Journal of the American Academy of Orthopaedic Surgeons最新文献

{"title":"Heterotopic Ossification After Shoulder Arthroplasty: A Systematic Review.","authors":"Fahad A Nadeem, Caleb V Hayes, James R Jones, Mathew D Hargreaves, Eugene W Brabston, Aaron J Casp, Amit M Momaya, Thomas B Evely","doi":"10.5435/JAAOS-D-24-00063","DOIUrl":"10.5435/JAAOS-D-24-00063","url":null,"abstract":"<p><strong>Introduction: </strong>Shoulder arthroplasty is increasing in incidence over time. One potential complication that is not well studied following shoulder arthroplasty is heterotopic ossification (HO), the abnormal growth of extraskeletal bone in soft tissue. HO has been described as a complication in total hip arthroplasty literature but less described in the setting of shoulder arthroplasty. The aim of this systematic review is to present available evidence regarding the incidence, risk factors, and potential management of HO after shoulder arthroplasty.</p><p><strong>Methods: </strong>A systematic search was conducted in June 2023 using Pubmed, Embase, and Ovid Medline databases to retrieve all relevant studies evaluating the occurrence of HO after shoulder arthroplasty. The search was done in duplicate, and a quality assessment of all studies was included.</p><p><strong>Results: </strong>A total of 170 studies were retrieved, of which 6 were included, involving 1,028 patients undergoing shoulder arthroplasty with 1,038 operated shoulders. HO developed postoperatively in 28% of the included shoulders and was symptomatic in 12% with most cases occurring in shoulders that developed osteoarthritis and cuff tear arthropathy. Men appear to have an increased risk of developing HO post shoulder arthroplasty. Fewer than 2% of HO shoulders went on to have revision surgery, and no notable differences were observed in the postoperative mean elevation and external rotation angles of non-HO and HO shoulders. In addition, no reported benefit of the use of nonsteroidal anti-inflammatory drugs was found against the formation of HO after shoulder arthroplasty.</p><p><strong>Conclusion: </strong>HO occurs in 28% of shoulder arthroplasties in our review. Most of these were asymptomatic in the reviewed articles. Male patients and revision surgery with osteoarthritis and cuff tear arthroplasty seem to be at higher risk of developing HO post shoulder arthroplasty. Nonsteroidal anti-inflammatory drugs seem to not prevent the development of HO after shoulder arthroplasty; yet, future studies are needed to verify this claim.</p><p><strong>Level of evidence: </strong>Level III; Systematic Review.</p>","PeriodicalId":51098,"journal":{"name":"Journal of the American Academy of Orthopaedic Surgeons","volume":" ","pages":"585-593"},"PeriodicalIF":2.6,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142814852","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Advocacy for Patients and the Profession.","authors":"Stuart L Weinstein","doi":"10.5435/JAAOS-D-24-01390","DOIUrl":"10.5435/JAAOS-D-24-01390","url":null,"abstract":"<p><p>Every aspect of our professional lives as orthopaedic surgeons, regardless of practice model, is affected by the policies and laws passed by the US Congress and implemented by the federal regulatory agencies. Similar dynamics play out at the state level for many other issues that affect orthopaedic practices. The United States spends 18% of our gross domestic product on health care, 2 to 3 times as much as the other developed countries in the world, with less-than-ideal outcomes for health metrics. Recognizing the challenges faced by the US healthcare system is fundamental to understanding the importance of advocacy in shaping the conversation on Capitol Hill. All healthcare advocacy is based on preserving the doctor-patient relationship, ensuring access to appropriate care, and improving the quality of that care. Advocating on behalf our patients is part of our physicians' contract with society. Physicians are the secondary beneficiary of effective patient advocacy. Understanding how practicing orthopaedic surgeons can have a positive effect on the decisions that are made at the federal and state level is of critical importance in the increasingly complex healthcare dynamic that affects our patient's lives and our profession.