Journal of the American Academy of Orthopaedic Surgeons最新文献

{"title":"Hip Fracture Surgery Performed <24 Hours vs. >24 Hours (Next Calendar Day) After Emergency Department Presentation Yields Equivalent Outcomes.","authors":"Benjamin Hammond, Danielle Olson, Abhishek Ganta, Kenneth A Egol, Sanjit R Konda","doi":"10.5435/JAAOS-D-25-00799","DOIUrl":"10.5435/JAAOS-D-25-00799","url":null,"abstract":"<p><strong>Introduction: </strong>To compare outcomes of patients with geriatric hip fracture undergoing surgery <24 hours from emergency department (ED) arrival to those who underwent surgery >24 hours from arrival but within the next calendar day.</p><p><strong>Methods: </strong>A retrospective review of a single-institution hip fracture database (2014 to 2024) was performed. The study cohort was divided into two groups based on time from ED arrival to surgery start time: <24-hour surgery (<24h) and next calendar day surgery >24 hours from arrival (>24h [next calendar day]). Univariate analysis was performed to compare baseline health, injury factors, and outcomes. Multivariate linear and logistic regression analyses were performed to adjust for procedure type and risk profile.</p><p><strong>Results: </strong>There were 1,694 patients included in the study analysis, of whom 964 (56.91%) were <24h and 730 (43.09%) were >24h (next calendar day). The mean time to surgery for cohorts were <24h: 17.66 ± 5.05 vs. >24h (next calendar day): 28.78 ± 3.86 hours; P < 0.001. Univariate analysis revealed no differences between <24h and >24h (next calendar day) cohorts for in-hospital complication incidence (35.5% vs. 35.1%; P = 0.862), inpatient mortality (0.5% vs. 1.0%; P = 0.285), 30-/90-day readmission (5.6% vs. 6.2%; P = 0.625; 8.2% vs. 11.0%; P = 0.053), and 30-day/1-year mortality (2.4% vs. 2.3%; P = 0.939; 5.0% vs. 6.2%; P = 0.289). Length of stay (5.15 ± 3.15 vs. 5.58 ± 3.31; P = 0.006) and discharge location (36.4% home discharge vs. 31.0%; P = 0.019) favored the <24h cohort. After adjusting for baseline health with Score for Trauma Triage in the Geriatric and Middle-Aged and procedure type, only longer length of stay was found to be associated with the >24h (next calendar day) cohort (B = 0.407; P = 0.010).</p><p><strong>Conclusion: </strong>No notable differences were observed in key outcomes for patients undergoing <24 hours from ED arrival versus those who undergo surgery >24 hours after arrival but on the next calendar day. This study suggests that \"next day hip fracture surgery\" appears safe for patients with geriatric hip fracture.</p>","PeriodicalId":51098,"journal":{"name":"Journal of the American Academy of Orthopaedic Surgeons","volume":" ","pages":"e1426-e1431"},"PeriodicalIF":2.8,"publicationDate":"2026-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145893441","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":"Transplant Medications and Their Effects on Wound Healing in Orthopaedic Surgery.","authors":"Sonia E Ubong, Santiago A Lozano-Calderon","doi":"10.5435/JAAOS-D-25-00829","DOIUrl":"10.5435/JAAOS-D-25-00829","url":null,"abstract":"<p><p>Transplant medications are an indispensable component of treatment for patients with autoimmune diseases, malignancy, or solid organ transplants. These immunosuppressive agents, although life preserving, create unique challenges when patients require orthopaedic surgery. With increased survival rates, immunosuppressed transplant patients frequently require orthopaedic intervention, with approximately 5% developing osteonecrosis, 15% to 20% experiencing osteoporotic fractures, and many developing degenerative joint disease necessitating arthroplasty or reconstructive procedures. By inhibiting inflammatory responses, decreasing collagen synthesis, reducing angiogenesis, and impairing cellular proliferation, transplant medications compromise normal immune function and wound healing processes. This physiological interference leads to elevated risks of surgical site infections, wound dehiscence, delayed union, and implant failure-complications resulting in prolonged hospitalization and poorer functional outcomes. Perioperative management becomes even more complex because of the two to fourfold higher incidence of malignancy in long-term immunosuppressed patients, with orthopaedic surgeons frequently treating individuals on both immunosuppressive and antineoplastic therapies. Despite the growing prevalence of orthopaedic procedures in this population, comprehensive guidance on perioperative wound healing management remains fragmented across the literature. This review systematically examines how transplant medications interfere with tissue repair mechanisms and provides evidence-based recommendations for perioperative medication adjustment to optimize surgical outcomes in this high-risk patient group.