Journal of the American Academy of Orthopaedic Surgeons最新文献

{"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":"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":"336-345"},"PeriodicalIF":2.6,"publicationDate":"2025-04-01","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":"Perioperative Nutritional Optimization in Spine Surgery.","authors":"Sapan Gandhi, Ikechukwu C Amakiri, Jason Pittman, Andrew White","doi":"10.5435/JAAOS-D-24-01101","DOIUrl":"https://doi.org/10.5435/JAAOS-D-24-01101","url":null,"abstract":"<p><p>Although spine surgery has been shown to be an effective treatment for many spinal disorders, perioperative complications can increase patient morbidity and lead to poorer surgical outcomes. Nutritional status is a modifiable factor that affects spine surgery results. Malnutrition can negatively influence inflammatory pathways and can change circulating stress hormones. Perioperative nutrition status can be evaluated by both clinical and laboratory parameters, with nutritional indices allowing for determination of perioperative risk. Perioperative nutritional optimization has been attempted and has been associated with improved outcomes, for patients undergoing spine surgery. Additional investigation is needed to determine effective perioperative nutritional protocols.</p>","PeriodicalId":51098,"journal":{"name":"Journal of the American Academy of Orthopaedic Surgeons","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143773570","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":"External Fixation of Lower Extremity Injuries in an Austere Environment: A Technique for Safe Application Without the Use of Fluoroscopy.","authors":"Jonathan C Savakus, Lauren Luther, Daniel J Stinner","doi":"10.5435/JAAOS-D-24-00967","DOIUrl":"https://doi.org/10.5435/JAAOS-D-24-00967","url":null,"abstract":"<p><p>External fixation is a fundamental technique for the initial care of major extremity trauma. External fixation is used to provide temporary stability in both the damage control setting and environments where resources for definitive fixation are not readily available or definitive fixation is ill-advised. In the austere or resource-constrained environment-particularly in the battlefield setting or in disaster response-external fixation has demonstrated to be a reliable and efficient method for stabilizing the injured extremity without notable disruption of the soft-tissue envelope. Although instruments and implants used for external fixation are highly portable, standard intraoperative fluoroscopy is cumbersome and often unavailable outside of a standard operating room. We present a safe, reproducible technique for external fixator placement without the use of fluoroscopic guidance. In addition to its utility in austere environments, this technique offers several advantages in the standard healthcare setting, particularly in minimizing radiation exposure and allowing for application of an external fixator in settings not optimized for fluoroscopic imaging such as the intensive care unit or combined damage control surgical cases where a nonradiolucent operating room table is used.</p>","PeriodicalId":51098,"journal":{"name":"Journal of the American Academy of Orthopaedic Surgeons","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143735688","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":"Low-Molecular-Weight Heparin Combined With Somatosensory Evoked Potential Monitoring for Prevention of Postoperative Lower Extremity Deep Vein Thrombosis in Patients With Spinal Fracture.","authors":"Junjun Liao, Guangliang Lu, Zhihua Wang","doi":"10.5435/JAAOS-D-24-01437","DOIUrl":"https://doi.org/10.5435/JAAOS-D-24-01437","url":null,"abstract":"<p><strong>Background: </strong>To assess the effect of low-molecular-weight heparin (LMWH) combined with evoked potentials somatosensory evoked potential (SEP) on the prevention of deep vein thrombosis (DVT) in patients undergoing spinal surgery.</p><p><strong>Methods: </strong>One hundred twenty-eight patients who underwent spinal surgery from August 2022 to August 2023 were chosen, and the patients were randomly classified into the control group and the observation group, with 64 cases in each group. The control group received LMWH injections.The observation group received SEP monitoring on the basis of the control group. The blood flow velocity of popliteal veins of both lower limbs was measured by Color Doppler ultrasonography. The D-dimer concentration was measured using intravenous blood samples taken 1 day before surgery, after surgery, and 24 hours after surgery. The incidence of lower extremity DVT was diagnosed by ultrasonography during surgery and 24 hours after surgery.