</p>","PeriodicalId":51098,"journal":{"name":"Journal of the American Academy of Orthopaedic Surgeons","volume":" ","pages":"569-577"},"PeriodicalIF":2.6,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144059334","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"An External Validation of the Pathologic Fracture Mortality Index for Predicting 30-day Postoperative Morbidity Using 978 Institutional Patients.","authors":"Joseph O Werenski, Marie W Su, Ryan K Krueger, Olivier Q Groot, Marilee J Clunk, Alisha Sodhi, Ruhi Patil, Nicole Bell, Adam S Levin, Santiago A Lozano-Calderon","doi":"10.5435/JAAOS-D-24-01131","DOIUrl":"10.5435/JAAOS-D-24-01131","url":null,"abstract":"<p><strong>Introduction: </strong>Skeletal metastases increase the risk of pathologic fractures, causing functional impairment and pain. Predicting morbidity in patients undergoing surgical fixation for these fractures is challenging due to the complexity of metastatic disease. The Pathologic Fracture Mortality Index (PFMI) was developed to predict 30-day postoperative morbidity in long bone fractures caused by metastases. External validation is necessary for clinical use. This study aims to evaluate the following: (1) How well does the PFMI predict 30-day medical, surgical, utilization, and all-cause morbidity after pathologic fracture fixation in an external cohort of patients with long bone metastases? (2) How does the performance of the PFMI compare to established predictive indices including the American Society of Anesthesiologists (ASA) classification score, the modified 5-Item Frailty Index (mF-I5), and the modified Charlson Comorbidity Index (mCCI)?</p><p><strong>Methods: </strong>We analyzed 978 patients who underwent internal fixation for pathologic fractures at two urban tertiary centers. The area under the receiver operating characteristic curve (AUC) was calculated for each predictive index to assess their accuracy in predicting 30-day morbidity across medical, surgical, utilization, and all-cause categories.</p><p><strong>Results: </strong>All four predictive indices demonstrated suboptimal performance, with AUC values ranging from 0.51-0.62, 0.45-0.51, 0.51-0.62, and 0.50-0.57 for medical, surgical, utilization, and all-cause morbidity, respectively. The PFMI outperformed the ASA ( P < 0.001), mF-I5 ( P = 0.018), and mCCI ( P = 0.034) in predicting utilization morbidity. It also better predicted medical ( P = 0.021) and all-cause ( P = 0.009) morbidity than ASA but did not outperform mF-I5 or mCCI in these areas. The PFMI did not surpass any indices in surgical morbidity.</p><p><strong>Conclusion: </strong>None of the indices reached the ideal AUC of 0.80 for any morbidity type, emphasizing the need for refinement. Updating these tools with contemporary data and exploring new prognostic factors is critical to improve morbidity risk stratification in metastatic bone disease.</p>","PeriodicalId":51098,"journal":{"name":"Journal of the American Academy of Orthopaedic Surgeons","volume":" ","pages":"e615-e624"},"PeriodicalIF":2.6,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143781896","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Use of Patient-Reported Outcomes Measurement Information System Measures in Orthopaedic Specialties: Results of a Scoping Review for 2018 to 2022.","authors":"Maia S Cella, Judith F Baumhauer, Nan E Rothrock, Kathleen Swantek, Patricia D Franklin","doi":"10.5435/JAAOS-D-24-00432","DOIUrl":"10.5435/JAAOS-D-24-00432","url":null,"abstract":"<p><p>The Patient-Reported Outcomes Measurement Information System (PROMIS) is a collection of patient-reported outcome measures assessing physical, mental, and social health that are relevant across a variety of conditions. The use of PROMIS measures in capturing important symptoms and functions has increased over time, yet detail on more recent use of PROMIS measures in orthopaedics and its specialties has been lacking. The goal of this scoping review is to characterize and quantify the use of PROMIS measures in orthopaedic populations across published studies from 2018 through 2022 to inform opportunities for expansion of PROMIS across orthopaedics in research and clinical practice. We identified 699 published studies with 1,835 PROMIS measures. Publications were distributed across orthopaedic subspecialties, including 27% (185 studies) in spine patient populations, 21% (143 studies) in hand/shoulder/elbow, 11% (80 studies) in arthroplasty, 9% (65 studies) in foot/ankle, and 9% (65 studies) in sports medicine. The most commonly used PROMIS measures across all orthopaedic publications assessed physical function (63%), pain interference (55%), and depression (30%). We observed an overall increase in orthopaedic publications using and reporting on PROMIS measures. PROMIS measures are efficient, and precise tools and their use is expected to continue to increase across medical and surgical specialties.