JBJS Reviews最新文献

{"title":"From Accuracy to Adoption: A Clinical Readiness Framework for Artificial Intelligence in Orthopaedic Surgery (OSCAR).","authors":"Audrey R Byrne, Nana O Sarpong","doi":"10.2106/JBJS.RVW.26.00182","DOIUrl":"https://doi.org/10.2106/JBJS.RVW.26.00182","url":null,"abstract":"<p><p>Technical performance alone does not establish clinical readiness; strong accuracy or discrimination does not demonstrate that an artificial intelligence (AI) tool will generalize, improve clinical care, or remain safe after deployment. Existing AI frameworks provide important guidance for reporting, risk of bias, model evaluation, and clinical trials, but they do not provide a single longitudinal stage describing a technology's progression from development through monitored clinical deployment. We propose the Orthopaedic Surgery Clinical AI Readiness (OSCAR) scale as a 6-stage conceptual framework spanning model development, internal and external validation, early clinical evaluation, comparative clinical validation, and monitored deployment. Illustrative applications of OSCAR demonstrate how technically strong models may remain at stage 1, external validation advances a tool to stage 2, live workflow evaluation represents stage 3, and comparative clinical evidence is required for stage 4. OSCAR is intended to complement, not replace, established reporting and risk-of-bias standards. The framework remains unvalidated and requires stakeholder consensus, explicit decision criteria, inter-rater reliability testing, and prospective evaluation.</p>","PeriodicalId":47098,"journal":{"name":"JBJS Reviews","volume":"14 10","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149225234","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Metal Hypersensitivity Reactions Following Spinal Implants: A Systematic Review.","authors":"Joseph Abbo, Jacob Thomas, Christian Stipho, Erik Nakken, Rakesh Patel, Joshua D Piche, IIyas Aleem","doi":"10.2106/JBJS.RVW.26.00099","DOIUrl":"https://doi.org/10.2106/JBJS.RVW.26.00099","url":null,"abstract":"<p><strong>Background: </strong>Metal hypersensitivity reactions are infrequently reported but clinically significant after spinal implant surgery. Clinical presentation can mimic infection or mechanical failure, making diagnosis difficult. Evidence to guide diagnosis and management is largely limited to short case series and case reports. The purpose of this study was to systematically review the clinical presentation, diagnostic methods, and outcomes of metal hypersensitivity associated with spinal implants.</p><p><strong>Methods: </strong>A systematic review was conducted of PubMed, Embase, and Scopus from inception through June 22, 2026, in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Title and abstract screening, full-text review, and data extraction were performed independently by 2 reviewers with conflicts resolved by a third reviewer. Eligible studies included adult patients with suspected or confirmed metal hypersensitivity following spinal implant surgery that reported patient-level clinical outcomes.</p><p><strong>Results: </strong>Fifteen studies with a total of 19 patients met inclusion criteria (53% female, 42% male, and 5% not reported). The median patient age was 47 years (range, 19-69). Twelve procedures (63%) were fusion-based, while 7 (37%) were motion preserving, including disk arthroplasty and artificial facet replacement systems. Common clinical presentations included persistent pain, with 8 patients (42%) exhibiting dermatologic manifestations. Metal hypersensitivity was immunologically confirmed by positive patch testing and/or lymphocyte transformation testing in 11 patients (58%), while 8 (42%) were diagnosed clinically. Onset of symptoms ranged from immediately postoperatively to 15 years after implantation. Eighteen patients underwent removal or revision with clinical improvement in 14 of 16 with a reported outcome (88%).</p><p><strong>Conclusion: </strong>Metal hypersensitivity reactions following spinal implants are infrequently reported but may present either immediately or in a delayed manner with symptoms that mimic more common postoperative complications, such as infection or pseudarthrosis, or may present with dermatologic manifestations. In cases where other etiologies are ruled out, hardware removal was frequently, though not invariably, associated with clinical improvement, which was reported narratively rather than by validated outcome measures.</p><p><strong>Level of evidence: </strong>Therapeutic Level V. See Instructions for Authors for a complete description of levels of evidence.