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

{"title":"Accuracy of Ultrasound and MRI in Preoperative and Postoperative Management of Flexor Tendon Injuries: A Systematic Review and Meta-Analysis.","authors":"David Sahai, Gilad Rotem, Ruby Grewal, Assaf Kadar","doi":"10.5435/JAAOSGlobal-D-25-00091","DOIUrl":"10.5435/JAAOSGlobal-D-25-00091","url":null,"abstract":"<p><strong>Background: </strong>Complete and partial flexor tendon lacerations are challenging injuries to diagnose and manage. Imaging modalities can determine grade of laceration, and location of tendon ends preoperatively while detecting presence of adhesions, repair failure, and gap formation postoperatively. Despite these clear advantages, imaging modalities are underutilized because of issues with availability and concerns about accuracy.</p><p><strong>Methods: </strong>A systematic search of MEDLINE and Embase was conducted to identify papers examining the accuracy of ultrasonography (US) and MRI in preoperative and postoperative management of flexor tendon lacerations. COVIDENCE was used in blinded selection of papers for abstract and full-text review. R Studio was used for meta-analysis of pooled sensitivities and specificities, diagnostic odds ratios, and summary receiver operating curves of both US and MRI.</p><p><strong>Results: </strong>A total of 1197 papers were returned, with 40 being selected after full-text review and 24 being sufficient for statistical analysis. Significant heterogeneity existed for preoperative sensitivity of US and MRI, as well as preoperative specificity of US. MRI was more specific than US in the postoperative period (P < 0.01). Diagnostic odds ratios were >1 for all imaging modalities. The area under the curve for summary receiver operating curves in US preoperative, US postoperative, MRI preoperative, and MRI postoperative were 0.92, 0.81, 0.83, and 0.91, respectively.</p><p><strong>Conclusion: </strong>MRI is likely more specific than US in postoperative detection of tendon adhesions, tendon rupture, and gap formation following tendon repair. Notable heterogeneities exist in the literature, highlighting the future need for standardized comparisons of imaging modalities in preoperative management.</p>","PeriodicalId":45062,"journal":{"name":"Journal of the American Academy of Orthopaedic Surgeons Global Research and Reviews","volume":"9 11","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-11-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12571102/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145446127","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":"Sinus Tarsi Versus Extensile Lateral Approach For Calcaneal Fractures - A Multicenter Study.","authors":"Thomas M Seaver, Zachary Zeller, Paul Tornetta, Andrew J Marcantonio, Alexander J Ment, Hassan R Mir, Meghan McCaskey, Mitchell K Messner, Clay A Spitler, Erin L Hofer, Anna N Miller, Jerald Westberg, Jessica M Downes, Noah Joseph, Heather A Vallier, Yu Min Suh, Robert F Ostrum, Benjamin Ollivere, Adeel Ikram, Brian Mullis, Jorge Figueras, Darin M Friess, Emelia Sodders, Noelle L Van Rysselberghe, Michael J Gardner, Amanda Pawlak, Stephen Kottmeier, Saam Morshed, Zachary Lim, Aden Malik, Lawrence H Goodnough, Eli W Bunzel, Reza Firoozabadi, Patrick Yoon, Todd Pottinger, Pierce Johnson, Kalyan Chaliki","doi":"10.5435/JAAOSGlobal-D-25-00313","DOIUrl":"10.5435/JAAOSGlobal-D-25-00313","url":null,"abstract":"<p><strong>Introduction: </strong>The optimal surgical approach for intraarticular calcaneal fractures remains debated. This study compares deep infection rates between the extended lateral (EL) and sinus tarsi (ST) approaches.</p><p><strong>Methods: </strong>A retrospective review was conducted of 782 patients treated surgically for OTA 82B/C calcaneal fractures across 15 institutions. Deep infection was defined as requiring surgical débridement or treatment for osteomyelitis. Risk factors were identified using univariate and multivariate analyses.</p><p><strong>Results: </strong>Of 782 fractures, 444 were treated with EL and 338 with ST. Deep infections occurred in 6.8% of EL and 3.0% of ST cases (P = 0.017). Multivariate analysis found that surgical approach (P = 0.03) and age (P < 0.001) were independent risk factors. EL had more wound complications; ST had more symptomatic implants.