Journal of the American Academy of Orthopaedic Surgeons最新文献

{"title":"Determinants of Patient-Rated Benefit 6 Months Post Arthroscopic Rotator Cuff Repair: An Analysis of 2010 Patients.","authors":"Kaitlin Zhong, Ryan S Ting, Ron Rosenthal, Patrick Lam, George Anthony Calvert Murrell","doi":"10.5435/JAAOS-D-24-00646","DOIUrl":"10.5435/JAAOS-D-24-00646","url":null,"abstract":"<p><strong>Introduction: </strong>From the surgeon's perspective, a successful rotator cuff is one that remains intact. However, it is undetermined which factors contribute to an improved shoulder from the patient's perspective. The aim of this study was to determine the variables that predicted greater patient-rated benefit from presurgery to 6 months postarthroscopic rotator cuff repair.</p><p><strong>Methods: </strong>Multiple linear regression analysis was conducted on prospectively collected data of 2010 consecutive patients who underwent arthroscopic rotator cuff repair by a single surgeon to determine the predictors of greater patient-rated benefit. Patient-rated shoulder ranking was graded on a five-point Likert scale in response to \"How is your shoulder overall?\" preoperatively and at 6 months postoperatively. The patient-rated benefit was the difference in rankings between these time points.</p><p><strong>Results: </strong>Six months following rotator cuff repair, a self-reported benefit was observed in 84% of patients. Patients who rated their shoulder as poor preoperatively reported the greatest benefit (t = 22, P < 0.001). Other preoperative determinants of greater patient-rated benefit were lower patient-rated shoulder stiffness (t = 5, P < 0.001), an injury that was not related to work (t = 4, P < 0.001), stronger internal rotation strength (t = 4, P < 0.002), a more strenuous line of work preinjury (t = 3, P = 0.007), female sex (t = 2, P = 0.019), having a larger tear area (t = 2, P = 0.020), and weaker abduction strength (t = 2, P = 0.046).</p><p><strong>Conclusions: </strong>Patients who were most likely to perceive a benefit from rotator cuff repair at 6 months postoperation were those who preoperatively rated their shoulder poorly, had a less stiff shoulder, an injury that was not related to work, stronger internal rotation, more strenuous line of work preinjury, were female, had larger tear area, and weaker abduction strength.</p>","PeriodicalId":51098,"journal":{"name":"Journal of the American Academy of Orthopaedic Surgeons","volume":" ","pages":"e161-e171"},"PeriodicalIF":2.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142395040","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":"A Retrospective Comparison of Headless Versus Standard Interlocking Screw Fixation of Tibia Intramedullary Nails.","authors":"Benjamin D Pesante, Byron A Ward, Stephen C Stacey, Joshua A Parry","doi":"10.5435/JAAOS-D-24-00703","DOIUrl":"10.5435/JAAOS-D-24-00703","url":null,"abstract":"<p><strong>Introduction: </strong>Symptomatic interlocking screws are common after intramedullary nail fixation of tibia fractures. Low-profile headless interlocking screws recently became available and could potentially reduce the rate of symptomatic screws. The purpose of this study was to compare the rate of symptomatic screws and screw removals between these screw types.</p><p><strong>Methods: </strong>A retrospective review identified patients with tibia shaft fractures treated with tibia intramedullary nails between August 1, 2018 to September 1, 2023 by 11 surgeons. Low-profile headless interlocking screws became available on June 28, 2021 and were routinely used thereafter. Patients treated with low-profile headless versus standard headed interlocking screws were compared in terms of symptomatic screws, defined as a patient reporting pain or discomfort at the site of a screw head in clinical documentation, symptomatic screw removals, screw failure (breakage or backout), and procedures to promote bone union.