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

{"title":"Short-Term Outcomes of Noncemented Total Knee Arthroplasty in Patients With Morbid Obesity.","authors":"Michelle R Shimizu, Hanna E House, Nicholas M Brown","doi":"10.5435/JAAOSGlobal-D-24-00299","DOIUrl":"https://doi.org/10.5435/JAAOSGlobal-D-24-00299","url":null,"abstract":"<p><strong>Introduction: </strong>Noncemented primary total knee arthroplasty (TKA) compromises over 14% of all primary TKA procedures reported in the American Joint Replacement Registry. While studies have indicated similar outcomes for cemented and noncemented TKA in obese individuals, the efficacy and safety of noncemented TKA in morbidly obese patients (body mass index [BMI] ≥ 40 kg/m2) remain unexplored. This study compares short-term postoperative outcomes and complications between noncemented and cemented TKA in morbidly obese patients.</p><p><strong>Methods: </strong>A retrospective review of 605 cases of patients with a BMI of at least 40 kg/m2 (22.5% of 2,691 total cases at a single tertiary center) who underwent TKA was conducted. All patients had a minimum follow-up of 1 year. Data collected included age, BMI, sex, race, ethnicity, American Society of Anesthesiologists status, and the Charlson Comorbidity Index. Postoperative complications were tracked, including 90-day readmission, 1-year mortality, 1-year revision surgery, wound complications, fractures, and infections. Categorical variables were analyzed with chi-square tests and continuous variables with t-tests.</p><p><strong>Results: </strong>Of the included patients with a BMI ≥ 40 kg/m2, 40 (6.6%) received noncemented TKA. The noncemented TKA group had a lower mean BMI (43.3 ± 3.1 vs. 45.0 ± 4.4; P = 0.012) and a higher proportion of male patients compared with the cemented group (n = 17 [42.5%] vs. n = 143 [25.3%]; P = 0.028). Surgical time was shorter for noncemented TKA (97 ± 27 minutes) than for cemented TKA (118.0 ± 39.4 minutes; P = 0.001). No significant differences were found in length of stay and postoperative complications, including 90-day readmission, 1-year mortality, revision surgery rates, wound complications, fractures, and infections.</p><p><strong>Conclusion: </strong>The findings of the study suggest that noncemented TKA may be a feasible, safe alternative and not inferior to the standard cemented TKA in patients with morbid obesity with the benefit of decreasing surgical time.</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":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11845207/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143558144","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":"Below-Knee Amputations: A Qualitative Social Media Analysis of Perceived Outcomes.","authors":"Jacob Anderson, Paul Gaschen, Neil Jain, Caroline Cushman, Evan J Hernandez, Brendan J Mackay","doi":"10.5435/JAAOSGlobal-D-24-00198","DOIUrl":"10.5435/JAAOSGlobal-D-24-00198","url":null,"abstract":"<p><strong>Introduction: </strong>Below-knee amputations (BKAs) treat lower-limb conditions such as ischemia, peripheral artery disease, and trauma. This study uses social media to examine patient outcomes and perspectives post-BKA.</p><p><strong>Methods: </strong>Data from Facebook, Instagram, and X (formerly Twitter) from February 26, 2014, to February 26, 2024, were analyzed. Posts from the Facebook groups \"Amputee Support Group\" and \"Below Knee Amputee,\" along with posts tagged with #belowkneeamputation and #belowkneeamputee on Instagram and X, were examined for demographics, perspective, and perceived outcomes.</p><p><strong>Results: </strong>Analysis of 571 Facebook posts, 520 Instagram posts, and 64 X posts revealed 67% positive outcomes, 20.1% neutral, and 12.9% negative. Instagram showed the most positive responses, often from patients resuming physical activities. Facebook was predominant with neutral posts seeking advice, while X displayed mostly positive feedback. Negative feedback on Facebook centered on phantom pain and reduced quality of life.</p><p><strong>Discussion and conclusion: </strong>Most BKA patients reported positive postoperative outcomes. Facebook emerged as a vital platform for individuals to share their challenges and seek support, enabling them to join specialized support groups where they can connect with others facing similar issues and receive advice and encouragement. Negative outcomes, often related to persistent pain and dissatisfaction with life quality, underscore the need for surgeons to manage expectations and address physical and emotional recovery aspects of BKA.