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

{"title":"Diagnosis and Management of Soft-Tissue Sarcomas: Current Insights.","authors":"Nelo Joao Zeca Chihal Lima","doi":"10.5435/JAAOSGlobal-D-25-00237","DOIUrl":"10.5435/JAAOSGlobal-D-25-00237","url":null,"abstract":"<p><p>Soft-tissue sarcomas (STSs) are a complex and remarkable heterogeneous group of uncommon malignancies originating from fat, muscle, and other connective tissues. They constitute approximately 1% of all cancers with 50 to 70 distinct histologic subtypes or tumor entities. This type of tumor, also known as \"the loneliest cancer\" because of its rarity, can manifest at any age, but they are most commonly diagnosed in individuals older than 40 years. They can rise from any anatomic location (somatic, visceral, or bone), but the extremity is the most common primary site. STS presents a notable clinical challenge due to its gradual onset and variable symptoms. Consequently, soft-tissue masses should be thoroughly evaluated to rule out malignancy. Some STSs can be aggressive and tend to have high recurrence and metastasis rates (40-50%), particularly in the lungs (80% of the cases) and less often in the liver, brain, bones, and peritoneum, where their occurrence might indicate a poor prognosis. The fact that they are rare and their histologic morphology varies and sometimes can overlap with different genetic, molecular, and clinical profiles contributes to their delayed and complex diagnoses. A high index of suspicion, coupled with appropriate clinical and radiologic assessment and biopsy, can help identify STS. A systematic, multidisciplinary team (e.g., orthopaedic surgeons, oncologists, radiologists, and pathologists) approach is essential for accurately diagnosing and treating soft-tissue sarcomas. Correlating clinical and radiologic information and involving a multidisciplinary team aid in accurate diagnosis. Biopsy, a crucial step, requires rigorous rules and appropriate technique selection. Histologic diagnosis can be challenging because of limited material and divergent interpretations. Advanced tools such as immunophenotypic panels and genetics can enhance accuracy. The fifth edition of the WHO manual can classify soft tissue, while the AJCC-TNM system can stage tumors. Surgical resection, often supplemented with radiation and chemotherapy, is the primary treatment for STS. However, some subtypes (e.g., liposarcoma, synovial sarcoma, and undifferentiated pleomorphic sarcoma) have high local recurrence rates or metastasis, leading to inconsistent treatment outcomes. Innovative immune and radiation therapy treatment regimens and targeted therapy can offer potential effective alternatives for these challenging cases.</p>","PeriodicalId":45062,"journal":{"name":"Journal of the American Academy of Orthopaedic Surgeons Global Research and Reviews","volume":"10 8","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13406251/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148686001","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":"25-Hydroxyvitamin D Levels, Free Serum Calcium, Glomerular Filtration Rate, Albumin, and Femoral Fracture Elderly Patient Mortality.","authors":"Oded Hershkovich, Orit Twito, Arthur Kogan, Racheli Rozeblum, Raphael Lotan","doi":"10.5435/JAAOSGlobal-D-25-00108","DOIUrl":"10.5435/JAAOSGlobal-D-25-00108","url":null,"abstract":"<p><strong>Introduction: </strong>Proximal femoral fractures (PFFs) in older adults carry a high risk of morbidity, mortality, and disability. Although vitamin D deficiency has been associated with increased fracture incidence and poor outcomes, its precise role in hospitalization length, mortality, and long-term recovery remains unclear. Understanding how vitamin D levels interact with other factors, such as renal function and albumin status, could improve patient management strategies.</p><p><strong>Methods: </strong>We conducted a prospective cohort study of 760 patients aged 65 years and older admitted with femoral fractures between November 2022 and October 2024. Serum 25(OH)D levels, corrected calcium, and glomerular filtration rate (GFR) were assessed at admission. Vitamin D status was categorized as deficient (<20 ng/mL), insufficient (20 to 30 ng/mL), or normal (>30 ng/mL). Albumin levels and GFR were also evaluated.</p><p><strong>Results: </strong>When analyzed categorically, vitamin D classification did not markedly predict short-term outcomes, including immediate postoperative mortality or length of hospital stay. However, vitamin D as a continuous variable was modestly associated with shorter hospital stays. By contrast, lower GFR was strongly linked to longer hospitalization and increased in-hospital mortality. Albumin levels were not markedly related to survival. Notably, over a 2-year follow-up, vitamin D status emerged as an important predictor of long-term survival.