Journal of the American Academy of Orthopaedic Surgeons最新文献

{"title":"Analysis of Costs Associated With Increased Length of Stay After Total Joint Arthroplasty at a Single Private Practice.","authors":"Adam S Kohring, Rex Lutz, Nihir Parikh, John Hobbs, Tiffany N Bridges, Chad A Krueger","doi":"10.5435/JAAOS-D-23-01262","DOIUrl":"10.5435/JAAOS-D-23-01262","url":null,"abstract":"<p><strong>Introduction: </strong>As the demand for total hip arthroplasty (THA) and total knee arthroplasty (TKA) increases, so does the financial burden of these services. Despite efforts to optimize spending and bundled care payments, THA and TKA costs still need to be assessed. Our study explores the relationship between perioperative costs and length of stay (LOS) for THA and TKA.</p><p><strong>Methods: </strong>A total of 614 patients undergoing THA or TKA at a single private practice with LOS from zero to 3 days were identified. All patients were insured by private or Medicare Advantage insurance from a single provider. Primary outcomes included total costs and their relationship with LOS, classified into surgeon reimbursement, facility costs, and anesthesia costs. Secondary outcomes included readmission rates and discharge disposition. Analyses involved Student t -test, analysis of variance, and chi-square tests.</p><p><strong>Results: </strong>Longer LOS was associated with increased total, facility, and anesthesia costs. Costs for THA patients were stable except for reduced surgeon reimbursement with longer LOS. Patients undergoing TKA experienced an increase in facility costs with longer LOS. Total facility and anesthesia costs increased with LOS for Medicare Advantage patients, but surgeon reimbursement remained stable. Privately insured patients experienced higher total and facility costs but stable surgeon reimbursement and anesthesia costs regardless of LOS.</p><p><strong>Conclusion: </strong>Our study shows an increase in total cost with longer LOS, especially pronounced in privately insured patients. A notable reduction was observed in the surgeon reimbursement for Medicare Advantage patients with extended LOS. These findings underscore the need for efficient surgical practices and postoperative care strategies to optimize hospital stays and control costs.</p>","PeriodicalId":51098,"journal":{"name":"Journal of the American Academy of Orthopaedic Surgeons","volume":" ","pages":"e24-e35"},"PeriodicalIF":2.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141075371","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":"The Effect of Anesthetic Regimen on Bone Cement Implantation Syndrome in Cemented Hemiarthroplasty for Hip Fracture.","authors":"Ryley K Zastrow, Sandesh S Rao, Carol D Morris, Adam S Levin","doi":"10.5435/JAAOS-D-24-00239","DOIUrl":"10.5435/JAAOS-D-24-00239","url":null,"abstract":"<p><strong>Introduction: </strong>Bone cement implantation syndrome (BCIS) is characterized by hypoxia, hypotension, and cardiovascular compromise during cementation in arthroplasty cases. This study examines the association between anesthetic regimen and risk of BCIS in cemented hemiarthroplasty for hip fractures. We hypothesized that neuraxial anesthesia would be associated with markedly lower BCIS incidence compared with general anesthesia alone or in combination with regional anesthesia.</p><p><strong>Methods: </strong>This retrospective cohort study included patients aged 50 years or older who underwent cemented hemiarthroplasty for hip fractures at a single institution between January 2017 and December 2022. Patient demographics, comorbidities, procedural factors, anesthetic characteristics including anesthetic regimen (general, general plus regional, or neuraxial), cement timing, BCIS development, postoperative complications, and mortality data were extracted. BCIS was identified by changes in postcementation vitals and its severity classified according to previously established criteria. Univariate statistical analyses and multivariate logistic regression were conducted.</p><p><strong>Results: </strong>Of the 137 included patients, 58 (43%) developed BCIS. No notable differences were observed in demographics, comorbidities, or procedural characteristics between patients who developed BCIS and those who did not. However, anesthetic regimen was markedly correlated with BCIS development, with general anesthesia demonstrating the highest rates (26/43, 55%), followed by general plus regional anesthesia (26/58, 45%) and neuraxial anesthesia (6/32, 19%; P = 0.005). Compared with neuraxial anesthesia, general anesthesia and general plus regional anesthesia conferred 6.8 and 5.5 times greater odds of developing BCIS, respectively. The development of BCIS was associated with significantly higher rates of postoperative hypoxia ( P = 0.04) and unplanned prolonged intubation ( P = 0.04).