</p><p><strong>Results: </strong>Overall, 79 patients were included in the analysis: 33 patients treated with 144 headless screws and 46 patients treated with 187 standard screws. The median patient age was 35 years, and a majority were male (68.4%, n = 54). The median follow-up length was 8.5 months (interquartile range 5.5 to 8.8 months). The headless screw group, compared with standard screw group, did not differ in age, injury mechanism severity, open fracture classification, tobacco use, American Society of Anesthesiologists classification >2, number of interlocking screws used, or follow-up time ( P > 0.05). The headless screw group was less likely to have symptomatic screws (0.0% vs. 23.9%; P = 0.002), less likely to have symptomatic screw removal (0.0% vs. 13.0%; P = 0.03), and had no difference in procedures to promote bone union (10.0% vs. 6.8%; P = 0.68) or screw backout (0.0% vs. 4.4%; P = 0.50).</p><p><strong>Discussion: </strong>Standard headed interlocking screws were symptomatic in 23.9% of patients and 13.0% underwent symptomatic screw removal. In comparison, no patients treated with low-profile headless interlocking screws had symptomatic screws.</p><p><strong>Level of evidence: </strong>Level 3, diagnostic.</p>","PeriodicalId":51098,"journal":{"name":"Journal of the American Academy of Orthopaedic Surgeons","volume":" ","pages":"145-149"},"PeriodicalIF":2.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142741123","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":"Personal Financial Literacy for the Orthopaedic Trainee and Early Career Surgeon: A Review of the Basics.","authors":"Michael J Kutschke, Paul D Fadale","doi":"10.5435/JAAOS-D-23-01260","DOIUrl":"10.5435/JAAOS-D-23-01260","url":null,"abstract":"<p><p>Personal finance is a topic that has historically been shunned as a point of conversation in academia, often avoided and seldom discussed in medical training. However, this aversion leaves trainees and early career surgeons to make complex financial decisions without sufficient understanding while simultaneously facing the pressures of building an orthopaedic practice-a recipe destined for burnout. This simple review serves to equip young orthopaedic surgeons with the fundamental personal financial concepts essential for making wise financial choices early in their careers. Prompt elimination of all high-interest consumer debt and devising a strategy to address student loans are crucial first steps in establishing the foundation for personal financial success. Progressing through training and entering practice bring about enhanced personal discretionary funds that are most effectively deployed through consistent budgeting and automated saving strategies. Malpractice, disability, and life insurances are keys to protecting current and future earnings as well as preventing financial catastrophe. Augmenting these items with a functional understanding of taxation systems, tax diversification, and asset protection is essential to recognize in the early years of practice to set the trajectory for financial independence and a well-deserved retirement.</p>","PeriodicalId":51098,"journal":{"name":"Journal of the American Academy of Orthopaedic Surgeons","volume":" ","pages":"108-116"},"PeriodicalIF":2.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142300226","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":"Race, Ethnicity, and Gender Representation Among US Academic Spine Surgeons.","authors":"Olivia A Opara, Rajkishen Narayanan, Omar H Tarawneh, Yunsoo Lee, Alexa Tomlak, Alexander Zavitsanos, John Czarnecki, Waqaas Hassan, Shaina A Lipa, Addisu Mesfin, Jose A Canseco, Alan S Hilibrand, Alexander R Vaccaro, Gregory D Schroeder, Christopher K Kepler, Barrett I Woods","doi":"10.5435/JAAOS-D-24-00349","DOIUrl":"10.5435/JAAOS-D-24-00349","url":null,"abstract":"<p><strong>Background: </strong>Although diversity has improved across certain orthopaedic subspecialties, enhancing diversity within spine surgery has remained a challenge. We aimed to investigate the current state of sex, racial, and ethnic diversity among academic orthopaedic spine surgeons in the United States.