Journal of the American Academy of Orthopaedic Surgeons最新文献

{"title":"Survivorship of Periprosthetic Joint Infection in Unicompartmental Knee Arthroplasty: A Single Healthcare System's 23-Year Experience.","authors":"Perry L Lim, Anoop K Prasad, Mehdi S Salimy, Christopher M Melnic, Hany S Bedair","doi":"10.5435/JAAOS-D-23-01202","DOIUrl":"https://doi.org/10.5435/JAAOS-D-23-01202","url":null,"abstract":"<p><strong>Introduction: </strong>Unicompartmental knee arthroplasty (UKA) is increasingly favored in clinical practice due to its favorable long-term survival rates, positive clinical outcomes, and expedited recovery. Periprosthetic joint infections (PJIs) remain a formidable complication in knee arthroplasty, and guidelines for the management are limited. This study aims to assess the failure rates of débridement, antibiotics, and implant retention (DAIR) in UKAs, providing insights into optimal treatment management and infection-free survival for PJI in this context.</p><p><strong>Methods: </strong>Twenty-five patients met the inclusion criteria of PJI, as defined by Musculoskeletal Infection Society criteria, and were retrospectively reviewed from January 2000 to September 2023. Surgical treatment included 17 DAIRs (78%), six one-stage revision procedures (20%), and three two-stage revision procedures (12%). Seventeen patients (78%) had acute hematogenous infections (<3 weeks of symptoms). Kaplan-Meier survivorship analysis was done for reinfection and revision procedures.</p><p><strong>Results: </strong>The overall infection-free survival and all-cause survival regardless of management at 3 years was 60.1% (95% confidence interval [CI], 45.7% to 89.6%) and 55.8% (95% CI, 38.2% to 81.5%), respectively. Both two-stage and one-stage revision procedures had an infection-free survivorship of 100% at 3 years (95% CI, 100% to 100%). DAIR treatment had an infection-free survival at 3 years of 41.6% (95% CI, 22.4% to 77.4%). Nine of 17 patients (53%) undergoing DAIR were unsuccessful and required subsequent second DAIR, one-stage, or two-stage revision procedures.</p><p><strong>Discussion: </strong>The efficacy of DAIR following PJI in UKA is notably limited, suggesting a need for reevaluation of its role in managing UKA PJIs. Given the absence of established guidelines for PJI management specifically tailored to UKA, there is an urgent and compelling need for future studies to elucidate optimal clinical strategies to allow for the best treatment for patients.</p><p><strong>Level of evidence: </strong>Level III, retrospective comparative study.</p>","PeriodicalId":51098,"journal":{"name":"Journal of the American Academy of Orthopaedic Surgeons","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143015593","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":"Learning Curve of Microsurgical Anastomosis: Training for Resident Education.","authors":"Dae Hee Lee, Young Kwang Shin, Su Hyeok Son, Kyung Wook Kim","doi":"10.5435/JAAOS-D-24-00981","DOIUrl":"https://doi.org/10.5435/JAAOS-D-24-00981","url":null,"abstract":"<p><strong>Background: </strong>Acquiring microsurgical anastomosis skills requires considerable time and effort. Moreover, appropriate and systematic training for acquiring microsurgical anastomosis skills is lacking. Therefore, this study investigated the learning curve for acquiring microsurgical anastomosis techniques among orthopaedic surgery residents.</p><p><strong>Methods: </strong>The study involved 12 orthopaedic surgery residents without experience in microsurgical anastomosis. The residents were divided into two groups: the 'Experienced group' with more than 6 months of suturing experience and the 'Inexperienced group' with no suturing experience. Each participant underwent 30 practice sessions, suturing a 3.5-mm diameter silastic tube. The time taken for each anastomosis and its quality were evaluated. Individual learning curves were derived, and the number of trials required to reach the time plateau was determined.