</p>","PeriodicalId":51098,"journal":{"name":"Journal of the American Academy of Orthopaedic Surgeons","volume":" ","pages":"561-568"},"PeriodicalIF":2.6,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143781899","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Response to Letters to the Editor: Is Dexamethasone Administration During Total Hip and Knee Arthroplasty Safe in Diabetic Patients?","authors":"Kareem J Kebaish, Jennifer C Wang, Amit S Piple, Julian Wier, Kevin C Liu, Alexander B Christ, Nathanael D Heckmann","doi":"10.5435/JAAOS-D-25-00221","DOIUrl":"10.5435/JAAOS-D-25-00221","url":null,"abstract":"","PeriodicalId":51098,"journal":{"name":"Journal of the American Academy of Orthopaedic Surgeons","volume":" ","pages":"e614"},"PeriodicalIF":2.6,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144004414","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Tenosynovial Giant Cell Tumor and Pigmented Villonodular Synovitis.","authors":"Alysia K Kemp, Brian Brigman, Geoffrey Siegel, Charles A Popkin, Wakenda K Tyler","doi":"10.5435/JAAOS-D-24-01255","DOIUrl":"10.5435/JAAOS-D-24-01255","url":null,"abstract":"<p><p>Tenosynovial giant cell tumors (TGCTs) are a spectrum of benign growths that can occur in both intra-articular and extra-articular locations. The pattern of involvement also varies from nodular, typically small-volume disease to extensive and diffuse synovial infiltration. Surgical resection remains the treatment of choice for most patients and resection techniques include arthroscopic, open, or a combined approach. However, TGCT can be locally aggressive and exhibit high recurrence rates even after adequate surgical removal. Improved understanding of the complex genetic and environmental factors that lead to these proliferative disorders have modernized treatment options. Discovery of the unique role that tumor cell expression of the colony-stimulating-factor1 and propagation of the inflammatory cascade has led to the use of adjuvant medications to improve outcomes. In-depth knowledge of the etiology, clinical presentation, diagnosis, workup, historical treatments, and new treatment options for patients with TGCT are crucial for orthopaedic surgeons to understand and work effectively with a multidisciplinary treatment team.</p>","PeriodicalId":51098,"journal":{"name":"Journal of the American Academy of Orthopaedic Surgeons","volume":" ","pages":"e593-e602"},"PeriodicalIF":2.6,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143702067","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Machine Learning Algorithms Exceed Comorbidity Indices in Prediction of Short-Term Complications After Hip Fracture Surgery.","authors":"Anirudh K Gowd, Edward C Beck, Avinesh Agarwalla, Dev M Patel, Ryan C Godwin, Brian R Waterman, Milton T Little, Joseph N Liu","doi":"10.5435/JAAOS-D-23-01144","DOIUrl":"10.5435/JAAOS-D-23-01144","url":null,"abstract":"<p><strong>Background: </strong>Hip fractures are among the most morbid acute orthopaedic injuries often due to accompanying patient frailty. The purpose of this study was to determine the reliability of assessing surgical risk after hip fracture through machine learning (ML) algorithms.</p><p><strong>Methods: </strong>The American College of Surgeons National Surgical Quality Improvement Program was queried from 2011 to 2018 and the American College of Surgeons National Surgical Quality Improvement Program hip fracture-targeted data set was queried from 2016 to 2018 for all patients undergoing surgical fixation for a diagnosis of an acute primary hip fracture. The data set was randomly split into training (80%) and testing (20%) sets. 3 ML algorithms were used to train models in the prediction of extended hospital length of stay (LOS) >13 days, death, readmissions, home discharge, transfusion, and any medical complication. Testing sets were assessed by receiver operating characteristic, positive predictive value (PPV), and negative predictive value (NPV) and were compared with models constructed from legacy comorbidity indices such as American Society of Anesthesiologists (ASA) score, modified Charlson Comorbidity Index, frailty index, and Nottingham Hip Fracture Score.