JBJS Open Access最新文献

{"title":"Development of Explainable Machine Learning Models to Identify Patients at Risk for 1-Year Mortality and New Distant Metastases Postendoprosthetic Reconstruction for Lower Extremity Bone Tumors: A Secondary Analysis of the PARITY Trial.","authors":"Jiawen Deng, Myron Moskalyk, Madhur Nayan, Ahmed Aoude, Michelle Ghert, Sahir Bhatnagar, Anthony Bozzo","doi":"10.2106/JBJS.OA.24.00213","DOIUrl":"10.2106/JBJS.OA.24.00213","url":null,"abstract":"<p><strong>Background: </strong>Accurate prediction of postoperative metastasis and mortality risks in patients undergoing lower-limb oncological resection and endoprosthetic reconstruction is essential for guiding adjuvant therapies and managing patient expectations. Current prediction methods are limited by variability in patient-specific factors. This study aims to develop and internally validate explainable machine learning (ML) models to predict the 1-year risk of new distant metastases and mortality in these patients.</p><p><strong>Methods: </strong>We performed a secondary analysis of data from the Prophylactic Antibiotic Regimens in Tumor Surgery trial, which included 604 patients. Candidate features were selected based on availability and clinical relevance and then narrowed using Least Absolute Shrinkage and Selection Operator (LASSO) regression and Boruta algorithms. Six ML classification algorithms were tuned and calibrated: logistic regression, support vector machines, random forest, Light Gradient Boosting Machine (LightGBM), eXtreme Gradient Boosting (XGBoost), and neural networks. Models were developed with and without including percent tumor necrosis due to its high missing data rate (>30%). Hyperparameters were tuned using Bayesian optimization. Internal validation was conducted using a 30% hold-out set. Model explainability was assessed using permutation-based feature importance and SHapley Additive exPlanations.</p><p><strong>Results: </strong>LightGBM was identified as the best-performing algorithm for both outcomes. For 1-year mortality prediction without percent necrosis, LightGBM achieved an area under the receiver operating characteristic curve (AUC-ROC) of 0.78 (95% confidence interval [CI] 0.70-0.86) during cross-validation and 0.72 on internal validation. For distant metastasis prediction, the LightGBM model without percent necrosis achieved an AUC-ROC of 0.77 (95% CI 0.71-0.84) during cross-validation and 0.77 on internal validation. Including percent necrosis did not significantly improve model performance. The top predictors identified were patient age, largest tumor dimension, and tumor stage.</p><p><strong>Conclusions: </strong>Explainable ML models can effectively predict the 1-year risk of mortality and new distant metastases in patients undergoing lower-limb oncological resection and endoprosthetic reconstruction. Further external validation and consideration of other data modalities are required before integrating these ML-driven risk assessments into routine clinical practice.</p><p><strong>Level of evidence: </strong>Level II, Prognostic Study. See Instructions for Authors for a complete description of levels of evidence.</p>","PeriodicalId":36492,"journal":{"name":"JBJS Open Access","volume":"10 2","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12080683/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144129067","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 Value of Research in the Orthopaedic Surgery Residency Applicant: A Pilot Survey of Orthopaedic Surgery Residency Program Directors.","authors":"Ryan C White, Rithvik Vutukuri, Shreya M Saraf, Mia V Rumps, Mary K Mulcahey","doi":"10.2106/JBJS.OA.24.00216","DOIUrl":"10.2106/JBJS.OA.24.00216","url":null,"abstract":"<p><strong>Introduction: </strong>The role of research in the orthopaedic surgery residency application process has become increasingly important, particularly in the wake of the United States Medical Licensing Examination (USMLE) Step 1 examination transitioning to pass/fail. The purpose of this study was to determine the value that orthopaedic surgery residency program directors and other faculty place on various research elements included in residency applications.</p><p><strong>Methods: </strong>An anonymous cross-sectional survey was distributed to program directors and other faculty involved with the review of orthopaedic surgery residency applications within the Collaborative of Orthopaedic Education Research Group in February 2024. The survey asked questions related to the value placed on publication types, authorship position, dedicated research years, and the general importance of research.