Journal of the American Academy of Orthopaedic Surgeons Global Research and Reviews最新文献

{"title":"A Systematic Review and Meta-Analysis of Periprosthetic Joint Infection Rates in Morbidly Obese Patients Undergoing Total Hip Arthroplasty.","authors":"Jared Rubin, Ajay S Potluri, Kyleen Jan, Siddhartha Dandamudi, Brett R Levine","doi":"10.5435/JAAOSGlobal-D-24-00306","DOIUrl":"https://doi.org/10.5435/JAAOSGlobal-D-24-00306","url":null,"abstract":"<p><strong>Introduction: </strong>Periprosthetic joint infection (PJI) is a severe complication associated with higher rates in obese individuals after total hip arthroplasty (THA). Hard cutoffs for body mass index (BMI) levels may lead to restricted access to care; however, a certain level of obesity may warrant these restrictions for patient safety. The purpose of this study was to perform a systematic review and meta-analysis of articles comparing PJI rates in morbidly versus nonmorbidly obese patients undergoing primary THA.</p><p><strong>Methods: </strong>A systematic search of PubMed, EMBASE, Cochrane, and Google Scholar databases was conducted following Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. Original studies comparing PJI rates in morbidly obese (BMI ≥40 kg/m2) and nonobese (BMI <40 kg/m2) THA patients were included. Data extraction, bias assessment, and quantitative synthesis were done.</p><p><strong>Results: </strong>After exclusion criteria, 10 studies comprising 46,080 THAs were included. Morbidly obese patients were found to have markedly higher rates of PJI compared with nonmorbidly obese patients (odds ratio = 4.332, 95% confidence interval [CI], 2.943 to 6.375, I2 = 0, P-value = 0.901). Analysis of cohorts stratified by BMI showed consistent trends; morbidly obese patients demonstrated markedly increased risk of blood transfusions, postoperative fractures, superficial infections, dislocations, readmission within 90 days, surgical complications, and revision surgery.</p><p><strong>Conclusion: </strong>Morbidly obese patients demonstrate markedly increased risk of PJI and other complications after primary THA. This should be discussed with patients to safely provide the option of THA while minimizing restrictions on access to care.</p>","PeriodicalId":45062,"journal":{"name":"Journal of the American Academy of Orthopaedic Surgeons Global Research and Reviews","volume":"9 4","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143812672","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Total Hip Arthroplasty Patients With Systemic Sclerosis Have Worse Medical Outcomes But Clinically Similar Implant Survival Independent of Immunomodulatory Therapy.","authors":"Anthony E Seddio, Helia Hosseini, Rajiv S Vasudevan, Michael J Gouzoulis, Lee E Rubin, Jonathan N Grauer","doi":"10.5435/JAAOSGlobal-D-24-00257","DOIUrl":"https://doi.org/10.5435/JAAOSGlobal-D-24-00257","url":null,"abstract":"<p><strong>Introduction: </strong>Systemic sclerosis (SSc) is a multisystem autoimmune disorder characterized by fibrosis and often early articular degeneration. Total hip arthroplasty (THA) is a procedure for which SSc patients may be considered. However, outcomes past hospital discharge and the association of exposure to common immunomodulatory therapy (IMT) agents on such outcomes remain unknown.</p><p><strong>Methods: </strong>Retrospective cohort study of SSc patients who underwent THA. Patients with SSc were matched in 4:1 ratio with (-)SSc controls based on age, sex, and Elixhauser Comorbidity Index. Incidence of 90-day medical and implant-related adverse events (AEs) were assessed by multivariable logistic regression, and 5-year revision was assessed by Kaplan-Meier survival analysis and log-rank test.</p><p><strong>Results: </strong>SSc patients undergoing THA demonstrated greater odds ratio (OR) of severe (OR 1.46) and minor AEs (OR 1.47; P < 0.001 for both). However, perioperative IMT utilization was not associated with notable modification of these odds (P > 0.05 for both). SSc patients demonstrated similar odds of 90-day implant-related AEs (P > 0.05 for all) and similar 5-year revision-free survival vs (-)SSc controls (97.3% vs. 96.6%, respectively; P = 0.200).</p><p><strong>Discussion: </strong>Patients with SSc undergoing THA experience increased 90-day medical AEs, independent of IMT utilization. Encouragingly, SSc patients demonstrated similar 90-day implant-related AEs and 5-year revision-free survival, suggesting that the major barrier to superior outcomes may not be implant related but rather driven by medical complications.</p>","PeriodicalId":45062,"journal":{"name":"Journal of the American Academy of Orthopaedic Surgeons Global Research and Reviews","volume":"9 4","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143812722","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"S2 Alar-Iliac Screw Insertion Safety With Augmented Reality-Assisted Surgical Navigation.","authors":"Maximillian Y Lee, Hania Shahzad, Varun K Singh, Richard Lee Price, Frank M Phillips, Safdar N Khan","doi":"10.5435/JAAOSGlobal-D-25-00012","DOIUrl":"10.5435/JAAOSGlobal-D-25-00012","url":null,"abstract":"<p><strong>Introduction: </strong>Augmented reality (AR) technology has existed for decades but is not commonly used in spine surgery. Studies have found AR to have a good safety profile and workflow advantages over robotic navigation in pedicle screw placement. This study evaluates the safety and accuracy of AR navigation with S2 alar-iliac (S2AI) screw placement, an area with challenging surgical anatomy and little published research.