JBJS Reviews最新文献

{"title":"Intraoperative Calcar Fractures in Uncemented Total Hip Replacement: A Systematic Review.","authors":"Amaar Awais Ali, Muhammad Yasir Tarar, Zubayr Ali, Qing Zhi Tan, Minahil Arshad","doi":"10.2106/JBJS.RVW.26.00135","DOIUrl":"https://doi.org/10.2106/JBJS.RVW.26.00135","url":null,"abstract":"<p><strong>Background: </strong>Intraoperative calcar fractures (IOCFs) are a recognized complication of uncemented total hip arthroplasty (THA), often occurring during femoral preparation or stem insertion due to the press-fit fixation required for cementless implants. The aim of this systematic review was to synthesize current evidence regarding the epidemiology, risk factors, management strategies, and outcomes associated with IOCFs in uncemented THA.</p><p><strong>Methods: </strong>A systematic search of electronic databases, including PubMed, MEDLINE, and Embase, was performed for studies reporting IOCFs during primary uncemented THA. Studies underwent 2 rounds of screening by 2 independent reviewers followed by data extraction and narrative synthesis. Risk-of-bias assessment was performed for each study.</p><p><strong>Results: </strong>Sixty studies were selected for inclusion in this systematic review, encompassing 465,030 primary uncemented THAs. The rate of IOCFs across all studies was 0.74% with reported incidences ranging from 0% to 10% for individual studies. Stem impaction was the most common step of the operation in which IOCF were sustained (72%). The most common fracture morphology reported involved extension until the lesser trochanter. Cerclage fixation was the most popular management strategy intraoperatively (>95%). Patient body mass index, use of smaller stems, procedures performed by trainees, and various aspects of femoral morphology were associated with significantly higher rates of IOCFs. At follow-up, patients managed for IOCFs showed minimal rates of complications including loosening of femoral components, need for revision surgery and stem subsidence.</p><p><strong>Conclusion: </strong>IOCFs during uncemented THA are uncommon but clinically important complications. Prompt recognition and appropriate fixation, most commonly, with cerclage wiring generally result in favorable outcomes. Awareness of patient-related and procedure-related risk factors may help reduce the incidence of this complication and optimize intraoperative management.</p><p><strong>Level of evidence: </strong>This review included studies ranging from between Level I to Level III evidence.</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":"149031699","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":"Total Hip and Knee Arthroplasty in the Pediatric and Adolescent Population: A Systematic Review and Meta-Analysis.","authors":"Amir Human Hoveidaei, Mohammad Reza Ramezanpour, Mahyaar Omouri-Kharashtomi, Raha Shahrokhi, María Belén López Villagra, Sean Tabaie, Mustafa Citak","doi":"10.2106/JBJS.RVW.26.00096","DOIUrl":"10.2106/JBJS.RVW.26.00096","url":null,"abstract":"<p><strong>Background: </strong>Total hip arthroplasty (THA) and total knee arthroplasty (TKA) are rarely performed in children and adolescents but may be required for end-stage joint disease. Evidence regarding safety, survivorship, and patient-reported outcomes in patients younger than 25 years remains limited. The aim of this study was to systematically evaluate postoperative complications, functional outcomes, quality of life, and revision rates following THA and TKA in this age group.</p><p><strong>Methods: </strong>A systematic review and meta-analysis was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020. MEDLINE, Embase, Scopus, and Web of Science were searched through October 2025 for studies reporting outcomes of THA or TKA in patients aged younger than 25 years. Random-effects models were used to pool complication rates, functional outcomes, quality of life, and all-cause revision separately for THA and TKA. Meta-regression explored the influence of age, sex, year of patient inclusion, arthroplasty indications, and bearing surface types.</p><p><strong>Results: </strong>A total of 44 studies involving 3,317 patients and 5,632 joints were included. Following THA, pooled rates of periprosthetic joint infection (PJI), aseptic loosening, and periprosthetic fracture were 1.6%, 5.4%, and 1.4%, respectively, and all-cause revision rate was 8.7%. Functional scores (standardized mean difference [SMD] = 4.9) and quality-of-life measures (SMD = 1.8) improved substantially after THA. For TKA, pooled PJI and aseptic loosening rates were 2.9% and 9.9%, with an all-cause revision rate of 12.4%. Subgroup analyses demonstrated that more recent years of patient inclusion were associated with lower revision and infection rates following THA.</p><p><strong>Conclusion: </strong>THA and TKA in patients younger than 25 years can improve function and quality of life, although the risks of revision and infection remain higher than those in older adults. Outcomes have improved in more recent cohorts with advances in implant design and surgical technique. Further prospective studies with standardized reporting are needed to define optimal implant selection and long-term outcomes in this population.