</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":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11878987/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143558023","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":"Pediatric Rupture of Hallux Interphalangeal Joint Lateral Collateral Ligament.","authors":"Mazen Zamzam, Colin Van Wagoner, Imran Bitar, Ehab Saleh","doi":"10.5435/JAAOSGlobal-D-24-00307","DOIUrl":"10.5435/JAAOSGlobal-D-24-00307","url":null,"abstract":"<p><p>Ligamentous injuries of the hallux are rare, and when seen, they are most commonly treated conservatively. Surgical treatment of such injuries is also rare, making reports on the postoperative outcome and complications even less frequent. A case report of a hallux interphalangeal joint (IPJ) lateral collateral ligament tear in a 16-year-old gymnast is presented. Initially, she presented to the clinic with pain in her left hallux. She injured her toe while doing a gymnastic maneuver in which it got stuck and hyperextended. Physical examination revealed pain in her left great toe metatarsophalangeal and IPJs. Her medical history included the diagnosis of Ehlers-Danlos syndrome. She was managed conservatively with a controlled ankle motion boot for 4 weeks. When she returned for follow-up, her physical examination showed increased laxity to the great toe IPJ lateral collateral ligament compared with the other foot. A left foot MRI was done, which showed a complete rupture of the IPJ lateral collateral ligament origin (Figure 1). She underwent surgical intervention 6 weeks following her injury, in which the collateral ligament was repaired with suture anchors along with IP joint pinning to protect the repair (Figure 2). Following surgery, she returned to the clinic because of persistent drainage from a small hole near the incision site. During further incision and débridement, we discovered granulomatous tissue surrounding an embedded suture. The suture was removed, and the wound was irrigated. Following this procedure, the patient recovered fully in 3 weeks. She was provided a home exercise program and returned to gymnastics without limitations, toe pain, or instability. This case demonstrates an interesting complication following collateral ligament repair in the hallux.</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":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11878989/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143558024","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":"Effectiveness of a Supervised Patient Ambulation Program in Reducing Fall Risk Following Total Joint Arthroplasty.","authors":"Steven G Kenney, Kishan S Shah, Jenna M Tabbaa, Audree S Evans, William D Bugbee, Steven N Copp","doi":"10.5435/JAAOSGlobal-D-24-00407","DOIUrl":"10.5435/JAAOSGlobal-D-24-00407","url":null,"abstract":"<p><strong>Background: </strong>Total hip arthroplasty and total knee arthroplasty rank among the most prevalent orthopaedic procedures performed globally. Early mobilization postarthroplasty reduces complications, shortens length of stay, and optimizes recovery. However, the incidence of falls remains high, leading to complications and increased costs. Ensuring patient safety during mobilization is critical to minimizing fall risks.</p><p><strong>Methods: </strong>In 2014, our institution created a supervised patient ambulation program called \"No One Walks Alone\" (NOWA). A retrospective review of patients undergoing total knee arthroplasty or total hip arthroplasty between 2011 and 2017 was conducted. The inclusion criteria spanned the preimplementation group (2011 to 2013) (N = 3069) and the postimplementation group (2015 to 2017) (N = 3947). Patients in the postimplementation group were enrolled in the \"No One Walks Alone\" supervised ambulation program. Data on patient demographics, procedures, hospital stay, fall rates, and postfall complications were collected. A logistic regression analysis was done to identify fall risk factors, and statistical analyses were used to compare outcomes between the patient groups.