Journal of the American Academy of Orthopaedic Surgeons最新文献

{"title":"Efficacy of Topical Antibiotic Powder Application in the Emergency Department on Reducing Deep Fracture-Related Infection in Type III Open Lower Extremity Fractures: A Multicenter Study.","authors":"Mir Ibrahim Sajid, Whisper Grayson, Mitchell P John, Shea Taylor, Bradley J Lauck, Zohair Zaidi, Alex Savage, Nicole Griffin, Mohamed Awad, Andrew T Chen, John Hwang, Nicholas Alfonso, Hassan R Mir","doi":"10.5435/JAAOS-D-24-00474","DOIUrl":"https://doi.org/10.5435/JAAOS-D-24-00474","url":null,"abstract":"<p><strong>Objectives: </strong>Deep fracture-related infections (FRIs) are a common complication of type III open lower extremity fractures, resulting in notable patient morbidity. The purpose of this study was to determine whether topical application of antibiotic (ABX) powder to type III open lower extremity fracture wounds upon presentation to the emergency department (ED) reduces the rate of FRI.</p><p><strong>Methods: </strong>This is a retrospective review of ABX powder application compared with a historical cohort at 4 level 1 trauma centers. Patients with type III open lower extremity fractures from July 1, 2019, to October 1, 2022, who received topical ABX powder (1 g vancomycin and 1.2 g tobramycin) in the ED were compared with patients from a 4-year historical cohort who were treated through the same protocol without topical ABX powder. Outcomes include the development of FRI within 6 months of follow-up. Patient demographics, injury characteristics, and postoperative data were analyzed in addition to FRI.</p><p><strong>Results: </strong>One hundred fifteen patients received topical ABX powder in the ED and were compared with 135 patients who were treated without topical ABX powder. The rate of FRI in the intervention group was 8 of 115 (6.96%) vs. 22 of 135 (16.30%) in the control cohort (P = 0.024). Multivariate regression analysis demonstrated higher body mass index as a risk factor for the development of FRI (P = 0.003). When excluding those with intraoperative ABX powder use, there was still a markedly lower rate of FRI when ED ABX powder was used on regression analysis (P = 0.048).</p><p><strong>Conclusion: </strong>Antibiotic powder application to type III open fracture wounds in the ED markedly reduces the incidence of FRI in this multicenter study. Further large-scale studies are warranted.</p><p><strong>Level of evidence: </strong>Therapeutic Level III.</p>","PeriodicalId":51098,"journal":{"name":"Journal of the American Academy of Orthopaedic Surgeons","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143781898","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":"Risk Factors for Venous Thromboembolism Following Total Knee Arthroplasty: An Analysis of 3,052 Pulmonary Emboli.","authors":"Nicholas Kusnezov, Avinash Iyer, Mary K Richardson, Amit S Piple, Jennifer C Wang, Kevin C Liu, Alexander B Christ, Jay R Lieberman, Nathanael D Heckmann","doi":"10.5435/JAAOS-D-23-00426","DOIUrl":"10.5435/JAAOS-D-23-00426","url":null,"abstract":"<p><strong>Introduction: </strong>Identifying risk factors for pulmonary embolism (PE) and deep vein thrombosis (DVT) following primary total knee arthroplasty (TKA) may improve risk stratification and guide surgeons in prophylaxis selection. This study aimed to identify factors associated with postoperative venous thromboembolism (VTE) following TKA.</p><p><strong>Methods: </strong>A national healthcare database was queried for adults who underwent primary, elective TKA from January 1, 2015 to December 31, 2020. Patients who developed PE or DVT within 90 days postoperatively were compared with patients who did not. Demographics, comorbidities, hospital factors, perioperative medications, and blood transfusion needs were assessed. A multivariate model was used to identify independent risk factors for VTE. Overall, 847,496 patients were identified, of whom 8,002 (0.94%) developed a VTE postoperatively (3,052 PE, 5,294 DVT).