</p><p><strong>Prospero registration code: </strong>CRD420261303010.</p><p><strong>Level of evidence: </strong>Therapeutic Level III (systematic review of retrospective cohort studies). See Instructions for Authors for a complete description of levels of evidence.</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":"149031691","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":"Beyond Infection Eradication: Reframing Decision Making for Chronic Hip Periprosthetic Joint Infection: Commentary on \"One- vs. Two-Stage Exchange for Chronic Hip Periprosthetic Joint Infection: A Framework Based on Patient Treatment Burden and Institutional Capability\".","authors":"Bassam A Masri","doi":"10.2106/JBJS.RVW.26.00206","DOIUrl":"https://doi.org/10.2106/JBJS.RVW.26.00206","url":null,"abstract":"","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":"149031742","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":"To Screen or Partially Screen; That Is the Question: Commentary on \"Preventing Missed Developmental Dysplasia of the Hip: Universal vs. Selective Ultrasound Screening\".","authors":"James G Wright","doi":"10.2106/JBJS.RVW.26.00188","DOIUrl":"https://doi.org/10.2106/JBJS.RVW.26.00188","url":null,"abstract":"","PeriodicalId":47098,"journal":{"name":"JBJS Reviews","volume":"14 8","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148841482","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":"Preventing Missed Developmental Dysplasia of the Hip: Universal vs. Selective Ultrasound Screening.","authors":"Noah David Miller, Mark Gibson, Ajay Nair, Jiayong Liu","doi":"10.2106/JBJS.RVW.26.00126","DOIUrl":"10.2106/JBJS.RVW.26.00126","url":null,"abstract":"<p><strong>Background: </strong>Developmental dysplasia of the hip (DDH) encompasses a spectrum of hip abnormalities in infants. Early identification enables nonoperative management and improved outcomes. Selective screening uses clinical examination to determine referral for ultrasound (US), whereas universal screening performs routine US in all newborns after birth. Despite widespread use of both strategies, there is no consensus on the optimal approach.</p><p><strong>Methods: </strong>A systematic review was conducted to evaluate the outcomes of selective vs. universal screening. MEDLINE, Embase, and the Cochrane Library were searched for studies published from 2005 to 2025. The primary outcomes were late diagnosis and surgical intervention rates. Secondary outcomes included screening rates, overall DDH incidence, and nonoperative treatment rates.</p><p><strong>Results: </strong>A total of 819,277 infants were identified. Universal screening had higher US utilization (98.5% vs. 8.7%; p < 0.001). Overall DDH incidence was higher with universal screening (11.86 vs. 4.36 per 1,000; p = 0.025). Both groups had similar rates of late diagnosis (0.25 vs. 0.59 per 1,000; p = 0.243). Nonoperative treatment rates were higher for universal screening (10.07 vs. 3.54 per 1,000; p = 0.039), while surgical treatment rates were similar (0.50 vs. 0.32 per 1,000; p = 0.291).</p><p><strong>Conclusion: </strong>Universal US screening had increased detection and rates of nonoperative treatment but did not reduce late diagnosis or surgical intervention. This highlights a tradeoff between increased detection and treatment burden without clear evidence of improved outcomes.</p><p><strong>Level of evidence: </strong>Level III evidence (systematic review and meta-analysis of cohort studies). See Instructions for Authors for a complete description of levels of evidence.</p>","PeriodicalId":47098,"journal":{"name":"JBJS Reviews","volume":"14 8","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148841558","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":"The Therapeutic Effect of Saline in Lumbar Injection Trials: A Systemic Review and Meta-Analysis of Randomized Controlled Trials.","authors":"Puru Sadh, Maxwell Dassow, Yousuf Suleman, Marc Greenberg, Jinseong Kim, Bryce A Basques","doi":"10.2106/JBJS.RVW.26.00057","DOIUrl":"10.2106/JBJS.RVW.26.00057","url":null,"abstract":"<p><strong>Background: </strong>Normal saline is commonly used as a presumed inert placebo control in lumbar injection trials. However, prior studies suggest that saline injections may be associated with improvements in patient-reported outcomes, potentially confounding interpretation of comparative treatment effects. The magnitude, durability, and clinical relevance of these changes have not been systematically characterized. The primary aim of this study was to evaluate changes in patient-reported outcomes following saline injection in patients with lumbar radiculopathy and, separately, in patients with diskogenic low back pain.