</p><p><strong>Methods: </strong>A retrospective chart review was conducted on patients undergoing spine surgery involving the S2AI corridor between November 2022 and September 2024 at two large academic medical centers. Patient and screw information was collected, and radiographs and CT scans were analyzed for screw safety and accuracy.</p><p><strong>Results: </strong>All 70 screws analyzed fully penetrated the sacroiliac joint with only one screw breaching the pelvis medially and no screws breaching the greater sciatic notch. No complications were found in the S2AI corridor.</p><p><strong>Conclusion: </strong>The S2AI corridor contains high-risk neurovasculature. Studies have demonstrated the superiority of robotic navigation over freehand navigation in this area. AR is noninferior to robotic navigation. AR, however, has radiation exposure, workflow, and training advantages over robotic navigation. Future work should investigate patient-reported outcomes, cost-benefit, and learning curve.</p>","PeriodicalId":45062,"journal":{"name":"Journal of the American Academy of Orthopaedic Surgeons Global Research and Reviews","volume":"9 4","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11964378/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143784552","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":"Orthopaedic Trainee Confidence in Elbow Arthrocentesis Using a Cadaveric Elbow Effusion Training Model.","authors":"Hassan Farooq, Andrew Chen, Amir M Boubekri, Madeline S Tiee, Dane Salazar, Nickolas G Garbis","doi":"10.5435/JAAOSGlobal-D-24-00333","DOIUrl":"10.5435/JAAOSGlobal-D-24-00333","url":null,"abstract":"<p><strong>Introduction: </strong>Elbow arthrocentesis facilitates diagnosis of infectious versus noninfectious elbow joint pathologies. Arthrocentesis is considered minimally invasive, but there is still risk for injury to surrounding structures and an associated learning curve. The purpose of this investigation was to compare orthopaedic trainee confidence and success at different levels of training while performing an elbow arthrocentesis through lateral and posterior approaches.</p><p><strong>Methods: </strong>Ten, fresh-frozen, cadaveric specimens were assigned to senior residents, junior residents, and interns. Two milliliters of ISOVUE contrast and fluoroscopic imaging was used to confirm needle placement. Twenty milliliters of blue dye was used to create a simulated effusion. Standardized instructions on performing a lateral and posterior elbow arthrocentesis were provided. Three consecutive lateral or posterior aspirations on three specimens were done and level of confidence (1 to 5) and number of attempts to successful aspiration were recorded. Data were analyzed using analysis of variance, t-tests, Kruskal-Wallis, and Mann-Whitney tests.</p><p><strong>Results: </strong>Mean attempts to successful aspiration did not differ between seniors, juniors, and interns (1.6, 1.5, and 2.4, respectively, P = 0.068). For all trainees, posterior approach required a mean of 2.7 attempts, whereas the lateral approach required a mean of 1.3 attempts (P < 0.001). Interns were not as confident as seniors and juniors during any aspiration (P < 0.05). Juniors and seniors had equivalent confidence (P = 0.234). Finally, trainees were more confident (mean rank = 73.5) with the lateral approach compared with the posterior approach (mean rank = 47.5; P < 0.001).</p><p><strong>Conclusion: </strong>Procedural confidence was dependent on the level of trainee and familiarity with approach. The number of attempts leading to successful aspiration only differed with approach and did not vary with respect to the level of training or confidence. These results provide important implications to consider while teaching orthopaedic trainees at varying levels of experience.</p>","PeriodicalId":45062,"journal":{"name":"Journal of the American Academy of Orthopaedic Surgeons Global Research and Reviews","volume":"9 4","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11957656/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143774535","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 Thumb Metacarpophalangeal Arthrodesis to Volar Plate Capsulodesis for Metacarpophalangeal Hyperextension in the Setting of Basal Joint Arthritis-A Case-Control Study.","authors":"Jeffrey Alan Marchessault, Benjamin Roy Smith, Alexandra Jordan Johnson, William David Currie","doi":"10.5435/JAAOSGlobal-D-25-00032","DOIUrl":"10.5435/JAAOSGlobal-D-25-00032","url":null,"abstract":"<p><strong>Introduction: </strong>Surgical treatment of metacarpophalangeal (MCP) joint hyperextension in the treatment of thumb basal joint arthritis can be categorized as motion preserving and arthrodesis. We compared minimum 2-year results between nonsurgical thumbs and thumbs undergoing ligament reconstruction with tendon interposition (LRTI) alone, thumb MCP arthrodesis, and volar plate capsulodesis as adjunct procedures to LRTI.