</p><p><strong>Results: </strong>Inpatient fall rates decreased from 2.5 to 1.0 per 1000 inpatient days between the preimplementation and postimplementation groups, respectively. The difference in fall rates between the two periods was statistically significant (P value < 0.002). Fall-related complications were notably reduced in the postimplementation group. In addition, the postimplementation group saw a statistically and clinically notable reduction in average length of stay in the hospital compared with the preimplementation group by 0.75 days (P value < 0.001).</p><p><strong>Conclusion: </strong>Implementation of a supervised ambulation program was found to markedly reduce fall rates, length of stay, and fall-related complications, demonstrating the importance of proactive interventions to improve patient safety following arthroplasty.</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":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11875583/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143543981","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 Burden of Revision Arthroplasty: An Ergonomic Analysis of Surgeon Posture in the Operating Room.","authors":"Cody Green, Zachary Gapinski, Eric Mason, Ezan Kothari, Pratik Desai, George Haidukewych","doi":"10.5435/JAAOSGlobal-D-24-00290","DOIUrl":"10.5435/JAAOSGlobal-D-24-00290","url":null,"abstract":"<p><strong>Background: </strong>Revision total joint arthroplasties are physically demanding cases. Recent studies have shown increased cardiovascular stress in surgeons performing revision total knee arthroplasty (rTKA) and revision total hip arthroplasty (rTHA) compared with primary cases. To our knowledge, no study has compared surgeon ergonomics during these cases. The purpose of this study was to analyze surgeon posture during primary and revision THA and TKA.</p><p><strong>Methods: </strong>We prospectively evaluated 286 consecutive cases (103 primary TKAs, 95 primary THAs, 57 rTKAs, and 31 rTHAs) performed by three high-volume, fellowship-trained arthroplasty surgeons. Throughout each case, surgeons wore a posture-tracking device to evaluate time spent slouching. The threshold for slouching was set to 30 degrees of flexion from the neutral spinal axis. Demographic and surgical factors were collected. Two-tailed t-tests and multivariate analysis were used to assess differences between groups.</p><p><strong>Results: </strong>After controlling for individual differences in posture, we found an increase in percentage and duration of time spent slouching between rTHA and primary THA cases (58.9% vs. 43.2%, P < 0.001; 65.1 vs. 32.6 minutes, P < 0.001). In the multivariate analysis, patient body mass index and rTHA were found to be an individual contributor to slouching percentage in THAs (P = 0.001). We found increased duration of time spent slouching between rTKA and primary TKA (80.2 vs. 45.7 minutes, P < 0.001); however, percentage time slouching showed no difference (67.1% vs. 58.5%, P = 0.175). Active fellow involvement was an individual contributor to decreased time slouching in both TKA and THA groups (P < 0.001).</p><p><strong>Conclusions: </strong>Surgeons performing revision total joint arthroplasty spend markedly more case time in a slouched posture compared with primary arthroplasty, particularly in patients with a higher body mass index. Awareness of the surgical and patient factors that can affect posture in TKAs and THAs can help arthroplasty surgeons gain more awareness about injury prevention and potentially help prolong their career.</p>","PeriodicalId":45062,"journal":{"name":"Journal of the American Academy of Orthopaedic Surgeons Global Research and Reviews","volume":"9 2","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-02-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11826046/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143442380","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":"Is the Effect of Chronological Age on Postoperative Complications Related to Comorbidity Burden? A Population Study of Revision Total Knee Arthroplasty Patients.","authors":"Yun Yan, Weixia Li, Alex Illescas, Gwo-Chin Lee, Stavros G Memtsoudis, Jing Zhao, Jiabin Liu","doi":"10.5435/JAAOSGlobal-D-24-00266","DOIUrl":"10.5435/JAAOSGlobal-D-24-00266","url":null,"abstract":"<p><strong>Background: </strong>The number of revision total knee arthroplasty (TKA) procedures continues to rise. Both advanced chronological age and comorbidity burden are associated with poor surgical outcomes. However, the question remains whether these two factors have a synergistic effect. Does a patient with advanced age and notable comorbidity burden carry an exponentially increased risk of complications after revision TKA? This study aims to investigate the effect of chronological age on various Charlson-Deyo Comorbidity Index (CDI) categories among revision TKA patients.