Journal of the American Academy of Orthopaedic Surgeons最新文献

{"title":"Bone Loss Progression in Two-stage Revision Total Knee Arthroplasty: The Potential Role of Reimplantation Timing in Prosthetic Joint Infection Management.","authors":"Farideh Najafi, Alexander K Hahn, Matthew Sherman, Jonah M Stein, Javad Parvizi, Matthew J Grosso","doi":"10.5435/JAAOS-D-25-00929","DOIUrl":"https://doi.org/10.5435/JAAOS-D-25-00929","url":null,"abstract":"<p><strong>Background: </strong>Periprosthetic joint infection (PJI) after total knee arthroplasty (TKA) and its management with two-stage exchange arthroplasty can lead to notable femoral and tibial bone loss, further complicating subsequent reconstruction. This study aims to characterize the extent of bone loss in two-stage TKA revision for infection and assess the effect of reimplantation timing on bone loss progression.</p><p><strong>Methods: </strong>We conducted a retrospective cohort study of patients who underwent a two-stage TKA revision for PJI between 2007 and 2022. The primary outcome was the degree of bone loss between the index and reimplantation procedures, and whether it was influenced by the rate of timing of reimplantation. Patients undergoing single-stage revisions were excluded. A total of 160 patients met the inclusion criteria. Bone loss was characterized using the Anderson Orthopaedic Research Institute (AORI) classification (1/2A/2B/3) before the index procedure and after reimplantation, with progression defined as an increase in AORI classification.</p><p><strong>Results: </strong>Among the 160 patients, 100 (62.5%) experienced bone loss progression. This included 19 patients (11.9%) with a progression score of 1, 75 patients (46.9%) with a progression score of 2, and six patients (3.75%) with a progression score of 3. A higher AORI score at the index procedure showed a statistically significant association with bone loss progression (P < 0.001). Time to reimplantation was statistically significant (P = 0.034), with patients progressing from AORI 1 to AORI 3 experiencing the longest reimplantation interval (mean: 147 days). No notable differences were observed in revision surgery rates, time to revision surgery, infection eradication rates, or baseline medical comorbidities across progression groups.</p><p><strong>Conclusion: </strong>This study demonstrates that two-stage revision TKA for PJI is associated with a notable degree of bone loss, particularly in cases of delayed reimplantation. These findings emphasize the importance of timely reimplantation, or other strategies, to mitigate bone loss and surgical complexity.</p>","PeriodicalId":51098,"journal":{"name":"Journal of the American Academy of Orthopaedic Surgeons","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147845836","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":"Who Gets Five Stars? Surgeon-Level Predictors of Patient Ratings in Hand Surgery.","authors":"Krishna N Chopra, Sameer R Khawaja, Karishma R Desai, Ozair R Khawaja, Shammah E Udoudo, Julianne W Gillis, Paul A Ghareeb, Michael B Gottschalk, Amanda L Dempsey, Eric R Wagner","doi":"10.5435/JAAOS-D-25-01644","DOIUrl":"https://doi.org/10.5435/JAAOS-D-25-01644","url":null,"abstract":"<p><strong>Introduction: </strong>Online physician ratings are a model for patient satisfaction and play a key role in patient recruitment. This study examines the influence of different variables on hand surgeons' average ratings and patient engagement on physician review websites (PRWs).</p><p><strong>Methods: </strong>The American Society for Surgery of the Hand directory was queried for all actively practicing orthopaedic or plastic-trained hand surgeons in the United States. Individuals were randomly selected and searched on various social media platforms for professional accounts. A summated online presence score was calculated to identify the top 20% of social media users. The use of a practice group or personal website was also recorded, as was a surgeon's practice setting and region of practice. H-index was searched on Scopus. Patient rating information was collected from Healthgrades, Google, and Vitals. Physicians' medical school and residency programs were noted for being a top 20 program based on US News and Doximity rankings.</p><p><strong>Results: </strong>A total of 97 orthopaedic and 102 plastic-trained surgeons were reviewed. Private practice orthopaedic surgeons had higher mean ratings on Healthgrades than those in academic practice. The top 20% of social media users had markedly higher mean patient satisfaction ratings. H-index was positively associated with patient ratings and social media usage. Male surgeons had higher ratings and engagement than female surgeons. Younger hand surgeons had greater ratings and engagement compared with surgeons who have been in practice longer. Medical school or residency program prestige did not markedly affect patient satisfaction ratings.