</p><p><strong>Methods: </strong>Single surgeon patients with thumb MCP hyperextension >30° underwent arthrodesis or volar plate capsulodesis with LRTI. Thirty-one LRTI thumbs were compared with 22 LRTI with arthrodesis (LRTI + A), 21 LRTI with MCP capsulodesis (LRTI + C), and 65 nonsurgical controls. Patient-reported outcome measures were recorded with grip strength, tip pinch, lateral pinch, opposition, and pre-/postoperative hyperextension measured by one of the authors.</p><p><strong>Results: </strong>No difference was found in Michigan Hand Questionnaire scores (P = 0.13), QuickDASH values (P = 0.38), or visual analog scale results (P = 0.86). No difference was observed in grip strength (P = 0.97) or tip pinch (P = 0.66). Lateral pinch was decreased between LRTI and nonsurgical thumbs but not when compared with groups with adjunct MCP procedures (P = 0.0064). LRTI + A had the least opposition (P < 0.001). In the LRTI + C group, MCP hyperextension worsened in two patients (9%) and 14 of 22 (63%) had postoperative values equal or greater than 30°.</p><p><strong>Discussion and conclusion: </strong>Our LRTI + C cohort experienced persistent MCP hyperextension, with mean postoperative hyperextension of >30°. Despite the literature suggesting that this portends inferior outcomes, our LRTI + C cohort demonstrated near-equal outcomes when compared with the LRTI, LRTI + A, and control groups. We no longer perform capsulodesis for MCP hyperextension and offer arthrodesis for MCP arthrosis or hyperextension not actively correctable by the patient.</p>","PeriodicalId":45062,"journal":{"name":"Journal of the American Academy of Orthopaedic Surgeons Global Research and Reviews","volume":"9 4","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11939946/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143784545","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Novel Intravertebral Fixation Technique of Lumbar Osteoporotic Vertebral Bipedicular Dissociation Fractures.","authors":"Raphael Lotan, Arsan Shpigelman, Oded Hershkovich","doi":"10.5435/JAAOSGlobal-D-24-00372","DOIUrl":"10.5435/JAAOSGlobal-D-24-00372","url":null,"abstract":"<p><strong>Objective: </strong>A significant portion of traumatic spinal fractures involves the thoracolumbar spine. Fracture stabilization using pedicle screws initially demanded fixation of two levels above and below the fractured vertebra to achieve a stable construct. Over the years, a short-segment pedicle screw fixation was found to be adequate. Balloon kyphoplasty (BKP) is commonly used as a minimally invasive treatment for vertebral compression fractures. At times, lumbar burst fractures can extend to the posterior elements. These recently acknowledged subtypes of fracture do not cause posterior column instability other than coronal bipedicular dissociation. BKP alone is inadequate in these cases; a combination of BKP addressing anterior column reduction and support with a middle column stabilization by transpedicular fixation has the potential to treat all fracture elements without losing motion segments through a minimally invasive technique. This study aims to describe this novel concept and technique.</p><p><strong>Methods: </strong>Five patients were treated with the intravertebral fixation (IVF) technique for coronal bipedicular dissociation fractures. We describe the surgical technique and review the pertinent literature.</p><p><strong>Results: </strong>The IVF technique is clinically safe in stabilizing the specified fractures, with good clinical and functional outcomes.</p><p><strong>Conclusion: </strong>IVF is a promising surgical technique and an exciting treatment concept for unique fracture types involving bipedicular coronal dissociation with or without burst fracture. Further studies are required to assess long-term results and possible complications.</p><p><strong>Study design: </strong>Case series for a new surgical technique.</p>","PeriodicalId":45062,"journal":{"name":"Journal of the American Academy of Orthopaedic Surgeons Global Research and Reviews","volume":"9 4","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11939932/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143784543","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":"Rating the Efficacy of Diagnostic Imaging Studies Conducted for the Workup of Musculoskeletal Tumors.","authors":"William T Li, Sumail Bhogal, Matthew F Gong, Alexander P Hoffman, Trudy Zou, Margaret Gajda, Rana Naous, Karen Schoedel, Carol Andrews, Andrew Cordle, Stella Lee, Kurt R Weiss, Richard L McGough","doi":"10.5435/JAAOSGlobal-D-25-00015","DOIUrl":"10.5435/JAAOSGlobal-D-25-00015","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Concerns for missed diagnoses have led to increased ordering of diagnostic imaging. Patients with suspected musculoskeletal tumors may undergo nondiagnostic and unnecessary imaging studies before referral to a musculoskeletal oncologist. This can result in patients receiving excessive radiation exposures, accruing unnecessary costs, delays in treatment, and an unnecessary burden on healthcare systems.