</p><p><strong>Conclusion: </strong>The ST approach was associated with lower rates of deep infection and wound complications, even in higher-risk patients.</p>","PeriodicalId":45062,"journal":{"name":"Journal of the American Academy of Orthopaedic Surgeons Global Research and Reviews","volume":"9 11","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-11-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12577901/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145446129","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 Technique: Management of a Pathological Fracture in the Femoral Neck: Case Report and Literature Review.","authors":"Ali Hashem, Zaid AlShammari, Ahmed Altuwaim, Nouf A Altwaijri","doi":"10.5435/JAAOSGlobal-D-25-00119","DOIUrl":"10.5435/JAAOSGlobal-D-25-00119","url":null,"abstract":"<p><p>The unicameral bone cyst (UBC) is a benign lesion that affects children and adolescents between 4 and 14 years of age. They are defined by an osteolytic cavity filled with serous fluid, enclosed by a thin fibrous membrane. Moreover, they are closely associated with skeletal growth and biomechanical stresses during development. Surgical management of UBCs is crucial, particularly in weight-bearing bones, to reduce the risk of pathological fractures and maintain structural stability. These surgical procedures (such as curretage and bone grafting) aim to restore bone stability, prevent recurrence, and enhance long-term functional outcomes. Studying UBCs provides insight into the natural history and behavior of benign bone lesions, emphasizing the importance of growth and mechanical factors in skeletal pathology. This case report seeks to present our experience in managing UBCs of the proximal femur in Riyadh, Saudi Arabia, focusing on the tips needed in the surgical technique that can aid surgeons in the management of such cases.</p>","PeriodicalId":45062,"journal":{"name":"Journal of the American Academy of Orthopaedic Surgeons Global Research and Reviews","volume":"9 11","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-11-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12578122/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145446092","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":"Self-harm After Lumbar Fusion: Incidence of and Risk Factors for a Rare But Potentially Devastating Complication.","authors":"Justin J Turcotte, Jane C Brennan, Andrea H Johnson, Chad M Patton","doi":"10.5435/JAAOSGlobal-D-25-00199","DOIUrl":"10.5435/JAAOSGlobal-D-25-00199","url":null,"abstract":"<p><strong>Introduction: </strong>Unfortunately, some lumbar fusion patients will experience psychological distress and a deterioration of mental health postoperatively. At the extreme, these changes can lead to self-harm and suicide. This study evaluated the incidence of self-harm within 1 year of elective lumbar fusion procedures to identify risk factors for self-harm events.</p><p><strong>Methods: </strong>The PearlDiver Mariner 170 data set from 2010 to 2023 was retrospectively analyzed. Patients undergoing 1-level to 3-level posterior lumbar fusion with minimum 1-year follow-up were included. Patients with a history of self-harm before surgery were excluded. Univariate and multivariate analyses were done to assess risk factors for self-harm. Statistical significance was assessed at P < 0.05.</p><p><strong>Results: </strong>In total, 138,223 patients were included. The incidence of self-harm within 1 year was 0.40% (549 patients). In the multivariable model, younger age, male sex, and higher Charlson Comorbidity Index scores were risk factors for self-harm. Specific comorbidities associated with increased risk for self-harm included alcohol use disorder, anxiety disorders, depression, tobacco use, and preoperative opioid use (all P < 0.001). The strongest associations between comorbidity and self-harm were seen for depression (odds ratio [OR] = 2.68), anxiety (OR = 2.03), and alcohol use disorder (OR = 1.89).</p><p><strong>Conclusion: </strong>Self-harm is a rare, yet understudied potential complication of lumbar fusion procedures. In this national database study, the incidence of self-harm was 0.4% in the year after elective lumbar fusion. Although some risk factors for self-harm are nonmodifiable, other behavioral and mental health comorbidities may serve to flag patients as targets for early preventive intervention.