</p><p><strong>Methods: </strong>In January 2024, a cross-sectional analysis of orthopaedic spine surgery faculty in the United States was conducted using the Doximity database to identify eligible surgeons. Fellowship-trained orthopaedic spine surgeons (professor, associate professor, and assistant professor) who graduated residency between 1990 and 2022 were included. Race, sex, academic rank, residency year of graduation, and H-Index scores were recorded using publicly available information from faculty profile pages and the Doximity database.</p><p><strong>Results: </strong>Four hundred fifty-two spine faculty were included in the analysis: 95.1% men and 4.84% women. Across race and ethnicity, 315 surgeons (69.7%) were White, 111 (24.6%) Asian, 15 (3.32%) Black or African American, and 11 (2.43%) Hispanic or Latino or of Spanish origin. Of the 101 professor-level surgeons, 3 (2.97%) were Black men. Among female professors, none were Black, Asian, or Hispanic/Latino. No Hispanic or Latino female professors, associate professors, or assistant professors were identified. The sex and race/ethnicity demographics that have increased in percentage over time include White women (0.92% to 6.08%), Asian men (11.0% to 26.5%), Asian women (0% to 1.66%), and Hispanic/Latino men (1.83% to 3.87%). The surgeon demographic groups that demonstrated minimal fluctuations over time included Black men, Black women, and Hispanic/Latino women.</p><p><strong>Conclusion: </strong>Our findings demonstrate that underrepresentation among academic spine surgeons remains an ongoing challenge that warrants increased attention. Enhancing the representation of Black and Hispanic men, as well as Black, Asian, and Hispanic women, in spine surgery requires a deliberate effort at every level of orthopaedic training.</p>","PeriodicalId":51098,"journal":{"name":"Journal of the American Academy of Orthopaedic Surgeons","volume":" ","pages":"e151-e160"},"PeriodicalIF":2.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142395045","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":"Navigating the Orthopaedic Maze as a New Patient: A National Mystery Caller Study on Medicaid Coverage and Access to Specialized Surgeons.","authors":"Authors Nicholas A Felan, Elizabeth Garcia-Creighton, Ankit Hirpara, Isabella Narváez, Adam Miller, Alexis J Batiste, Daniel J Stokes, Ryan Tseng, Alessandra Santiago, Anthony Smyth, Nicholas R Pulciano, Benjamin R Wharton, Eric C McCarty, Tyler M Muffly","doi":"10.5435/JAAOS-D-24-00668","DOIUrl":"10.5435/JAAOS-D-24-00668","url":null,"abstract":"<p><strong>Introduction: </strong>Medicaid coverage is associated with longer appointment wait times, decreased access to care, and poorer health outcomes compared with private insurance across medical subspecialties. The purpose of this study was to evaluate new patient appointment wait times for subspecialty Orthopaedic care based on insurance type and to identify factors influencing these wait times.</p><p><strong>Methods: </strong>Orthopaedic physicians were identified using the American Academy of Orthopaedic Surgeons patient-facing database in the fields of Adult Reconstruction, Foot and Ankle, Hand, Sports Medicine, Spine, Pediatric, and General Orthopaedic surgery. Mystery callers, posing as patients with either Medicaid or Blue Cross/Blue Shield (BCBS) insurance, contacted physicians to request the next available new patient appointment. The business days until the first available new patient appointment were recorded and analyzed using a linear mixed Poisson model.</p><p><strong>Results: </strong>A total of 1,002 phone calls were made to 501 unique physicians in 47 states. Among the 349 physicians meeting inclusion criteria, 37% (n = 130) did not accept Medicaid. Medicaid patients experienced a 10% longer wait for a new patient appointment compared with patients with BCBS (incidence rate ratio: 1.10; CI: 1.05 to 1.15; P < 0.01) with mean wait times of 24.9 business days (SD ± 24) and 19.6 business days (SD ± 23), respectively. Increased waiting times were also associated with academic institutions ( P < 0.01), prolonged call times ( P < 0.01), and specific geographic regions ( P < 0.05). Our model achieved an R-squared value of 0.94, demonstrating strong explanatory power.