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

{"title":"Reporting the Pooled Last Follow-up Musculoskeletal Tumor Society Score Underestimates Functional Improvements Seen Over Time.","authors":"Alysia K Kemp, Theresa Nalty, Grant McChesney, Yimin Geng, Shalin S Patel, Valerae O Lewis, Justin E Bird","doi":"10.5435/JAAOSGlobal-D-24-00315","DOIUrl":"10.5435/JAAOSGlobal-D-24-00315","url":null,"abstract":"<p><strong>Introduction: </strong>The Musculoskeletal Tumor Society (MSTS) score is the most commonly used functional outcome tool in Orthopaedic Oncology. However, there are no published recommendations on how to collect, analyze, and report these data. To address this knowledge gap, we performed (1) a systematic review to analyze the methodology of reporting MSTS scores and (2) an analysis of two different reporting methods (pooled last follow-up versus longitudinal time based).</p><p><strong>Methods: </strong>The mean MSTS score and length of follow-up were calculated using data provided in articles included in the systematic review. Paired t-tests were used to compare mean MSTS scores calculated at standardized postoperative intervals versus mean MSTS scores calculated from last follow-up time points using prospectively collected data from a single institutional database.</p><p><strong>Results: </strong>More than 300 articles met inclusion criteria. Most authors reported a single pooled score calculated from MSTS scores obtained at the patients' last follow-up visits (91.6%, n = 356). When comparing this method (pooled reporting) versus longitudinal time-based reporting, the pooled MSTS scores were only comparable to the MSTS scores at the 6-month postoperative visit. The pooled last follow-up scores underestimated MSTS scores obtained after 6 months (P < 0.0001 at 1 year and P = 0.0047 at 3 years). Improvements were seen in the MSTS domains after the 6-month visit (average time to stability was 1.8 years).</p><p><strong>Conclusion: </strong>The most common historical method of reporting MSTS scores, the pooled last follow-up method, underestimates functional improvements observed during long-term follow-up. Longitudinal time-based reporting provides more accurate representation of the functional outcomes over time.</p>","PeriodicalId":45062,"journal":{"name":"Journal of the American Academy of Orthopaedic Surgeons Global Research and Reviews","volume":"9 9","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12393213/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144973012","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":"Femoral Neck Complications in Isolated Femoral Neck Fractures Versus Ipsilateral Femoral Neck and Shaft Fractures.","authors":"Jeremy Hreha, Thomas M Large, Brian Batko, Janice M Bonsu, Ujjawal Savani, Helyn Fraser, Emily Wild, Dhruv Mendiratta, Mark R Adams","doi":"10.5435/JAAOSGlobal-D-25-00224","DOIUrl":"10.5435/JAAOSGlobal-D-25-00224","url":null,"abstract":"<p><strong>Objectives: </strong>There are limited data on the difference in outcomes between patients with isolated femoral neck fractures (IsoFN) and those with a femoral neck and ipsilateral femoral shaft fracture (IpsiFNS) in terms of osteonecrosis, nonunion, and revision surgery rates. We hypothesized that displaced IsoFN fractures would have higher rates of femoral neck nonunion, osteonecrosis, and hip revision surgery than displaced IpsiFNS fractures. Comparisons were made to determine the relationship between these outcomes and other variables.</p><p><strong>Methods: </strong>A retrospective review of patients age 18 to 55 years from 2005 to 2020 at two level-I trauma academic institutions was performed, identifying 107 patients in total (IpsiFNS 51, IsoFN 56). The review analyzed the rates of displacement, osteonecrosis, nonunion, and revision surgery. Further comparisons were made to determine the effect of reduction quality, fixation method, and reduction type on these outcomes.</p><p><strong>Results: </strong>Patients with displaced IsoFN had a significantly higher nonunion, revision surgery and osteonecrosis rate (38.5%, 38.5%, 17.3%) than in patients with IpsiFNS (6.7%, 13.3%, 0%; P = 0.004, P = 0.010, P = 0.016 respectively). There was a relationship between nonunion and femoral neck fixation with fully threaded screws (P = 0.036 and P = 0.004). Among patients who underwent an open reduction, nonunion rates were significantly higher for displaced IsoFN than for displaced IpsiFNS (7.4% vs. 43.2%, P = 0.008). Osteonecrosis rates had a relationship with reduction quality (P = 0.044).</p><p><strong>Conclusions: </strong>Patients with a displaced isolated femoral neck fractures are at higher risk for nonunion, osteonecrosis, and revision surgery than those with a displaced femoral neck fracture associated with an IpsiFNS. Quality of reduction had a relationship with osteonecrosis rates. An open approach to the neck reduction was associated with nonunion at a higher rate in displaced IsoFN than in displaced IpsiFNS. A fixation construct of multiple cancellous independent screws that included fully threaded screws had higher odds for nonunion.