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Purpose: &lt;/strong&gt;The purposes of this study were to (1) internally rate the usefulness of imaging tests completed for musculoskeletal oncology patients undergoing evaluation using a novel scoring system, (2) determine the inter-rater reliability of providers who rated imaging tests, and (3) assess the costs incurred for imaging studies based on Medicare reimbursement rates.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A single-center, retrospective study was conducted on 112 patients who presented to our musculoskeletal oncology clinic for workup of a suspected mass from February 2021 to May 2021. After obtaining institutional review board approval, information regarding all radiographic images pertinent to the patient's workup was collected through a manual chart review. Patient information and images were sent to six fellowship-trained physicians for review. Providers then graded the appropriateness of each study using a five-point rating system. Final diagnoses were divided into three categories: bone lesions, soft-tissue lesions, and metastatic skeletal lesions. Inter-rater reliability was assessed using interclass correlation coefficient tests. The cost of wasteful tests was calculated using Medicare reimbursement rates.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Three hundred twenty-two imaging studies conducted on 112 patients were included in the study. For primary bone lesions, plain radiographs and MRI scans with and without contrast were the highest rated diagnostic studies. For soft-tissue lesions, MRI and CT scans without contrast were the highest rated diagnostic studies. For metastatic bone lesions, positron emission tomography/CT and MRI scans with and without contrast were highly rated diagnostic studies. For all tumor types, core needle biopsy was the highest rated invasive study. The overall interclass correlation coefficient between all providers was 0.33. 1.2% of studies ordered by our department were considered wasteful, accounting for around $1,775 (2.3%) of costs.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;Our study was conducted to internally rate the usefulness of imaging tests ordered for patients who presented to a musculoskeletal oncology clinic. For all tumor types, MRI, CT, and plain radiographs were frequently rated as helpful studies. Core needle biopsy was the highest rated invasive study. Bone scans were considered of limited utility for most bone lesions. The quantity of wasteful studies was low overall. Our study demonstrates the complexity in obtaining appropriate diagnostic imaging for the evalua","PeriodicalId":45062,"journal":{"name":"Journal of the American Academy of Orthopaedic Surgeons Global Research and Reviews","volume":"9 4","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11936625/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143784548","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 Medial Mini-Open Supine Achilles Repair: Outcomes of a Medially Based Mini-Open Technique Compared With Prone Techniques.","authors":"Christopher P Miller, Katherine Stanwood, Caroline Williams, John Zhao, Fernando Raduan","doi":"10.5435/JAAOSGlobal-D-24-00390","DOIUrl":"10.5435/JAAOSGlobal-D-24-00390","url":null,"abstract":"<p><strong>Background: </strong>Achilles tendon rupture treatment has changed substantially in the past decade, with an evolution toward less-invasive techniques and more convenient patient positioning. This review aims to report on the 1-year clinical outcomes of a medially based, mini-open, supine, Achilles tendon repair technique.</p><p><strong>Methods: </strong>In this retrospective review, all patients who underwent surgical management of an Achilles tendon rupture were included and analyzed based on approach, including (1) standard open prone technique, (2) mini-open repair, prone, and (3) medial mini-open repair, supine. Primary outcomes were the Patient-Reported Outcome Measures Information Systems (PROMIS) Physical Function, PROMIS Pain Interference, and PROMIS Depression scores. Secondary outcomes of interest were surgical time and complications.</p><p><strong>Results: </strong>Seventy-eight patients were included in this study who underwent Achilles tendon repair and were seen in follow-up at least 1-year postoperatively. Demographics are displayed in Table 1. No statistical difference was observed regarding sex, laterality, age, and mechanism between those with 1-year follow-up data and those who were lost to follow-up before the 1-year mark. Primary outcomes were notable for statistically significant difference in the PROMIS Depression score between the mini-open repair, prone group, and the mini-open repair, supine group. The remainder of the primary outcomes of interest were not statistically significant. Secondary outcomes were notable for markedly shorter surgical time for the mini-open repair, supine group compared with both the standard open prone and mini-open repair, prone groups, with times being 89, 72, and 58 minutes, respectively. Surgical time was defined as starting from the time the patient was anesthetized in the room and included positioning and time up until extubation.