</p><p><strong>Conclusion: </strong>Patients with Medicaid experience longer wait times and decreased access to care when scheduling an appointment with an Orthopaedic surgeon compared with patients with private insurance. This may be due to reimbursement structures in Medicaid that do not cover the full cost of treatment. Aside from advocating for higher reimbursement rates, telehealth initiatives may help bridge this gap to ensure accessibility to orthopaedic surgery for all patients.</p>","PeriodicalId":51098,"journal":{"name":"Journal of the American Academy of Orthopaedic Surgeons","volume":" ","pages":"e181-e190"},"PeriodicalIF":2.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142787461","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":"Predicting Proximal Humerus Fracture Mechanical Complications: Are Computed Tomography Hounsfield Units the Answer?","authors":"Nina D Fisher, Andrew S Bi, Kenneth A Egol","doi":"10.5435/JAAOS-D-24-00594","DOIUrl":"10.5435/JAAOS-D-24-00594","url":null,"abstract":"<p><strong>Introduction: </strong>The purpose was to determine whether computed tomography (CT) Hounsfield units (HU) as a proxy for bone quality can predict postoperative complications following surgical treatment of proximal humerus fractures.</p><p><strong>Methods: </strong>Sixty-six patients with 2-, 3-, or 4-part proximal humerus fractures who underwent surgical fixation at single institution and had complete radiographic data available were included. Radiographic measurements included the deltoid tuberosity index (DTI) on preoperative anterior-posterior shoulder radiographs, and the HU value from the surgical proximal humerus was determined by measuring the humeral head at the midaxial/coronal/sagittal CT image using a circle-type region of interest (≥35 mm 2 ). Postoperative complications recorded were implant failure, development of osteonecrosis, nonunion, and acute periprosthetic fracture. Patients with and without complications were statistically compared, and binary logistic regression was performed to determine whether preoperative proximal humerus CT HU were predictive of complications.</p><p><strong>Results: </strong>Eight patients (12.1%) developed 11 overall complications, with three patients experiencing multiple complications each. Complications included osteonecrosis (4), implant failure (5), nonunion (1), and acute periprosthetic fracture (1). No difference was observed in demographics or Neer or AO/OTA classification between those with and without complications. Patients with complications had markedly lower DTI and overall HU as well as HU in the coronal and sagittal planes. Regression analysis for average DTI demonstrated a higher DTI and had a 10 times decreased risk of complication ( P = 0.040, odds ratio = -10.5, 95% confidence interval, 0.000 to 0.616). Regression analysis for average total HU also found a higher HU associated with a decreased risk of complications ( P = 0.034, odds ratio = -0.020, 95% confidence interval, 0.980 to 0.962). Logistic regression analysis, including age, age-adjusted Charlson Comorbidity Index, mean DTI, and mean total HU, only found mean total HU to be notable within the model.</p><p><strong>Discussion: </strong>CT HU may identify patients with poorer bone quality and thus help predict postoperative complications.</p><p><strong>Level of evidence: </strong>Diagnostic Level III.</p>","PeriodicalId":51098,"journal":{"name":"Journal of the American Academy of Orthopaedic Surgeons","volume":" ","pages":"150-155"},"PeriodicalIF":2.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142523630","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":"Medicaid and the Children's Health Insurance Program: Understanding These Programs to Promote Advancements.","authors":"David M Kalainov, Ken Yamaguchi","doi":"10.5435/JAAOS-D-23-00735","DOIUrl":"https://doi.org/10.5435/JAAOS-D-23-00735","url":null,"abstract":"<p><p>Medicaid and the Children's Health Insurance Program together represent the largest healthcare coverage programs in the United States, providing benefits for approximately one in four residents and more than half of all children. Both programs are funded by a combination of federal and state dollars with more than 70% of beneficiaries enrolled in managed care plans. The size and scope of these programs underpin the importance of a working knowledge to understand healthcare delivery in the United States. This primer provides an overview of several interrelated topics for an improved understanding of the Medicaid and Children's Health Insurance Program programs for orthopaedic surgeons, other clinicians, healthcare administrators, policy makers, and business leaders.