</p>","PeriodicalId":45062,"journal":{"name":"Journal of the American Academy of Orthopaedic Surgeons Global Research and Reviews","volume":"9 9","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12393214/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144973046","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":"Noninstrumented Posterolateral Lumbar Fusions Continue to Fade Relative to Instrumented Posterolateral Approaches for Lumbar Degenerative Spondylolisthesis Over the Past Decade.","authors":"Albert H Lee, Wesley Day, Siddhartha Lavu, Alexandros F Pappajohn, Michael J Gouzoulis, Jonathan N Grauer","doi":"10.5435/JAAOSGlobal-D-25-00192","DOIUrl":"10.5435/JAAOSGlobal-D-25-00192","url":null,"abstract":"<p><strong>Introduction: </strong>Although posterolateral lumbar fusions (PLFs) were historically routinely performed without instrumentation, instrumentation has become ubiquitous in this setting. Recent assessments of noninstrumented PLFs practices are lacking.</p><p><strong>Methods: </strong>Lumbar degenerative spondylolisthesis patients undergoing noninstrumented or instrumented single-level PLFs (with or without interbody) were identified from 2012 to 2022 M170 Ortho PearlDiver. Univariable analysis identified differences in patient characteristics. Yearly utilization trends were tracked and analyzed using simple linear regression/overall F-tests. Ninety-day postoperative adverse outcomes were compared using multivariable logistic regression with 4:1 matching for patient age, sex, and Elixhauser comorbidity index. Five-year lumbar revision surgery rates were assessed using Kaplan-Meier survival analyses and log-rank tests.</p><p><strong>Results: </strong>A total of 117,796 (95.8%) instrumented and 5147 (4.2%) noninstrumented PLF lumbar degenerative spondylolisthesis patients were identified. Noninstrumented PLFs declined from 5.52% to 3.49% from 2012 to 2022 (P < 0.001). These were more common in older, male, osteoporotic patients, varied by insurance and region, and were more often performed by orthopaedic surgeons. After matching, no notable differences were found between instrumented versus noninstrumented cases in 90-day aggregated adverse events or 5-year lumbar revision surgery rates.</p><p><strong>Discussion: </strong>For lumbar degenerative spondylolisthesis, noninstrumented fusion represents a small and declining percentage of PLFs over the past decade, with usage varied by clinical and nonclinical patient characteristics. No differences were found in 90-day aggregated postoperative adverse events and 5-year lumbar revision surgery rates, suggesting that instrumentation can be safely performed and that both approaches had similarly durable results. These findings support considering noninstrumented PLFs in select cases when the safety, utility, or cost-benefit of instrumentation is questioned.</p>","PeriodicalId":45062,"journal":{"name":"Journal of the American Academy of Orthopaedic Surgeons Global Research and Reviews","volume":"9 8","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12366972/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144884089","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":"Preoperative Patient-Reported Outcomes Predict Candidacy for Outpatient Total Knee Arthroplasty.","authors":"Bhavana Gunda, Sara Strecker, Robert James Magaldi, Donald A Allen, Dan Witmer","doi":"10.5435/JAAOSGlobal-D-25-00068","DOIUrl":"10.5435/JAAOSGlobal-D-25-00068","url":null,"abstract":"<p><strong>Background: </strong>The incidence of total knee arthroplasty (TKA), an effective orthopaedic procedure for end-stage osteoarthritis, is increasing substantially. The shift toward performing this procedure in the outpatient setting necessitates precise patient selection criteria to ensure optimal postoperative outcomes. This study examines the predictive value of preoperative patient-reported outcome measures (PROMs), including the Brief Resilience Scale (BRS), in determining candidacy for outpatient TKA.</p><p><strong>Methods: </strong>A retrospective analysis of 2,167 patients undergoing elective primary, unilateral TKA from May 2020 to June 2023 was conducted. Preoperative PROMs, including Knee Injury and Osteoarthritis Outcome Score for Joint Replacement (KOOS, JR), Patient-Reported Outcomes Measurement Information System (PROMIS)-10, Risk Assessment and Prediction Tool (RAPT), and BRS, were collected. Patients were stratified into three groups by BRS score: low (BRS score < 3), average (BRS score ≥ 3 and < 4.3), and high (BRS score ≥ 4.3) resilience. Length of stay (LOS), discharge disposition, and complications were assessed postoperatively. Logistic regression and receiver operative characteristic (ROC) curve analyses were used to assess the predictive validity of PROMs for discharge to a skilled nursing facility (SNF) in conjunction with extended LOS.