</p><p><strong>Discussion: </strong>Social media utilization and research productivity can influence patient satisfaction, measured by ratings and comments on PRWs. Given that most patients read PRWs before making an appointment, hand surgeons can use these data to optimize their online presence and overall ratings.</p><p><strong>Level of evidence: </strong>IV.</p>","PeriodicalId":51098,"journal":{"name":"Journal of the American Academy of Orthopaedic Surgeons","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147845765","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":"Smoking Cessation Success-Total Joint Arthroplasty as a Powerful Motivator.","authors":"Mary E Hennekes, Aaron Pang, Hamza M Raja, Husain Rasheed, Brian Darrith, W Trevor North, Michael A Charters","doi":"10.5435/JAAOS-D-25-00059","DOIUrl":"10.5435/JAAOS-D-25-00059","url":null,"abstract":"<p><strong>Introduction: </strong>Smoking is a well-established risk factor for perioperative complications after total joint arthroplasty (TJA), yet only 8% of people are successful at smoking cessation yearly. This study aimed to assess the success rate of smoking cessation in TJA patients through one framework and explore potential demographic factors associated with smoking cessation.</p><p><strong>Methods: </strong>All adult patients pursuing primary TJA and who had received smoking cessation counseling within a 2-year period (2021 to 2022) were included in this retrospective cohort study. Nicotine and cotinine blood tests were used to confirm smoking cessation after a 6-week period of self-reported abstinence. The smoking cessation interval was calculated as the duration between smoking cessation counseling and the date of normal nicotine (<2.0 ng/mL) and cotinine (<8.0 ng/mL) laboratory tests. Logistic regression analyses were conducted to determine associations between smoking cessation and demographic variables.</p><p><strong>Results: </strong>One hundred three patients met inclusion criteria. Thirty-two patients (31.1%) self-reported abstinence after a 6-week period of smoking cessation. Ultimately, 29 patients (28.2%) demonstrated objective evidence of smoking cessation. The time from initial smoking cessation counseling to normal labs was a median of 84.0 days (interquartile ranges: 45.5 to 178.5). Being married was a significant predictor for smoking cessation success (odds ratio: 0.26; P < 0.05). Married patients were also able to achieve success faster than their single counterparts ( P = 0.043).</p><p><strong>Conclusion: </strong>This study highlights the high percentage (28.2%) of smoking cessation success achieved within a single smoking cessation framework before TJA. These findings underscore the increased potential for success when smoking cessation efforts are motivated by improved function and pain relief offered by TJA. The addition of objective measures such as nicotine and cotinine testing may further increase smoking cessation rates by providing concrete measures of success.</p>","PeriodicalId":51098,"journal":{"name":"Journal of the American Academy of Orthopaedic Surgeons","volume":" ","pages":"e1288-e1295"},"PeriodicalIF":2.8,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145294378","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":"Unlike Tobacco Users, Documented Cannabis Users Are Not at an Increased Risk of Adverse Events After Total Hip Arthroplasty.","authors":"Oghenewoma P Oghenesume, Meera M Dhodapkar, Philip P Ratnasamy, Zachary J Radford, Jonathan N Grauer","doi":"10.5435/JAAOS-D-24-00811","DOIUrl":"10.5435/JAAOS-D-24-00811","url":null,"abstract":"<p><strong>Background: </strong>Perioperative tobacco use has been identified as an independent risk factor for adverse events after total hip arthroplasty (THA). It is unknown if perioperative cannabis users share similar levels of risk for adverse events after THA.</p><p><strong>Methods: </strong>Patients undergoing THA were identified from the 2010 to 2021 PearlDiver M151 administrative data set. Patient subcohorts were categorized based on presence or absence of cannabis and/or tobacco use, as determined by coding. These subcohorts were equally matched based on patient age, sex, and Elixhauser Comorbidity Index scores to form groups of nonusers, tobacco users, tobacco and cannabis users, as well as cannabis users. The incidences of adverse events within 90 days postoperatively were obtained and compared using univariate and multivariate analyses that controlled for age, sex, and Elixhauser Comorbidity Index. Bonferroni correction was applied.