</p>","PeriodicalId":51098,"journal":{"name":"Journal of the American Academy of Orthopaedic Surgeons","volume":" ","pages":"e1337-e1348"},"PeriodicalIF":2.8,"publicationDate":"2026-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146068459","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":"Alcohol Misuse, Posttraumatic Stress Symptoms, and Recovery After Musculoskeletal Injury: Implications for Effective Orthopaedic Care.","authors":"Jafar Bakhshaie, Michael J Zvolensky, Anka A Vujanovic, Joseph W Ditre, David Ring","doi":"10.5435/JAAOS-D-25-00641","DOIUrl":"10.5435/JAAOS-D-25-00641","url":null,"abstract":"<p><p>Musculoskeletal injuries severe enough to warrant hospitalization commonly co-occur with alcohol misuse and posttraumatic stress disorder (PTSD) symptoms, complicating recovery (return of comfort and capability). Nearly half of trauma patients have detectable alcohol at injury, and over one in five exhibit symptoms of PTSD during recovery. These co-occurring conditions are associated with greater levels of pain intensity and incapability, limited participation in exercises, and adverse events and hospital readmissions. Routine screening and brief interventions such as Screening, Brief Intervention, and Referral to Treatment for alcohol misuse and standardized self-report screening tools such as the Primary Care PTSD Screen for DSM-5 (PC-PTSD-5) have established clinical utility; however, implementation within orthopaedic practice remains inconsistent because of resource limitations, clinician uncertainty, and fragmented care coordination. Integrated, technology-enhanced interventions incorporate psychoeducation, coping-skills training, motivational interviewing, and personalized feedback to concurrently address alcohol misuse, PTSD symptoms, and pain. Digital health platforms-including telehealth and mobile applications-may help overcome barriers to implementing integrated interventions in orthopaedic trauma settings, thereby supporting widespread use and long-term sustainability. Adopting multidisciplinary care pathways tailored to individual risk profiles may facilitate implementation of these interventions, enhancing clinical efficiency, patient adherence, and orthopaedic recovery outcomes.</p>","PeriodicalId":51098,"journal":{"name":"Journal of the American Academy of Orthopaedic Surgeons","volume":" ","pages":"e1359-e1367"},"PeriodicalIF":2.8,"publicationDate":"2026-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147391612","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":"Rotator Cuff Repair Augmentation.","authors":"Scott W Huff, Brett D Haislup, Anand M Murthi","doi":"10.5435/JAAOS-D-25-00307","DOIUrl":"10.5435/JAAOS-D-25-00307","url":null,"abstract":"<p><p>Rotator cuff repair (RCR) failure and retear remain a persistent problem and concern in shoulder surgery. Successful healing is paramount for long-term functional results. Failure of rotator cuff healing can be broadly separated into biologic and structural complications. Biologic issues include poor host variables such as healing ability and blood flow. Structural problems include tendon thinning and loss as well as poor time-zero fixation. Recently, commercial grafts or \"patches\" designed for rotator cuff augmentation have increased dramatically. Various grafts aim to enhance biology, provide structure, or both. In addition, grafts are designed to be placed either on-lay, over an RCR, or interpositional, at the bone-tendon interface. Graft may be allograft, xenograft, or fully synthetic. This article discusses the current RCR augmentation graft types and representative products currently available.