</p><p><strong>Conclusion: </strong>BCIS was highly prevalent among patients undergoing cemented hemiarthroplasty for hip fractures. The anesthetic regimen was the only variable markedly associated with BCIS development and is a potentially modifiable risk factor.</p><p><strong>Level of evidence: </strong>III.</p>","PeriodicalId":51098,"journal":{"name":"Journal of the American Academy of Orthopaedic Surgeons","volume":" ","pages":"e46-e57"},"PeriodicalIF":2.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142134399","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":"The Association Between Surgeon Volume and Dislocation After Total Hip Arthroplasty: A Nationwide Evaluation of 5,106 Orthopaedic Surgeons.","authors":"Kevin C Liu, Mary K Richardson, Brandon S Gettleman, Cory K Mayfield, Anna Cohen-Rosenblum, Alexander B Christ, Jay R Lieberman, Nathanael D Heckmann","doi":"10.5435/JAAOS-D-23-01247","DOIUrl":"10.5435/JAAOS-D-23-01247","url":null,"abstract":"<p><strong>Introduction: </strong>The relationship between surgeon volume and risk of dislocation after total hip arthroplasty (THA) is debated. This study sought to characterize this association and assess patient outcomes using a nationwide patient and surgeon registry.</p><p><strong>Methods: </strong>The Premier Healthcare Database was queried for adult primary elective THA patients from January 1, 2016, to December 31, 2019. Annual surgeon volume and 90-day risk of dislocation were modeled using multivariable logistic regression with restricted cubic splines. Bootstrap analysis identified a threshold annual case volume, corresponding to the maximum decrease in dislocation risk. Surgeons with an annual volume greater than the threshold were deemed high volume, and those with an annual volume less than the threshold were low volume. Each surgeon within a given year was treated as a unique entity (surgeon-year unit). 90-day complications of patients treated by high-volume and low-volume surgeons were compared.</p><p><strong>Results: </strong>From 2016 to 2019, 352,131 THAs were performed by 5,106 surgeons. The restricted cubic spline model demonstrated an inverse relationship between risk of dislocation and surgeon volume (threshold: 109 cases per year). A total of 9,967 (87.8%) low-volume surgeon-year units had individual dislocation rates lower than the average of the entire surgeon cohort. Patients treated by high-volume surgeons had decreased risk of dislocation (adjusted odds ratio [aOR], 0.60; 95% CI, 0.54 to 0.67), periprosthetic fracture (aOR, 0.87; 95% CI, 0.76 to 0.99), periprosthetic joint infection (aOR, 0.63; 95% CI, 0.56 to 0.69), readmission (aOR, 0.70; 95% CI, 0.67 to 0.73), and in-hospital death (aOR, 0.60; 95% CI, 0.46 to 0.80).</p><p><strong>Conclusion: </strong>While most of the low-volume surgeons had dislocation rates lower than the cohort average, increasing annual surgeon case volume was associated with a reduction in risk of dislocation after primary elective THA.</p><p><strong>Therapeutic level of evidence: </strong>Level IV.</p>","PeriodicalId":51098,"journal":{"name":"Journal of the American Academy of Orthopaedic Surgeons","volume":" ","pages":"23-33"},"PeriodicalIF":2.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141318934","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":"Bridging the Gap: Advocating for Medical Students Without Home Orthopaedic Surgery Programs.","authors":"Sean A Tabaie, Sarah Dance, Julie B Samora","doi":"10.5435/JAAOS-D-24-00495","DOIUrl":"10.5435/JAAOS-D-24-00495","url":null,"abstract":"<p><p>Medical students without a home orthopaedic surgery program face unique challenges due to the absence of institutional connections and mentorship opportunities. This review explores the hurdles faced by these students, including financial constraints, emotional strains, mentorship gaps, and networking hurdles. Drawing from empirical evidence and scholarly research, tailored advocacy strategies to empower these medical students pursuing orthopaedic surgery residency are proposed, including mentorship programs, financial assistance, psychosocial support, and community-building initiatives.</p>","PeriodicalId":51098,"journal":{"name":"Journal of the American Academy of Orthopaedic Surgeons","volume":" ","pages":"3-8"},"PeriodicalIF":2.