</p><p><strong>Results: </strong>Of 494,431 THA patients, nonusers were 442,000 (89.40%), tobacco users 46,925 (9.50%), tobacco and cannabis users 3,390 (0.69%), and cannabis users 2,116 (0.43%). After matching, there were 1,897 in each group. By multivariate analyses, tobacco-only users were at significantly greater risk of severe adverse events, sepsis, and pneumonia ( P < 0.001 for each). Tobacco and cannabis users were at significantly greater risk of severe adverse events, myocardial infarction, pneumonia, and readmission ( P < 0.001 for each). Conversely, cannabis-only users were not at significantly greater risk for any of the combined or individual adverse events assessed.</p><p><strong>Discussion: </strong>This study confirmed that THA patients with tobacco-only use were at greater risk of perioperative adverse events and that these were relatively similar to those with concurrent tobacco and cannabis use. However, cannabis-only users were not at greater risk, a finding that is of clinical interest given the evolving access and increasing use of this agent.</p>","PeriodicalId":51098,"journal":{"name":"Journal of the American Academy of Orthopaedic Surgeons","volume":" ","pages":"e1296-e1303"},"PeriodicalIF":2.8,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145379716","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":"Patient-level Value Analysis: A Model for Implementing the Concept of Value-based Healthcare Into Clinical Practice.","authors":"Prakash Jayakumar, Haley D Puckett, Rebekah M Kleinsmith, Brian P Cunningham","doi":"10.5435/JAAOS-D-25-00568","DOIUrl":"10.5435/JAAOS-D-25-00568","url":null,"abstract":"<p><p>As interest in incorporating value-based healthcare (achieving better health outcomes for patients relative to costs) into clinical practice and policy expands, there is a growing need for a well-understood and easily implemented methodological approach. Patient-level value analysis (PLVA) quantifies patient outcomes (using patient-reported outcome measures [PROMs]) in the context of total costs of care (using time-driven activity-based costing). When both aspects are paired, optimal value is achieved. There are six steps to perform PLVA: (1) defining the care pathway, (2) identifying low- and high-value interventions, (3) defining PROMs of interest, (4) determining costs, (5) evaluating the relationship between PROMs and total costs of care, and (6) identifying potential value drivers. This approach equips users with information on how to minimize variation, implement best practices, and encourage the delivery of high-value care. The primary objectives of this article are (1) to compile a synthesis of PLVA literature and (2) to use the Capability, Opportunity, Motivation-Behavior model and the Theoretical Domains Framework to provide orthopaedic surgeons with tactical guidance for implementation of PLVA.</p>","PeriodicalId":51098,"journal":{"name":"Journal of the American Academy of Orthopaedic Surgeons","volume":" ","pages":"e1165-e1174"},"PeriodicalIF":2.8,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145811714","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":"Tandem Spinal Stenosis: A Proposed Therapeutic Algorithm Based on a Systematic Review and Meta-Analysis.","authors":"Vit Kotheeranurak, Peem Sarasombath, Todsapon Chancharoenchai, Yanting Liu, Weerasak Singhatanadgige, Worawat Limthongkul","doi":"10.5435/JAAOS-D-25-00824","DOIUrl":"10.5435/JAAOS-D-25-00824","url":null,"abstract":"<p><strong>Background: </strong>Tandem spinal stenosis (TSS) is characterized by stenosis in two or more noncontiguous spinal regions. Surgical management may involve simultaneous decompression or staged procedures; however, no universally accepted decision-making algorithm exists.</p><p><strong>Methods: </strong>A systematic review and meta-analysis were conducted in accordance with PRISMA guidelines. PubMed, Scopus, and EMBASE databases were searched for studies reporting outcomes of simultaneous and/or staged surgery for TSS. Fifteen studies were included in the qualitative review, and 12 were eligible for meta-analysis. Surgical strategies were compared based on postoperative functional outcomes.