</p><p><strong>Results: </strong>Following inclusion/exclusion criteria, 95,745 cases were available in the overall data set and 22,344 in the targeted data set. ML models outperformed comorbidity indices for each complication by area under the curve (AUC) analysis ( P < 0.01 for each): medical complications (AUC = 0.65, PPV = 67.5, NPV = 71.7), death (AUC = 0.80, PPV = 46.7, NPV = 94.9), extended LOS (AUC = 0.69, PPV = 71.4, NPV = 94.1), transfusion (AUC = 0.79, PPV = 64.2, NPV = 77.4), readmissions (AUC = 0.63, PPV = 0, NPV = 96.8), and home discharge (AUC = 0.74, PPV = 65.9, NPV = 76.7). In comparison, the best performing legacy index for each complication was medical complication (ASA: AUC = 0.60), death (NHFS: AUC = 0.70), extended LOS (ASA: AUC = 0.62), transfusion (ASA: AUC = 0.57), readmissions (CCI: AUC = 0.58), and home discharge (ASA: AUC = 0.61).</p><p><strong>Conclusions: </strong>ML algorithms offer an improved method to holistically calculate preoperative risk of patient morbidity, mortality, and discharge destination. Through continued validation, risk calculators using these algorithms may inform medical decision making to providers and payers.</p>","PeriodicalId":51098,"journal":{"name":"Journal of the American Academy of Orthopaedic Surgeons","volume":" ","pages":"e633-e647"},"PeriodicalIF":2.6,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142741176","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Lumbar Spondylolysis in the Pediatric Population: A Retrospective CT Review With Radiology Rereview.","authors":"Anna J Rambo, Benjamin W Sheffer, Blake Hajek, Abraham Almatari, Parker Suit, Leslie N Rhodes, Xueyuan Cao, William C Warner, Jeffrey R Sawyer, Derek M Kelly, David D Spence","doi":"10.5435/JAAOS-D-23-00543","DOIUrl":"10.5435/JAAOS-D-23-00543","url":null,"abstract":"<p><strong>Introduction: </strong>Spondylolysis, a defect in the pars interarticularis, can be symptomatic or asymptomatic with an estimated prevalence of 4% by age 6 years and 6% by adulthood. This study's goal was to determine the prevalence of lumbar spondylolysis found on CT scans in children and to characterize patient-specific risk factors.</p><p><strong>Methods: </strong>Abdominopelvic CT scans done (2017 to 2020) in patients up to age 18 years were reviewed. The radiology report was retrospectively reviewed for a spondylolysis, and a radiologist rereviewed the CT scan. Patient demographics and indications for CT scan were included. Firth bias-reduced logistic regression was used to model spondylolysis with each demographic variable as a predictor.</p><p><strong>Results: </strong>One thousand nine hundred thirty-one CT reports and imaging were reviewed; abdominal pain (41.91%) and trauma (29.46%) were the most common reasons for CT scan. Spondylolysis was found in 42 patients (2.18%) per the radiology report and in 71 patients (3.68%) on radiologist overread. Median age was 13 years (interquartile range, 10 to 16 years). Age groups had the following prevalence: 0 to 6 years (0.41%); 7 to 10 years (1.58%); 11 to 13 years (3.59%); 14 to 18 years (5.1%). Increased prevalence was found in ages 14 to 18 years that was statistically significant (odds ratio 1; P = 0.0004). L5 was the most common level; most defects were bilateral. White patients had a higher rate of spondylolysis (5.06%) than Black patients (2.05%). Black patients were less likely to have a spondylolysis with an OR of 0.4 (0.22 to 0.69; P = 0.0007).</p><p><strong>Discussion: </strong>This study demonstrated a lower prevalence of lumbar spondylolysis (3.68%) in children compared with the previous literature. Increasing prevalence with age suggests that spondylolysis develops over time, likely because of repetitive stress. Future studies should characterize these age-related and race-related differences for better understanding.</p><p><strong>Level of evidence: </strong>Level IV, retrospective.