</p><p><strong>Conclusion: </strong>Although vitamin D status alone may not influence immediate recovery, maintaining adequate levels may improve longer term survival after PFF surgery. Addressing renal impairment and other patient-specific factors remains critical for optimizing outcomes.</p>","PeriodicalId":45062,"journal":{"name":"Journal of the American Academy of Orthopaedic Surgeons Global Research and Reviews","volume":"10 8","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-08-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13395487/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148685962","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":"Postoperative Intravenous Ketorolac Does Not Affect Nonunion Risk in Surgically Treated Long Bone Shaft Fractures.","authors":"Nicholas C Bank, Stephen J Perle, Alexander D Jeffs, Océane Mauffrey, Tanner M Orders, Andrew T Chen","doi":"10.5435/JAAOSGlobal-D-25-00329","DOIUrl":"10.5435/JAAOSGlobal-D-25-00329","url":null,"abstract":"<p><strong>Background: </strong>Nonsteroidal anti-inflammatory drugs (NSAIDs) have become an increasingly important component of orthopaedic pain management protocols in an effort to reduce dependence on opioids. However, concerns remain regarding their potential impact on fracture healing. Ketorolac is a potent NSAID commonly administered postoperatively in orthopaedic surgery, but its effects on nonunion rates remain unclear. This study aims to evaluate whether short-term postoperative intravenous (IV) ketorolac administration is associated with an increased risk of nonunion or nonunion-related revision surgery in patients undergoing surgical fixation of long bone fractures.</p><p><strong>Methods: </strong>A retrospective cohort analysis was done using the TriNetX database. Adult patients who underwent surgical fixation of femoral, tibial, humeral, radial, or ulnar shaft fractures between 2003 to 2023 were included. Patients with infection, open fractures, or a history of nonunion were excluded. Cohorts were defined based on postoperative IV ketorolac use within 5 days of surgery. After 1:1 propensity score matching for demographics and comorbidities, nonunion and revision surgery rates were compared using odds ratios (ORs) with 95% confidence intervals (CIs). Subgroup analyses were done by fracture type and age group.</p><p><strong>Results: </strong>A total of 14,951 matched patients (7464 ketorolac; 7487 no ketorolac) were analyzed. No notable differences in nonunion rates were observed between the ketorolac and no ketorolac groups overall (2.2% vs 1.9%; OR 1.187 [95% CI, 0.941 to 1.498]) or within the tibial, femoral, or humeral subgroups. Ulnar and radial shaft fractures lacked sufficient sample sizes for subgroup analysis. Revision surgery rates were likewise comparable between the groups (1.2% vs 1.1%; OR 1.094 [95% CI, 0.803 to 1.491]). Age-stratified analyses showed no increased risk across age groups (18 to 29, 30 to 64, ≥65 years).</p><p><strong>Conclusions: </strong>Postoperative administration of IV ketorolac within 5 days of surgery does not increase the odds of nonunion or nonunion-related revision surgery for femoral, tibial, or humeral shaft fractures in low-risk adults. These findings support the use of short-duration IV ketorolac as part of multimodal analgesia protocols in postoperative fracture care.</p>","PeriodicalId":45062,"journal":{"name":"Journal of the American Academy of Orthopaedic Surgeons Global Research and Reviews","volume":"10 8","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-08-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13395486/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148686059","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":"Physeal Bar Formation After Salter-Harris III and IV Medial Malleolus Fractures in Children Aged ≤10 Years.","authors":"Jacob D Kodra, Milan Patel, Ankit Choudhury, Sean Rodriguez, Jacob Matthews, Bridget K Ellsworth","doi":"10.5435/JAAOSGlobal-D-26-00174","DOIUrl":"10.5435/JAAOSGlobal-D-26-00174","url":null,"abstract":"<p><strong>Introduction: </strong>Salter-Harris (SH) III and IV medial malleolar fractures in young children pose a risk of physeal bar formation and subsequent growth disturbance. The aim of this study was to compare surgical versus nonsurgical treatment and to identify factors predictive of physeal injury.</p><p><strong>Methods: </strong>A retrospective cohort analysis examined patients aged ≤10 years treated for SH III/IV medial malleolar fractures between 2012 and 2024 at a single institution. Patients received either surgical (open reduction and internal fixation (ORIF) or percutaneous reduction and screw fixation (PRSF)) or nonsurgical (casting/boot) management and had ≥6 months of radiographic follow-up. Demographic, clinical, and radiographic variables including articular displacement, lateral distal tibial angle (LDTA), and physeal bar formation were compared between treatment groups and subgroups with or without bar formation.