</p><p><strong>Results: </strong>Patients with low resilience (BRS score < 3) were found to have a significantly higher likelihood of discharge to a SNF and extended LOS compared with the other two groups (11.5% vs. 1.6%, P < 0.001). Logistic regression demonstrated that BRS, RAPT, and PROMIS-10 scores were also notable predictors, with a combined model predicting an extended LOS and discharge to SNF with 82.4% sensitivity and 79.9% specificity.</p><p><strong>Conclusions: </strong>Preoperative PROMs such as BRS can serve as a valuable tool in predicting the failure of outpatient TKA. Incorporating preoperative PROMs into presurgical decision making can enhance patient selection for ambulatory procedures and improve surgical outcomes. Additional prospective studies are warranted to validate these findings within other elective surgical populations and to determine how to best modify resilience.</p>","PeriodicalId":45062,"journal":{"name":"Journal of the American Academy of Orthopaedic Surgeons Global Research and Reviews","volume":"9 8","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12366888/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144884090","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":"Single-Position Lumbar Fusion Online Videos for Patient Education: Understandability, Reliability, and Quality.","authors":"Chimobi Emukah, Jerod McCarrell, Tyler K Williamson, Victor H Martinez, Yusuf Mufti, Peter G Passias","doi":"10.5435/JAAOSGlobal-D-24-00275","DOIUrl":"10.5435/JAAOSGlobal-D-24-00275","url":null,"abstract":"<p><strong>Introduction: </strong>Patients undergoing surgical interventions, particularly spine surgery, often rely on online videos as a first source for medical information. In this study, we sought to investigate the understandability, reliability, and quality of online patient educational videos focused on single-position lumbar fusion.</p><p><strong>Methods: </strong>The YouTube platform was searched using five search terms: prone transpsoas lumbar fusion, prone lateral lumbar fusion, single position lumbar fusion, prone single position lumbar fusion, and lateral single position lumbar fusion. The relevance-based ranking search option was used with each of the search terms and was investigated for videos relevant that met the inclusion criteria. Videos from academic institutions, commercial entities, individual physician, and physician groups were included for final evaluation in this study. The DISCERN instrument, patient education material assessment tool (PEMAT), the Global Quality Scale, and Journal of the American Medical Association Benchmark were used to evaluate the reliability, quality, and understandability of the videos.</p><p><strong>Results: </strong>A total of 500 videos were initially identified, and after applying inclusion criteria, 13 videos were selected for evaluation. The videos exhibited an overall average score in each category: DISCERN (41.8 ± 10), PEMAT understandability (65% ± 12%), PEMAT actionability (28% ± 15%), Global Quality Scale (2.9 ± 0.4), and Journal of the American Medical Association Benchmark (2.9 ± 0.7). Notably, there was no discernible correlation between video popularity and the assigned scores. There was no correlation between video popularity and scores.</p><p><strong>Discussion: </strong>The findings of this study demonstrate that patients who seek to access information about single-position lumbar fusion by using the YouTube platform will be presented with a moderate overall quality of educational content on this procedure. As single-position lumbar fusion becomes a more prevalent choice for patients, we recommend enhancing patient education on this spine surgery approach by encouraging academic institutions to produce standardized and dependable video educational materials. This would greatly benefit patients looking to better understand this procedure and make informed decisions.