</p>","PeriodicalId":45062,"journal":{"name":"Journal of the American Academy of Orthopaedic Surgeons Global Research and Reviews","volume":"9 11","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-11-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12578104/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145446154","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 Postoperative Acetabular Wall Index on Patient-Reported Outcomes After Transposition Osteotomy of the Acetabulum in Patients With Hip Dysplasia.","authors":"Shiori Tanaka, Masanori Fujii, Shunsuke Kawano, Masaya Ueno, Satomi Nagamine, Masaaki Mawatari","doi":"10.5435/JAAOSGlobal-D-25-00154","DOIUrl":"10.5435/JAAOSGlobal-D-25-00154","url":null,"abstract":"<p><strong>Introduction: </strong>This study aimed to determine the effect of preoperative variables and three-dimensional acetabular correction on patient-reported outcome measures after transposition osteotomy of the acetabulum (TOA), a spherical periacetabular osteotomy.</p><p><strong>Methods: </strong>We retrospectively reviewed 442 patients (582 hips) with hip dysplasia who underwent TOA between 1998 and 2019 and completed validated questionnaires, including the visual analog scale (VAS) for pain and satisfaction and the Hip disability and Osteoarthritis Outcome Score (HOOS). The median follow-up was 12 years. Associations between patient-reported outcome measures and preoperative variables and postoperative acetabular coverage (lateral center-edge angle, anterior wall index, and posterior wall index) were analyzed.</p><p><strong>Results: </strong>Older age was negatively correlated with HOOS-ADL (r = -0.26, P < 0.001) and HOOS-sports/recreation (r = -0.25, P < 0.001). Male patients reported lower median HOOS-QOL than female patients (P = 0.038). Patients with Tönnis grade 0 had higher median satisfaction-VAS than those with grade 2 (P = 0.031), and higher median HOOS-ADL, sports/recreation, and QOL subscales than those with grade 1 or 2. For postoperative anterior wall index, the deficient group had higher VAS-pain (P = 0.045) and lower HOOS-pain (P = 0.047) than the normal group. For postoperative posterior wall index, the excessive group had lower HOOS-pain than the normal group (P = 0.029).</p><p><strong>Conclusion: </strong>Even in preserved hips after TOA, sagittal plane acetabular correction influenced postoperative pain, whereas age, sex, and Tönnis grade affected satisfaction, functional capacity, and QOL. These insights have implications for refining surgical indications and acetabular reorientation strategies, improving postoperative patient experience.</p>","PeriodicalId":45062,"journal":{"name":"Journal of the American Academy of Orthopaedic Surgeons Global Research and Reviews","volume":"9 10","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12543230/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145349133","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":"Effect of Glucagon-like Peptide-1 Receptor Agonists on Outcomes After Hip Hemiarthroplasty for Femoral Neck Fractures in Patients With Type 2 Diabetes.","authors":"McKenna W Box, Troy B Puga, Neil J Werthmann, Yingxian Liu, John T Riehl","doi":"10.5435/JAAOSGlobal-D-25-00312","DOIUrl":"10.5435/JAAOSGlobal-D-25-00312","url":null,"abstract":"<p><p>The use of glucagon-like peptide-1 receptor agonists (GLP-1RA) in patients with type 2 diabetes mellitus (T2DM) has increased substantially over the past several years. The purpose of this study was to determine whether GLP-1RA use affects outcomes after hip hemiarthroplasty (HA) for femoral neck fractures (FNFs). A retrospective cross-sectional analysis of a local hospital system database was conducted between 2016 and 2023 to identify patients with T2DM aged at least 18 years who underwent HA for FNFs and were on a GLP-1RA at the time of injury. A 1:1 random patient sample of those who underwent HA and were not on a GLP-IRA was used as a control. Patient characteristics and Elixhauser comorbidity index were recorded. Outcomes included hospital length of stay, aspiration pneumonitis during index hospitalization, inpatient readmissions and emergency department encounters within 365 days, medical complications, surgical site infection, implant complications, revision hip surgery, and in-hospital mortality/discharge to hospice within 30, 90, and 365 days. Binary logistic regression was