</p><p><strong>Results: </strong>Thirty-two patients (16 surgical, 16 nonsurgical) met inclusion criteria. The overall incidence of physeal bar formation did not differ between treatment groups (surgical: 25% vs. nonsurgical: 19%; P = 1.000). Physeal bar formation was significantly associated with greater pre-reduction articular displacement (median: 9.1 mm vs. 2.4 mm; P = 0.045), changes in LDTA (6.2° vs. 1.0°; P = 0.006), and delayed union (57% vs. 4%; P = 0.004). Clinically significant physeal bars occurred exclusively in patients with comminuted fractures (P = 0.007). Final articular displacement was significantly lower after ORIF (0.0 mm vs. 1.0 mm; P = 0.012), although revision surgery for implant removal was more common (P < 0.001).</p><p><strong>Conclusion: </strong>The risk of physeal bar formation after SH III and IV medial malleolar fractures was not influenced by surgical versus nonsurgical treatment. Instead, greater initial fracture displacement and comminuted fracture morphology predicted physeal injury.</p>","PeriodicalId":45062,"journal":{"name":"Journal of the American Academy of Orthopaedic Surgeons Global Research and Reviews","volume":"10 8","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-08-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13395512/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148685977","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":"Implementation of Robotic-Assisted Procedure for Total Hip Arthroplasty Is Not Economical in a High-Volume Orthopaedic Facility.","authors":"Andrea T Kwaczala, Sara E Strecker, Matthew J Solomito, Caitlin McCracken, Robert Carangelo, Daniel Witmer","doi":"10.5435/JAAOSGlobal-D-25-00431","DOIUrl":"10.5435/JAAOSGlobal-D-25-00431","url":null,"abstract":"<p><strong>Background: </strong>Advances in elective primary total hip arthroplasty (THA) have led to the use of robotic assistance and computer navigation during surgery; recent reports have demonstrated substantial benefits of this technology. However, few studies have made a head-to-head comparison of technology with a specific focus on patient-reported outcomes (PROs) when preoperative patient profiles are well controlled. Therefore, the purpose of this study was to compare outcomes among patients who underwent conventional, robotic-assisted, and computer-navigated procedures.</p><p><strong>Methods: </strong>This retrospective study included patients aged 25 to 89 years who underwent THAs between January 2020 and May 2025. Patients were matched on age, body mass index (BMI), Charlson Comorbidity Index (CCI), and preoperative Hip Disability and Osteoarthritis Outcome Score for Joint Replacement and were assigned to study groups based on the technology used: (1) conventional, (2) robotic-assisted, and (3) computer-navigated. Postoperative recovery metrics between groups were compared up to 1 year from the surgery.</p><p><strong>Results: </strong>A total of 3799 patients were included: 2582 (68%) in the conventional group, 389 (10%) in the robotic-assisted group, and 828 (22%) in the computer-navigated group. PROs improved with no differences between groups by 12 months but showed slightly slower recovery in computer-navigated cases. Complication rates (return to operating room and hospital readmittance) were similar in all groups. Both robotic-assisted surgery and computer-navigated procedures cost around $1000 more than the conventional procedure, with robotic-assisted procedures taking 3 minutes longer than conventional procedures (P < 0.05).</p><p><strong>Conclusion: </strong>Despite added cost, the technology-assisted procedures did not offer substantial improvements to surgical outcomes when used in primary THAs in a high-volume orthopaedic hospital. When controlled by matching demographics, comorbidities, and PROs, the technology-supported THA patients had no clinically relevant differences in postoperative outcomes and had higher hospital utilization compared with the conventional group.