</p>","PeriodicalId":51098,"journal":{"name":"Journal of the American Academy of Orthopaedic Surgeons","volume":" ","pages":"e1349-e1358"},"PeriodicalIF":2.8,"publicationDate":"2026-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146208077","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":"Sexual Harassment and Title IX Policy in Orthopaedic Surgery.","authors":"Michaela Juels, Nora A Galoustian, Nicole J Newman-Hung, Alexandra M Klomhaus, Rachel M Thompson, Lauren E Wessel","doi":"10.5435/JAAOS-D-25-00022","DOIUrl":"10.5435/JAAOS-D-25-00022","url":null,"abstract":"<p><strong>Introduction: </strong>A recent survey found that 68% of women reported experiencing sexual harassment (SH) during their orthopaedic training. This study aims to (1) characterize Title IX understanding; (2) describe SH occurrences, subtypes, and reporting rates; (3) evaluate the impact of Title IX understanding on SH reporting; and (4) compare these findings by level of training.</p><p><strong>Methods: </strong>An anonymous survey was distributed between June 1, 2023, and July 31, 2023, to Ruth Jackson Orthopaedic Society members. Surgeon demographics, SH experiences through the Racialized Sexual Harassment Scale, and Title IX understanding were assessed. Descriptive and comparative statistics analyzed SH occurrences and reporting. Pearson correlation and Fisher exact tests assessed relationships between Title IX knowledge and SH reporting.</p><p><strong>Results: </strong>Twenty percent (178 of 891) of Ruth Jackson Orthopaedic Society members completed the survey. Fifty-one percent (91/178) of orthopaedic surgeons endorsed experiencing SH during their careers, of whom 35% reported. The most common form of SH was \"nonphysical\" (34.1%). Formal reporting rates varied by SH type, with \"watching\" (67.0%) and \"fear\" (39.0%) being the most reported. The median score on the Title IX survey was 81.8%, with 47% knowing the reporting timeframe and 53% knowing who to report to. No significant associations were found between SH incident reporting rate and Title IX understanding (rho = 0.03, P = 0.9). Attending surgeons had significantly higher Racialized Sexual Harassment Scale scores (25.8 vs. 21.1, P = 0.004) and reported more occurrences (1.1 vs. 0.3, P < 0.001) compared with orthopaedic trainees.</p><p><strong>Discussion: </strong>Although most orthopaedic surgeons reported experiencing SH and understood Title IX policies, SH reporting rates remained low. Improved understanding of policy is important but may not lead to greater reporting of SH based on this study, suggesting other barriers to reporting.</p>","PeriodicalId":51098,"journal":{"name":"Journal of the American Academy of Orthopaedic Surgeons","volume":" ","pages":"e1418-e1425"},"PeriodicalIF":2.8,"publicationDate":"2026-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145566227","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":"Dual-Antiplatelet Therapy Is Not Associated With Greater Odds of Postoperative Bleeding Following Elective Total Joint Arthroplasty.","authors":"Sagar Telang, Ryan Palmer, Arjun Aron, Benjamin M Stronach, Jeffrey B Stambough, Jay R Lieberman, Nathanael D Heckmann","doi":"10.5435/JAAOS-D-25-00693","DOIUrl":"10.5435/JAAOS-D-25-00693","url":null,"abstract":"<p><strong>Introduction: </strong>Dual-antiplatelet therapy (DAPT), the combined administration of aspirin and clopidogrel, is commonly used to prevent thrombus formation in patients at an increased risk of thromboembolic complications. However, current guidelines regarding DAPT safety following primary elective total hip arthroplasty (THA) and total knee arthroplasty (TKA) are unclear. We sought to compare the odds of 90-day bleeding and thromboembolic complications among patients receiving DAPT relative to clopidogrel alone.</p><p><strong>Methods: </strong>All patients who underwent primary TKA or THA between 2016 and 2021 were identified using the Premier Healthcare Database. Patients who received DAPT for postoperative thromboprophylaxis were compared with those receiving only clopidogrel for demographic and comorbidity differences. Chi-square analysis was employed to evaluate differences between categorical variables, whereas independent t -tests were used for continuous variables. Univariate and multivariable regression analyses were used to assess differences in 90-day outcomes.