</p><p><strong>Results: </strong>After controlling for confounders, an elevated risk of VTE was associated with increased age (adjusted odds ratio [aOR]: 1.01, 95% confidence interval [CI] = 1.01-1.01, P < 0.001), Black patients (aOR: 1.30, 95% CI=1.28-1.47, P < 0.001), and patients enrolled in Medicare (aOR: 1.18, 95% CI = 1.13-1.24, P < 0.001) or Medicaid (aOR: 1.24, 95% CI = 1.12-1.37, P < 0.001). Independent risk factors for PE included obesity (aOR: 1.25, 95% CI = 1.16-1.35, P < 0.001), pulmonary hypertension (aOR: 3.64, 95% CI = 3.05-4.35, P < 0.001), and history of VTE (aOR: 1.71, 95% CI = 1.54-1.91, P < 0.001). Risk factors associated with an increased risk of DVT included iron deficiency anemia (aOR:1.38, 95% CI = 1.14-1.66, P < 0.001) and abnormal weight loss (aOR: 1.67, 95% CI = 1.07-2.60, P = 0.023).</p><p><strong>Conclusion: </strong>Increasing age, Black race, Medicare, or Medicaid insurance were associated with increased risk of VTE. Obesity, history of VTE, and pulmonary hypertension were risk factors for both PE and DVT. These data can assist surgeons in the selection of a prophylactic regimen after TKA.</p>","PeriodicalId":51098,"journal":{"name":"Journal of the American Academy of Orthopaedic Surgeons","volume":" ","pages":"e380-e390"},"PeriodicalIF":2.6,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142830462","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":"American Academy of Orthopaedic Surgeons/ASSH Clinical Practice Guideline Summary Management of Carpal Tunnel Syndrome.","authors":"Lauren M Shapiro, Robin N Kamal","doi":"10.5435/JAAOS-D-24-01179","DOIUrl":"10.5435/JAAOS-D-24-01179","url":null,"abstract":"<p><p>Management of Carpal Tunnel Syndrome Evidence-Based Clinical Practice Guideline is based on a systematic review of published studies with regard to the diagnosis and treatment of carpal tunnel syndrome in adult patients (≥18 years of age). The scope of this guideline addresses the diagnosis and treatment of carpal tunnel syndrome and contains nine recommendations to assist orthopaedic surgeons and all qualified clinicians managing patients presenting with signs and symptoms which may be attributable to carpal tunnel syndrome based on the best current available evidence. It is also intended to serve as an information resource for professional healthcare practitioners, health services researchers, and developers of practice guidelines and recommendations. In addition to providing pragmatic practice recommendations, this guideline also highlights gaps in the literature and informs areas for future research and quality measure development.</p>","PeriodicalId":51098,"journal":{"name":"Journal of the American Academy of Orthopaedic Surgeons","volume":" ","pages":"e356-e366"},"PeriodicalIF":2.6,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11928260/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142786610","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":"Data-Driven Estimated Glomerular Filtration Rate Strata Predict 90-Day Major Complications Following Total Knee Arthroplasty in Patients With Chronic Kidney Disease.","authors":"Daniel A Raftis, Amy Y Zhao, Amil R Agarwal, Alex Gu, Andrew B Harris, Shyam Kurian, Savyasachi C Thakkar, Gregory J Golladay","doi":"10.5435/JAAOS-D-24-01029","DOIUrl":"10.5435/JAAOS-D-24-01029","url":null,"abstract":"<p><strong>Introduction: </strong>Lower estimated glomerular filtration rate (eGFR) in patients who have chronic kidney disease (CKD) is associated with increased risk of complications following total knee arthroplasty (TKA). However, there is a lack of literature that identifies eGFR levels those are associated with notable differences in risk of these complications. The purpose of this study was to create eGFR strata for CKD patients that are associated with varying risks of 90-day major complications following TKA.