</p>","PeriodicalId":45062,"journal":{"name":"Journal of the American Academy of Orthopaedic Surgeons Global Research and Reviews","volume":"10 8","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-08-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13395494/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148685986","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":"Augmented Reality-Guided Individualized Total Knee Arthroplasty: Initial Clinical Implementation and Results.","authors":"H Gene Dossett, Michael Stickels, Rini Desai, Alexander Kozak, Brooke Shanahan, Sailesh Tummala","doi":"10.5435/JAAOSGlobal-D-25-00318","DOIUrl":"10.5435/JAAOSGlobal-D-25-00318","url":null,"abstract":"<p><strong>Background: </strong>Contemporary total knee arthroplasty (TKA) practice has evolved from uniform mechanical alignment to individualized alignment planning in response to growing evidence that a single alignment strategy does not optimize outcomes for all patients. However, precise execution of patient-specific alignment strategies remains challenging with manual instrumentation. Augmented reality (AR) technology addresses this limitation by providing real-time intraoperative visualization of anatomic landmarks and planned resection parameters. In this study, individualized alignment was applied within predefined safety envelopes, including femoral valgus relative to the mechanical axis of 0° to 3°, tibial varus of 0° to 3°, and hip-knee-ankle alignment within 0° to 3° of neutral. All procedures were performed using the Pixee Knee + AR system (Pixee Medical, Besançon, France). Despite growing interest in AR-assisted surgery, clinical data regarding the accuracy, precision, and early outcomes of AR-guided individualized TKA remain limited, providing the rationale for this study.</p><p><strong>Methods: </strong>This retrospective consecutive case series evaluated 50 patients with end-stage knee osteoarthritis who underwent primary TKA using the Pixee Knee + AR system between April and August 2024. All procedures used individualized alignment strategies with patient-specific planning parameters. Radiographic accuracy was assessed using postoperative CT imaging, and validated patient-reported outcome measures were collected at minimum 6-month follow-up.</p><p><strong>Results: </strong>The cohort comprised 45 men and 5 women with mean age 71.4 ± 7.6 years, American Society of Anesthesiologists score 3.0 ± 0.2, and body mass index 31.0 ± 4.1 kg/m2. Alignment accuracy was excellent, with 96% of coronal measurements within 3° of planned values and 53.3% within 1°. Component-specific accuracy rates within 1° were as follows: tibial component 72%, femoral implant 62%, and overall hip-knee-ankle alignment 46%. Four percent of measurements exceeded 3° deviation from planned alignment. No revision surgeries, infections, or mechanical complications occurred during follow-up. Patient-reported outcomes demonstrated notable improvements from preoperative scores: modified single assessment numeric evaluation scores improved 4.7 ± 3.1 points (P < 0.001) and KOOS Jr. normalized scores improved 21.6 ± 23.2 points (P < 0.001).</p><p><strong>Conclusion: </strong>AR-guided individualized TKA demonstrated high accuracy in executing patient-specific alignment plans with favorable early clinical outcomes and no complications at 6 months. These initial results suggest that AR technology may provide a viable alternative for precise implementation of individualized alignment strategies, although larger studies with longer follow-up are needed to establish long-term efficacy and safety.</p>","PeriodicalId":45062,"journal":{"name":"Journal of the American Academy of Orthopaedic Surgeons Global Research and Reviews","volume":"10 8","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13395493/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148680337","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":"Technology Review: The Hidden Influence of AI in Orthopaedic Surgery.","authors":"Samantha N Olson, Marisa N Ulrich, Cody C Wyles, Derek F Amanatullah","doi":"10.5435/JAAOSGlobal-D-26-00004","DOIUrl":"10.5435/JAAOSGlobal-D-26-00004","url":null,"abstract":"<p><p>Artificial intelligence (AI) has rapidly integrated into multiple facets of society, specifically within the realm of orthopaedics. To understand its effects, we provide an overview of AI models, their presence in health care over time, current integrations, and regulations regarding AI. This overview highlights different perspectives, the variety of influences that AI currently has, and the implications for the future of orthopaedics. AI is agnostic to the outcome and will have both a positive and negative effect on the next generation of trainees, educators, practitioners, consumers, and leaders, necessitating proactive discussions about AI.