</p><p><strong>Results: </strong>In total, 18,117 primary THA and TKA patients (DAPT: 83.0%; clopidogrel: 17.0%) were identified. After adjusting for confounders, DAPT patients did not demonstrate increased rates of bleeding complications, transfusion, acute anemia, hematoma, or hemorrhage compared with those receiving clopidogrel alone. In addition, no significant differences were found in rates of deep vein thrombosis, pulmonary embolism, myocardial infarction, or mortality between the cohorts. However, compared with patients receiving clopidogrel, those receiving DAPT were more likely to suffer stroke (adjusted odds ratio 2.34, 95% confidence interval: 1.16 to 4.69, P = 0.017).</p><p><strong>Discussion: </strong>Despite the notable efficacy of DAPT in reducing thromboembolic risk, patients on DAPT did not have higher rates of postoperative bleeding complications within the early postoperative period following elective THA or TKA. These findings suggest that patients on long-term DAPT may safely resume these medications after THA or TKA.</p>","PeriodicalId":51098,"journal":{"name":"Journal of the American Academy of Orthopaedic Surgeons","volume":" ","pages":"e1480-e1487"},"PeriodicalIF":2.8,"publicationDate":"2026-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145764510","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":"Outcomes of Reverse Total Shoulder Arthroplasty With Lateralized Implant in a Patient With High Grade of Fatty Infiltration of Infraspinatus and Teres Minor Muscle.","authors":"Hyun Gon Kim, Eugene Baek, Su Cheol Kim, Jae Soo Kim, Dong Hun Suh, Jae Chul Yoo","doi":"10.5435/JAAOS-D-25-00787","DOIUrl":"10.5435/JAAOS-D-25-00787","url":null,"abstract":"<p><strong>Aims: </strong>This study aimed to evaluate the clinical outcomes and complication rates after reverse total shoulder arthroplasty (RTSA) with lateralized implant for patients with high-grade fatty infiltration (FI) of posterior rotator cuff including infraspinatus (ISP) and teres minor (TM).</p><p><strong>Methods: </strong>From January 2016 to June 2022, 139 patients who underwent primary RTSA with single lateralized implant with at least 2 years of follow-up were reviewed. According to FI of ISP from preoperative MRI, patients were divided into high ISP FI group (n = 88) and low ISP FI group (n = 51). Clinical outcomes and complications were compared between the two groups. A subgroup analysis was done with a high ISP FI group divided into low TM FI group (n = 77) and high TM FI group (n = 11).</p><p><strong>Results: </strong>At final follow-up, there was no significant difference in range of motion of forward elevation ( P = 0.282), external rotation (ER; P = 0.467), and Constant score ( P = 0.252) between the high ISP FI group and the low ISP FI group. At the final follow-up, patients in the high FI group demonstrated significantly reduced strength in both forward elevation ( P = 0.049) and ER ( P = 0.007) compared with those in the low FI group. However, the mean improvement in muscle strength from preoperative to postoperative evaluation in forward elevation and ER showed no significant difference between two groups ( P = 0.559, 0.675, respectively). Subgroup analysis comparing low TM FI group and high TM FI group in the high ISP FI group showed that there were no notable differences in clinical outcomes between two groups. Bone mineral density, tear size in mediolateral dimension, ISP FI, and ER lag angle were found to be markedly associated with poor ER strength at final follow-up in univariate and multivariate analyses.</p><p><strong>Conclusion: </strong>Lateralized RTSA yielded marked improvements in shoulder motion, including forward elevation and ER, despite severe fatty changes in the ISP and TM.</p><p><strong>Level of evidence: </strong>III, Retrospective case-control study.</p>","PeriodicalId":51098,"journal":{"name":"Journal of the American Academy of Orthopaedic Surgeons","volume":" ","pages":"e1382-e1392"},"PeriodicalIF":2.8,"publicationDate":"2026-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145543755","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":"Effect of Start Time, Intraoperative Shift Change, and Case Order on Outcomes After Cervical Spinal Fusion.","authors":"Jonathan Dalton, Robert J Oris, Teeto Ezeonu, Rachel Huang, Rajkishen Narayanan, Brandon J Martinazzi, William T DiCiurcio, Yunsoo Lee, Evan Bradley, Hassan Siddiqui, Thomas Swiderski, Anthony LaBarbiera, Lauren Micou, Barrett I Woods, Mark F Kurd, Jeffrey A Rihn, Ian David Kaye, Jose Canseco, Alan Hilibrand, Alexander Vaccaro, Gregory Schroeder, Christopher Kepler","doi":"10.5435/JAAOS-D-25-00377","DOIUrl":"10.5435/JAAOS-D-25-00377","url":null,"abstract":"<p><strong>Introduction: </strong>With increasing orthopaedic surgical demand, the importance of operating room (OR) efficiency and safety is paramount. However, there is a lack of research regarding the effect of OR and staff workflow factors on postoperative outcomes. The purpose of this study was to evaluate the effect of OR workflow on outcomes after elective cervical fusion, with a focus on inpatient complications and discharge disposition.