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142134395","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":"Quantifying the Scope of Artificial Intelligence-Assisted Writing in Orthopaedic Medical Literature: An Analysis of Prevalence and Validation of AI-Detection Software.","authors":"Joshua R Porto, Kerry A Morgan, Christian J Hecht, Robert J Burkhart, Raymond W Liu","doi":"10.5435/JAAOS-D-24-00084","DOIUrl":"10.5435/JAAOS-D-24-00084","url":null,"abstract":"<p><strong>Introduction: </strong>The popularization of generative artificial intelligence (AI), including Chat Generative Pre-trained Transformer (ChatGPT), has raised concerns for the integrity of academic literature. This study asked the following questions: (1) Has the popularization of publicly available generative AI, such as ChatGPT, increased the prevalence of AI-generated orthopaedic literature? (2) Can AI detectors accurately identify ChatGPT-generated text? (3) Are there associations between article characteristics and the likelihood that it was AI generated?</p><p><strong>Methods: </strong>PubMed was searched across six major orthopaedic journals to identify articles received for publication after January 1, 2023. Two hundred and forty articles were randomly selected and entered into three popular AI detectors. Twenty articles published by each journal before the release of ChatGPT were randomly selected as negative control articles. 36 positive control articles (6 per journal) were created by altering 25%, 50%, and 100% of text from negative control articles using ChatGPT and were then used to validate each detector. The mean percentage of text detected as written by AI per detector was compared between pre-ChatGPT and post-ChatGPT release articles using independent t -test. Multivariate regression analysis was conducted using percentage AI-generated text per journal, article type (ie, cohort, clinical trial, review), and month of submission.</p><p><strong>Results: </strong>One AI detector consistently and accurately identified AI-generated text in positive control articles, whereas two others showed poor sensitivity and specificity. The most accurate detector showed a modest increase in the percentage AI detected for the articles received post release of ChatGPT (+1.8%, P = 0.01). Regression analysis showed no consistent associations between likelihood of AI-generated text per journal, article type, or month of submission.</p><p><strong>Conclusions: </strong>As this study found an early, albeit modest, effect of generative AI on the orthopaedic literature, proper oversight will play a critical role in maintaining research integrity and accuracy. AI detectors may play a critical role in regulatory efforts, although they will require further development and standardization to the interpretation of their results.</p>","PeriodicalId":51098,"journal":{"name":"Journal of the American Academy of Orthopaedic Surgeons","volume":" ","pages":"42-50"},"PeriodicalIF":2.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142741208","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":"Early Care of Polytraumatized Patients: A Framework for Orthopaedic Surgeons.","authors":"Michael M Polmear, Jaquelyn Kakalecik, Chasen Croft, Jennifer E Hagen","doi":"10.5435/JAAOS-D-24-00990","DOIUrl":"https://doi.org/10.5435/JAAOS-D-24-00990","url":null,"abstract":"<p><p>The role of orthopaedic surgeons during trauma activations is vague and often underused. Advanced trauma life support (ATLS) is a training program and framework for performing initial life- and limb-threatening interventions. ATLS was created by Dr. James Styner, an orthopaedic surgeon, to systematically evaluate and treat trauma patients after his family received suboptimal initial care following a plane crash in 1976. There are numerous orthopaedic assessments done during the ATLS primary and secondary surveys. Understanding hierarchy and sequencing of these interventions may enhance orthopaedic integration into the broader resuscitation and surgical efforts. ATLS training is not standard in US orthopaedic residency programs. Fundamental understanding of ventilation parameters and resuscitative protocols enhance decision making for the extent of orthopaedic surgical intervention acutely. Defining indications for emergent interventions among other surgical specialties improves multidisciplinary surgical planning. This review aims to answer the question, \"What needs to be done now using the ATLS survey framework and how can an orthopaedic surgeon contribute?