</p><p><strong>Results: </strong>Compared with the control group, the blood flow velocity of the popliteal veins in both lower limbs in the observation group increased at T2-4 (P < 0.001), and the D-dimer and FIB concentrations in the observation group were decreased (P < 0.001); the occurrence of DVT in the observation group was lower than that in the control group (P < 0.05).</p><p><strong>Conclusion: </strong>LMWH combined with SEP monitoring can effectively prevent the occurrence of lower limb DVT in patients with spinal surgery.</p>","PeriodicalId":51098,"journal":{"name":"Journal of the American Academy of Orthopaedic Surgeons","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143735734","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":"Writing a Letter of Recommendation Without Bias.","authors":"Brian Feeley, Katherine Bach, Andrew Gatto, Nesa Milan","doi":"10.5435/JAAOS-D-24-00827","DOIUrl":"https://doi.org/10.5435/JAAOS-D-24-00827","url":null,"abstract":"<p><p>Letters of recommendation (LORs) play a pivotal role in the highly competitive orthopaedic surgery residency and fellowship applications, with increasing influence amid evolving evaluation metrics. LORs are crucial in providing nuanced insights into applicants' clinical competencies, personal qualities, and potential fit within programs, complementing standardized test scores and academic achievements. However, despite their importance, LORs are susceptible to implicit biases, particularly affecting women and underrepresented minorities. Research underscores disparities in language use, with gender and racial stereotypes influencing adjectival choices and narrative emphasis. Strategies to mitigate bias include adopting a consistent outline, emphasizing agentic and standout adjectives over communal and grindstone traits, and using precise language and specific examples. We advocate for LORs that are detailed, specific, equitable, and avoid stereotypes, aiming to support fair evaluation practices and promote diversity within orthopaedics. By examining current biases and proposing best practices, this review contributes to ongoing efforts to enhance equity in the residency and fellowship selection process.</p>","PeriodicalId":51098,"journal":{"name":"Journal of the American Academy of Orthopaedic Surgeons","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143735841","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 New Centers for Medicare and Medicaid Services Patient-Reported Outcome-Based Performance Measure: What It Means and How Can I Align.","authors":"Lauren M Shapiro, Kevin J Bozic, Mark McClellan, Kurt Spindler","doi":"10.5435/JAAOS-D-24-01000","DOIUrl":"https://doi.org/10.5435/JAAOS-D-24-01000","url":null,"abstract":"<p><p>The recognition of the benefits of the measurement and utilization of patient-reported outcome measures (PROMs) in clinical care continues to increase. Furthermore, the Centers for Medicare and Medicaid Services recently mandated a patient-reported outcome-based performance measure (PRO-PM) supporting the measurement of PROMs pre- and postoperatively for patients undergoing primary hip and knee arthroplasty. Under this new policy, hospitals not measuring and reporting complete data on 50% or more of included patients are at risk for substantial loss of Medicare Part A reimbursement. As with any new policy, there are nuances, barriers, possible undesirable consequences, and opportunities for improvement that should be considered and mitigated for said policy to have the greatest potential benefit on the population. In this article, we review the implications of the new policy, barriers to successful implementation, and possible undesirable consequences, and aim to provide guidance and strategies to assist surgeons, health systems, and other stakeholders in understanding, aligning with, and improving care based on the new Centers for Medicare and Medicaid Services PROM-PM.