</p>","PeriodicalId":51098,"journal":{"name":"Journal of the American Academy of Orthopaedic Surgeons","volume":" ","pages":"579-584"},"PeriodicalIF":2.6,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144040362","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluating the Readability, Credibility, and Quality of Spanish-Language Online Educational Resources for Knee Arthroplasty: Implications for Patient Education and Health Disparities.","authors":"Rodnell Busigó Torres, Mateo Restrepo Mejia, Juan Sebastian Arroyave, Brocha Z Stern, Darwin D Chen, Calin S Moucha, Jashvant Poeran, Brett L Hayden","doi":"10.5435/JAAOS-D-23-01012","DOIUrl":"10.5435/JAAOS-D-23-01012","url":null,"abstract":"<p><strong>Introduction: </strong>Spanish-speaking individuals may experience language-based disparities related to elective orthopaedic procedures. Because patients often seek online health information, we assessed the readability, credibility, and quality of Spanish-language educational websites for knee arthroplasty.</p><p><strong>Methods: </strong>We queried \"Google,\" \"Yahoo,\" and \"Bing\" using the term \"reemplazo de rodilla\" (knee replacement in Spanish) and extracted the top 50 websites per search engine. Websites were categorized by information source (physician/community hospital, university/academic, other) and presence of HONcode certification. Information was assessed for readability (Fernández-Huerta formula), credibility (Journal of the American Medical Association benchmark criteria), and quality (Brief DISCERN tool); scores were compared between the categories.</p><p><strong>Results: </strong>A total of 77 unique websites were included (40.3% physician/community hospital, 35.1% university/academic). The median readability score was 59.4 (10th to 12th-grade reading level); no websites achieved the recommended level of ≤6th grade. The median Journal of the American Medical Association benchmark score was 2 (interquartile range 1 to 3), with only 7.8% of websites meeting all criteria. The median Brief DISCERN score was 16 (interquartile range 12 to 20), with 50.7% meeting the threshold for good quality. University/academic websites had better readability ( P = 0.02) and credibility ( P = 0.002) but similar quality ( P > 0.05) compared with physician/community hospital websites. In addition, HONcode-certified websites had better quality scores ( P = 0.045) but similar readability and credibility ( P > 0.05) compared with noncertified websites.</p><p><strong>Discussion: </strong>We identified limitations in readability, credibility, and quality of Spanish-language online educational resources for knee arthroplasty. Healthcare providers should be aware of these patient education barriers when counseling patients, and efforts should be made to support the online information needs of Spanish-speaking orthopaedic patients and mitigate language-based disparities.</p>","PeriodicalId":51098,"journal":{"name":"Journal of the American Academy of Orthopaedic Surgeons","volume":" ","pages":"594-601"},"PeriodicalIF":2.6,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142395041","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Recommendations for Culturally Competent Orthopaedic Care of Muslim Patients.","authors":"Raed Maali, Houssam Bouloussa, Jonathan R Dubin, Akin Cil","doi":"10.5435/JAAOS-D-24-01026","DOIUrl":"10.5435/JAAOS-D-24-01026","url":null,"abstract":"<p><p>The growing cultural diversity in the patient populations in the United States highlights the necessity for improved cultural competence in healthcare, specifically for the estimated 3.45 million Muslims living in the country. Islam is one of the fastest-growing religions in the world, and the Muslim population in the United States is predicted to grow markedly. Such a demographic trend provides a compelling rationale to address this community's cultural and orthopaedic treatment peculiarities. Based on these estimates, US orthopaedic surgeons will highly likely care for Muslim patients during their careers. Islamic traditions can influence various aspects of daily life for Muslim patients, including health-related practices, with the degree of adherence varying widely among individuals. For a healthcare professional, it is vital to apprehend fundamental Islamic beliefs because this will help attend to patients' needs individually and respectfully and avoid possible harm in some cases. This article seeks to spread awareness among orthopaedic providers regarding fundamental Islamic beliefs and practices that may affect patient care, providing practical recommendations for accommodating Muslim patients across various healthcare settings.</p>","PeriodicalId":51098,"journal":{"name":"Journal of the American Academy of Orthopaedic Surgeons","volume":" ","pages":"e603-e611"},"PeriodicalIF":2.6,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144038308","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}