</p><p><strong>Methods: </strong>Adult patients who underwent primary cervical fusion (2020 to 2021) were retrospectively identified. OR workflow variables included (1) OR arrival before versus after 12 pm , (2) intraoperative shift change, and (3) case order. Outcomes included time to physical therapy, length of stay (LOS), inpatient complications, 90-day emergency department visits/readmissions, and 1-year revision surgery.</p><p><strong>Results: </strong>Four hundred sixty-three patients were included. Afternoon patients experienced more cardiopulmonary complications ( P = 0.043) and longer LOS ( P = 0.020). Intraoperative shift change was associated with longer and more commonly posterior surgery with more levels fused/decompressed (all P values < 0.05). Multivariable regression analyses demonstrated that an intraoperative shift change (estimate: 2.04, P < 0.001) and second or later case (estimate: 1.62, P = 0.002) were independently predictive of longer LOS when controlling for age, sex, body mass index, comorbidities, number of levels fused/decompressed, procedure time, time from OR to first physical therapy session, and inpatient complications. An intraoperative shift change was predictive of decreased home discharge (odds ratio: 0.47, P = 0.030). Non-first-case surgery was associated with lower odds of 1-year revision surgery (odds ratio: 0.41, P = 0.018).</p><p><strong>Conclusion: </strong>In a cohort of patients with similar demographics and comorbidities, intraoperative shift changes independently predicted increased LOS (2.04 days longer) and nonhome discharge, and second-case or later case order independently predicted LOS (1.62 days longer). However, second-case or later case order independently predicted lower odds of 1-year spine revision surgery. Additional work is needed to evaluate the potential reasons for these findings.</p>","PeriodicalId":51098,"journal":{"name":"Journal of the American Academy of Orthopaedic Surgeons","volume":" ","pages":"e1407-e1417"},"PeriodicalIF":2.8,"publicationDate":"2026-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145514622","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":"Minimum 48-month Clinical and Radiographic Outcomes of Anatomic Total Shoulder Arthroplasty With a Partially Cemented All-polyethylene Fluted Central Peg Glenoid Component.","authors":"Rose G Christensen, Branum G Griswold, Benjamin W Sears, James D Kelly, Michael S Khazzam, Libby A Mauter, Jacqueline E Bader, Hayden B Schuette, Mallory A Boyd, Armodios M Hatzidakis","doi":"10.5435/JAAOS-D-25-00185","DOIUrl":"10.5435/JAAOS-D-25-00185","url":null,"abstract":"<p><strong>Background: </strong>Partially cemented all-polyethylene glenoids with press-fit fluted central peg (FCP) fixation are commonly used for anatomic total shoulder arthroplasty (aTSA). The purpose of this study was to evaluate clinical outcomes and radiographic findings in patients with ≥48-month follow-up after aTSA with one FCP glenoid design.</p><p><strong>Methods: </strong>A prospective patient registry was used to identify a consecutive group of patients who had undergone aTSA using a FCP glenoid and had ≥48-month follow-up. Final postoperative radiographs, as well as short-term if available, were assessed by five shoulder specialists for bony incorporation and/or radiolucency about the FCP using a validated discriminatory method of evaluating native glenoid reaction to the FCP. Changes in patient-reported and clinical outcomes were evaluated, and regression analysis was performed to identify predictors of central peg osteolysis (CPO), poor clinical outcome, or revision.