</p><p><strong>Methods: </strong>A total of 144,402 patients who underwent elective revision TKA between 2006 and 2022 were identified from the Premier Healthcare Database. The primary outcome was the effect of chronological age on surgical outcomes following revision TKA, while stratified by the CDI. The analyzed postoperative complications in this study included postoperative cardiac complications, pneumonia, acute kidney injury, infections, central nervous system complications, and intensive care unit admissions. Spearman rank correlation coefficients and logistic regression models were used for analysis. Age was evaluated as both a continuous variable and categorical variable (<80 years versus 80+ years).</p><p><strong>Results: </strong>Both CDI and chronological age were associated with worse outcomes, with odds ratio (OR) 1.358 to 1.829 and OR 1.015 to 1.070, respectively, across these outcomes of interest. Patients aged 80 years and older had a markedly higher risk of postoperative complications across all CDI categories (OR 1.698 to 3.695) compared with patients younger than 80 years of age. The effect of chronological age on surgical outcomes does not vary under different CDI categories as chronological age presented similar patterns of OR trends on complications.</p><p><strong>Conclusion: </strong>Chronological age and CDI were independent risk factors for postoperative complications in patients after revision TKA. Chronological age and CDI did not exhibit a synergistic effect on outcomes after revision TKA as the trends of impact from chronological age on outcome remained similar across different CDI categories.</p>","PeriodicalId":45062,"journal":{"name":"Journal of the American Academy of Orthopaedic Surgeons Global Research and Reviews","volume":"9 2","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-02-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11826044/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143442377","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-Reported Mental Health and Quality of Life in Pediatric Adolescent Idiopathic Scoliosis Patients.","authors":"Tyler J Feddema, Florian Z A Miller, Mark A Erickson, Sumeet Garg","doi":"10.5435/JAAOSGlobal-D-24-00253","DOIUrl":"10.5435/JAAOSGlobal-D-24-00253","url":null,"abstract":"<p><p>Adolescent idiopathic scoliosis (AIS) is a prevalent spinal deformity that can affect patients' mental health and overall quality of life. Orthopaedic providers commonly employ questionnaires such as the (scoliosis research society) SRS-22, PROMIS, and pediatric/s quality of life, among others, to assess patient-reported outcomes, including pain interference, depressive symptoms, and self-image. This article aims to examine the effect of various AIS treatments on patients' mental health and health-related quality of life (HRQoL), while also discussing the utility of these questionnaires in clinical research. The reviewed studies consistently demonstrate that treatment may influence patients' mental health, emphasizing the vital role of questionnaires in measuring mental health and HRQoL throughout their treatment journey. Furthermore, these instruments enable healthcare providers to implement strategies that enhance patients' mental well being as part of their treatment plans. AIS poses a risk factor for poor mental health and HRQoL. However, further research is warranted to determine the longitudinal effect of AIS on mental health and HRQoL. These investigations will empower healthcare providers to identify optimal treatment plans, thereby alleviating the burden on the mental health and HRQoL of AIS patients.