</p>","PeriodicalId":45062,"journal":{"name":"Journal of the American Academy of Orthopaedic Surgeons Global Research and Reviews","volume":"9 8","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12366924/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144884091","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":"TikTok and Orthopaedic Education: Engaging the Next Generation of Patients.","authors":"Camila Vicioso, Charu Jain, Uma Balachandran, Ryan Smolarsky, Laurel Wong, Luca Valdivia, Julian Javier, Auston Locke, James Hong, Sheena C Ranade","doi":"10.5435/JAAOSGlobal-D-25-00152","DOIUrl":"10.5435/JAAOSGlobal-D-25-00152","url":null,"abstract":"<p><strong>Introduction: </strong>Social media is increasingly pivotal in healthcare communication, with TikTok emerging as a leading platform because of its visually engaging, short-format videos. With nearly 2 billion users spending over 50 minutes daily on the app, TikTok offers a novel medium for disseminating orthopaedic information. Pediatric fractures-employed here as a representative model-are particularly relevant given the high social media use among youth and caregivers. This study investigates TikTok's role as an educational tool for orthopaedic surgeons and examines public engagement.</p><p><strong>Methods: </strong>A cross-sectional study was conducted analyzing TikTok videos related to pediatric fractures. A newly created TikTok account was used to identify the top popular videos for each fracture type, excluding non-English, off-topic, private, or duplicate content. Engagement metrics, including views, likes, shares, comments, and bookmarks, were recorded. Video understandability was assessed using the Patient Education Materials Assessment Tool for Audiovisual Materials. Video reliability was assessed using the modified DISCERN scale. Videos were categorized by creator identity (physician, allied healthcare provider, patient, parent, and other).</p><p><strong>Results: </strong>A total of 190 TikTok videos accumulated more than 25.7 million views and 1.8 million likes. Although nonexpert sources (parents and patients) contributed 87.9% of the content, healthcare professional-generated videos comprised 12.1% and demonstrated markedly higher engagement and quality scores. In particular, physician-produced content achieved the highest median views and shares (P < 0.01).</p><p><strong>Discussion: </strong>The predominance of nonexpert content underscores a missed opportunity to leverage TikTok for disseminating reliable, evidence-based orthopaedic education. Expert-driven videos not only offer superior clarity, reliability, and actionable guidance but also align with the public's preference, suggesting broad applicability across orthopaedic subspecialties.</p><p><strong>Conclusion: </strong>TikTok represents a promising platform for enhancing orthopaedic education. Increasing healthcare professional engagement may improve the delivery of accurate, evidence-based content, ultimately advancing musculoskeletal health literacy and patient outcomes.</p>","PeriodicalId":45062,"journal":{"name":"Journal of the American Academy of Orthopaedic Surgeons Global Research and Reviews","volume":"9 8","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12366999/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144884092","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 Assessment of the Journal of Bone and Joint Surgery Publication Trends From 2012 Through 2022.","authors":"Kira L Smith, Monish S Lavu, Molly M Piper, Bhargavi Maheshwer, Kallie J Chen, Robert J Gillespie, Raymond E Chen","doi":"10.5435/JAAOSGlobal-D-25-00002","DOIUrl":"10.5435/JAAOSGlobal-D-25-00002","url":null,"abstract":"<p><strong>Background: </strong>Clinical research is an integral component of orthopaedic practice with the purpose of advancing the field and improving patient care. The Journal of Bone and Joint Surgery (JBJS) is a well-respected journal with a high impact factor and considerable influence on clinical practice. To our knowledge, there has been no systematic evaluation highlighting the variety of research published in this journal. Therefore, the purpose of this study was to evaluate trends in characteristics of articles published in JBJS from 2012 to 2022, including type of study, level of evidence, author information, and country of publication.</p><p><strong>Methods: </strong>Articles published in JBJS between 2012 and 2022 were retrieved from the JBJS Archives. Title, level of evidence, description of the study as delineated in the abstract, first author degree, number of authors, and country of publication were recorded for each published article.</p><p><strong>Results: </strong>A total of 2668 articles were published in JBJS from 2012 to 2022. The proportion of preclinical studies published per year significantly decreased (P = 0.0025), whereas no statistically significant change was observed in the proportion of clinical studies (P = 0.34). A significant increase was noted in the proportion of database studies published (P = 0.00012). Studies classified as level II decreased over the study period (P = 0.029), whereas level III increased over the study period (P = 0.034). The average number of authors per article was 6 ± 3 authors with a significantly increasing trend over the study period (P = 0.0043). The proportion of first authors who were MD or equivalent decreased (P = 0.025), whereas first authors who were non-MD or non-PhD equivalent increased (P = 0.0068).