</p><p><strong>Results: </strong>The Experienced group reached the time plateau after an average of 16.3 ± 1.4 attempts while the Inexperienced group reached it after an average of 24.2 ± 2.5 attempts. The time required for the first two attempts was 40.4 ± 6.2 min for the Experienced group and 61.2 ± 8.6 min for the Inexperienced group (P < 0.001). The time required for the last two attempts was 11.4 ± 0.7 min for the Experienced group and 12.8 ± 0.8 min for the Inexperienced group. Comparing the quality scores of the first two attempts, the Experienced group scored 4.3 ± 0.5 points and the Inexperienced group scored 3.1 ± 0.5 points (P < 0.001). The Experienced group scored 7.8 ± 0.5 points for the last two attempts while the Inexperienced group scored 6.9 ± 0.3 points (P < 0.001).</p><p><strong>Conclusions: </strong>Individuals new to suturing improved anastomosis time and quality by approximately 30 times. This finding suggests that practitioners can optimize their training while educators can refine the curriculum by predicting learning curves and providing timely feedback to enhance skill development.</p>","PeriodicalId":51098,"journal":{"name":"Journal of the American Academy of Orthopaedic Surgeons","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143015634","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":"Advances in Anatomic Total Shoulder Arthroplasty Glenoid Implant Design.","authors":"Melissa A Wright, Michael O'Leary, Peter Johnston, Anand M Murthi","doi":"10.5435/JAAOS-D-23-00257","DOIUrl":"10.5435/JAAOS-D-23-00257","url":null,"abstract":"<p><p>Since the advent of Neer's total shoulder arthroplasty in 1974, glenoid implant design has evolved to optimize patient function and increase implant longevity. Glenoid loosening continues to be a major cause of total shoulder arthroplasty failure due to both patient and implant factors. The more recent development of posterior augmented glenoids, peg fixation with ingrowth potential, inlay implants, zoned conformity implants, and convertible glenoids have all shown promising results in improving glenoid fixation and survival in different clinical circumstances. The increased utilization of 3D CT scans, preoperative planning, and patient-specific instrumentation has paralleled innovation in glenoid implants with the aim of improving the accuracy of glenoid implant placement to further optimize patient function and implant longevity. Specific indications for the variety of glenoid implants available today are still being studied. The shoulder arthroplasty surgeon should consider patient and implant factors and patient goals when determining the appropriate implant for each individual.</p>","PeriodicalId":51098,"journal":{"name":"Journal of the American Academy of Orthopaedic Surgeons","volume":" ","pages":"56-64"},"PeriodicalIF":2.6,"publicationDate":"2025-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141992562","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":"Dilute Povidone-Iodine Irrigation: The Science of Molecular Iodine (I2) Kinetics and Its Antimicrobial Activity.","authors":"John P Meehan","doi":"10.5435/JAAOS-D-24-00471","DOIUrl":"10.5435/JAAOS-D-24-00471","url":null,"abstract":"<p><p>Dilute povidone-iodine (polyvinylpyrrolidone iodine [PVP-I]) irrigation in spine surgery and total joint arthroplasty has seen a rapid and substantial increase in its use during the past decade. Yet, most surgeons do not know the chemistry and biochemistry that explain its efficacy in preventing infections. PVP-I forms a complex with molecular iodine (I2), facilitating the delivery of I2 to the membrane of the infectious organism. Here, PVP-I establishes an equilibrium between complexed and noncomplexed (free) I2 in the aqueous solution. The I2 acts at numerous cellular targets of infecting organisms augmenting its role as a biocidal molecule. The paradoxical increase in the concentration of I2 that occurs with dilution of PVP-I is a result of equilibrium kinetics and is associated with an enhanced antimicrobial activity. Cytotoxicity studies have yielded conflicting results, but most endorse diluted concentrations as being less damaging to tissues. Clinical studies have verified notable reductions in surgical site infections with a 3-minute soak of 0.35% dilute povidone-iodine irrigation. Guidelines from the World Health Organization, Centers for Disease Control and Prevention, and International Consensus Meeting on Musculoskeletal Infection support the use of prophylactic incisional wound irrigation with aqueous PVP-I to reduce and prevent surgical site infections.