</p><p><strong>Results: </strong>Eighty-three shoulders satisfied inclusion criteria. At final follow-up (average 90 months), notable improvements were noted in all outcomes ( P < 0.05), including a 75% satisfaction rate. On final imaging, 16 patients (19%) demonstrated optimal FCP bony ingrowth, and 23 (28%) demonstrated CPO. The radiographic appearance of bone around the central peg tended to deteriorate over time and trended with worsened clinical outcomes, but these differences were not notable. Of 73 patients with short-term and final imaging, progression of radiolucency was observed in 30 (41%) and associated with less improvement in American Shoulder and Elbow Surgeons score ( P = 0.026) and Single Assessment Numeric Evaluation ( P = 0.022) scores. Risk of revision was 13% greater in patients with CPO on final imaging while increased age was associated a lower risk of revision.</p><p><strong>Conclusion: </strong>Clinical improvement was observed in most of the patients, but with a dissatisfaction rate of 25%. Progression of CPO was associated with lower improvement in final American Shoulder and Elbow Surgeons score and Single Assessment Numeric Evaluation scores and a higher probability of revision.</p><p><strong>Level of evidence: </strong>Level IV Case Series.</p>","PeriodicalId":51098,"journal":{"name":"Journal of the American Academy of Orthopaedic Surgeons","volume":" ","pages":"e1459-e1471"},"PeriodicalIF":2.8,"publicationDate":"2026-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145727025","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":"More Short Term Pain in Noncemented Total Knee Arthroplasty: A Matched Cohort Analysis.","authors":"Edmund Hurdle, Sara Strecker, Durgesh Nagarkatti, Mark Shekhman, Leah Goldberg, Robert James Carangelo, Dan Witmer","doi":"10.5435/JAAOS-D-25-00644","DOIUrl":"10.5435/JAAOS-D-25-00644","url":null,"abstract":"<p><strong>Introduction: </strong>Despite the resurgence of noncemented total knee arthroplasty (TKA) following implant advancements in recent years, instances of greater postoperative pain remain a common finding compared with TKAs with cemented fixation. Newer noncemented designs have become appealing to younger, heavier, and active patients, with appropriate bone stock.</p><p><strong>Methods: </strong>A matched cohort analysis of patients undergoing primary, unilateral cemented and noncemented TKAs at a high-volume, orthopaedic specialty hospital. Enrolled patients had their index procedure between March 1, 2020, and December 31, 2023. The initial cohort was 4,275 patients, with 455 noncemented and 3,820 cemented TKA patients. Patients were matched 1:1, with MAKO instrumentation and sex being matched exactly, while age was matched within 2 years, yielding 229 patients per group. Patient-reported outcomes were completed preoperatively, at 12 weeks, 6 months and 1 year. Forgotten Joint scores were assessed at 1 year.</p><p><strong>Results: </strong>Patients' reported pain levels during their inpatient stay were higher in noncemented TKA patients, with pain values of 3.1 (±1.5) versus 3.2 (±1.7) at rest ( P = 0.397) and 4.4 (±1.6) versus 4.8 (±1.8) with activity ( P = 0.031). Morphine Milligram Equivalents were 26 points higher in the noncemented group (101.4 vs. 75.0, P < 0.001). Knee Injury and Osteoarthritis Outcome Scores for Joint Replacement were similar between cohorts at all time points, when adjusted for preoperative differences. Forgotten joint scores were significantly different with the noncemented group scoring lower (56.6 [±28.2] vs. 44.3 [±31.7], P = 0.013) and fewer patients met the threshold for forgetting their joint (75.3% vs. 51%, P = 0.002). Complications and readmissions were similar between groups.</p><p><strong>Conclusion: </strong>This study concludes that noncemented TKA patients experience greater early postoperative pain and are more likely to be aware of their prosthesis than cemented TKA patients. Morphine Milligram Equivalent utilization for noncemented TKA patients was also markedly higher. Future studies should examine how to best define success for noncemented TKAs.</p>","PeriodicalId":51098,"journal":{"name":"Journal of the American Academy of Orthopaedic Surgeons","volume":" ","pages":"e1393-e1399"},"PeriodicalIF":2.8,"publicationDate":"2026-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145514578","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}