</p>","PeriodicalId":45062,"journal":{"name":"Journal of the American Academy of Orthopaedic Surgeons Global Research and Reviews","volume":"9 2","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11810007/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143392171","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":"An Examination of Screening Practices for Developmental Dysplasia of the Hip Across Sri Lankan Medical Specialties.","authors":"Duneesha De Silva, Dimuthu Chrishantha Tennekoon, Shaman Rajindrajith, Upul Jerrard Fernando, Anuradha Rajapaksha, Alaric Aroojis, Kishore Mulpuri, Emily Schaeffer, Sunil Ranjith Wijayasinghe","doi":"10.5435/JAAOSGlobal-D-24-00264","DOIUrl":"10.5435/JAAOSGlobal-D-24-00264","url":null,"abstract":"<p><strong>Introduction: </strong>Sri Lanka has no formal care pathway to assess for developmental dysplasia of the hip (DDH), which may lead to later diagnosis, more invasive treatments, and long-term adverse health outcomes. With the goal of developing a care pathway for DDH in Sri Lanka, we first surveyed relevant medical specialties regarding their experience with DDH screening, diagnosis, and treatment to understand current screening and diagnosis practices.</p><p><strong>Methodology: </strong>A panel composed of four members affiliated with three Sri Lankan organizations collaborated with our team of researchers to inform the development of three specialty specific surveys. We distributed the surveys electronically to radiologists, pediatricians, neonatologists, and orthopedic surgeons.</p><p><strong>Results: </strong>From the surveys, we gained an understanding of the present screening procedures. We identified potential areas to improve screening and diagnosis, including investigating the reliability of ultrasound (US) imaging reports and providing guidance on conducting appropriate referrals.</p><p><strong>Discussion: </strong>These results will help inform the development of a DDH care pathway specific to the local context and needs in Sri Lanka.</p><p><strong>Conclusion: </strong>Care pathway development must be mindful of resource availability and strive to increase awareness of best care practices among healthcare practitioners.</p>","PeriodicalId":45062,"journal":{"name":"Journal of the American Academy of Orthopaedic Surgeons Global Research and Reviews","volume":"9 2","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11801793/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143366196","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":"What Is the Prevalence and Fate of Myxoid Soft-Tissue Tumors With an Indeterminate Diagnosis Prior to Resection?","authors":"Samuel R Johnson, Katherine S Hajdu, Julia C Quirion, Stephen W Chenard, Cullen P Moran, Andrew B Rees, Ben L Coiner, James P Norris, Hakmook Kang, Joanna L Shechtel, Nicholson S Chadwick, David S Smith, Reena Singh, Carlos Prieto-Granada, Jennifer L Halpern, Herbert S Schwartz, Ginger E Holt, Joshua M Lawrenz","doi":"10.5435/JAAOSGlobal-D-24-00370","DOIUrl":"10.5435/JAAOSGlobal-D-24-00370","url":null,"abstract":"<p><strong>Introduction: </strong>Differentiating benign and malignant myxoid soft-tissue tumors preoperatively can be challenging due to shared clinical, imaging, and histologic features. Biopsy specimens are frequently described as \"low-grade myxoid neoplasms\" without benign or malignant classification (ie, indeterminate). Our purpose is to evaluate the prevalence and prognosis of myxoid tumors with an indeterminate diagnosis before resection.</p><p><strong>Methods: </strong>A retrospective review identified 439 patients with a musculoskeletal myxoid soft-tissue tumor confirmed on final resection pathology. Biopsy result (benign, malignant, indeterminate) for each biopsy type was compared with the final resection diagnosis. Indeterminate diagnosis before resection was defined as when the preoperative diagnosis was uncertain to be benign or malignant based on all biopsy data. For patients with sarcomas on final resection and 2-year follow-up, the prevalence of positive margins and local recurrence were compared between patients with an indeterminate diagnosis before resection and those with a malignant diagnosis known preoperatively.</p><p><strong>Results: </strong>The prevalence of indeterminate diagnosis before resection was 28% (66/235). In these patients with sarcomas on final resection and 2-year follow-up, the positive margin rate at resection surgery was 37% (10/27) compared with 15% (11/74) in patients with a malignant diagnosis known preoperatively (P = 0.049). Their 5-year local recurrence-free survival was 73% (95% confidence interval, 58 to 92) compared with 92% (95% confidence interval, 86 to 98) in patients with a malignant diagnosis known preoperatively (P = 0.022).