JBJS Reviews最新文献

{"title":"Fixation vs. Revision of Vancouver B2 Periprosthetic Fractures Around Polished Tapered Cemented Femoral Stems: A Meta-Analysis of Outcomes.","authors":"Zain Choudhary, Sachin Singal, Amr Selim, Abdelrahman Ibrahim, Ronald Hang Kin Nam, Abdul-Basit Rafi, Siddharth Govilkar, Geraint Thomas","doi":"10.2106/JBJS.RVW.25.00215","DOIUrl":"10.2106/JBJS.RVW.25.00215","url":null,"abstract":"<p><strong>Background: </strong>The management of periprosthetic femoral fractures (PFFs) around polished taper-slip (PTS) cemented femoral stems in total hip arthroplasty has seen a recent shift in practice from revision to open reduction and internal fixation (ORIF). While ORIF is the accepted standard for stable uncemented stems, evidence guiding optimal management of PFF around cemented stems remains inconclusive. This metanalysis aimed to compare the outcomes of ORIF vs. revision in patients with Vancouver B2 PFFs around cemented PTS femoral stems.</p><p><strong>Methods: </strong>We systematically searched MEDLINE, Embase, CENTRAL, Scopus, and ClinicalTrials.gov from inception to May 2025, for studies comparing ORIF with revision arthroplasty in adults with Vancouver type B2 PFFs around cemented PTS stem. None of the included studies were randomized control trials (RCTs). The outcomes were 5-year implant survival, 2-year reoperation rate, 1-year mortality, infection, aseptic loosening, nonunion, and operative time.</p><p><strong>Results: </strong>Eight studies involving 675 patients (318 ORIF, 357 revision) met eligibility criteria. The mean age was 82.2 years, and the mean follow-up was 2.8 years. Two-year reoperation was significantly lower with ORIF (odds ratio [OR] 0.28, 95% confidence interval [CI] 0.14-0.53, p < 0.001). Operative time was significantly shorter in the ORIF group (mean difference -42.28 minutes, 95% CI -71.27 to -13.29; p < 0.001). No significant differences were observed in 5-year implant survival (OR 0.64, 95% CI 0.26-1.60) or 1-year mortality (OR 2.05, 95% CI 0.71-5.89). Postoperative infection, aseptic loosening, and nonunion rates were also similar. Risk of bias was moderate overall.</p><p><strong>Conclusion: </strong>For patients with Vancouver B2 PFFs around cemented PTS femoral stems, ORIF was associated with a significantly lower 2-year reoperation rate and shorter operative time compared with revision, while other outcomes were similar. These findings indicate comparable overall performance between ORIF and revision; however, given the heterogeneity and potential selection bias, uncertainty remains high, supporting the need for an RCT to evaluate both options.</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":"13 12","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-12-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145844266","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":"Failures in Cervical Disc Arthroplasty: A Narrative Review of Failure Modes and Clinical Implications.","authors":"James G Lyman, Kaitlyn L Hurka, Jake A Morales, Connor P McCloskey, Arun K Movva, Daniel E Herrera, Cody Goedderz, Theodore A Joaquin, Vadim Goz, Srikanth N Divi, Alpesh A Patel","doi":"10.2106/JBJS.RVW.25.00208","DOIUrl":"https://doi.org/10.2106/JBJS.RVW.25.00208","url":null,"abstract":"<p><p>» Cervical disc arthroplasty (CDA) offers a potential alternative for patients with degenerative disc disease, improving long-term outcomes such as preserved range of motion, decreased incidence of adjacent segment degeneration, and lower morbidity.» CDA offers potential advantages over anterior cervical discectomy and fusion in regard to length of stay, cost, and routine discharge, but the motion-preserving design may introduce novel complications and failure modalities that are poorly understood.» Complications of CDA may include heterotopic ossification, decreased range of motion, persistent or worsening pain, unintended fusion, and permanent neurologic deficit.» Preventing CDA failures begins with careful recognition of contraindications such as cervical instability, osteoporosis or osteopenia, previous surgery at the surgical level(s), and extensive facet joint arthropathy.» Complication profiles associated with CDAs vary in accord with device characteristics, highlighting a potential need for matching prosthesis design with patient-specific factors.