</p><p><strong>Conclusion: </strong>The publication trends in JBJS over the past decade demonstrate the changing landscape of orthopaedic research as it aims to address the burden of musculoskeletal injury and disease.</p>","PeriodicalId":45062,"journal":{"name":"Journal of the American Academy of Orthopaedic Surgeons Global Research and Reviews","volume":"9 8","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12366918/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144884032","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":"Migraines as a Risk Factor for Many 90-Day Postoperative Complications Following Single-Level Anterior Cervical Diskectomy and Fusion.","authors":"Beatrice M Katsnelson, Anshu Jonnalagadda, Albert L Rancu, Adam D Winter, Jonathan N Grauer","doi":"10.5435/JAAOSGlobal-D-25-00060","DOIUrl":"10.5435/JAAOSGlobal-D-25-00060","url":null,"abstract":"<p><strong>Introduction: </strong>Anterior cervical diskectomy and fusion (ACDF) is a common spinal surgery for which patient factors may be associated with adverse outcomes. One such potential predisposing risk factor is a history of migraines. The relationship between migraines and postoperative adverse outcomes following ACDF procedures has not been studied. Appreciating such correlations may aid in patient counseling and care pathways.</p><p><strong>Methods: </strong>Using the 2015-Q3 2022 PearlDiver Mariner161 database, adult patients undergoing single-level ACDF were identified. Patients who underwent concomitant spinal procedures and patients presenting with a spine infection, trauma, or neoplasm were excluded. Four-to-one matching was conducted for patients without versus with history of migraines based on age, sex, and Elixhauser Comorbidity Index.Ninety-day postoperative adverse events were then characterized, including individual and aggregated events, as well as emergency department visits, and compared for the matched populations with multivariate logistic regression analyses. Five-year occurrences of subsequent cervical spine surgeries were compared using a log-rank test and plotted by Kaplan-Meier survival curves.</p><p><strong>Results: </strong>Of the 326,722 ACDF patients studied, history of migraines was identified for 16,434 (5.03%). After matching, there were 14,774 patients with migraines and 58,820 patients without migraines.Following ACDF surgery, those with a history of migraines had independently higher odds ratios of experiencing most individual 90-day adverse outcomes, as well as any (OR: 2.53), severe (OR: 2.35), and minor (OR: 2.47) adverse events and emergency department visits (OR: 3.42; P < 0.0001). Those with migraines did not have different rates of subsequent cervical spine surgery out to 5 years.</p><p><strong>Conclusion: </strong>ACDF patients with a history of migraines were found to have higher rates of most 90-day postoperative adverse outcomes assessed. As such, patients with migraines ought to receive supplemental risk counseling and postoperative resource planning when undergoing ACDF surgery. Nonetheless, it was reassuring that 5-year revision surgeries were not significantly different for those with versus without history of migraines.</p>","PeriodicalId":45062,"journal":{"name":"Journal of the American Academy of Orthopaedic Surgeons Global Research and Reviews","volume":"9 8","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12367040/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144884088","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":"Dissatisfaction and Residual Symptoms in Younger and Older Adult Patients after Total Knee Arthroplasty.","authors":"Nicholas B Pohl, Parker L Brush, Adrian Santana, Sebastian I Fras, Eleanor Jenkins, Arjun Saxena","doi":"10.5435/JAAOSGlobal-D-25-00167","DOIUrl":"10.5435/JAAOSGlobal-D-25-00167","url":null,"abstract":"<p><strong>Introduction: </strong>Total knee arthroplasty (TKA) is an increasingly used treatment option for younger patients with osteoarthritis. Previous research has found only 66% patients <60 years who underwent TKA postoperatively reported that their knees felt normal. However, the prior studies did not compare underlying causes for dissatisfaction based on age. This study compared the satisfaction and residual symptom rates between patients ages <60 and ≥60 years and identified specific reasons for their dissatisfaction between the age groups.</p><p><strong>Methods: </strong>Patients who underwent unilateral TKA for osteoarthritis from 2014 to 2016 were electronically sent a 15-question survey pertaining to surgery satisfaction. Following patient identification and survey completion, patient demographics, medical history, surgical time, and length of stay were collected through manual review of medical records. Patients who completed surveys were grouped by age (<60 years or ≥60 years) for analysis.