</p><p><strong>Results: </strong>Ten respondents, including 7 program directors, 2 assistant program directors, and 1 director of research, participated. Eight (80%) indicated that the number of publications is important, with 4 (40%) identifying a minimum number of publications of 2 to 3 to be considered competitive at their program. Respondents also identified the following components as important: journal impact factor (9; 90%), authorship position (5; 50%), and study type (7; 70%). Clinical research within orthopaedic surgery was most highly regarded (9; 90%), while case studies were deemed least valuable (9; 90%). Six respondents (60%) agreed that research is more important now that USMLE Step 1 is pass/fail.</p><p><strong>Conclusions: </strong>Since the transition of Step 1 to pass/fail, research has become an increasingly important part of an orthopaedic surgery resident's application. Residency programs value research productivity, particularly clinical research within orthopaedics. While the minimum number of publications varies, 2 to 3 are often considered competitive. Factors contributing to the perceived value of research include journal impact factor, authorship position, and study type. With this knowledge, applicants can align their research activities with the values of orthopaedic surgery residency programs.</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 2","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12080675/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144129069","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":"Path to a Successful Match in Orthopaedic Surgery for International Medical Graduates.","authors":"Sukrit J Suresh, Krishna V Suresh, Diane Ghanem, Majd Marrache, Dawn LaPorte, Amiethab Aiyer","doi":"10.2106/JBJS.OA.24.00109","DOIUrl":"https://doi.org/10.2106/JBJS.OA.24.00109","url":null,"abstract":"<p><p>International medical graduates (IMG) comprise many annual applications submitted for the orthopaedic surgery match but traditionally have a noticeably lower match rate compared with graduates from allopathic and osteopathic medical schools in the United States. Barriers for IMGs include (1) limited US clinical experience, (2) suboptimal networking and sponsorship opportunities, and (3) the extended time and financial investment required to build a strong application. This review article identifies important tips to circumvent these barriers, providing IMGs with a pathway to a successful match into orthopaedic surgery.</p>","PeriodicalId":36492,"journal":{"name":"JBJS Open Access","volume":"10 2","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12063778/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144080517","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":"In Young Patients Undergoing Total Hip Arthroplasty, Is There a Correlation Between Activity Level and Wear of Highly Cross-Linked Polyethylene?","authors":"Sergio F Guarin Perez, Diego J Restrepo, Sheng-Hsun Lee, Michael B Stuart, Robert T Trousdale, Daniel J Berry, Rafael J Sierra","doi":"10.2106/JBJS.OA.24.00242","DOIUrl":"https://doi.org/10.2106/JBJS.OA.24.00242","url":null,"abstract":"<p><strong>Background: </strong>Total hip arthroplasty (THA) effectively restores mobility, reduces pain, and enhances the quality of life of patients of all ages. Despite its benefits, concerns regarding the long-term effects of high-impact activities and sports on implant longevity require further study. This study investigated the effect of activity level on long-term radiographic wear of highly cross-linked polyethylene (HXLPE) in young patients undergoing THA.</p><p><strong>Methods: </strong>Between 1999 and 2008, 785 patients (909 hips) aged ≤50 underwent primary THA using first-generation HXLPE liners from 4 different vendors with either metal or ceramic heads. Functional activity and participation questionnaires, including the Hip Injury and Osteoarthritis Outcome Score (HOOS Jr), University of California Los Angeles (UCLA) activity scale, and High-Activity Arthroplasty Score (HAAS), were surveyed in 2018 to 2019. The response rate was 44%. Radiographic linear wear rates were measured using the ROMAN software in patients who had completed questionnaires and had radiographs taken at least 10 years apart, leaving a final cohort of 249 patients (284 hips). Multivariate analyses were performed to determine the relationship between HXLPE wear rates and activity scores.