</p>","PeriodicalId":47098,"journal":{"name":"JBJS Reviews","volume":"14 10","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149225231","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Propensity Score Methods and Target Trial Emulation in Orthopaedic Surgery: A Practical Guide to Causal Inference from Observational Data.","authors":"Wayne Hoskins, Charles Gusho, Rown Parola, Jaime Bellamy, Elizabeth G Lieberman, Gerard P Slobogean, Nathan N O'Hara","doi":"10.2106/JBJS.RVW.26.00185","DOIUrl":"10.2106/JBJS.RVW.26.00185","url":null,"abstract":"<p><p>» The propensity score is a patient's modeled probability of receiving a treatment given measured baseline characteristics (covariates). Matching patients with similar scores balances those covariates between groups, approximating the comparability achieved by randomization. » Target trial emulation specifies the protocol of the ideal randomized trial and then reproduces it in observational data, enforcing an explicit eligibility window, time zero (the single point at which eligibility, treatment assignment, and the start of follow-up coincide), and analysis plan. » Regression adjusts for confounders within the outcome model, whereas propensity score matching balances those confounders before outcomes are examined. Propensity matching is preferred for rare outcomes or many confounders, where regression tends to overfit. » Neither propensity matching nor target trial emulation addresses unmeasured confounding, and both lose validity in small single-center cohorts with limited overlap (few treated and untreated patients who resemble one another closely enough to be fairly compared); a randomized trial remains the reference standard when feasible. » When appraising studies using propensity matching or target trial emulation, look for 3 key features: (1) Postmatching covariate balance: Are the treatment groups well balanced after matching? (standardized mean difference <0.10). (2) Positivity: Is there enough overlap in patient characteristics that treated and untreated patients can be fairly compared? (3) Unambiguous \"time zero\": Did follow-up begin at the same well-defined starting point for all patients?</p>","PeriodicalId":47098,"journal":{"name":"JBJS Reviews","volume":"14 10","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149225163","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Psychological Factors Associated with Function and Health-Related Quality of Life Outcomes following Total Hip or Knee Arthroplasty: An Umbrella Review of Systematic Reviews.","authors":"Motahareh Karimijashni, Victoria Drouin, Caroline Béland, Jeremy Jaillet, Émilie Pinard, Tim Ramsay, Yannick Tousignant-Laflamme, Alexe Hébert, Paul E Beaulé, Stéphane Poitras","doi":"10.2106/JBJS.RVW.26.00093","DOIUrl":"https://doi.org/10.2106/JBJS.RVW.26.00093","url":null,"abstract":"<p><strong>Background: </strong>There is growing interest in identifying psychological factors associated with outcomes following total hip arthroplasty (THA) or total knee arthroplasty (TKA). However, the available evidence is heterogeneous, and uncertainty remains regarding which psychological factors are most consistently associated with postoperative outcomes following arthroplasty. The aim of this study was to provide an overview of available evidence of association between psychological factors and function or health-related quality of life (HRQoL) after arthroplasty.</p><p><strong>Methods: </strong>An umbrella review was conducted, and 3 electronic databases were searched, and systematic reviews were included. We reported the risk of bias assessments of primary studies as reported in systematic reviews. Only high quality studies were included in qualitative synthesize.</p><p><strong>Results: </strong>A total of 25 systematic reviews, including data from 40,024 patients, were included. Two psychological vulnerability factors, including depression, and anxiety negatively affect postoperative function/HRQoL after THA or TKA. Our findings also indicated that distress, kinesiophobia, pain catastrophizing, and pessimism negatively impact postoperative function/HRQoL outcomes following TKA, though no reviews have addressed these factors for THA. Conversely, the psychological protective factors of patient expectations and mental well-being were found to positively influence function/HRQoL outcomes following both TKA.</p><p><strong>Conclusion: </strong>These findings may help clinicians target specific elements to enhance the management of patients and could potentially improve outcomes by addressing these factors through tailored interventions.</p><p><strong>Level of evidence: </strong>Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.</p>","PeriodicalId":47098,"journal":{"name":"JBJS Reviews","volume":"14 10","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149225144","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Networking, Mentorship, and Residency Match Success for Medical Students Interested in Orthopaedic Surgery.","authors":"Christopher B Song, Alexander Wentzel, Mitchell J Christiansen, Mary K Mulcahey","doi":"10.2106/JBJS.RVW.26.00171","DOIUrl":"10.2106/JBJS.RVW.26.00171","url":null,"abstract":"<p><p>» In-person networking, particularly away rotations, remains an important factor for medical students interested in pursuing orthopaedic surgery. There are also strong associations with doing an away rotation and matching at that specific institution. » Active engagement at a national