</p>","PeriodicalId":47098,"journal":{"name":"JBJS Reviews","volume":"13 12","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-12-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145844242","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":"Diagnosis and Management of Pediatric Syndesmosis Ankle Injuries.","authors":"Harjot Uppal, John Tis","doi":"10.2106/JBJS.RVW.25.00209","DOIUrl":"https://doi.org/10.2106/JBJS.RVW.25.00209","url":null,"abstract":"<p><p>» Pediatric syndesmotic ankle injuries are uncommon but increasingly recognized, particularly among youth athletes participating in pivoting and contact sports such as football, soccer, and skiing.» The most sensitive and specific modalities for diagnosis are advanced imaging techniques such as magnetic resonance imaging and computed tomography; standard radiographic parameters (tibiofibular overlap, medial clear space) are less reliable in children.» An evidence-based approach to management distinguishes stable injuries, amenable to nonoperative care with immobilization and rehabilitation, from unstable injuries that may require surgical fixation.» Surgical techniques-including syndesmotic screw and suture-button fixation-must account for skeletally immature anatomy; the decision to remove hardware is controversial.» There is a substantial gap in pediatric-specific literature regarding standard radiographic imaging parameters, optimal fixation methods, and long-term outcomes, highlighting the need for further prospective studies in skeletally immature athletes.</p>","PeriodicalId":47098,"journal":{"name":"JBJS Reviews","volume":"13 12","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-12-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145811075","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":"Chiropractic Care and Spinal Manipulation: Evidence, Risks, and Referral Considerations for Spine Surgeons.","authors":"Bryce A Basques, Shaoyang Ma, Puru Sadh, Alan H Daniels, Alejandro Perez-Albela","doi":"10.2106/JBJS.RVW.25.00196","DOIUrl":"https://doi.org/10.2106/JBJS.RVW.25.00196","url":null,"abstract":"<p><p>» Most evidence in low back pain (LBP): Evidence supports spinal manipulation therapy (SMT) as a conservative option for acute, subacute, and chronic LBP, especially when used as part of multimodal care.» Limited role beyond LBP: SMT shows insufficient or conflicting evidence for neck pain, headaches, extremity disorders, and is not recommended for nonmusculoskeletal conditions.» Risk profile: Serious adverse events are rare and may be underreported; minor, transient soreness is more common. Careful screening for contraindications (e.g., trauma, connective tissue disease, vascular disorders) is critical.» Ongoing gaps: Variability in practice standards, inconsistent informed consent, and poor adverse event reporting limit clarity on true effectiveness and safety.</p>","PeriodicalId":47098,"journal":{"name":"JBJS Reviews","volume":"13 12","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145769477","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":"Hypersensitivity Reactions to Liquid Skin Adhesives in Orthopaedic Surgery: A Review of the Literature.","authors":"Matthew T Geiselmann, George Economou, Constantina Economou, Edwin Sun, Randy M Cohn, James A Germano","doi":"10.2106/JBJS.RVW.25.00178","DOIUrl":"https://doi.org/10.2106/JBJS.RVW.25.00178","url":null,"abstract":"<p><p>» Skin adhesives are increasingly used in orthopaedic surgery because they provide secure incision closure, limit postoperative drainage, support wound integrity, and may reduce operative time. However, allergic contact dermatitis (ACD) remains an important consideration with their use. ACD is a hypersensitivity skin reaction seen in some patients exposed to surgical adhesives, particularly the 2-octyl cyanoacrylate ingredient. It can be difficult to distinguish ACD from cellulitis or surgical site infections due to overlapping clinical features. Timely recognition is critical, as early management can minimize wound complications and optimize outcomes. Management options include removal of the adhesive, topical corticosteroids, oral antihistamines, and antibiotics with concomitant infection. This review highlights the role of surgical adhesives across several orthopaedic surgery subspecialties, emphasizing the incidence, recognition, and management of surgical adhesive-related ACD.</p>","PeriodicalId":47098,"journal":{"name":"JBJS Reviews","volume":"13 12","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145769500","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":"Metabolic Functions of the Subacromial Bursa: Implications for Shoulder Health and Pathology.","authors":"Humza Bhatti, Nicholas D Operti, Toufic R Jildeh","doi":"10.2106/JBJS.RVW.25.00189","DOIUrl":"https://doi.org/10.2106/JBJS.RVW.25.00189","url":null,"abstract":"<p><p>» Historically viewed as a passive structure in shoulder pain, the subacromial bursa (SAB) is now understood to have metabolic function and to be an active participant in shoulder health by influencing cytokine production and cellular signaling pathways.» The variability in the SAB anatomically, along with its varied cell types, makes it an important consideration for shoulder health. Synoviocytes, mesenchymal stem cells, fibroblasts, and immune cells from the SAB can largely influence shoulder pathology.» The SAB influences metabolic function through the release of bioactive molecules such as interleukin-1, interleukin-6, tumor necrosis factor-ɑ, transformation growth factor, and basic fibroblast growth factor. These molecules alter shoulder health by modulating the immune/inflammatory response and promoting angiogenesis, cell proliferation, and fibrosis.» The SAB and its metabolic function are indicated in several clinical conditions, such as subacromial impingement syndrome, shoulder osteoarthritis, subacromial bursitis, and rotator cuff tears, demonstrating its importance and clinical utility.» Further understanding of the SAB and its metabolic function as opposed to its anatomical function allows for novel targets and therapeutics in shoulder pathologies that integrate the field of orthopaedics and immunology. Further studies demonstrating the role of the bioactive molecules released by the SAB and its effect on surrounding tissues are paramount for breakthroughs in shoulder health.» In this study, we present a narrative review of the current understanding of the metabolic function of the SAB.