</p>","PeriodicalId":51098,"journal":{"name":"Journal of the American Academy of Orthopaedic Surgeons","volume":"33 3","pages":"117-126"},"PeriodicalIF":2.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11708994/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143015766","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Identifying a Reliable Intra-articular Landmark to Avoid Vascular Injury During Transacetabular Screw Fixation: A 3D Computed Tomography Study.","authors":"Hansel E Ihn, Brian C Chung, Luke Lovro, Xiao T Chen, Douglass Tucker, Eric White, Darryl Hwang, Joseph T Patterson, Alexander B Christ, Nathanael D Heckmann","doi":"10.5435/JAAOS-D-24-00483","DOIUrl":"https://doi.org/10.5435/JAAOS-D-24-00483","url":null,"abstract":"<p><strong>Introduction: </strong>Vascular injury during acetabular screw fixation is a life-threatening complication of total hip arthroplasty. This study uses three-dimensional computed tomography to (1) measure absolute distance from the external iliac artery (EIA) to the acetabulum, (2) determine available bone stock along the EIA path, and (3) create a novel acetabular vascular risk map.</p><p><strong>Methods: </strong>A retrospective radiographic study was conducted using three-dimensional CT. Placement of four 6.5-mm screws in a radial projection from the acetabulum toward the EIA was simulated. The initial screw (Sc1) was placed anteriorly at the center of the anterior labral sulcus. The terminal screw (Sc4) was placed such that any screw placed further posteriorly would not be in contact with the EIA. The shortest distance to the EIA (AD) and acetabular bone depth (BD) were measured.</p><p><strong>Results: </strong>Fifty patients (100 hips) were included with an average age of 61.9 ± 15.4 years and average body mass index (BMI) of 27.5 ± 5.3 kg/m 2 . The mean AD at Sc1 was 25.1 ± 2.3 mm (range: 15.4 to 34.9), increasing to 71.5 ± 7.8 mm (range: 21.0 to 144.9) at Sc4. Mean BD at Sc1 was 4.6 ± 0.8 mm (range: 1.4 to 32.0), increasing to 20.1 ± 5.5 mm (range: 2.1 to 36.3) at Sc4. On univariate analysis, male patients demonstrated greater AD and BD at all screw positions. Multiple linear regression revealed an inverse correlation between age and AD and a direct correlation between weight and AD ( P value <0.005).</p><p><strong>Conclusion: </strong>This study identifies the tip of the cotyloid fossa as a reliable intra-articular landmark during total hip arthroplasty. Surgeons should remain wary of potential vascular injury during transacetabular screw fixation, particularly when operating on elderly, female patients.</p>","PeriodicalId":51098,"journal":{"name":"Journal of the American Academy of Orthopaedic Surgeons","volume":"33 3","pages":"e172-e180"},"PeriodicalIF":2.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143015758","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":"Recent Advances in Minimally Invasive Local Cancer Control and Skeletal Stabilization of Periacetabular Osteolytic Metastases Under C-Arm Imaging Guidance.","authors":"Jungo Imanishi, Rui Yang, Hirotaka Kawano, Francis Y Lee","doi":"10.5435/JAAOS-D-24-00077","DOIUrl":"10.5435/JAAOS-D-24-00077","url":null,"abstract":"<p><p>Cancers are chronic manageable diseases in the era of the second phase of the Cancer Moonshot program by the US government. Patients with cancer suffer from various forms of orthopaedic morbidities, namely locomotive syndrome in cancer patients ( Cancer Locomo ). Type I encompasses orthopaedic conditions directly caused by cancers such as pathological fractures. Type II includes conditions caused by cancer treatments in cases of osteopenia, bone necrosis, insufficiency fractures, nonunions, and postsurgical complications. Type III defines coexisting conditions such as arthritis. The fundamental philosophy is that orthopaedic surgeons