</p><p><strong>Methods: </strong>A systematic review of PubMed, Embase, and Google Scholar was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines to identify randomized controlled trials (RCTs) published between 2000 and 2025 that included a saline injection arm for lumbar radiculopathy or diskogenic pain. Within-arm pre-post changes in Visual Analog Scale (VAS) pain scores and Oswestry Disability Index (ODI) were pooled. Outcomes were evaluated at multiple time points up to 1 year. Subgroup analyses were performed based on injection route. Changes were contextualized relative to established minimal clinically important difference (MCID) thresholds.</p><p><strong>Results: </strong>Eighteen RCTs comprising 759 patients were included. In lumbar radiculopathy, saline arms demonstrated statistically significant reductions in leg pain and disability across all evaluated time points. Pooled mean differences for leg pain VAS ranged from -1.79 at 1 month to -3.85 at 1 year, while ODI improvements increased from -7.30 to -17.83 points over the same interval, exceeding MCID thresholds. Improvements were more consistent following epidural injection. By contrast, patients with diskogenic pain exhibited smaller changes in back pain and disability, with most pooled estimates failing to reach MCID thresholds.</p><p><strong>Conclusions: </strong>Saline injection arms of lumbar injection RCTs demonstrate meaningful improvements in pain and disability over time, particularly in patients with lumbar radiculopathy. These findings suggest that saline injections are not inert comparators and may elevate baseline response in interventional trials, potentially obscuring the incremental benefit of active injectates. Future RCTs should consider incorporating nonsaline control arms to better isolate treatment-specific effects and improve interpretability of comparative outcomes.</p><p><strong>Level of evidence: </strong>Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.</p>","PeriodicalId":47098,"journal":{"name":"JBJS Reviews","volume":"14 8","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148814489","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":"One- vs. Two-Stage Exchange for Chronic Hip Periprosthetic Joint Infection: A Framework Based on Patient Treatment Burden and Institutional Capability.","authors":"Daisy A Ference, Robert E Carrier, Gabriella N Capote, Derek S Scheinberg, Victor H Hernandez, Michele R D'Apuzzo, Colin A McNamara","doi":"10.2106/JBJS.RVW.26.00121","DOIUrl":"https://doi.org/10.2106/JBJS.RVW.26.00121","url":null,"abstract":"<p><p>» Recent evidence demonstrates equivalent infection-eradication rates between one-stage revision (OSR) and two-stage revision (TSR) in chronic hip periprosthetic infection at experienced centers. » The decision between OSR and TSR should account for patient treatment burden, which includes functional limitation, spacer complications, medical morbidity, psychological burden, and cost. » Traditional OSR selection criteria may identify patients with greater overall surgical complexity rather than reliably unfavorably biasing reinfection risk. » Standardized institutional protocols are critical for the success of OSR and include careful patient selection, microbiologic planning, thorough debridement, clean-phase separation and dual setup, experience with complex hip revision surgery, and multidisciplinary coordination. » TSR remains appropriate in clinical scenarios involving fungal infection, substantial host compromise, prior failed septic revision, and at institutions where highly specific and standardized protocols cannot be reliably implemented.</p>","PeriodicalId":47098,"journal":{"name":"JBJS Reviews","volume":"14 8","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13489767/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148799400","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":"Current Approaches to Arthroscopic Management of Anterior Shoulder Instability.","authors":"Sophie Ba, Matthew Macciacchera, Nagi Mikhail, Emmitt Hayes, J W Pollock, Michael Pickell, Bogdan A Matache","doi":"10.2106/JBJS.RVW.26.00033","DOIUrl":"https://doi.org/10.2106/JBJS.RVW.26.00033","url":null,"abstract":"<p><p>Operative management should be considered from the initial episode of anterior shoulder instability to prevent bone loss, minimize risk of recurrence, maximize the potential for return to sport at the preinjury level, and from a cost-effectiveness standpoint. The glenoid track concept will be examined as a crucial factor in determining whether bone loss is significant. The increasingly comprehensive understanding of the dynamic interactions between bone loss on the humeral head and glenoid rim will be further discussed as a key factor influencing both surgical management and outcomes. The indications for an isolated soft-tissue procedure in anterior shoulder instability are now narrower; the ideal candidate presents with minimal glenoid bone loss (13.5%). The indications for remplissage as an adjunct procedure continue to expand and remain an ongoing area of study; they now include arthroscopic Bankart repair with off-track and near-track Hill-Sachs lesions or subequatorial extension, and in conjunction with Latarjet, and free bone block procedures. Regarding bony stabilization, Latarjet remains the most established option, but arthroscopic anatomic glenoid reconstruction with a distal tibial allograft is a promising alternative, offering near-anatomic reconstruction and excellent short-term outcomes.