</p><p><strong>Methods: </strong>Nondialysis patients who have CKD and known eGFR levels one month before primary TKA were identified using a national database. Stratum-specific likelihood ratio (SSLR) analysis was used to construct data-driven eGFR strata associated with varying risks of 90-day major complications. The incidence rates were recorded for each stratum. Each stratum was propensity score matched to the highest eGFR stratum. The risk ratio with a corresponding 95% confidence interval for 90-day major complications was recorded for each stratum.</p><p><strong>Results: </strong>A total of 24,895 patients with CKD who underwent TKA were included in this study. SSLR identified four data-driven eGFR strata: 15-31, 32-44, 45-54, and 55+. The unmatched 90-day major complication incidence increased sequentially as the eGFR strata decreased: 55+ (10.72%), 45-54 (13.87%), 32-44 (17.30%), and 15-31 (25.16%). When compared with the matched highest eGFR strata (55+), the risk of sustaining a 90-day major complication increased sequentially as the eGFR strata decreased (RR: 1.27, 1.56, 2.06, P < 0.001). The risk of death within 90 days was higher in the 15-31 stratum (RR: 3.08, P < 0.001) when compared with the matched 55+ stratum.</p><p><strong>Conclusion: </strong>Using SSLR analysis, four data-driven strata were identified with varying risks of 90-day major complications following TKA. These eGFR thresholds were created specifically for TKA and can therefore be appropriately used to risk-stratify CKD patients in the preoperative setting when discussing TKA.</p>","PeriodicalId":51098,"journal":{"name":"Journal of the American Academy of Orthopaedic Surgeons","volume":" ","pages":"385-390"},"PeriodicalIF":2.6,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143068854","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 Insurance Is Associated With Increased Readmissions and Mortality After Surgery for Periprosthetic Joint Infection.","authors":"Mary K Richardson, Julian Wier, Dara Bruce, Kevin C Liu, Anna Cohen-Rosenblum, Jay R Lieberman, Nathanael D Heckmann","doi":"10.5435/JAAOS-D-24-00165","DOIUrl":"10.5435/JAAOS-D-24-00165","url":null,"abstract":"<p><strong>Background: </strong>Patients with Medicaid insurance are at an increased risk of postoperative complications following total knee arthroplasty and total hip arthroplasty (TJA); however, their outcomes following revision TJA for periprosthetic joint infection (PJI) requires further study.</p><p><strong>Methods: </strong>A retrospective query was conducted for adult patients undergoing implant explantation and antibiotic spacer placement for TJA PJI from the Premier Healthcare Database between December 1, 2016, and December 31, 2021. Patients were then grouped by Medicaid or non-Medicaid insurance status and were age matched through exact caliper matching. Multivariable regression models addressed potential confounding. Adjusted risks of 90-day postoperative complications were reported.</p><p><strong>Results: </strong>Of the 40,346 patients identified, 2,711 Medicaid patients were matched to 10,844 non-Medicaid patients on age (56.1 vs. 56.1 years, P = 1.000). Patients with Medicaid experienced higher risk of sepsis (adjusted odds ratio [aOR] = 1.20, P = 0.010), readmission (aOR = 1.12, P = 0.022), being discharged to a skilled nursing facility (aOR = 1.13, P = 0.031), and had longer length of stay (9.48 vs. 6.67 days, P < 0.001), compared with patients with non-Medicaid. Medicaid patients had a higher rate of inpatient mortality (0.81% vs. 0.48%, P = 0.038); however, the risk was similar after accounting for differences in comorbidities.</p><p><strong>Conclusion: </strong>Following revision TJA for PJI, patients with Medicaid were at an increased risk for postoperative complication, including sepsis and readmission. They experienced a higher rate of inpatient mortality that may be driven by differences in comorbidities. Insurers and policy makers should consider this information to develop risk stratification-based payment strategies that take into account the healthcare burden of this high-risk patient population.