</p><p><strong>Conclusion: </strong>The medial mini-open repair, supine technique shows promise as a noninferior surgical option for acute Achilles tendon rupture repair with markedly decreased operating room time and 1-year outcomes with comparable results to both open and mini-open prone techniques.</p>","PeriodicalId":45062,"journal":{"name":"Journal of the American Academy of Orthopaedic Surgeons Global Research and Reviews","volume":"9 3","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11913408/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143651235","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":"Orthopaedic Oncologic Consultation Using Asynchronous Telemedicine: Expedited Triage and Reduced Clinic Visits.","authors":"Jonathan D Kass, Nicholas C Arpey, Devin J Conway, C Parker Gibbs, Mark T Scarborough, Andre R Spiguel","doi":"10.5435/JAAOSGlobal-D-25-00028","DOIUrl":"10.5435/JAAOSGlobal-D-25-00028","url":null,"abstract":"<p><strong>Introduction: </strong>Asynchronous telemedicine has emerged as a promising tool for increasing access to care and triaging patients for evaluation in clinic. However, the role of asynchronous telemedicine in the delivery of orthopaedic oncologic care has yet to be determined. The purpose of this study was to evaluate response time for these electronic consults and characterize their triage outcomes.</p><p><strong>Methods: </strong>Two hundred sixty-eight patients whose clinical data were reviewed using asynchronous telemedicine by an orthopaedic oncologist at a tertiary academic medical center from May 2020 to August 2023 were retrospectively identified. Demographic and clinical information, response time to consult, and triage outcome were collected and reported with descriptive statistics. Response time to asynchronous consults was compared with wait time for patients referred directly for a synchronous telehealth appointment using the Mann-Whitney U test.</p><p><strong>Results: </strong>Most patients (71.6%) live more than 100 miles from the clinic. After initial asynchronous review, 131 patients (48.9%) were invited to schedule an in-person appointment, 42 (15.7%) of whom eventually underwent biopsy or surgery. Nonsurgical follow-up with repeat imaging in the future was recommended for 72 patients (26.9%). As-needed follow-up was suggested for 65 patients (24.2%). The average response time to asynchronous consult was 6.9 days (median 4.0, SD 7.9 days) compared with wait time of 17.0 days (median 13.0, SD 17.9 days) for synchronous telehealth visit (P < 0.01).</p><p><strong>Conclusion: </strong>Asynchronous telemedicine can expedite triage of orthopaedic oncology patients and reduce unnecessary in-person visits, which may be particularly beneficial for those seeking care from far distances. Additional studies are needed to assess clinical outcomes and patient satisfaction with this approach to care delivery.</p>","PeriodicalId":45062,"journal":{"name":"Journal of the American Academy of Orthopaedic Surgeons Global Research and Reviews","volume":"9 3","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11913409/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143651323","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":"Secondary Infection of Adverse Local Tissue Reaction Leading to Amputation in a Patient With a Modular Knee Endoprosthesis.","authors":"Mikaela H Sullivan, Paul J Gagnet, Joshua R Labott, Diva R Salomao, Matthew T Houdek","doi":"10.5435/JAAOSGlobal-D-24-00293","DOIUrl":"10.5435/JAAOSGlobal-D-24-00293","url":null,"abstract":"<p><p>Three years after endoprosthetic reconstruction of the proximal tibia, a patient presented with a skin ulceration near the surgical site. The knee was not clinically infected, but the patient had elevated serum cobalt levels. Dermatological evaluation diagnosed a friction ulcer. The ulcer failed to heal, and the patient underwent débridement and local flap advancement. Cultures grew Staphylococcus epidermidis, and they were treated with antibiotics. The ulceration recurred and repeated limb salvage was discussed, although eventually, the patient elected to undergo amputation. Pathology from the resected ulcer showed fibrinoid necrosis with aseptic lymphocytic vasculitis-associated lesion.</p>","PeriodicalId":45062,"journal":{"name":"Journal of the American Academy of Orthopaedic Surgeons Global Research and Reviews","volume":"9 3","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11913413/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143651324","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}