</p>","PeriodicalId":51098,"journal":{"name":"Journal of the American Academy of Orthopaedic Surgeons","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143735810","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":"Assessing the Linking Between the Orthopaedic In-Training Examination and the American Board of Orthopaedic Surgery Part I Certification Examination.","authors":"Erik Fritz, Michael Bednar, John Harrast, David F Martin, Mona Saniei, Paul Tornetta, Ann Van Heest","doi":"10.5435/JAAOS-D-24-00544","DOIUrl":"10.5435/JAAOS-D-24-00544","url":null,"abstract":"<p><strong>Introduction: </strong>Since 2020, the American Academy of Orthopaedic Surgeons (AAOS) and American Board of Orthopaedic Surgery (ABOS) have collaborated to link the AAOS Orthopaedic In-Training Examination (OITE) and the ABOS part I Certification Examination, allowing the identification of a minimum score on each annual OITE that corresponds to a minimum passing part I score. The purpose of this study is to assess the performance of this examination linking over these past 3 years.</p><p><strong>Methods: </strong>From 2020 to 2022, the AAOS provided each graduating resident's OITE score; from 2021 to 2023, the ABOS provided each examinee's ABOS part I pass-fail result. Examination scores were matched at the individual level and deidentified for data analysis.</p><p><strong>Results: </strong>A total of 2,247 subjects took both the OITE and the ABOS during the same cycle, during the 3-year study period. The ABOS part I pass rates in 2021, 2022, and 2023 were 92.9%, 98.1%, and 98.4%, respectively, for those taking the OITE the prior year. The positive predictive value of achieving the minimum passing score on the OITE for passing part I increased from 95.1% in 2021 to 99.8% and 99.7% in 2022 and 2023, respectively. The negative predictive value of not achieving the minimum passing score on the OITE for failing part I decreased from 24.7% in 2021 to 5.3% in 2022 and 10.1% in 2023.</p><p><strong>Discussion: </strong>This study is the first of its kind and demonstrates the initial results of the examination linking between the OITE and the ABOS part I Examination. This information can be helpful for residents and residency program directors. Moreover, the examination linking provides a step toward obtaining a standardized assessment of knowledge throughout all 5 years of residency.</p>","PeriodicalId":51098,"journal":{"name":"Journal of the American Academy of Orthopaedic Surgeons","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143617709","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 Challenges of Using ChatGPT for Clinical Decision Support in Orthopaedic Surgery: A Pilot Study.","authors":"Michael A McNamara, Brandon G Hill, Peter L Schilling","doi":"10.5435/JAAOS-D-24-01072","DOIUrl":"https://doi.org/10.5435/JAAOS-D-24-01072","url":null,"abstract":"<p><strong>Background: </strong>Artificial intelligence (AI) technologies have recently exploded in both accessibility and applicability, including in health care. Although studies have demonstrated its ability to adequately answer simple patient issues or multiple-choice questions, its capacity for deeper complex decision making within health care is relatively untested. In this study, we aimed to delve into AI's ability to integrate multiple clinical data sources and produce a reasonable assessment and plan, specifically in the setting of an orthopaedic surgery consultant.</p><p><strong>Methods: </strong>Ten common fractures seen by orthopaedic surgeons in the emergency department were chosen. Consult notes from patients sustaining each of these fractures, seen at a level 1 academic trauma center between 2022 and 2023, were stripped of patient data. The history, physical examination, and imaging interpretations were then given to ChatGPT4 in raw and semistructured formats. The AI was asked to determine an assessment and plan as if it were an orthopaedic surgeon. The generated plans were then compared with the actual clinical course of the patient, as determined by our multispecialty trauma conference.</p><p><strong>Results: </strong>When given both raw and semistructured formats of clinical data, ChatGPT4 determined safe and reasonable plans that included the final clinical outcome of the patient scenario. Evaluating large language models is an ongoing field of research without an established quantitative rubric; therefore, our conclusions rely on subjective comparison.