JBJS Reviews最新文献

{"title":"Isolated Tibial or Femoral Component Revision Is Associated with Greater Revision Failure Rate Compared with Full Component Revision in Aseptic Revision Total Knee Arthroplasty: A Systematic Review and Meta-Analysis on Reconstructed Individual Participant Data.","authors":"Sina Hajiaghajani, Ali Soltani Farsani, Mohammad Poursalehian, Alireza Mirahmadi","doi":"10.2106/JBJS.RVW.26.00060","DOIUrl":"10.2106/JBJS.RVW.26.00060","url":null,"abstract":"<p><strong>Background: </strong>Aseptic loosening is a leading indication for revision total knee arthroplasty (rTKA). When one component remains well-fixed, surgeons may choose between isolated component revision (ICR) and full component revision (FCR), but the outcomes of these strategies remain uncertain. This systematic review and meta-analysis compared ICR with FCR in aseptic rTKA.</p><p><strong>Methods: </strong>Comparative studies of adult patients undergoing aseptic rTKA with ICR vs. FCR were identified. Outcomes included all-cause and cause-specific revision failure, patient-reported outcome measures (PROMs), and range of motion (ROM). The risk of bias was assessed using the Risk of Bias in Nonrandomized Studies of Interventions tool, and the certainty of evidence was evaluated using the Grading of Recommendations, Assessment, Development, and Evaluation approach for statistically significant meta-analyses. Individual participant data (IPD) were reconstructed from Kaplan-Meier curves and pooled for time-to-event analyses to estimate hazard ratios (HRs). Aggregate data (AD) meta-analyses used random-effects models to calculate pooled odds ratios (ORs) and mean differences (MDs).</p><p><strong>Results: </strong>Fifteen cohort studies (4,429 patients; 2,893 FCR, 1,536 ICR) were included. Reconstructed IPD from 5 studies (3,187 patients) showed a higher hazard of all cause revision failure after ICR compared with FCR (HR 1.51; 95% CI 1.28-1.78; p < 0.001). The AD meta-analysis of 13 studies showed a similar association (OR 1.58; 95% CI 1.21-2.07; p < 0.001; I2 = 33%). Cause-specific analyses were imprecise and crossed the null for aseptic loosening (OR 1.50; 95% CI 0.75-2.99), infection related failure (OR 0.90; 95% CI 0.41-1.96), and instability-related failure (OR 1.03; 95% CI 0.43-2.46). PROMs did not clearly differ between strategies. ICR was associated with greater postoperative ROM (MD 7.03°; 95% CI 0.21-13.85; p = 0.043).</p><p><strong>Conclusion: </strong>ICR in aseptic rTKA was associated with an increased overall all-cause revision failure rate compared with FCR. While ICR is associated with a higher all-cause revision failure rate, the choice between techniques remains subject to surgeon discretion and patient-specific factors.</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":"148608539","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":"Contemporary Concepts in Cervical Disk Arthroplasty: Implant Design, Constraint, Complications, and Technical Pearls.","authors":"Austin Q Nguyen, Andrei Demkov, Don Le, Rohan Vemu, Mark L Prasarn, Corey T Walker, Hyun W Bae, Todd Albert, Andrew A Sama, Sheeraz A Qureshi, Karim A Shafi","doi":"10.2106/JBJS.RVW.26.00041","DOIUrl":"10.2106/JBJS.RVW.26.00041","url":null,"abstract":"<p><p>» Cervical disk arthroplasty (CDA) is a Food and Drug Administration (FDA)-approved motion-preserving alternative to anterior cervical diskectomy and fusion for 1-level and 2-level degenerative disk diseases, supported by high-level evidence and associated with reduced adjacent segment degeneration and comparable or improved clinical outcomes. » FDA-approved CDA implants differ in biomechanical design, degrees of freedom (DoF), and constraint, affecting motion preservation, segmental control, and long-term kinematics. Devices range from constrained (3 DoF) to semiconstrained and viscoelastic designs (4-6 DoF). Implant articulation and materials impact wear, imaging compatibility, and biomechanical behavior and should be considered during device selection. » Constraint-based classification provides a practical, biomechanics-informed framework for CDA implant selection. Constraint level should be matched to patient pathology. Constrained implants may be preferable in cases of segmental instability, compromised endplate integrity, or poor bone quality. Semiconstrained or viscoelastic devices may offer better outcomes for patients with preserved motion, healthy facets, and high functional demands. » A structured understanding of failure modes is critical for safe and effective CDA use. Complications and failure can result from surgical technique errors (e.g., endplate violation, malposition), biologic response (e.g., osteolysis, heterotopic ossification), or mechanical complications (e.g., implant fracture, subsidence). Technical considerations aid the surgeon in reducing risk of complications.