</p><p><strong>Level of evidence: </strong>IV.</p>","PeriodicalId":51098,"journal":{"name":"Journal of the American Academy of Orthopaedic Surgeons","volume":" ","pages":"e391-e400"},"PeriodicalIF":2.6,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142787501","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":"Journey of International Medical Graduates Toward Orthopaedic Surgery Residency in the United States.","authors":"Pablo Sanchez-Urgelles, Suleiman Y Sudah, Joaquin Sanchez-Sotelo, Mariano E Menendez","doi":"10.5435/JAAOS-D-24-00761","DOIUrl":"10.5435/JAAOS-D-24-00761","url":null,"abstract":"<p><p>International medical graduates (IMGs) are integral to the US healthcare system but are scarce in orthopaedic residency classes. Positive contributions of IMGs to the field of orthopaedic surgery in the United States are well documented, but successfully matching into an orthopaedic residency position as an IMG remains very challenging. The purpose of this study was to review current processes, strategies, and potential barriers of IMGs applying for orthopaedic surgery residency in the United States as an IMG.</p>","PeriodicalId":51098,"journal":{"name":"Journal of the American Academy of Orthopaedic Surgeons","volume":" ","pages":"327-335"},"PeriodicalIF":2.6,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142814862","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":"Shoulder Arthroplasty Patients Are Underscreened for Osteoporosis.","authors":"Alisa Malyavko, Amil R Agarwal, Jacob D Mikula, Matthew J Best, Uma Srikumaran","doi":"10.5435/JAAOS-D-23-00408","DOIUrl":"10.5435/JAAOS-D-23-00408","url":null,"abstract":"<p><strong>Introduction: </strong>Osteoporosis screening and subsequent treatment has been shown to be efficacious in decreasing the rates of fragility fractures and periprosthetic fractures (PPF). However, current screening and treatment rates are low. This study aims to determine (1) the prevalence of total shoulder arthroplasty (TSA) patients who meet criteria for osteoporosis screening, (2) the prevalence of those screened, and (3) the 5-year cumulative incidence of fragility fracture (FF) and periprosthetic fractures (PPF).</p><p><strong>Methods: </strong>The PearlDiver database was used to identify all patients older than 50 years who underwent TSA. Guidelines from the American Association of Clinical Endocrinologists were used to stratify patients into \"high risk\" and \"low risk\" of osteoporosis cohorts using International Classification of Disease codes for various risk factors. The prevalence of osteoporosis screening using dual-energy x-ray absorptiometry (DXA) scan was analyzed, and the 5-year cumulative incidence of FF and PPF was calculated between the \"low-risk\" and \"high-risk\" groups using Kaplan-Meier analysis.</p><p><strong>Results: </strong>In total, 66,140 (65.5%) who underwent TSA were considered \"high risk\" for osteoporosis. Of the \"high-risk\" patients, 11.7% patients received routine osteoporosis screening preoperatively. Within 5 years, \"high-risk\" TSA patients had markedly higher cumulative incidence for PPF (HR: 1.4; 95% CI: 1.0-1.9; P = 0.037) and FF (HR: 2.42; 95% CI: 2.1-2.8; P < 0.001) when compared with those at \"low risk\".</p><p><strong>Discussion: </strong>There is a high prevalence of osteoporosis among patients undergoing TSA but a low rate of routine osteoporosis screening in this cohort. Patients with osteoporosis who are categorized as \"high risk\" have an increased rate of fragility fractures and PPF. Therefore, there is an opportunity to increase appropriate osteoporosis screening and management in this cohort, which may affect future risk of FF and periprosthetic fracture.</p><p><strong>Level of evidence: </strong>III.