or regional conference is a more effective means of networking compared with passive participation. Poster and podium presentations are a better way of networking at conferences and enhance the student's application for residency. » Local, regional, and national orthopaedic society meetings and structured education programs are great opportunities for medical students interested in orthopaedic surgery to network with other residents, attendings, and leaders in the field. » Virtual networking modalities, such as emailing, participating in webinars, and engaging on social media, are another source of effective communication with attendings, residents, and internal and external institutions. » Students underrepresented in medicine also have networking opportunities such as targeted pipeline programs and mentorship initiatives that improve exposure to orthopaedic surgery and advocacy.</p>","PeriodicalId":47098,"journal":{"name":"JBJS Reviews","volume":"14 10","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149225226","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Core Muscle Injury: A Combined Orthopaedic and General Surgery Algorithmic Approach for Diagnosis, Imaging, and Treatment.","authors":"Ariana Lott, Caroline A Dannacher, Mohammad M Samim, Mary Ann Hopkins, Jordan Taylor, Spencer Stein, Xavier Pereira, Natasha Desai, Abigail Campbell","doi":"10.2106/JBJS.RVW.26.00097","DOIUrl":"https://doi.org/10.2106/JBJS.RVW.26.00097","url":null,"abstract":"<p><p>» Core muscle injury (CMI) is a common cause of groin pain in athletes and reflects pathology of the inguinal canal, rectus abdominis-adductor longus (RA-AL) aponeurosis, and pubic symphysis. » There is a substantial lack of consensus on terminology and diagnostic criteria for CMI, hindering standardized evaluation, management, and research initiatives. » Diagnosis relies on structured history, physical examinations, and provocative maneuvers to identify CMI and concurrent pathology, and fluid-sensitive pelvic magnetic resonance imaging to characterize RA-AL injury. » Treatment strategies differ across sports medicine physicians, general surgeons, and orthopaedic surgeons, underscoring the need for early cross-departmental referrals to ensure all contributing pathologies are comprehensively identified and addressed. » When both adductor/RA-AL aponeurosis and inguinal canal/abdominal wall pathologies are present, prioritizing collaborative cases between orthopaedic and general surgeons is essential for decreasing operating room time, streamlining rehabilitation, and optimizing return-to-sport outcomes.</p>","PeriodicalId":47098,"journal":{"name":"JBJS Reviews","volume":"14 10","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149225199","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Optimal Radial Head Prosthesis Sizing in Elbow Trauma: A Review of Anatomical Principles and Clinical Techniques.","authors":"Khaled K Alabbasi, Graham J W King","doi":"10.2106/JBJS.RVW.26.00067","DOIUrl":"10.2106/JBJS.RVW.26.00067","url":null,"abstract":"<p><p>» This review synthesizes current evidence and techniques for optimal spherical radial head arthroplasty, focusing on the importance of accurate prosthesis sizing to ensure a successful outcome. » Replication of the native radial head's diameter and height is important. Mismatch can lead to pain, stiffness, capitellar wear, altered joint kinematics, and accelerated arthritis. » For diameter, the minimal outer diameter of the reconstructed native head is the most reliable guide. If comminution prevents this, the capitellar width on computed tomography scans provides a strong correlative measurement. » For height, the prosthesis should align with the proximal edge of the lesser sigmoid notch. Intraoperatively, direct visualization or fluoroscopic assessment of the lateral ulnohumeral joint space is recommended to detect overlengthening. » Diagnosing postoperative sizing errors is challenging. A defined radiographic technique comparing the radial head/neck length with the contralateral elbow on 45° flexion views can help quantify overlengthening.</p>","PeriodicalId":47098,"journal":{"name":"JBJS Reviews","volume":"14 9","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13608325/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149065034","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":"Beyond Density: Fixation Strategies and Healing Paradoxes in Osteogenesis Imperfecta Fractures.","authors":"Zina Smadi, Aditya Rao, Sami Ghanim, Sydnee Latrese Brown, Scott Rosenfeld, Vinithia Shenava","doi":"10.2106/JBJS.RVW.26.00157","DOIUrl":"https://doi.org/10.2106/JBJS.RVW.26.00157","url":null,"abstract":"<p><p>» Osteogenesis imperfecta (OI) produces lifelong skeletal fragility from collagen synthesis defects, with fracture risk 13-fold higher than the general population, despite bone mineral density-increasing drugs lacking fracture reduction evidence. » Telescoping intramedullary rods remain the gold standard for pediatric OI fractures and deformity correction, pioneered by Bailey-Dubow and refined by Fassier-Duval to accommodate growth. » Surgical fixation faces unique challenges including thin cortices and poor screw purchase. Adjunctive plating reduces complications from 45% (rods alone) to 16% by enhancing stability. » Early operative intervention, before the age of 3 years in severe type III OI, prevents disuse osteopenia cycles, while concurrent deformity correction at fracture sites optimized alignment and function.