done to assess the 30-day risk of medical and the 365-day risk of implant postoperative outcomes. Four hundred ninety-nine patients (GLP-1RA, N = 248; No GLP-1RA, N = 251), with T2DM, who underwent HA for FNF were included for analysis. GLP-1RA use was not markedly associated with medical complications within 30, 90, or 365 days; implant complications or revision surgery within 365 days; in-hospital mortality/discharge to hospice within 30 or 90 days; postoperative aspiration; length of stay; or inpatient readmissions or emergency department encounters. GLP-IRA use was associated with a decreased risk of in-hospital mortality/discharge to hospice within 365 days. When controlling for confounding variables, the use of GLP-IRA was not associated with any adverse outcome measured in the study (P > 0.05). GLP-1RA use in T2DM patients undergoing HA for FNF is not associated with an increased risk of early postoperative medical and surgical complications.</p>","PeriodicalId":45062,"journal":{"name":"Journal of the American Academy of Orthopaedic Surgeons Global Research and Reviews","volume":"9 10","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12543238/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145349137","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":"Improving Total Joint Outcomes: A Survey of Surgeon Implementation of Perioperative Optimization Protocols.","authors":"Fong H Nham, Mouhanad M El-Othmani, Devan O Higginbotham, Daniel Alsoof, Carlos Higuera Rueda, Hussein Darwiche, Eric Cohen","doi":"10.5435/JAAOSGlobal-D-25-00041","DOIUrl":"10.5435/JAAOSGlobal-D-25-00041","url":null,"abstract":"<p><strong>Introduction: </strong>Perioperative nutritional, functional status, and bone health optimization has been supported in the literature before arthroplasty procedures; however, surgeon's perception and implementation of such efforts have yet to be investigated. This study aims to identify the current perception and implementation efforts of arthroplasty surgeons in the nation regarding nutritional, functional status, and bone health optimization.</p><p><strong>Methods: </strong>A 28-question survey was anonymously distributed to orthopaedic arthroplasty surgeons through the American Association of Hip and Knee Surgeon contact database. Survey responses were compiled and analyzed with chi square.</p><p><strong>Results: </strong>Sixty-four total arthroplasty surgeons completed the questionnaire with the following geographic distribution: 33% Midwest, 27% Northeast, 23% Southeast, and 16% West. Forty-six percentage of survey participants reported a formal departmental nutrition optimization protocol despite 14% of surgeons doubting the benefits of nutritional optimization. The perceived goals of nutrition intervention were predominantly decreasing complications rates and weight loss. Seventy-five percentage of surveyed respondents report an absence of functional status optimization protocol in place with 38% of surgeons' initial functional assessment begins with patient ambulation dependency. In addition, 13% of surgeon routinely assess bone health with a dual energy x-ray absorptiometry scan for suspicion of osteoporosis, and 87% of surgeons would not delay surgery for bone health optimization.</p><p><strong>Conclusion: </strong>Despite data suggesting the benefits of perioperative nutritional, functional status, and bone health optimization, many barriers to implementation exist. Predominant barriers include compliance rate and logistical challenges of implementation. Comprehension of current perceptions and common practice can provide information to direct future optimization protocol development.</p>","PeriodicalId":45062,"journal":{"name":"Journal of the American Academy of Orthopaedic Surgeons Global Research and Reviews","volume":"9 10","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12543228/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145349056","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 Local Vancomycin on Postoperative Outcomes in Ankle Arthrodesis: A Propensity-Matched Cohort Study.","authors":"Avani A Chopra, Tuckerman Jones, Abhiram Dawar, Gnaneswar Chundi, David Ahn, Jonathan Lopez, Scott Tucker, Sheldon Lin, Michael Aynardi","doi":"10.5435/JAAOSGlobal-D-25-00320","DOIUrl":"10.5435/JAAOSGlobal-D-25-00320","url":null,"abstract":"<p><strong>Introduction: </strong>In orthopaedic surgery, intrawound vancomycin has become a widely used strategy to reduce the incidence of surgical site infections, commonly caused by gram-positive microorganisms. This study evaluated the incidence of postoperative orthopaedic complications in patients undergoing ankle arthrodesis with and without the use of intrawound vancomycin.