</p>","PeriodicalId":51098,"journal":{"name":"Journal of the American Academy of Orthopaedic Surgeons","volume":"33 2","pages":"65-73"},"PeriodicalIF":2.6,"publicationDate":"2025-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11661569/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142900237","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":"Robot-Assisted Spine Surgery: The Pearls and Pitfalls.","authors":"Nathan J Lee, Joseph M Lombardi, Sheeraz Qureshi, Ronald A Lehman","doi":"10.5435/JAAOS-D-24-00692","DOIUrl":"10.5435/JAAOS-D-24-00692","url":null,"abstract":"<p><p>Robot-assisted spine surgery has gained notable popularity among surgeons because of recent advancements in technology. These innovations provide several key benefits, including high screw accuracy rates, reduced radiation exposure, customized preoperative and intraoperative planning options, and improved ergonomics for surgeons. Despite the promising outcomes reported in literature, potential technical challenges remain across various robotic platforms. It is crucial for surgeons to remember that robotic platforms are shared-control systems, requiring the surgeon to maintain primary control throughout the procedure. To ensure patient safety, surgeons should be well versed in common technical pitfalls and strategies to mitigate these limitations.</p>","PeriodicalId":51098,"journal":{"name":"Journal of the American Academy of Orthopaedic Surgeons","volume":" ","pages":"e81-e92"},"PeriodicalIF":2.6,"publicationDate":"2025-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142300228","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":"Reducing Overprescription Practices for Opioid Use Post Anterior Cervical Surgery: The Impact of a Standardized Prescription Protocol.","authors":"Dagoberto Pina, Hania Shahzad, Zachary Booze, Michael Seidu, Joseph Wick, Thomas Shen, Yashar Javidan, Rolando Roberto, Eric Klineberg, Hai Van Le","doi":"10.5435/JAAOS-D-24-00746","DOIUrl":"https://doi.org/10.5435/JAAOS-D-24-00746","url":null,"abstract":"<p><strong>Purpose: </strong>This study aimed to evaluate the impact of implementing a standardized opioid prescription protocol on prescription practices post-elective ACS surgery at a large academic institute.</p><p><strong>Methods: </strong>A prospective cohort study with a retrospective control group was conducted following institutional review board approval. A standardized protocol was created and implemented which specified opioid prescriptions post-surgery. Data on opioid doses, total and daily Morphine Milligram Equivalents requirements, and the need for refills were collected and compared between both cohorts.</p><p><strong>Results: </strong>The study included 83 patients in the post-protocol cohort compared with 315 age- and sex-matched patients in the pre-protocol cohort. The postprotocol cohort received markedly lower daily and total doses at discharge compared with the preprotocol group (P < 0.01). No increase was observed in prescription refills before the initial follow-up in the postprotocol cohort (P = 0.35). At 12 weeks postsurgery, fewer patients in the postprotocol group remained on opioids compared with the preprotocol group (P = 0.14).</p><p><strong>Conclusion: </strong>Standardizing opioid prescriptions post-ACS surgery effectively reduces opioid doses prescribed without increasing refill rates. The findings support the efficacy of procedure-specific opioid prescription guidelines in reducing unnecessary opioid use and associated health and economic burdens.