</p>","PeriodicalId":47098,"journal":{"name":"JBJS Reviews","volume":"13 12","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145769513","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":"Bucket-Handle Meniscus Tears: Epidemiology, Diagnosis, Management, and Outcomes.","authors":"Phara Ross, Magnolia Livingston, Shreya M Saraf, John R Miller, Mary K Mulcahey","doi":"10.2106/JBJS.RVW.25.00144","DOIUrl":"10.2106/JBJS.RVW.25.00144","url":null,"abstract":"<p><p>» Bucket-handle meniscus tears (BHMTs) are complex injuries that often cause mechanical symptoms such as locking, restricted motion, and pain, with high prevalence in active individuals and those with concomitant anterior cruciate ligament (ACL) injuries.» BHMTs may occur acutely from trauma or pivoting movements, often in association with ACL injuries, or develop chronically from degenerative changes. Bucket-handle tears of the medial meniscus are most common, while lateral BHMTs are less frequent but more often seen in younger athletes with ACL tears. Typical symptoms include pain, locking, swelling, and restricted motion. Risk factors such as meniscal morphology, ligamentous laxity, tibial slope, obesity, malalignment, and high-impact sports increase susceptibility and may influence outcomes.» Nonoperative treatment may be suitable for selected low-demand patients or those who medically are not operative candidates, or patients with asymptomatic chronic tears who have significant knee arthritis. Patients should also be informed that nonoperative treatment carries the risk of accelerated osteoarthritis and knee instability.» Surgical repair, using either inside-out or all-inside techniques, is preferred when feasible and has been shown to improve functional outcomes and delay the onset of osteoarthritis. Both approaches restore meniscal load transmission, though failure rates vary.» Postoperative rehabilitation strategies remain heterogeneous. Gradual and accelerated protocols differ in timelines for weight-bearing, bracing, and return to sport, yet both aim to restore range of motion, strength, and dynamic stability.» While short-term and mid-term outcomes are promising following meniscal repairs, long-term data are limited. Optimizing repair techniques and defining rehabilitation protocols are essential for improving survivorship and functional recovery after BHMT repair.</p>","PeriodicalId":47098,"journal":{"name":"JBJS Reviews","volume":"13 12","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145769446","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":"Leadership Opportunities for Orthopaedic Surgery Residents and Medical Students: Growing Interest for Formal Training.","authors":"Hayden Hartman, Alberto Vasquez, Mitchell J Christiansen, Mary K Mulcahey","doi":"10.2106/JBJS.RVW.25.00188","DOIUrl":"https://doi.org/10.2106/JBJS.RVW.25.00188","url":null,"abstract":"<p><p>» Leadership is a critical skill for orthopaedic surgeons, who are expected to lead effectively in the operating room, clinic, academic settings, and within national organizations.» While technical proficiency remains essential, leadership competencies, such as communication, emotional intelligence, team management, and mentorship, are increasingly recognized as vital to success in the field.» There is a growing emphasis for residency programs, subspecialty societies, and national organizations to establish structured leadership training and mentorship opportunities during residency to prepare orthopaedic trainees for future leadership roles.» The purpose of this review was to highlight key leadership styles within orthopaedic surgery, characteristics of effective leaders, and opportunities for growth through formal leadership and mentorship programs targeted towards orthopaedic trainees.</p>","PeriodicalId":47098,"journal":{"name":"JBJS Reviews","volume":"13 12","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145745246","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":"Dual Mobility vs. Large Femoral Head (≥36 mm) in Primary and Revision Total Hip Arthroplasty: A Meta-Analysis of Outcomes.","authors":"Abdelrahman Ibrahim, Amr Selim, Christina Dwebeng, Zain Choudhary, Sachin Singal, Mohamed Omar Ahmed, Khadija Khamdan, Musab Al-Musabi, Siddharth Govilkar, Geraint Thomas","doi":"10.2106/JBJS.RVW.25.00181","DOIUrl":"10.2106/JBJS.RVW.25.00181","url":null,"abstract":"<p><strong>Background: </strong>Instability is a frequent complication after total hip arthroplasty (THA) and remains a leading cause of revision surgery. Dual mobility (DM) and large femoral heads (LFHs) have been used to mitigate this risk, particularly in high-risk patients. This study aimed to compare the postoperative outcomes of DM vs. LFH in THA.