</p><p><strong>Methods: </strong>This retrospective study used data from the TriNetX Research Network to identify patients who underwent ankle arthrodesis between October 1, 2002, and October 1, 2022. This population was divided into two cohorts: patients who received perioperative cefazolin and local vancomycin (cefazolin-vancomycin) and patients who received perioperative cefazolin but no local vancomycin (cefazolin-only). This study assessed rates of implant-related complications occurring within 2 years of the arthrodesis.</p><p><strong>Results: </strong>A total of 374 patients in the cefazolin-vancomycin cohort and 5,218 in the cefazolin-only cohort were identified, with an average age of 58.0 ± 14.0 years and 56.6 ± 14.6 years, respectively (P = 0.083). Before matching, the cefazolin-vancomycin cohort had higher rates of comorbidities, including diabetes (30% vs. 21%, P < 0.001), obesity (32% vs. 21%, P < 0.001), and liver disease (13% vs. 5%, P < 0.001). After propensity matching, each cohort had 373 patients. The cefazolin-vancomycin group demonstrated a significantly lower risk of nonunion (13% vs. 19%, P = 0.020), whereas other outcomes showed no statistically significant differences.</p><p><strong>Conclusion: </strong>This study evaluated the incidence of postoperative complications in patients undergoing ankle arthrodesis with and without intrawound vancomycin. The analysis demonstrated a markedly lower nonunion rate in the cefazolin-vancomycin group (13%) compared with the cefazolin-only group (19%), aligning with previously reported rates but lower than those seen in high-risk populations. These findings suggest that local vancomycin administration may mitigate nonunion risk and optimize fusion outcomes in ankle arthrodesis by reducing infection.</p>","PeriodicalId":45062,"journal":{"name":"Journal of the American Academy of Orthopaedic Surgeons Global Research and Reviews","volume":"9 10","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12543240/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145349058","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":"Simultaneous or Staged Bilateral Total Hip Arthroplasty: An Analysis of 82,897 Patients.","authors":"Lindsey Peng, Blaire Peterson, Aaron Singh, Travis Kotzur, Kathleen Lundquist, Chance Moore, Frank Buttacavoli","doi":"10.5435/JAAOSGlobal-D-25-00046","DOIUrl":"10.5435/JAAOSGlobal-D-25-00046","url":null,"abstract":"<p><strong>Introduction: </strong>Total hip arthroplasty (THA) is one of the most common orthopaedic procedures. Although unilateral THA is routine, there is limited guidance on managing patients who require bilateral arthroplasty. This study aims to compare the outcomes of simultaneous versus staged bilateral THA.</p><p><strong>Methods: </strong>This was a cohort retrospective study drawing data from the National Readmissions Database, years 2016 to 2020. Patients undergoing bilateral THA were identified using International Classification of Diseases, 10th Revision, Clinical Modification/Procedure Coding System (ICD-10) codes. For staged procedures, outcomes for each surgery were combined for appropriate comparison with simultaneous surgeries. Propensity score matching was performed to balance patient demographics, socioeconomic status, and comorbidities, between the two groups. Multivariate regression was performed to assess outcomes between groups. Multivariate regression analyses were conducted on the matched cohorts to assess postoperative outcomes, 90-day readmission, and 90-day revision surgery rates.</p><p><strong>Results: </strong>A total of 82,897 patients, 71,560 (86.3%) undergoing staged bilateral and 11,337 (13.7%) undergoing simultaneous bilateral THA, were included. After successful matching, those undergoing staged bilateral THA had increased medical (odds ratio [OR], 1.26; P < 0.001), but reduced surgical complications (OR, 0.66; P < 0.001), particularly reduced need for blood transfusions (OR, 0.38; P < 0.001). Those undergoing the staged procedure also had reduced odds of revision surgery (OR, 0.85; P = 0.001) but increased odds of readmission (OR, 1.14; P < 0.001), routine discharge (OR, 1.20; P < 0.001), longer lengths of stay (OR, 1.09; P < 0.001), and greater total charges (OR, 1.20; P < 0.001).