</p>","PeriodicalId":51098,"journal":{"name":"Journal of the American Academy of Orthopaedic Surgeons","volume":" ","pages":"362-369"},"PeriodicalIF":2.6,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142787580","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":"Letter to the Editor: The Frailty of Fragility Index, Orthopaedic Paradigms and Practice.","authors":"Aleksi Reito, Teemu Karjalainen","doi":"10.5435/JAAOS-D-23-00862","DOIUrl":"10.5435/JAAOS-D-23-00862","url":null,"abstract":"","PeriodicalId":51098,"journal":{"name":"Journal of the American Academy of Orthopaedic Surgeons","volume":" ","pages":"e410-e411"},"PeriodicalIF":2.6,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142814899","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":"Contemporary Management of Proximal Humeral Fractures.","authors":"Erin Stockwell, Adil Ahmed, Hassan R Mir","doi":"10.5435/JAAOS-D-24-01073","DOIUrl":"https://doi.org/10.5435/JAAOS-D-24-01073","url":null,"abstract":"<p><p>Proximal humerus fractures (PHFs) are common injuries managed by orthopaedic surgeons. Treatment for PHFs remains somewhat controversial. This review article discusses indications, techniques, and outcomes for several modes of contemporary management of PHFs including nonsurgical treatment, surgical fixation, and reverse shoulder arthroplasty.</p>","PeriodicalId":51098,"journal":{"name":"Journal of the American Academy of Orthopaedic Surgeons","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143781897","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":"Characterizing the Rotational Profile of the Distal Femur: A Roadmap for Distal Femoral Replacement Surgery.","authors":"Matthew S Chen, Kevin C Liu, Matthew C Gallo, Nicholas Kusnezov, Brian C Chung, Darryl Hwang, Alexander B Christ, Nathanael D Heckmann","doi":"10.5435/JAAOS-D-24-00207","DOIUrl":"10.5435/JAAOS-D-24-00207","url":null,"abstract":"<p><strong>Introduction: </strong>Standard references for determining rotational alignment are often unavailable when performing distal femoral replacement (DFR) surgery. This study aimed to describe the rotational profile of the distal femoral osteology at common resection levels.</p><p><strong>Methods: </strong>Adults with CT scans of the bilateral legs were included. Exclusion criteria included fractures, congenital deformity, prior arthroplasty, or inadequate imaging. Referencing the transepicondylar axis, angles were measured in the axial plane using the following reference lines: anterior condylar axis or anterior femoral cortex axis (AFCA), posterior condylar axis or posterior femoral cortex axis (PFCA), lateral projection of the linea aspera (LAA), and Whiteside line (WL). These rotational measurements were assessed at 3, 5, 7, and 9 cm proximal of the joint line. External and internal rotation were denoted as positive and negative, respectively.</p><p><strong>Results: </strong>Fifty-one patients (102 femora) were included (mean age: 62.6 ± 13.4 years; mean body mass index: 26.0 ± 6.7 kg/m 2 ). Proximally, the anterior condylar axis/anterior femoral cortex axis became increasingly internally rotated (3-cm: -13.1 ± 3.5°, 9-cm: -21.2 ± 6.6°), whereas the posterior condylar axis/PFCA became increasingly externally rotated (3-cm: -6.7 ± 2.3°, 9-cm: 9.6 ± 6.1°). WL remained nearly perpendicular (3-cm: 88.8 ± 2.3°, 5-cm: 89.8 ± 3.7°) but was not reliably measured beyond 5 cm. The LAA was measurable proximal to 5 cm from the joint line and was internally rotated (5-cm: -58.5 ± 14.3°, 9-cm: -45.6 ± 13.4°).</p><p><strong>Conclusion: </strong>Distally, WL is a reliable anatomic landmark for femoral implant rotation. At more proximal resection levels, the posterior cortex may be a valuable landmark as referencing the linea aspera may lead to gross internal rotation of the femoral implant.</p>","PeriodicalId":51098,"journal":{"name":"Journal of the American Academy of Orthopaedic Surgeons","volume":" ","pages":"e401-e409"},"PeriodicalIF":2.6,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142814835","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}