</p><p><strong>Conclusion: </strong>Indeterminate diagnosis before resection in myxoid tumors is relatively common, compared with prior reports in nonmyxoid neoplasms. Patients with indeterminate diagnosis before resection had two times higher rate of positive margins at resection surgery and markedly shorter local recurrence-free survival at 5 years compared with patients with malignant diagnosis known preoperatively. Diagnostic uncertainty at the time of resection is associated with worse oncologic outcomes in myxoid tumors.</p>","PeriodicalId":45062,"journal":{"name":"Journal of the American Academy of Orthopaedic Surgeons Global Research and Reviews","volume":"9 2","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11789853/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143123860","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":"Predictive Factors for Failed Nonsurgical Management of Long Bone Metastasis and Myeloma.","authors":"Yixuan A Pei, Jaret M Karnuta, Joshua A Jones, Bradley Griffith, Lori Jia, Barzin Behzad, Kristy L Weber, Cara A Cipriano","doi":"10.5435/JAAOSGlobal-D-24-00362","DOIUrl":"10.5435/JAAOSGlobal-D-24-00362","url":null,"abstract":"<p><strong>Background: </strong>Understanding the risk factors for failing nonsurgical management of metastatic bone disease is necessary to determine those patients who will benefit from prophylactic stabilization; however, standard predictive models do not include several clinically relevant factors. The primary and secondary objectives of this study were to evaluate comprehensive patient- and disease-related factors as potential predictors of failure of radiation therapy alone for long bone lesions and overall survival in metastatic disease and myeloma.</p><p><strong>Methods: </strong>All patients who underwent radiation therapy for long bone metastases at our tertiary care institution from May 2011 to February 2020 were retrospectively reviewed. Of 475 lesions, we excluded those with prophylactic fixation or fracture before radiation therapy, and those <0.5 cm on plain radiographs. Outcomes of the 186 lesions were classified as no progression, progression requiring prophylactic fixation, or progression to pathologic fracture. Blinded radiograph review was done by two orthopaedic oncology surgeons and two musculoskeletal radiologists. Demographic, socioeconomic, lesion, cancer severity, and patient-specific risk factors were identified, and potential predictors were analyzed using backwards stepwise regression.</p><p><strong>Results: </strong>Following radiation therapy, 8.6% lesions underwent prophylactic fixation and 14.0% fractured. Prophylactic fixation was associated with Mirels' score (OR = 1.98, P = 0.025), lesion cortical involvement (OR = 16.96, P = 0.010), and younger patient age (OR = 0.93, P = 0.024). Fracture was associated with lesion cortical involvement (OR = 10.16, P = 0.003) and \"low risk\" histology (OR = 9.01, P = 0.057). Orthopaedic treatment (either prophylactic surgery or pathologic fracture management) was associated with Mirels' score (OR = 1.62, P = 0.015), lesion cortical involvement (OR = 8.94, P = 0.002), humerus location (OR = 4.19, P = 0.042), and Medicare (OR = 4.12, P = 0.062) or private insurance (OR = 5.69, P = 0.022) compared with Medicaid. ECOG score (OR = 1.28, P = 0.003) was found to be a risk factor for increased mortality after radiotherapy, while \"low risk\" histology (OR = 0.51, P = 0.029), mixed lesion type (OR = 0.34, P = 0.006), and increased body mass index (OR = 0.95, P = 0.001) were protective factors.</p><p><strong>Conclusions: </strong>Radiograph measurements of cortical involvement were the most clinically relevant for determination of metastatic lesion fracture risk; however, predictors of local failure not addressed in Mirels' score should be considered in clinical decisions about prophylactic fixation. Surgery may be underperformed for histologies commonly considered to be \"low risk\" for local progression after radiation therapy.</p>","PeriodicalId":45062,"journal":{"name":"Journal of the American Academy of Orthopaedic Surgeons Global Research and Reviews","volume":"9 2","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11789852/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143123857","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}