</p><p><strong>Conclusion: </strong>When given history, physical examination, and imaging interpretations, ChatGPT is able to synthesize complex clinical data into a reasonable and most importantly safe assessment and plan for common fractures seen by orthopaedic surgeons. Evaluating large language models is an ongoing challenge; however, using actual clinical courses as a \"benchmark\" for comparison presents a possible avenue for further research.</p>","PeriodicalId":51098,"journal":{"name":"Journal of the American Academy of Orthopaedic Surgeons","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143735777","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":"Anterior Intrapelvic Approach: A Comprehensive Understanding of the Anatomy.","authors":"Guillaume David, Claude H Sagi, Pierre Guy, Cyril Mauffrey","doi":"10.5435/JAAOS-D-24-01050","DOIUrl":"https://doi.org/10.5435/JAAOS-D-24-01050","url":null,"abstract":"<p><p>The anterior intrapelvic (AIP) approach has become a standard technique for the fixation of acetabular fractures. While the critical steps for performing the AIP approach are well described in the literature, a comprehensive overview of the anatomical structures at risk remains limited. This review aims to provide an in-depth understanding of the AIP approach with a focus on the historically \"nonorthopaedic\" surgical anatomy and associated risks. Ultimately, this knowledge empowers orthopaedic trauma surgeons to perform acetabular surgery with improved exposure, safety, and confidence.</p>","PeriodicalId":51098,"journal":{"name":"Journal of the American Academy of Orthopaedic Surgeons","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143732928","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 Impact of Crossing the Cervicothoracic Junction on Opioid Consumption, Readmission, and Revision Rates.","authors":"Gregory Toci, Rajkishen Narayanan, Michael Carter, Jonathan Dalton, Rachel Huang, Andrew Vanichkachorn, Andrew Kim, Asad Pasha, Nathaniel Pineda, Mark Kurd, Ian David Kaye, Thomas Cha, Barrett Woods, Jose Canseco, Alan Hilibrand, Alexander Vaccaro, Christopher Kepler, Gregory Schroeder","doi":"10.5435/JAAOS-D-24-01197","DOIUrl":"https://doi.org/10.5435/JAAOS-D-24-01197","url":null,"abstract":"<p><strong>Introduction: </strong>The risks and benefits of extending posterior cervical decompression and fusion (PCDF) constructs across the cervicothoracic junction (CTJ) remain controversial. Previous studies have used fusions beginning at different levels and varying in construct length. There are no studies that examine the effect of crossing the CTJ on opioid consumption. This study aims to compare short-term and long-term postoperative outcomes among patients undergoing PCDF at C3 and ending at C7, T1, or T2.</p><p><strong>Methods: </strong>Adult patients who underwent C3-C7, C3-T1, and C3-T2 PCDF from 2017 to 2022 were identified. All patients were retrospectively reviewed for demographic and surgical information. Perioperative opioid utilization from 1 year preoperatively to 1 year postoperatively was obtained from the Pennsylvania Prescription Drug Monitoring Program (PDMP). Acute postoperative outcomes included rates of 30-day and 90-day readmission and any revision surgery.</p><p><strong>Results: </strong>This study included 72 (C3-C7: 30.2%), 143 (C3-T1: 60.1%), and 23 (C3-T2: 9.7%) patients-groups were demographically similar. The average length of follow-up was 503 ± 433 days. Cut-to-close time differed between groups (166 ± 37.9 [C3-C7] vs. 182 ± 43.2 vs. 199 ± 40.9 minutes [C3-T2]; P = 0.003). Total in-hospital morphine milligram equivalents (205 ± 136 [C3-C7] vs. 247 ± 191 vs. 285 ± 136 [C3-T2]; P = 0.007) and average daily in-hospital morphine milligram equivalents (59.5 ± 29.9 [C3-C7] vs. 73.2 ± 52.1 vs. 81.0 ± 22.9 [C3-T2]; P = 0.008) were highest among C3-T2 fusions. Patients who underwent C3-T2 fusion consumed higher MMEs from 0 to 90 days postoperatively (148 ± 197 [C3-C7] vs. 223 ± 307 vs. 260 ± 363 [C3-T2]; P = 0.027). Length of stay, opioid use beyond 90 days, 30-day and 90-day readmission rates, revision surgery rates, and revision rates were similar between groups.</p><p><strong>Conclusion: </strong>Crossing the CTJ increased cut-to-close time and early postoperative opioid consumption but did not affect length of stay, readmission rates, long-term opioid misuse, or revision surgery rates.</p>","PeriodicalId":51098,"journal":{"name":"Journal of the American Academy of Orthopaedic Surgeons","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143702068","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}