</p>","PeriodicalId":45062,"journal":{"name":"Journal of the American Academy of Orthopaedic Surgeons Global Research and Reviews","volume":"10 8","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13395488/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148686054","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 Preexisting Dementia on Mortality, Readmissions, and Complications After Surgical Repair of Hip Fractures: A Cohort Analysis.","authors":"Spencer T Rasmussen, Kamal Shaik, Kimberly Dong, Zachary Demetriou, Yale A Fillingham, Asif M Ilyas","doi":"10.5435/JAAOSGlobal-D-26-00177","DOIUrl":"10.5435/JAAOSGlobal-D-26-00177","url":null,"abstract":"<p><strong>Objectives: </strong>As the population ages, hip fractures are projected to increase. These fractures carry high morbidity and mortality in older adults. Dementia, common among these patients, may further worsen outcomes. This study evaluates the impact of preexisting dementia on mortality after surgical repair of femoral neck and intertrochanteric fractures, with the study hypothesis that the presence of preoperative dementia can result in increased mortality postoperatively.</p><p><strong>Methods: </strong>Using the TriNetX Research Network, 68,639 patients aged 65 to 90 years who underwent surgical treatment of femoral neck or intertrochanteric fractures from 2015 to 2025 were identified. Patients were grouped based on the presence or absence of a dementia diagnosis before fracture. Surgeries included hemiarthroplasty, internal fixation, or intramedullary nailing. Propensity score matching adjusted for age, sex, and comorbidities. The primary outcome was all-cause mortality at 90 days, 2, and 5 years for patients who had sufficient follow-up data. Secondary outcomes included 90-day readmissions and complications (pneumonia, stroke, urinary tract infection, and heart failure). Risk ratios (RRs) with 95% confidence intervals (CIs) were calculated.</p><p><strong>Results: </strong>Patients with dementia had higher mortality at all time points. In intertrochanteric fractures, dementia patients had increased mortality at 90 days (RR, 0.61; 95% CI, 0.57 to 0.65; P < 0.001), 2 years (RR, 0.68; 95% CI, 0.65 to 0.70; P < 0.001), and 5 years (RR, 0.76; 95% CI, 0.73 to 0.78; P < 0.001). In femoral neck fractures, mortality was also higher at 90 days (RR, 0.56; 95% CI, 0.49 to 0.63; P < 0.001), 2 years (RR, 0.64; 95% CI, 0.59 to 0.70; P < 0.001), and 5 years (RR, 0.71; 95% CI, 0.67 to 0.76; P < 0.001) in patients with dementia. At 90 days for both fracture types, the risk of mortality was nearly double among dementia patients. Similarly, 90-day readmissions and postoperative complications, including pneumonia, stroke, urinary tract infection, heart failure, and revision surgery, were statistically significantly higher among dementia patients.</p><p><strong>Conclusion: </strong>Preexisting dementia is associated with higher mortality after hip fracture repair in older adults, approaching nearly double at 90 days. Readmissions and complications are also markedly higher among dementia patients. These findings underscore the importance of tailored perioperative planning, enhanced care pathways for patients with cognitive impairment, and shared decision making between the patient, caregivers, and the care teams.</p>","PeriodicalId":45062,"journal":{"name":"Journal of the American Academy of Orthopaedic Surgeons Global Research and Reviews","volume":"10 8","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13395499/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148680319","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":"Characterizing Comorbidities in Total Joint Arthroplasty in a Safety-Net Hospital Using Age-Adjusted Charlson Comorbidity Index.","authors":"Matthew Chan, Lily Khabie, Noshin Nuzhat, Melanie Anaya, Gabriela de Queiroz Campos, Ira Kirschenbaum","doi":"10.5435/JAAOSGlobal-D-25-00223","DOIUrl":"10.5435/JAAOSGlobal-D-25-00223","url":null,"abstract":"<p><strong>Background: </strong>The joint arthroplasty population has a high number of comorbidities at the time of surgery, which increases the cost of care per episode. The goal of this study was to analyze the distribution of comorbid diseases in patients who have undergone total joint arthroplasty at our institution, which serves the poorest congressional district in the United States. We hypothesized that patients in an urban safety-net hospital would have higher comorbidity rates and higher Charlson Comorbidity Indices and that this would suggest the need for improved risk stratification in payment systems.</p><p><strong>Methods: </strong>A retrospective analysis was conducted by reviewing consecutive patients who underwent total joint arthroplasty between 2008 and 2023 (N = 3011). Relevant comorbidities were used to calculate the age-adjusted Charlson Comorbidity Index. From this, we determined the score distribution and identified the most frequent conditions. Descriptive statistical analysis was conducted to determine the mean and variance.