</p><p><strong>Results: </strong>At the time of the survey, approximately 10% of the patients performed high-impact activities not-recommended by consensus guidelines. The HXLPE linear wear rate was 0.036 mm/year (SD: 0.026). Patients with higher activity levels, as measured on the continuous UCLA/HAAS activity scale, did not exhibit increased wear (β = -0.0009; p = 0.31). Stair climbing was correlated with increased wear rates (β = 0.0066; p = 0.004), whereas walking (β = 0.0005; p = 0.66) and running (β = 0.0017; p = 0.30) were not significantly correlated. Patients performing nonrecommended activities did not show increased wear rates compared with those performing recommended activities (β = 0.0063; p = 0.19).</p><p><strong>Conclusions: </strong>Linear wear rates of first-generation HXLPE were not related to functional activity or participation in high-impact activities. Future research should include longitudinal assessments of activity levels and data on other potential complications related to high-impact sports to provide robust evidence regarding recommended activity level postoperatively.</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":"10 2","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12063786/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144080328","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":"Cow Hitch Cerclage Suture Fixation of the Greater Tuberosity in Reverse Total Shoulder Arthroplasty Performed for Proximal Humerus Fractures: A Retrospective Cohort Study With a Minimum Follow-up of 2 Years.","authors":"Zendeli Flamur, Philipp Kriechling, Bouaicha Samy, Sabine Wyss, Wieser Karl, Grubhofer Florian","doi":"10.2106/JBJS.OA.24.00152","DOIUrl":"10.2106/JBJS.OA.24.00152","url":null,"abstract":"<p><strong>Background: </strong>Reverse total shoulder arthroplasty (RTSA) is a well-established treatment option for complex proximal humeral fractures in older patients, with greater tuberosity (GT) healing being critical for achieving optimal clinical outcomes. We compared the clinical and radiological outcomes between 2 GT fixation techniques: the \"cow hitch\" (CH) cerclage suture fixation technique and conventional suture fixation technique.</p><p><strong>Methods: </strong>This retrospective cohort study compared 20 consecutive patients who underwent RTSA using the CH cerclage suture fixation technique (CH group) with 29 consecutive patients who underwent RTSA using the conventional suture fixation technique (control group). Radiological healing of the GT was defined as the primary outcome parameter and assessed using standard radiographs at the last follow-up visit. Clinical outcomes were assessed as secondary outcome parameters and measured using the absolute and relative Constant-Murley scores (aCS and rCS), Subjective Shoulder Value (SSV), range of motion (ROM), and patient-reported outcome satisfaction (PROS).</p><p><strong>Results: </strong>At a mean follow-up at 47 ± 30 (range, 24-120) months, the radiographic findings revealed a 95% healing rate of the GT in the CH group compared with a 66% healing rate in the control group (p = 0.03). No secondary displacement was observed in the CH group, whereas 5 cases (17%) were observed in the control group (p = 0.14). Overall, aCS, rCS, SSV, ROM (flexion, abduction, external rotation), and PROS were significantly higher in the CH group than in the control group (p-values: 0.03, 0.002, 0.004, 0.03, 0.01, 0.01, 0.047, respectively).</p><p><strong>Conclusion: </strong>Compared with the conventional suture GT fixation technique, the CH cerclage suture fixation technique in RTSA performed for complex proximal humerus fractures resulted in higher healing rates with no secondary displacement of the GT, improved clinical outcomes, and enhanced patient satisfaction.</p><p><strong>Level of evidence: </strong>Level III (Retrospective cohort study). See Instructions for Authors for a complete description of levels of evidence.