</p><p><strong>Results: </strong>In total, 1189 ≥ 60-year-old patients and 388 < 60-year-old patients were included. Most patients in both cohorts reported satisfaction with overall knee function (<60: 68.6%; ≥60: 71.8%; P = 0.175). Fewer <60-year patients reported normal knee function (66.5% vs. 75.2%; P < 0.001). The most common residual symptom in both cohorts was continued pain.</p><p><strong>Conclusion: </strong>Patients younger than 60 years reported less satisfaction with performing normal activities and decreased normal knee function postoperatively. The <60 cohort reported requiring more readmissions for TKA concerns; however, no difference was observed in the rate of revision TKA between the cohorts. This information may be beneficial to clinicians and younger patients when discussing postoperative outcomes and functional expectations following TKA.</p>","PeriodicalId":45062,"journal":{"name":"Journal of the American Academy of Orthopaedic Surgeons Global Research and Reviews","volume":"9 8","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12367000/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144884086","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":"Emergency Department Visits Within Ninety Days of Endoscopic Lumbar Decompression.","authors":"Philip P Ratnasamy, Sahir S Jabbouri, Gwyneth C Maloy, Arya G Varthi, Daniel R Rubio, Jonathan N Grauer","doi":"10.5435/JAAOSGlobal-D-25-00009","DOIUrl":"10.5435/JAAOSGlobal-D-25-00009","url":null,"abstract":"<p><strong>Background context: </strong>Endoscopic lumbar decompression is growing in popularity as an alternative to an open approach for management of lumbar radiculopathy. Although endoscopic procedures are inherently less invasive, emergency department (ED) visits may occur postoperatively. Although many quality improvement initiatives target readmissions, ED visits may be more common, be a marker of quality of care, affect patient satisfaction, and contribute to healthcare resource utilization and costs.</p><p><strong>Purpose: </strong>To characterize the timing and risk factors of ED utilization following single-level endoscopic lumbar decompression.</p><p><strong>Study design/setting: </strong>Retrospective database review.</p><p><strong>Patient sample: </strong>PearlDiver M165Ortho data set.</p><p><strong>Outcome measures: </strong>Timing of ED utilization following endoscopic lumbar decompression, independent risk factors of ED utilization following endoscopic lumbar decompression, and revision surgery rate among patients who use the ED.</p><p><strong>Methods: </strong>Single-level endoscopic lumbar decompression patients were identified from the PearlDiver M165Ortho data set. Patients were excluded if additional procedures were performed, if they were younger than 18 years, if they had a concomitant diagnosis of trauma, neoplasm, or infection on the day of surgery, or if there was not 90-day follow-up in the data set. Patient factors were extracted, including age, sex, Elixhauser Comorbidity Index, region of the country in which their procedure was performed (Midwest, Northeast, South, West), and patient insurance plan (Commercial, Medicaid, Medicare).The incidence, timing, and frequency of ED utilization within 90 days of endoscopic lumbar decompression was then determined. A baseline rate of weekly ED utilization for the study cohort was calculated based on average weekly ED utilization at 52 to 56 weeks postoperatively. Patient factors predictive of postoperative ED utilization were then determined by univariate and multivariate analyses.</p><p><strong>Results: </strong>Of 1397 endoscopic lumbar decompression patients identified, 151 (10.8%) visited the ED within 90 days of surgery. Of note, approximately 29% of these ED visits occurred in the first 2 postoperative weeks.Multivariate analysis revealed several independent predictors of ED utilization following endoscopic lumbar decompression, including female sex (odds ratio [OR] 1.57 relative to male), higher Elixhauser Comorbidity Index (OR 1.15 per two-point increase), and Medicaid coverage (OR 2.49 relative to Medicare).Of patients who visited the ED, 97 (64.2%) were readmitted. Less than 11 patients who used the ED underwent revision surgery in the subsequent 2 weeks.</p><p><strong>Conclusions: </strong>Following endoscopic lumbar decompression, close to 11% of patients were found to visit the ED in the 90 days following their surgery, most commonly in the first two postoperative","PeriodicalId":45062,"journal":{"name":"Journal of the American Academy of Orthopaedic Surgeons Global Research and Reviews","volume":"9 8","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12366965/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144884087","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}