</p><p><strong>Conclusion: </strong>When compared with simultaneous THA, staged THA was associated with reduced surgical complications, particularly transfusions, but greater medical complications. Although associated with reduced revision surgeries and resulted in better discharge disposition, staged bilateral THA required more days in the hospital and were more expensive. This suggests that both simultaneous and staged bilateral THA are viable options. Surgeons should consider individual patient risks and preferences when planning bilateral THA.</p><p><strong>Study design: </strong>Level III; Retrospective Cohort Study.</p>","PeriodicalId":45062,"journal":{"name":"Journal of the American Academy of Orthopaedic Surgeons Global Research and Reviews","volume":"9 10","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12543236/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145349099","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":"Effect of Mental Health Diagnoses on Postoperative Outcomes and Secondary Treatment Utilization After Surgery for Adhesive Capsulitis: A Retrospective Large Database Analysis.","authors":"Harmon S Khela, Monty S Khela, John D Kelly, Liane Miller","doi":"10.5435/JAAOSGlobal-D-24-00394","DOIUrl":"10.5435/JAAOSGlobal-D-24-00394","url":null,"abstract":"<p><strong>Introduction: </strong>Adhesive capsulitis (AC) is a debilitating condition that markedly affects shoulder mobility and function. Mental health disorders have been associated with poorer outcomes for orthopaedic patients; however, their specific effect on postoperative outcomes after surgery for AC remains underexplored.</p><p><strong>Methods: </strong>Patients who underwent arthroscopic capsular release or manipulation under anesthesia for AC were identified in the PearlDiver database. Patients with preexisting mental health diagnoses (anxiety, depression, bipolar disorder, or schizophrenia) were matched 1:1 with control subjects based on age, sex, and Charlson Comorbidity Index. Rates of 90-day complications and 2-year surgical outcomes were analyzed through multivariable logistic regression. Kaplan-Meier analyses generated 10-year cumulative incidence rates of postoperative therapeutic modalities, and a Cox proportional hazard ratio (HR) model generated HRs and 95% confidence intervals.</p><p><strong>Results: </strong>Among 42,862 patients identified, 26.1% had a preoperative mental health diagnosis. After matching, patients with a mental health disorder experienced greater risk for 90-day hospital readmission (odds ratio [OR] = 1.33, P < 0.001), emergency department visits (OR = 1.81, P < 0.001), and several postoperative complications, including acute kidney injury (OR = 1.60, P < 0.001), wound complications (OR = 1.63, P = 0.028), pneumonia (OR = 1.46, P < 0.001), urinary tract infection (OR = 1.22, P < 0.001), and stroke (OR = 1.75, P = 0.005). Patients with mental health disorders were also more likely to undergo physical therapy (OR = 1.18, P < 0.001), intra-articular injections (OR = 1.27, P < 0.001), and any secondary treatment (OR = 1.22, P < 0.001) 2 years after surgery. In addition, preexisting mental health disorders were associated with an increased 10-year cumulative incidence and risk of physical therapy (53.7% versus 52.0%, HR = 1.09, P 0.001), intra-articular injections (32.0% versus 28.6%, HR = 1.20, P < 0.001), and any secondary treatment (64.9% versus 62.7%, HR = 1.10, P < 0.001).</p><p><strong>Conclusion: </strong>Patients with existing mental health disorders experienced increased rates of complications and a higher risk of secondary treatment utilization over a 10-year period after surgery for AC. Awareness of these risks is essential for optimizing postoperative care and addressing the complex needs of this patient population.</p>","PeriodicalId":45062,"journal":{"name":"Journal of the American Academy of Orthopaedic Surgeons Global Research and Reviews","volume":"9 10","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12543239/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145349069","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}