</p>","PeriodicalId":36492,"journal":{"name":"JBJS Open Access","volume":"10 2","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12063785/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144080273","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":"Uneven Ground: Exploring the Impact of Geographical Region and Gender on Orthopaedic Surgery Resident Research Productivity.","authors":"Natasja Lessiohadi, Hayden Hartman, James Pai, William B Goodman, Mia V Rumps, Mary K Mulcahey","doi":"10.2106/JBJS.OA.24.00224","DOIUrl":"https://doi.org/10.2106/JBJS.OA.24.00224","url":null,"abstract":"<p><strong>Introduction: </strong>Research plays a crucial role in orthopaedic surgery advancement, patient outcomes, and both residency and fellowship training. This study aimed to examine associations between research productivity of orthopaedic surgery residents, gender proportion of residents, and the geographical region of orthopaedic surgery residency programs.</p><p><strong>Methods: </strong>Using the Fellowship and Residency Electronic Interactive Database (FRIEDA) and the Doximity Residency Navigator, a list of the top 10 Accreditation Council for Graduate Medical Education (ACGME) orthopaedic surgery residency programs for each region (Northeast, South, Midwest, and West) were identified. FRIEDA, program websites, SCOPUS, PubMed, and ResearchGate were utilized to collect the following: residency program name, type, and location; and resident name, gender, H-index, and number of publications.</p><p><strong>Results: </strong>Forty orthopaedic surgery residency programs and 1,377 residents across 4 regions were evaluated. Of these, 29.6% (408/1,377) were female and 70.4% (969/1,377) were male. Northeast programs averaged the highest publications (11.6) per resident, while the South averaged the fewest publications (5.9, p < 0.0001). Similarly, residents in Northeast programs had the highest average H-index (2.9), and residents in the South had the lowest average H-index (1.6) (f-ratio = 11.19, p < 0.0001). Male residents averaged more publications (9.0 vs. 5.5, p < 0.05) and higher H-indices (2.3 vs. 1.8, p < 0.05) than female residents. These differences were greatest in the South (male:female publication ratio = 1.9, H-index ratio = 1.4) and lowest in the Midwest (male:female publication ratio = 1.3, H-index ratio = 1.1).</p><p><strong>Conclusion: </strong>At the top 10 orthopaedic surgery residency programs across all regions, female residents remain underrepresented in academic research compared with male residents, evidenced by a lower average number of publications H-indices, with the degrees of these discrepancies varying regionally. Further research is needed to identify the underlying factors influencing these differences. Program directors and orthopaedic surgery residents should be aware of these geographic and gender-based trends to improve their academic productivity and address the existing inequities within academic orthopaedics.</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 2","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12063782/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144080530","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":"When is Growth the Greatest? Spine and Total Body Growth in Idiopathic Scoliosis Through Sanders Maturation Stages 2, 3A, 3B, and 4.","authors":"Yusuke Hori, Bryan Menapace, Norihiro Isogai, Sadettin Ciftci, Burak Kaymaz, Luiz Carlos Almeida da Silva, Kenneth J Rogers, Petya K Yorgova, Peter G Gabos, Suken A Shah","doi":"10.2106/JBJS.OA.24.00189","DOIUrl":"https://doi.org/10.2106/JBJS.OA.24.00189","url":null,"abstract":"<p><strong>Background: </strong>Sanders maturation stages (SMS) 2 to 4 represent periods of rapid growth and are considered ideal candidates for growth modulation surgery, such as anterior vertebral body tethering. A detailed assessment of spine growth during these stages is essential but limited. This study aimed to clarify the differences in growth rates for spine and total body height across SMS 2, 3A, 3B, and 4, as well as to assess cumulative growth until skeletal maturity for these stages.</p><p><strong>Methods: </strong>This single-center, retrospective, case-control longitudinal study evaluated consecutive patients with idiopathic scoliosis staged SMS 2 to 4. T1-S1 spine height, total body height, and curve magnitude were measured at each visit. Monthly growth rates for spine and total body height were calculated between baseline and first follow-up visit (6-12 months). In a subset followed to skeletal maturity, cumulative spine and total body height gain were assessed. To account for height loss due to scoliosis, spine and total body height were adjusted for curve magnitude using validated formulas. Multivariate linear regression models were employed to evaluate the relationship between SMS and growth, adjusting for confounding factors.