</p>","PeriodicalId":47098,"journal":{"name":"JBJS Reviews","volume":"14 7","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148537228","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":"Immersive Virtual Reality: Meeting Our Bioethical Imperative to Train the Next Generation of Physicians?: Commentary on: \"Immersive Virtual Reality Simulation-Based Assessments in Orthopedic Surgery: A Systematic Scoping Review\".","authors":"Paul E Levin","doi":"10.2106/JBJS.RVW.26.00160","DOIUrl":"10.2106/JBJS.RVW.26.00160","url":null,"abstract":"","PeriodicalId":47098,"journal":{"name":"JBJS Reviews","volume":"14 7","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148537238","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 Algorithm Is Already Scrubbed in and Why Orthopaedic Surgeons Must Lead, Not Follow, the AI Revolution: Commentary on: \"Artificial Intelligence in Total Hip and Knee Arthroplasty: A Primer on Current Applications, Algorithms, and Future\".","authors":"Jason Strelzow","doi":"10.2106/JBJS.RVW.26.00122","DOIUrl":"10.2106/JBJS.RVW.26.00122","url":null,"abstract":"","PeriodicalId":47098,"journal":{"name":"JBJS Reviews","volume":"14 6","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148309980","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":"How Studying Thresholds Can Harm Health: Commentary on: \"Loss of Reduction Following Nonoperative Management for Distal Radius Fractures: A Prognostic Factor Systematic Review and Meta-Analysis\".","authors":"David Ring","doi":"10.2106/JBJS.RVW.26.00101","DOIUrl":"10.2106/JBJS.RVW.26.00101","url":null,"abstract":"","PeriodicalId":47098,"journal":{"name":"JBJS Reviews","volume":"14 6","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148310020","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 Interplay of Diabetes, Glucose Variability, and Antidiabetic Therapy in Preventing Periprosthetic Joint Infection Following Hip and Knee Arthroplasty: A Review.","authors":"Alireza Askari, Sina Bazmi, Mohammadreza Dehghani, Matin Sepehrinia, Mohammad Poursalehian","doi":"10.2106/JBJS.RVW.26.00049","DOIUrl":"10.2106/JBJS.RVW.26.00049","url":null,"abstract":"<p><p>» Traditional reliance on preoperative glycated hemoglobin (HbA1c) for surgical eligibility and periprosthetic joint infection (PJI) risk stratification has significant limitations, including surgical delays and poor reflection of short-term metabolic instability. » Perioperative hyperglycemia and glucose variability are stronger and more consistent determinants of PJI risk than static glycemic indices such as HbA1c. » Novel markers, such as fructosamine, and technologies, including continuous glucose monitoring, provide improved assessment of short-term glycemic control and variability and demonstrate superior prognostic utility for PJI compared with HbA1c. » Antidiabetic therapies may differentially influence PJI risk: insulin dependence marks higher risk, whereas oral agents, particularly metformin and glucagon-like peptide-1 receptor agonists, are increasingly associated with reduced short-term PJI risk, especially among diabetic and morbidly obese patients undergoing hip and knee arthroplasty. » Mechanistic evidence implicates effects on inflammation, angiogenesis, immune function, and bacterial biofilm formation in mediating the relationship between glycemic control, antidiabetic therapies, and PJI risk.</p>","PeriodicalId":47098,"journal":{"name":"JBJS Reviews","volume":"14 6","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148309966","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 the Screw: Commentary on an article by Megna Panchbhavi et al.: \"Beyond the Screw: Mapping the Evidence Landscape of Modern Syndesmotic Fixation\".","authors":"Jan Bartoníček","doi":"10.2106/JBJS.RVW.26.00127","DOIUrl":"10.2106/JBJS.RVW.26.00127","url":null,"abstract":"","PeriodicalId":47098,"journal":{"name":"JBJS Reviews","volume":"14 6","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148309870","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":"Immersive Virtual Reality Simulation-Based Assessments in Orthopedic Surgery: A Systematic Scoping Review.","authors":"Mads Emil Jacobsen, Rasmus Drews Wenda, Mikkel Engell Sandager Nielsen, Kristoffer Borbjerg Hare, Lars Konge, Amandus Gustafsson","doi":"10.2106/JBJS.RVW.26.00028","DOIUrl":"10.2106/JBJS.RVW.26.00028","url":null,"abstract":"<p><strong>Background: </strong>Immersive virtual reality (iVR) is increasingly used in orthopedic surgical training, and many platforms generate automated performance metrics that enable scalable competency-based training programs. However, the extent to which iVR-based assessments are supported by validity evidence remains unclear. The purpose of this study was to conduct a scoping review of iVR-based assessments in orthopedic surgery and map validity evidence using Messick's framework.</p><p><strong>Methods: </strong>Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews guidelines, we searched PubMed and Embase for original studies evaluating technical performance within orthopedic iVR simulations. Two reviewers independently screened studies and extracted data. They appraised assessment validity evidence mapped to Messick's framework using the Ghaderi scoring instrument and evaluated methodological quality using the Medical Education Research Study Quality Instrument (MERSQI). Data were synthesized descriptively.