2 tasks: the Steering Operation Test (pylon-passing) and the Hazard Anticipation Task (urban driving). The Steering Operation Test outcomes included reaction time, accuracy, left-right balance, and adaptability. The Hazard Anticipation Task outcomes included maximum steering angle, number of collisions, percentage of distance speeding, average excess speed, average turning speed at intersections, and number of turn-signal errors. Moreover, demographic and clinical factors potentially associated with driving performance were explored only among patients with DRFs using multivariable analysis.</p><p><strong>Results: </strong>Twenty-seven patients completed the DS assessment at all 6 point sessions, and 25 healthy controls completed a single session. Accuracy on the Steering Operation Test was significantly lower in patients than in controls at postoperative weeks 1 and 2, whereas no significant between-group differences were observed from week 3 onward. No significant differences were observed between the groups in any of the indicators for the Hazard Anticipation Task. Multivariable analysis showed a negative correlation of steering accuracy with female sex and older age and a positive correlation with forearm pronation.</p><p><strong>Conclusions: </strong>In patients with DRFs after VLP without wrist immobilization, driving performance did not differ significantly from that of healthy controls at postoperative week 3. These findings suggest that postoperative week 3 could serve as a reference point when considering return to driving. Gradual and careful guidance on returning to driving is recommended for women, older adults, and patients with insufficient recovery in forearm pronation.</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":"2026-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13322480/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148369880","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}