\" Furthermore, this review intends to introduce ATLS for orthopaedic surgeons in supportive roles with surgical and nonsurgical responsibilities by describing basic protocols and evidence of benefit.</p>","PeriodicalId":51098,"journal":{"name":"Journal of the American Academy of Orthopaedic Surgeons","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2024-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142911111","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":"Current Concepts in the Surgical Management of Elbow Medial Ulnar Collateral Ligament Injuries.","authors":"Thomas M Spears, Patrick Luchinni, Christopher L Camp, Eric N Bowman","doi":"10.5435/JAAOS-D-24-00839","DOIUrl":"https://doi.org/10.5435/JAAOS-D-24-00839","url":null,"abstract":"<p><p>The elbow medial ulnar collateral ligament (UCL) serves as the primary soft tissue restraint to valgus stress and is therefore critical to the stabilization of the elbow in overhead-throwing athletes. Injuries to the UCL present with medial elbow pain and altered performance. Reconstruction of the UCL is the \"gold standard\" for surgical treatment; however, rehabilitation after reconstruction can take 12 to 18 months. Recent advances in technique have led to an increased interest in augmented UCL repair, which boasts a quicker return to sport at 6 months on average. Appropriate candidates for repair may include athletes with proximal or distal avulsions with otherwise adequate quality UCL tissue. Augmented repair is biomechanically equivalent to reconstruction and clinically demonstrates high rates of return to play (>90%). Recently, augmented reconstruction has emerged as a technique to merge the benefits of reconstruction with repair, although clinical outcomes have yet to be defined.</p>","PeriodicalId":51098,"journal":{"name":"Journal of the American Academy of Orthopaedic Surgeons","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2024-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143494696","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":"Surgical Management of Hip Pain in Active Patients With Early Osteoarthritis: Navigating the Choice Between Hip Preservation and Arthroplasty.","authors":"Tyler R McCarroll, Benjamin D Kuhns, Benjamin G Domb","doi":"10.5435/JAAOS-D-24-00242","DOIUrl":"https://doi.org/10.5435/JAAOS-D-24-00242","url":null,"abstract":"<p><p>Hip pain in active patients with early osteoarthritis can be quite debilitating, affecting mobility, quality of life, and overall well-being. Management of this patient population is challenging because arthroplasty implants inevitably have limited life expectancy while chondral damage can mitigate the benefits of arthroscopic or open hip preservation. A multifaceted, patient-specific approach to clinical decision making is crucial in this patient population, given their higher activity level and expectations compared with older cohorts. Several advances have been made to better stratify patients into the spectrum of management, which includes nonsurgical measures; injections, including orthobiologics; arthroscopic hip preservation; open hip preservation; hip resurfacing; and total hip arthroplasty.</p>","PeriodicalId":51098,"journal":{"name":"Journal of the American Academy of Orthopaedic Surgeons","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2024-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143029690","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":"Odds of Metastatic Disease at Diagnosis of Primary Bone and Soft-Tissue Sarcomas of the Extremity and Pelvis Based on Preferred Language and Socioeconomic Factors.","authors":"Ambar Garcia, Wakenda Tyler","doi":"10.5435/JAAOS-D-24-00634","DOIUrl":"10.5435/JAAOS-D-24-00634","url":null,"abstract":"<p><strong>Introduction: </strong>The odds of metastatic disease at diagnosis of bone (BS) and soft-tissue sarcomas (STS) of the extremities and pelvis may vary among patients due to several factors. There is limited research comparing the rates of metastatic disease at diagnosis in patients from different demographic and socioeconomic backgrounds.</p><p><strong>Methods: </strong>Patients with a primary BS or STS of the extremity or pelvis were identified using International Classification of Diseases codes. Sex, ethnicity, race, insurance type, and preferred language were collected from the medical records. Cross-tabulations and odds ratios with 95% confidence intervals were calculated to compare the frequencies of metastatic disease at diagnosis in various subgroups. Univariate and multivariate analyses were conducted to evaluate the relationship between socioeconomic factors and metastatic status at diagnosis.