facilitate lifesaving ambulatory anticancer drug therapies by preventing and improving Cancer Locomo . Skeletal metastasis-specific procedures are evolving currently. Recently emerging percutaneous ambulatory minimally invasive procedures address skeletal reinforcement and local cancer control while avoiding many complications and drawbacks from extensive open surgical reconstructive procedures. Three-dimensional imaging techniques are useful but are not always available for acetabular procedures in all healthcare facilities. In this review, the techniques of percutaneous guidewire and antegrade cannulated screw placement under standard C-arm fluoroscopy are described in detail. In addition, cancer-induced bone loss, biomechanical data of percutaneous skeletal reinforcement, and clinical outcomes of minimally invasive procedures were reviewed.</p>","PeriodicalId":51098,"journal":{"name":"Journal of the American Academy of Orthopaedic Surgeons","volume":" ","pages":"e136-e150"},"PeriodicalIF":2.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142512550","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":"Identification of Data-Driven Preoperative Hemoglobin Strata That Predict the Likelihood of Blood Transfusion and the Risk of Major Complications and Prosthetic Joint Infection After Total Hip Arthroplasty.","authors":"Mark Haft, Amil R Agarwal, Eliza R Brufsky, Zachary C Pearson, Alex Gu, Andrew Harris, Savyasachi Thakkar, Gregory J Golladay","doi":"10.5435/JAAOS-D-24-00435","DOIUrl":"10.5435/JAAOS-D-24-00435","url":null,"abstract":"<p><strong>Introduction: </strong>Preoperative anemia is an independent risk factor of complications after primary total hip arthroplasty (THA). Currently used hemoglobin thresholds are not developed for risk stratification of arthroplasty patients and do not provide surgery-specific information on postoperative complication risk. Thus, we aimed to calculate THA-specific preoperative hemoglobin strata that observe the likelihood of 90-day blood transfusion and determine whether these strata are associated with increased risk of 90-day complications and 2-year prosthetic joint infection (PJI).</p><p><strong>Methods: </strong>A retrospective cohort analysis identified 56,101 patients who underwent primary THA from 2013 to 2022. Using the lowest hemoglobin value for each patient one month before THA, stratum-specific likelihood ratio (SSLR) analysis calculated sex-based hemoglobin strata associated with the likelihood of 90-day postoperative blood transfusion. Propensity score matching was performed. Incidence rates and risk of 90-day major complications and 2-year PJI were observed for each identified preoperative hemoglobin stratum.</p><p><strong>Results: </strong>SSLR analysis identified five male (strata, likelihood ratio [<10.4 g/dL, 12.5; 10.5 to 11.4 g/dL, 8.0; 11.5 to 12.4 g/dL, 2.4; 12.5 to 13.4 g/dL, 1.3; 13.5 to 13.9 g/dL, 0.5]) and five female (<8.9 g/dL, 10.7; 9.0 to 10.9 g/dL, 4.0; 11.0 to 11.4 g/dL, 2.0; 12.0 to 12.9 g/dL, 1.0; 13.0 to 13.4 g/dL, 0.6) preoperative hemoglobin strata associated with varying likelihoods of 90-day blood transfusion after THA. After matching in both male and female cohorts, as the calculated preoperative hemoglobin strata decreased, the relative risk of overall 90-day major complications and 2-year PJI increased incrementally (all P < 0.05).</p><p><strong>Conclusion: </strong>SSLR analysis established THA-specific sex-based preoperative hemoglobin strata that observe the likelihood of 90-day blood transfusion and predict the risk of 90-day medical complications and 2-year PJI. These strata are a first of their kind in THA research. While preoperatively optimizing patients, we recommend using these hemoglobin thresholds to help guide decisions on presurgery anemia optimization and to reduce the need for postoperative blood transfusion.</p><p><strong>Level of evidence: </strong>Level III.</p>","PeriodicalId":51098,"journal":{"name":"Journal of the American Academy of Orthopaedic Surgeons","volume":" ","pages":"127-134"},"PeriodicalIF":2.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141538918","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}