</p>","PeriodicalId":51098,"journal":{"name":"Journal of the American Academy of Orthopaedic Surgeons","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143015589","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":"Increasing Body Mass Index Not Associated With Worse Patient-Reported Outcomes After Primary THA or TKA.","authors":"John Patrick Connors, Sara Strecker, Durgesh Nagarkatti, Robert James Carangelo, Dan Witmer","doi":"10.5435/JAAOS-D-24-00154","DOIUrl":"10.5435/JAAOS-D-24-00154","url":null,"abstract":"<p><strong>Introduction: </strong>As the US obesity epidemic continues to grow, so too does comorbid hip and knee arthritis. Strict body mass index (BMI) cutoffs for total hip and knee arthroplasty (THA and TKA) in the morbidly obese have been proposed and remain controversial, although current American Academy of Orthopaedic Surgeons guidelines recommend a BMI of less than 40 m/kg 2 before surgery. This study sought to compare patient-reported outcomes and 30-day complication, readmission, and revision surgery rates after THA or TKA between morbidly obese patients and nonmorbidly obese control subjects.</p><p><strong>Methods: </strong>All patients undergoing primary THA and TKA at our institution from May 2020 to July 2022 were identified. Patient demographics, surgical time, length of stay and 30-day readmission, revision surgery, and complication rates were prospectively collected. Preoperative and postoperative Hip and Knee Society (Hip Osteoarthritis Outcome Score [HOOS] and Knee Osteoarthritis Outcome Score [KOOS]) were collected. Patients were stratified by BMI as ideal weight (20 to 24.9), overweight (25 to 29.9), class I obese (30 to 34.9), class II obese (35 to 39.9), and morbidly obese (>40 m/kg 2 ).</p><p><strong>Results: </strong>A total of 1,423 patients were included for final analysis. No difference was observed in 30-day unplanned return to emergency department, readmission, or revision surgery in the morbidly obese cohort. Morbidly obese patients undergoing THA had lower preoperative HOOS (49.5 versus 54.5, P = 0.004); however, there was no difference in postoperative HOOS or KOOS at 12 months across all cohorts.</p><p><strong>Discussion: </strong>No difference was observed in 30-day return to emergency department, readmission, or revision surgery in the morbidly obese cohort. Despite a lower preoperative HOOS, there was no difference in 12-month HOOS or KOOS when stratified by BMI. These findings suggest that such patients may achieve similar benefit from arthroplasty as their ideal weight counterparts.</p>","PeriodicalId":51098,"journal":{"name":"Journal of the American Academy of Orthopaedic Surgeons","volume":" ","pages":"e114-e123"},"PeriodicalIF":2.6,"publicationDate":"2025-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141089447","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":"Evolution of Reverse Shoulder Arthroplasty Design Rationales and Where We Are Now.","authors":"Anup A Shah, Mihir Sheth, Michael McKee, Evan Lederman","doi":"10.5435/JAAOS-D-23-01265","DOIUrl":"10.5435/JAAOS-D-23-01265","url":null,"abstract":"<p><p>Reverse shoulder arthroplasty (RSA) will soon reach its 20-year anniversary in the United States and has now become the most performed shoulder arthroplasty in the United States. The evolution from Grammont style implants to lateralized designs continues to generate debate as comparable outcomes have been reported with both types of systems. While early literature focused on fixation and expanded indications, recent studies have evaluated component design and position and their effect on functional outcomes and complications. The purpose of this article was to provide a synopsis of design rationales of current RSA prostheses and review outcomes related to RSA design and position.