</p><p><strong>Results: </strong>A total of 517 patients (68% female) were included. Spine height growth was highest in patients at SMS 3A, approximately 1.4 times stage 2, 1.5 times stage 3B, and 1.8 times stage 4. Total body height growth rates were comparable between SMS 2 and 3A, both significantly exceeding SMS 3B and 4. Among 314 patients followed to skeletal maturity, cumulative growth in spine and total body height was greatest in patients at SMS 2.</p><p><strong>Conclusions: </strong>This study demonstrated that spinal growth was most pronounced in patients at SMS 3A, while total body height growth was greatest during SMS 2 and 3A. Less mature patients exhibited greater cumulative growth potential in both spine and total body height. These findings provide crucial insights for determining the optimal timing of growth modulation surgery.</p><p><strong>Level of evidence: </strong>Level III Case-control study. See Instructions for Authors for a complete description of levels of evidence.</p>","PeriodicalId":36492,"journal":{"name":"JBJS Open Access","volume":"10 2","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12055122/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144015462","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":"Unicompartmental Knee Arthroplasty Offers More Natural Feeling Joints Compared with Total Knee Arthroplasty: A Systematic Review and Meta-Analysis.","authors":"Mohammad Poursalehian, Yashar Khani, Rezvan Ghaderpanah, Sanam Mohammadzadeh, Amir Mehrvar, Sina Hajiaghajani","doi":"10.2106/JBJS.OA.25.00011","DOIUrl":"https://doi.org/10.2106/JBJS.OA.25.00011","url":null,"abstract":"<p><strong>Background: </strong>Unicompartmental knee arthroplasty (UKA) preserves healthy cartilage and may provide a more \"natural-feeling\" joint compared with total knee arthroplasty (TKA). The Forgotten Joint Score (FJS) is increasingly used to assess joint awareness. We aimed to systematically compare FJS outcomes in patients undergoing UKA versus TKA.</p><p><strong>Methods: </strong>Following Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines, we searched PubMed, Embase, Scopus, and Web of Science. We included studies reporting FJS in UKA vs. TKA, assessed risk of bias using the Newcastle-Ottawa Scale, and Cochrane RoB-2, and conducted random-effects meta-analyses to calculate pooled mean differences (MD), and sensitivity analyses were performed to assess the robustness of the findings.</p><p><strong>Results: </strong>Ninteen studies (16 cohort, 3 randomized clinical trials; 4,500 knees) were included. Overall, the pooled MD in FJS favored UKA by 8.45 points (95% CI: 6.03-10.88; p < 0.001), indicating lower joint awareness. However, heterogeneity was high (I² = 96.24%) and publication bias was detected. Sensitivity analyses, including a leave-one-out analysis and an analysis restricted to randomized controlled trials, confirmed the consistency of the results, with no single study disproportionately influencing the findings.</p><p><strong>Conclusion: </strong>Despite substantial heterogeneity, these findings suggest that UKA may offer superior joint awareness compared with TKA.</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 2","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12055126/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143988352","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":"Socioeconomic Deprivation Influences Failure to Attend Arranged Orthopaedic Outpatient Appointments as Well as Access to and Engagement With Health Care: A Cohort Study.","authors":"V Badial, S F Turner, H Jeffrey, R Barter, E Hayter, R E Anakwe","doi":"10.2106/JBJS.OA.24.00238","DOIUrl":"https://doi.org/10.2106/JBJS.OA.24.00238","url":null,"abstract":"<p><strong>Background: </strong>We undertook this study to examine the \"did-not-attend\" (DNA) rate for the orthopaedic outpatient clinic at a large tertiary center, to understand the influencing factors and reasons from the patient perspective and to determine the impact of socioeconomic deprivation.</p><p><strong>Methods: </strong>We reviewed all scheduled outpatient attendances to our trauma and orthopaedic surgery service over a 12-month period and demographic information for each patient, including the Index of Multiple Deprivation. We studied the rate and predictors for nonattendance in the outpatient clinic and the influence of socioeconomic deprivation. We undertook a secondary study to evaluate the reasons patients gave for nonattendance, their perception of the accessibility, usefulness, and format of the outpatient model and any relationship with socioeconomic deprivation.