</p><p><strong>Results: </strong>A total of 1,006 interventions (604 staged and 402 simultaneous) were analyzed. Overall, significant postoperative improvement in Japanese Orthopaedic Association scores was observed (pooled SMD, 2.87; 95% CI, 1.88 to 3.86). Subgroup analysis demonstrated the greatest improvement with staged surgery using a cervical-first approach (SMD, 4.31; 95% CI, 3.87 to 4.76; I 2 = 0%), followed by simultaneous surgery (SMD, 2.65; 95% CI, 1.76 to 3.53). Lumbar-first staged surgery showed smaller and statistically negligible improvement (SMD, 1.94; 95% CI, -1.69 to 5.56). Complication rates were higher in older patients and in those with longer operative times and greater estimated blood loss.</p><p><strong>Conclusions: </strong>Surgical strategy for TSS should be individualized. In the presence of myelopathy, staged surgery prioritizing cervical decompression is recommended. In the absence of myelopathy, simultaneous decompression may be considered in patients who can tolerate longer operative times. We propose a treatment algorithm to guide surgical decision-making based on symptom predominance, presence of myelopathy, and patient comorbidities.</p>","PeriodicalId":51098,"journal":{"name":"Journal of the American Academy of Orthopaedic Surgeons","volume":" ","pages":"e1277-e1287"},"PeriodicalIF":2.8,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147391561","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":"Complex Total Knee Arthroplasty for Posttraumatic Osteoarthritis: Assessment, Approach, and Outcomes.","authors":"Clayton W Wing, Aleksander P Mika, Bryan D Springer, Cameron K Ledford","doi":"10.5435/JAAOS-D-25-00411","DOIUrl":"https://doi.org/10.5435/JAAOS-D-25-00411","url":null,"abstract":"<p><p>The incidence of posttraumatic knee osteoarthritis occurs in nearly one-third of patients sustaining intra-articular fracture and/or ligamentous knee injury. As a result, complex total knee arthroplasty may become the best treatment option for these patients. Several challenges must be considered when planning and executing the surgery, including exposure with prior incisions, implant retention or removal, angular deformity, bone defects, stability, and the use of enabling technologies. Although these patients demonstrate notable improvement in pain and function after complex total knee arthroplasty, higher complication rates, increased revision risk, and inferior patient-reported outcomes have also been shown comparatively. This review will summarize how to effectively approach these complicated cases and report contemporary outcomes.</p>","PeriodicalId":51098,"journal":{"name":"Journal of the American Academy of Orthopaedic Surgeons","volume":"34 9","pages":"e1192-e1202"},"PeriodicalIF":2.8,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147700497","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":"Preoperative Cannabis Use Is Associated With Elevated Risk for Complications and Revision Surgery After Anterior Cervical Diskectomy and Fusion.","authors":"Sri Tummala, Tarun R Sontam, Jason Noor, David C Gibbs, James M Rizkalla, Ioannis Avramis","doi":"10.5435/JAAOS-D-25-00813","DOIUrl":"10.5435/JAAOS-D-25-00813","url":null,"abstract":"<p><strong>Background: </strong>Cannabis use has increased markedly in recent decades, with US adult usage doubling from 4.1% to 9.5% between 2001 and 2013, and 43% of young adults reporting use by 2021. As legalization expands and cannabis becomes more mainstream, its perioperative implications have become clinically relevant. Although the orthopaedic literature has begun exploring the effect of cannabis use, its effect on anterior cervical diskectomy and fusion (ACDF) remains underinvestigated. Given the widespread adoption of ACDF and the projected rise in spinal procedures, understanding cannabis-related risks is essential to optimizing surgical outcomes.</p><p><strong>Methods: </strong>This retrospective cohort study used the TriNetX Research Network to identify patients undergoing primary ACDF from 2003 to 2023. Patients with cannabis use within 3 months before surgery were compared with matched nonusers using 1:1 propensity-score matching across key demographics and comorbidities. Outcomes included 90-day medical complications and healthcare utilization, as well as 2-year surgical outcomes including revision surgery, pseudarthrosis, and implant failure.</p><p><strong>Results: </strong>After matching (n = 2,169 per group), cannabis users demonstrated significantly higher 90-day rates of dysphagia (7.10% vs. 5.40%, P = 0.03), infection (1.60% vs. 0.90%, P = 0.04), postprocedural pain (7.20% vs. 4.10%, P < 0.001), opioid use (48.0% vs. 25.0%, P = 0.03), and readmission (3.90% vs. 2.70%, P = 0.04). At 2 years, cannabis users had higher rates of revision surgery (7.82% vs. 5.15%, P = 0.001), pseudarthrosis (10.10% vs. 8.25%, P = 0.04), and implant failure (4.31% vs. 2.78%, P = 0.01).