</p><p><strong>Results: </strong>Of the 2,598 individuals identified by the International Classification of Diseases search, 711 met criteria for this study. Preferred language was not associated with the American Joint Committee on Cancer stage (P value = 0.94). The odds of metastases at diagnosis were higher in patients who had Spanish as a primary language (odds ratio = 2.14 [1.20-3.72], P value = 0.007), no insurance (P value = 0.002), and histology consistent with leiomyosarcoma (P value = 0.003) or Ewing sarcoma (P value = 0.0004). Patients who identified Spanish as a preferred language had lower odds of having employer insurance (odds ratio = 0.29 [0.16-0.49], P value = 0.0000007).</p><p><strong>Conclusions: </strong>This study was conducted at a single academic medical center that serves a large Spanish-speaking patient population. The results highlight health disparities in patients diagnosed with primary BS and STS of the extremity and pelvis, including higher rates of metastatic disease at diagnosis among primary Spanish-speaking and uninsured patients. Further research is needed to assess the effect of primary language on outcomes in orthopaedic surgery. Additional research should compare how different methods of interpretation affect the quality of care in orthopaedic surgery.</p>","PeriodicalId":51098,"journal":{"name":"Journal of the American Academy of Orthopaedic Surgeons","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2024-12-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142900235","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":"Five-Year Fracture Rate for Transgender and Gender Diverse Patients on Gender-Affirming Hormone Therapy.","authors":"Alicia R Jacobson, Daniel G Whitney, Tania Mamdouhi, Carol A Janney, Julie Blaszczak, Jaimo Ahn","doi":"10.5435/JAAOS-D-24-00353","DOIUrl":"https://doi.org/10.5435/JAAOS-D-24-00353","url":null,"abstract":"<p><strong>Introduction: </strong>Gender-affirming hormone therapy (GAHT) is a cornerstone of gender-affirming care for transgender and gender diverse (TGD) patients, with a direct biological role on bone metabolism. However, a paucity of data describes how GAHT influences fracture rate over time. The study's primary objective was to describe the 5-year all-cause fracture incidence rate (IR) among TGD patients initiating estrogen-based GAHT (E-GAHT) or testosterone-based GAHT (T-GAHT), compared with TGD patients not using GAHT (non-GAHT).</p><p><strong>Methods: </strong>This retrospective cohort study of TGD adults aged 18 to 65 years used insurance data from the Merative MarketScan Commercial Database (MarketScan) from January 1, 2009, to December 31, 2019. The main outcome was IR (IR with 95% confidence intervals [CIs]) of all-cause fracture after up to 5 years of follow-up. The IR ratio was estimated by comparing E-GAHT and T-GAHT groups with the non-GAHT group. Cox proportional hazards regression models estimated the hazard ratio (HR) of fracture after adjusting for age, comorbidity status using Charlson Comorbidity Index (CCI), recent fractures, and study start year.</p><p><strong>Results: </strong>Nine thousand six hundred ninety-six TGD adults (E-GAHT [n = 1,131]; T-GAHT [n = 1,046]; non-GAHT [n = 7,519]) were identified using clinical and enrollment criteria. No differences in age (mean age [SD], 33.4 [13.2] years, 30.8 [11.7] years, and 33.2 [13.6] years, respectively) and CCI (percent with CCI = 0 [%CCI = 3+]; 86.7% [2.2%], 84.9% [1.4%], and 85.3% [1.9%]) were observed by group. The fracture IR was 13.9 (95% CI, 9.1 to 18.8) for E-GAHT, 15.3 (95% CI, 10.1 to 20.4) for T-GAHT, and 19.2 (95% CI, 16.9 to 21.4) for non-GAHT. Compared with non-GAHT, the crude IR ratio and fully adjusted HR was 0.73 (95% CI, 0.51 to 1.04) and 0.71 (95% CI, 0.49 to 1.02), respectively, for E-GAHT and 0.80 (95% CI, 0.56 to 1.14) and 0.78 (95% CI, 0.55 to 1.12), respectively, for T-GAHT.</p><p><strong>Conclusion: </strong>Based on United States commercial claims data, the use of GAHT was not associated with 5-year all-cause fracture IR.</p><p><strong>Level of evidence: </strong>III.</p>","PeriodicalId":51098,"journal":{"name":"Journal of the American Academy of Orthopaedic Surgeons","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2024-12-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142900233","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}