</p><p><strong>Results: </strong>Within the patient population concerning CCI scores, 10.93% of the patient population scored 0, 22.42% scored 1, 27.33% scored 2, 20.86% scored 3, 10.73% scored 4, and 7.74% scored 5 and above. The mean CCI score was 2.25 ± 1.50. The most frequently occurring comorbid conditions according to hospital criteria in this population were hypertension (N = 2078, 69.01%), obesity (N = 1366, 45.37%), diabetes (N = 906, 30.09%), and anemia (N = 694, 23.05%). A total of 19.10% of patients were current smokers. Of all TJA patients, 96.9% had at least 1 comorbidity.</p><p><strong>Conclusion: </strong>The major finding from this retrospective analysis revealed the presence of a high incidence of comorbidities in the our health system's total joint arthroplasty population. We confirmed that this closed urban population is a unique subset of at-risk individuals who are undergoing TJA, which may increase their complication rates. Consideration for proper risk stratification in communities like this need to be considered.</p>","PeriodicalId":45062,"journal":{"name":"Journal of the American Academy of Orthopaedic Surgeons Global Research and Reviews","volume":"10 8","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13395510/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148680331","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 Influence of Media Type and Posting Time on Altmetric Engagement of Orthopaedic Surgery Journals on X.","authors":"Firas Moussa, Thomas Leonard, Mitchell J Christiansen, Mary K Mulcahey","doi":"10.5435/JAAOSGlobal-D-26-00178","DOIUrl":"10.5435/JAAOSGlobal-D-26-00178","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Introduction: &lt;/strong&gt;Digital promotion of orthopaedic research is increasingly associated with scholarly visibility yet the influence of specific social media posting characteristics on online attention remains unclear. The Altmetric Attention Score (AAS) is a weighted score that measures the amount of attention a study has received. The score is based on three factors: the volume of mentions, the medium the mention came from, and the author of the mention. In orthopaedic research, a higher AAS is correlated with higher citation rates. The purpose of this study was to examine the relationship between AAS and the presence of various types of multimedia in posts on X by orthopaedic surgery journals and the time posts were made.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Data were collected from the X accounts of the British Journal of Sports Medicine (BJSM), Journal of Bone and Joint Surgery (JBJS), Arthroscopy, Journal of Arthroplasty, American Orthopedic Society for Sports Medicine Journals (AOSSM), and Journal of the American Academy of Orthopaedic Surgeons (JAAOS) over two separate periods, January 1, 2023, to June 31, 2023, and July 1, 2024, to December 31, 2024. Media types were classified into the following categories: no media, text only, simple media, infographics, and videos. To analyze the effect of post time on AAS score, posts were grouped into three different time groups: 10 pm to 5:59 am, 6 am to 1:59 pm, and 2 pm to 9:59 pm. Statistical analysis for data sets with three or more groups was done with an Analysis of Variance (ANOVA) with post hoc t-tests performed when statistical significance was found. For data sets with only two groups, t-tests were done.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;One-way ANOVA results showed a significant difference in the average AAS between media types for the Journal of Bone and Joint Surgery (JBJS) in the 2024 period (P &lt; 0.01) and in Arthroscopy for both the 2023 and 2024 periods (P &lt; 0.0001 and P &lt; 0.05, respectively). Post hoc t-tests showed a significant difference in average AAS between simple media and infographics for JBJS in 2024 with average AAS scores of 2.81 and 11, respectively (P &lt; 0.001). In 2023, Arthroscopy showed significant differences in the average AAS of simple media vs infographics, simple media vs text only, and infographics vs no media (P &lt; 0.0001, 0.0001, and 0.05, respectively). In 2024, Arthroscopy showed significant differences in average AAS for simple media vs infographics, videos vs infographics, and videos vs text only with P &lt; 0.05, 0.005, and 0.05, respectively. For the American Orthopaedic Society for Sports Medicine (AOSSM) journals, t-tests showed a statistically significant difference in average AAS between posts made from 6 am to 1:59 pm and posts made from 2 pm to 9:59 pm with a P &lt; 0.05 and average AAS of 12.9 and 74.5, respectively.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;Although results were not consistent across all journals, one trend was the increased AAS of inf","PeriodicalId":45062,"journal":{"name":"Journal of the American Academy of Orthopaedic Surgeons Global Research and Reviews","volume":"10 8","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13395518/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148686103","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}