</p>","PeriodicalId":47098,"journal":{"name":"JBJS Reviews","volume":"14 9","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149031718","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Dural Tears in Endoscopic Spine Surgery: Incidence, Risk Factors, Prevention, and Management.","authors":"Mark Kurapatti, Junho Song, Samuel K Cho","doi":"10.2106/JBJS.RVW.26.00128","DOIUrl":"https://doi.org/10.2106/JBJS.RVW.26.00128","url":null,"abstract":"<p><p>Dural tear risk in endoscopic spine surgery is determined more by procedural complexity and surgeon experience than by the endoscopic technique alone, with the highest rates observed in interlaminar decompression for lumbar stenosis and the lowest in transforaminal procedures. Most incidental dural tears can now be managed endoscopically without routine conversion to open surgery, particularly when tears are recognized early and stratified according to size, location, cerebrospinal fluid flow, and neural element involvement. Patch- and graft-based techniques represent the current workhorse strategy for moderate dural tears (5-10 mm), whereas endoscopic suturing is increasingly feasible for larger or high-flow defects in experienced hands. There is currently no standardized postoperative management protocol for endoscopic dural tears, and practices regarding bed rest, mobilization, and drain usage remain highly variable across the literature. The clinical significance of dural tear is determined less by its occurrence than by the adequacy of its management as most patients achieve favorable long-term outcomes when tears are recognized and treated appropriately.</p>","PeriodicalId":47098,"journal":{"name":"JBJS Reviews","volume":"14 9","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149031724","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Nutritional Resuscitation in Patients With Orthopaedic Trauma: A Guide for the Practicing Orthopaedic Surgeon.","authors":"Harjot Uppal, Anthony Spinncickie, Patricio Grob, Donald Adams, David Klein, George Naseef, Richard Schenk, Anisha Chhibber, John Tis, Harpal Khanuja","doi":"10.2106/JBJS.RVW.26.00116","DOIUrl":"https://doi.org/10.2106/JBJS.RVW.26.00116","url":null,"abstract":"<p><p>» Postoperative nutritional optimization is an important, evidence-based intervention in trauma fracture care. Trauma induces a sustained hypermetabolic-catabolic response that overlaps with the critical phases of fracture healing, making early (within 24-48 hours) and structured nutritional intervention an opportunity for improvement in standard care. » A 12-week supplementation protocol is suggested for patients with operatively treated fractures. High-protein supplementation (1.5-2.0 g/kg/d for body mass index [BMI] <30; adjusted body weight-based dosing for BMI ≥30), vitamin D3 (cholecalciferol), calcium, and a multivitamin initiated postoperatively and continued through the hard callus phase may improve healing biology and reduce complications. » High-risk patients require enhanced and extended protocols with close medical follow-up and comanagement with an internal medicine physician or appropriate specialist. Elderly, malnourished, polytrauma, open fracture, and comorbid patients benefit from additional conditionally essential amino acids-that is, amino acids that the body can synthesize under normal conditions but cannot produce in sufficient quantities during metabolic stress (including arginine, glutamine, and branched-chain amino acids)-and wound-healing cofactors, with supplementation often continued for 6 months or until radiographic union. Arginine and glutamine should be used with caution in patients with chronic kidney disease (estimated glomerular filtration rate <60 mL/min/1.73 m2). » Monitoring and objective discontinuation criteria are important. Prealbumin (interpreted alongside C-reactive protein), albumin, and 25-hydroxyvitamin D should be reassessed at 2, 6, and 12 weeks, with supplementation discontinued only when laboratory values normalize, dietary intake recovers, and fracture healing progresses appropriately. Radiographic healing is not expected at 2 weeks; the 2-week visit focuses on nutritional markers and adherence assessment. » For osteoporotic fractures, nutritional optimization and maintenance of vitamin D status and calcium supplementation should be integrated into secondary fracture-prevention strategies and fracture liaison services.</p>","PeriodicalId":47098,"journal":{"name":"JBJS Reviews","volume":"14 9","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149031737","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}