</p><p><strong>Conclusion: </strong>Preoperative cannabis use is associated with higher rates of medical and surgical complications, as well as an increased risk of revision surgery after ACDF. With cannabis use projected to rise markedly among surgical patients, these findings highlight its potential role as a modifiable risk factor, similar to tobacco use. Recognizing this association, incorporating evidence-based risk stratification, cannabis cessation counseling, and optimized perioperative care pathways may help reduce complication rates and improve fusion outcomes in patients undergoing ACDF.</p>","PeriodicalId":51098,"journal":{"name":"Journal of the American Academy of Orthopaedic Surgeons","volume":" ","pages":"e1267-e1276"},"PeriodicalIF":2.8,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145349813","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":"Management of Chest Wall Injuries: An Updated Review.","authors":"Niloofar Dehghan, Aaron Nauth, Michael McKee","doi":"10.5435/JAAOS-D-25-00313","DOIUrl":"10.5435/JAAOS-D-25-00313","url":null,"abstract":"<p><p>Injuries to the chest wall are common after blunt thoracic trauma, which can cause injury to the ribcage and intrathoracic structures. Such trauma can result in a spectrum of injuries, ranging from minor injuries such as an isolated rib fracture to extensive injuries such as multiple rib fractures/flail segments with underlying lung or intrathoracic injury. The primary focus of this article will be on the assessment and treatment of injuries of the bony chest wall, with an emphasis on flail chest and multiple rib fractures. Patient evaluation, treatment, and outcomes differ depending on the severity of injury. The use of CT scans has become routine in the diagnosis and evaluation of injury severity. Treatment options include both nonsurgical care (analgesia, regional anesthetic techniques, and mechanical ventilation) and surgical fixation of the chest wall. While there has been notable interest in surgical fixation of flail chest injuries over the past two decades, there remains controversy regarding the potential benefits of surgery and the indications for surgical management. However, it is clear that patients with flail chest injuries are best managed by a multidisciplinary team, including collaboration between orthopaedic and trauma surgery.</p>","PeriodicalId":51098,"journal":{"name":"Journal of the American Academy of Orthopaedic Surgeons","volume":" ","pages":"e1203-e1212"},"PeriodicalIF":2.8,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145960731","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":"Acute Total Hip Arthroplasty for Acetabular Fractures.","authors":"Cyrus Anthony Pumilia, Daniel J Cunningham, Kevin Murr, Thomas Jones","doi":"10.5435/JAAOS-D-24-01541","DOIUrl":"10.5435/JAAOS-D-24-01541","url":null,"abstract":"<p><p>Acetabular fractures are becoming more common, especially in the elderly population. Standard goals of management include restoring stability and articular congruity to the hip joint in an effort to minimize the risk of posttraumatic arthritis. This is most commonly achieved through open reduction and internal fixation, from which outcomes are generally positive. However, several preoperative risk factors have been identified that correlate with poor outcomes, such as severe acetabular impaction, femoral-sided lesions, and older age. Furthermore, goals of management in the increasingly encountered elderly acetabular fracture may predominantly consist of postoperative mobilization and minimizing revision surgery. In the select patient with identifiable risk factors, acute total hip arthroplasty with or without concurrent fracture fixation may be able to improve outcomes. Specifically, acute total hip arthroplasty appears to reduce the risk of revision surgery in comparison to fracture fixation alone and may improve complication profiles in comparison to conversion arthroplasty after failed fixation, albeit at the expense of an increased surgical insult at the initial surgery. However, given the heterogeneity and short-term nature of the available data, more robust and long-term data will be required before definitive conclusions can be drawn.</p>","PeriodicalId":51098,"journal":{"name":"Journal of the American Academy of Orthopaedic Surgeons","volume":" ","pages":"e1182-e1191"},"PeriodicalIF":2.8,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145946867","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}