</p><p><strong>Methods: </strong>A systematic review was conducted following the Preferred Reporting Items for Systematic Review and Meta-Analyses guidelines. MEDLINE, Embase, CINAHL, CENTRAL, and ClinicalTrials.gov were searched for relevant studies up to May 2025. Inclusion criteria comprised studies directly comparing DM and LFH ≥36 mm in primary and revision THA.</p><p><strong>Results: </strong>Eighteen studies (2 randomized controlled trials and 16 nonrandomized) involving a total of 133,474 hips (13,508 DM; 119,966 LFH) were included. The analysis revealed that LFH was associated with a significantly higher risk of dislocation compared with DM in both primary THA (odds ratio [OR] = 4.81, p < 0.001) and revision THA (OR = 1.99, p < 0.001). This was further confirmed in a time-to-event analysis for dislocation (hazard ratio = 2.67, 95% confidence interval [CI] 1.54-4.63, p < 0.001). Meta-regression adjusting for acetabular cup size showed no significant moderating effect (β = 0.19, 95% CI -0.13 to 0.51; OR = 1.20, 95% CI 0.88-1.67; p = 0.12), indicating that the protective effect of DM on dislocation risk was independent of cup size. The overall pooled analysis indicated that the risks of revision for dislocation (OR = 1.38, p = 0.02) and aseptic loosening (OR = 1.77, p = 0.02) were significantly higher with LFH.</p><p><strong>Conclusion: </strong>Across both primary and revision THA, LFH was associated with a significantly higher risk of dislocation, consistent in time-to-event analyses and after adjustment for acetabular cup size. The pooled analysis also showed higher risks of revision for dislocation and aseptic loosening with LFH. However, longer-term implant survival requires further investigation in future studies.</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":"13 12","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145745173","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":"Hip Resurfacing Arthroplasty Is Associated with Lower Metal Ion Levels and Revision Risk Compared with Large-Head Metal-on-Metal Total Hip Arthroplasty: A Systematic Review and Meta-Analysis.","authors":"Jean Shanaa, Orr Amar, Shaheryar Asad, Theodor Di Pauli von Treuheim, Vinay K Aggarwal, Scott Marwin","doi":"10.2106/JBJS.RVW.25.00204","DOIUrl":"10.2106/JBJS.RVW.25.00204","url":null,"abstract":"<p><strong>Background: </strong>Large-diameter head total hip arthroplasty (LDH-THA) emerged in the late 1990s as a stemmed alternative to hip resurfacing arthroplasty (HRA). Both procedures use metal-on-metal (MoM) bearings to permit larger heads, lower dislocation risk, and optimize function in younger, active patients. While concerns over metal ion release and adverse local tissue reactions curtailed MoM use, long-term follow-up remains critical for the substantial population with these devices in situ. This review compares LDH-THA and HRA in clinical outcomes, metal ion levels, and revision rates to guide long-term management and future implant design.</p><p><strong>Methods: </strong>PubMed, Embase, and Scopus were searched for studies reporting patient-reported outcomes, metal ion levels, or revision rates for both LDH-THA and HRA. The risk of bias was assessed using the Methodological Index for Non-Randomized Studies score. Random-effects meta-analysis evaluated revision risk; cobalt and chromium levels; University of California, Los Angeles (UCLA) activity; Harris-Hip Scores (HHS); Oxford Hip Scores (OHS); and Western Ontario and McMaster Universities Osteoarthritis Index.</p><p><strong>Results: </strong>Of 221 studies, 21 met inclusion criteria, including 5,545 LDH-THAs and 3,197 HRAs. The unweighted pooled revision rate was 16% for THA and 7.8% for HRA. Meta-analysis showed higher cobalt (standardized mean difference [SMD] 1.07) and chromium (SMD 0.53) levels in THA. Revision risk (odds ratio 1.75), UCLA (-0.44), and HHS (-0.32) favored HRA, though not significantly.</p><p><strong>Conclusion: </strong>Although the usage of large-head MoM THA is largely historic, our findings suggest that MoM hip resurfacing arthroplasty has a more favorable outcomes profile with reduced systemic metal ion exposure, reinforcing its role in younger, active patients, where conventional or large-head THA may fall short.</p><p><strong>Level of evidence: </strong>Level III, systematic review of Level I, II, and III studies. See Instructions for Authors for a complete description of levels of evidence.</p>","PeriodicalId":47098,"journal":{"name":"JBJS Reviews","volume":"13 12","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145745176","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}