</p><p><strong>Results: </strong>Eighteen studies spanning 11 orthopedic procedures met the inclusion criteria. Validity evidence supporting score interpretation was limited across all 5 of Messick's domains: Total Ghaderi scores ranged from 0 to 7 (median 2.5) of 15, with 0 being the most frequent domain-level rating. Relations to other variables was the most addressed domain, while internal structure and consequences evidence were largely absent. By contrast, methodological quality was generally high (median MERSQI 13.5 of 18), but reporting quality was inconsistent.</p><p><strong>Conclusion: </strong>Despite the growing use of iVR in orthopedic training, current iVR-based assessments lack sufficient validity evidence to support meaningful interpretation of performance scores. The field risks mistaking technological sophistication for assessment quality. Strengthening iVR-based assessment requires clearer construct definitions, systematic validity evidence across Messick's domains, and improved reporting practices.</p><p><strong>Level of evidence: </strong>Level III. See Instructions for Authors for a complete description of levels of evidence.</p>","PeriodicalId":47098,"journal":{"name":"JBJS Reviews","volume":"14 6","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148309956","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":"Artificial Intelligence in Total Hip and Knee Arthroplasty: A Primer on Current Applications, Algorithms, and Future Directions.","authors":"Audrey R Byrne, Robert A Cecere, Wyatt H Buchalter, Krithi Pachipala, Alexander L Neuwirth, Roshan P Shah, H John Cooper, Nana O Sarpong","doi":"10.2106/JBJS.RVW.26.00059","DOIUrl":"10.2106/JBJS.RVW.26.00059","url":null,"abstract":"<p><p>» Artificial intelligence (AI) is increasingly integrated across the total hip and knee arthroplasty care continuum, including preoperative risk stratification and templating, intraoperative computer-vision guidance and robotic assistance, and postoperative complication detection and outcome prediction. » Machine-learning models often outperform traditional statistical approaches in predicting complications, discharge disposition, operative time, and patient-reported outcomes after total joint arthroplasty. » Deep learning and computer vision systems are rapidly improving radiographic interpretation, implant templating, mechanical alignment measurement, and early detection of prosthetic loosening. » Despite promising performance, most AI tools remain limited by incomplete external validation, workflow integration challenges, and potential bias from nonrepresentative data sets. » Future progress in arthroplasty AI will depend on multimodal data integration, large-scale registries, prospective validation, and careful collaboration between surgeons and data scientists to ensure safe and clinically meaningful implementation.</p>","PeriodicalId":47098,"journal":{"name":"JBJS Reviews","volume":"14 6","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148259984","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 the Screw: Mapping the Evidence Landscape of Modern Syndesmotic Fixation.","authors":"Megna Panchbhavi, Vishank Panchbhavi, Richard Liu, Ryan Lam, William McGarvey","doi":"10.2106/JBJS.RVW.26.00034","DOIUrl":"https://doi.org/10.2106/JBJS.RVW.26.00034","url":null,"abstract":"<p><p>» Syndesmotic fixation has evolved from predominantly rigid screw-based techniques toward dynamic stabilization methods, including suture-button devices and anatomic augmentation of the anterior inferior tibiofibular ligament (AITFL), which aim to restore more physiologic ankle motion while maintaining stability. » Suture-button fixation demonstrates clinical advantages over traditional screw fixation, including lower rates of hardware removal and reoperation, earlier return to weight bearing, and reduced implant-related complications. However, infection and neurovascular injury during medial placement remain important device-specific risks. » AITFL augmentation using suture tape or anchors shows promise in restoring native ligament biomechanics and may be particularly beneficial for young, high-demand patients with isolated ligamentous injuries, although long-term randomized trials are needed to validate early favorable outcomes. » Despite growing evidence for dynamic and hybrid fixation strategies, high-quality comparative data remain limited, with most studies consisting of cadaveric biomechanical analyses, retrospective case series, and technique descriptions rather than prospective randomized controlled trials with long-term functional outcomes. » Future research should prioritize standardized outcome measures, patient-reported functional data, and multicenter comparative trials to determine which fixation strategies provide optimal long-term stability, functional recovery, and cost-effectiveness across different patient populations and injury patterns.</p>","PeriodicalId":47098,"journal":{"name":"JBJS Reviews","volume":"14 6","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148260013","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}