</p><p><strong>Results: </strong>Eighteen thousand thirty-three patients attended 58,396 outpatient appointments over the 12-month study period. 2060 patients \"did not attend\" at least one arranged orthopaedic outpatient appointment over the 12 months of the study period. Men and more socioeconomically deprived patients were more likely to not attend. The most common reasons given for not attending were that patients did not feel that the appointment was useful for them. Patients from socioeconomically deprived groups were more likely to reference transport difficulties as a reason for not attending (p < 0.001). Socioeconomically deprived and disadvantaged patients reported poorer satisfaction scores regarding how able they felt to access orthopaedic help and services when they needed to and how able they felt to access orthopaedic help and services in a way that suits them.</p><p><strong>Conclusions: </strong>Socioeconomic deprivation affects health and access to health care. Patients who are more socioeconomically deprived are more likely to not attend, and they report poorer satisfaction with access to orthopaedic outpatient care. DNA rates may reflect underlying health disparities.</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 2","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12055086/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144022623","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":"Surgical Outcomes of Single-Stage Correction Using Cervical Pedicle Screw Fixation Rather Than Lateral Mass Fixation in NF1-Associated Pediatric Cervical Kyphosis: A Retrospective Study with a Minimum 2-Year Follow-Up.","authors":"Zeki Boğa, Semih Kıvanç Olguner, Tolga Türkmen, Ümit Kara, Ali Arslan, Mehmet Özer, Ahmet Hamit Çınkı, Yurdal Gezercan","doi":"10.2106/JBJS.OA.24.00252","DOIUrl":"https://doi.org/10.2106/JBJS.OA.24.00252","url":null,"abstract":"<p><strong>Background: </strong>Neurofibromatosis type 1 (NF-1) can cause severe kyphosis in the cervical vertebrae. There is no consensus on the optimal surgical treatment for this rare condition, although long-segment fixation and combined approaches are generally preferred. To our knowledge, this study is the first to report the clinical outcomes of patients with NF-related cervical kyphosis who underwent stand-alone posterior pedicle fixation surgery.</p><p><strong>Methods: </strong>The outcomes of 14 patients who underwent surgery using the pedicle screw were retrospectively examined between 2015 and 2022. Only patients with at least 2 years of follow-up were included. For each patient, the following parameters were recorded and evaluated at 1 month postoperatively and at the end of the follow-up period: cervical lordosis (CL), local kyphosis angle (LKA), T1 slope, cervical sagittal vertical axis, visual analog score for neck pain, modified Japanese Orthopedic Association score, and Neck Disability Index. Complications, surgical duration, blood loss, levels of instrumentation, and length of hospital stay were also recorded.</p><p><strong>Results: </strong>In terms of radiographic parameters, all patients achieved lordosis, with the cervical LKA improving from an average of 76.7° preoperatively to an average of 20.4° in the early postoperative period. At the 2-year follow-up, the postoperative CL significantly improved compared with preoperative values (p < 0.001) with only approximately 4° correction loss. Moreover, by the end of the follow-up, all postoperative symptoms showed improvement compared with the preoperative symptoms. The average surgical duration was 211.86 ± 49.83 min. During the follow-up, junctional kyphosis was observed in 4 patients all of whom required revision surgery. C5 palsy was detected in 3 patients. Infection-related complications occurred in 6 patients, with wound infection in only 1 patient.</p><p><strong>Conclusion: </strong>Cervical pedicle screw fixation is an effective treatment for NF-1-related cervical kyphosis. Although this technique is considered difficult and dangerous to apply by several spine surgeons, it exerts a positive effect on clinical improvement and provides optimal correction.</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 2","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12055176/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144039291","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}