</p>","PeriodicalId":47098,"journal":{"name":"JBJS Reviews","volume":"14 8","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148799602","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":"One-Stage or Two-Stage Revision for Infected Shoulder Arthroplasty: A Head-to-Head Meta-Analysis of Comparative Studies.","authors":"Amr Selim, Abdelrahman Ibrahim, Azhar Abbas, Salman Sadiq, Muhamed M Farhan-Alanie, Mohammed Lyeeq Ahmed, Jae Rhee","doi":"10.2106/JBJS.RVW.26.00055","DOIUrl":"10.2106/JBJS.RVW.26.00055","url":null,"abstract":"<p><strong>Background: </strong>Periprosthetic joint infection (PJI) following shoulder arthroplasty is a devastating complication associated with substantial morbidity and revision burden. While 2-stage revision has traditionally been regarded as the gold standard for chronic shoulder PJI, single-stage revision has emerged as a potential alternative. The aim of this systematic review was to directly compare infection-related outcomes and complications between single-stage and 2-stage revision arthroplasties for shoulder PJI.</p><p><strong>Methods: </strong>This systematic review was prospectively registered with PROSPERO (CRD420251159566) and conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. MEDLINE, EMBASE, and Web of Science were searched up to September 22, 2025. Comparative observational studies and randomized controlled trials (RCTs) evaluating single-stage vs. 2-stage revision for shoulder PJI in adults were eligible; no RCTs were identified. Primary outcomes were reinfection and infection control success; overall complications were secondary. Odds ratios (ORs) were calculated within each study and pooled using a random-effects model. Risk of bias was assessed with the Risk of Bias in Non-randomized Studies of Interventions tool, and the certainty of evidence was assessed using Grading of Recommendations Assessment, Development and Evaluation.</p><p><strong>Results: </strong>Thirteen retrospective comparative studies involving 260 patients (127 single-stage and 133 two-stage) were included. Compared with 2-stage revision, single-stage revision showed a lower, but not statistically significant, odds of reinfection (OR 0.46, 95% confidence interval [CI] 0.21-1.04; p = 0.06; I2 = 0%) and overall complications (OR 0.52, 95% CI 0.18-1.53; p = 0.24; I2 = 0%) and a higher, but nonsignificant, odds of infection control success (OR 1.57, 95% CI 0.45-5.40; p = 0.48; I2 = 17%).</p><p><strong>Conclusion: </strong>Single-stage revision demonstrated infection control and complication rates comparable with 2-stage revision for shoulder PJI. Although no statistically significant differences were observed, trends favored single-stage revision. Given that the certainty of the evidence was graded as low, these findings should be interpreted with caution, and high-quality RCTs are required to define optimal patient selection and surgical strategy.</p><p><strong>Level of evidence: </strong>Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.</p>","PeriodicalId":47098,"journal":{"name":"JBJS Reviews","volume":"14 7","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148608570","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":"Lateral Patellofemoral Ligament Reconstruction Remains Poorly Defined: A Review from Anatomy to Surgical Management.","authors":"Ramesses A Akamefula, Daniel C Touhey, Matthew V Smith, Derrick M Knapik","doi":"10.2106/JBJS.RVW.26.00085","DOIUrl":"10.2106/JBJS.RVW.26.00085","url":null,"abstract":"<p><p>» Lateral patellofemoral ligament (LPFL) deficiency is an under-recognized but clinically relevant cause of medial patellar instability, most commonly following excessive lateral retinacular release, though traumatic and atraumatic etiologies have also been described. » Diagnosis remains primarily clinical and is characterized by medial apprehension, pain in early knee flexion, and excessive medial translation, with imaging serving an adjunctive role in excluding osseous contributors and confirming direction-specific instability. » Anatomic LPFL reconstruction restores lateral restraint and has demonstrated consistent short-term to mid-term improvements in stability and patient-reported outcomes, although available evidence is limited to case series, technical reports, and biomechanical investigations. » LPFL reconstruction techniques vary substantially, but soft-tissue patellar fixation strategies may reduce patellar bone violation and potential fracture risk while attempting to restore lateral patellar restraint.</p>","PeriodicalId":47098,"journal":{"name":"JBJS Reviews","volume":"14 7","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148608520","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}