</p>","PeriodicalId":51098,"journal":{"name":"Journal of the American Academy of Orthopaedic Surgeons","volume":" ","pages":"e61-e71"},"PeriodicalIF":2.6,"publicationDate":"2025-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142019431","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":"Postoperative Complications and Readmission Rates in Robotic-Assisted Versus Manual Total Knee Arthroplasty: Large, Propensity Score-Matched Patient Cohorts.","authors":"Cole C Howell, Sietske Witvoet, Laura Scholl, Andrea Coppolecchia, Manoshi Bhowmik-Stoker, Antonia F Chen","doi":"10.5435/JAAOS-D-23-01117","DOIUrl":"10.5435/JAAOS-D-23-01117","url":null,"abstract":"<p><strong>Introduction: </strong>There is a paucity of research comparing postoperative complication rates between manual total knee arthroplasty (M-TKA) and robotic-assisted total knee arthroplasty (RA-TKA). This study aims to compare 90-day postoperative complication, readmission, and emergency department rates between RA-TKA and M-TKA.</p><p><strong>Methods: </strong>A retrospective review of a multihospital database identified patients who underwent TKA between January 2016 and May 2023. Surgeons who used the robotic-assisted surgery technique in <10% or >90% of their cases annually were excluded. This resulted in 15,999 cases (8,853 RA-TKAs; 7,146 M-TKAs) from 282 surgeons. RA-TKA and M-TKA cohorts were one-to-one matched based on patient sex, age, body mass index, hospital setting, surgeon experience, primary payer, and anesthesia type. Each cohort consisted of 7,146 patients (N = 14,292). 90-day revisits, specifically readmissions, readmissions with >23 hours of observation, and ED visit rates were compared between cohorts. Complications were classified according to the Clinical Classification Software schema and compared between cohorts. Mann-Whitney U, chi-squared, and Fisher exact tests, along with Bonferroni correction, were used to statistically compare cohorts.</p><p><strong>Results: </strong>All-cause 90-day readmission rates were 2.4% for RA-TKA and 2.6% for M-TKA ( P = 0.36). RA-TKA had fewer revisits (RA-TKA: 7.8%; M-TKA: 8.8%, P = 0.027) and rates of readmission with >23 hours of observation (RA-TKA: 1.4%; M-TKA: 2.0%, P = 0.003). RA-TKA had fewer hospital revisits due to joint stiffness (RA-TKA: 17 revisits; M-TKA: 42 revisits, P = 0.002) and chronic pain (RA-TKA: 1 revisit; M-TKA: 8 revisits, P = 0.039). Fewer readmissions were observed for acute injuries (lower extremity muscle/tendon strains) in the RA-TKA cohort (RA-TKA: 1; M-TKA: 9, P = 0.021). RA-TKA had fewer ED visits due to hematomas (RA-TKA: 0 visits; M-TKA: 7 visits, P = 0.016).</p><p><strong>Conclusion: </strong>In this retrospective matched cohort analysis, RA-TKA was associated with markedly fewer revisits and readmissions with >23 hours of observation compared with M-TKA. No differences in all-cause 90-day readmission were observed between cohorts.</p><p><strong>Level of evidence: </strong>Level III.</p><p><strong>Study design: </strong>Retrospective review.</p>","PeriodicalId":51098,"journal":{"name":"Journal of the American Academy of Orthopaedic Surgeons","volume":" ","pages":"83-91"},"PeriodicalIF":2.6,"publicationDate":"2025-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141728261","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-Demand Cemented Femoral Stem Designs and Revision Risk Following the Hemiarthroplasty Treatment of Geriatric Hip Fracture.","authors":"Kanu Okike, Heather A Prentice, Elizabeth W Paxton, Brian H Fasig, Ishan Shah, Christopher D Grimsrud, Foster Chen","doi":"10.5435/JAAOS-D-24-00985","DOIUrl":"https://doi.org/10.5435/JAAOS-D-24-00985","url":null,"abstract":"<p><strong>Background: </strong>Cemented fixation is recommended in the hemiarthroplasty treatment of geriatric femoral neck fractures. Certain cemented stems have similarly designed \"low-demand\" counterparts, but it is unclear whether they yield comparable clinical outcomes. The purpose of this study was to evaluate the revision risk associated with two low-demand stems, Summit Basic (DePuy Synthes) and Versys LD/Fx (Zimmer Biomet), in comparison to their standard counterparts, Summit (DePuy Synthes) and Versys Advocate (Zimmer Biomet).</p><p><strong>Methods: </strong>Using our U.S. integrated healthcare system's Hip Fracture Registry, we identified patients aged ≥60 years who were treated with one of these four cemented hemiarthroplasty devices (2009-2022). Low-demand stems were compared with standard stems on the basis of aseptic revision rates (primary outcome measure) as well as periprosthetic fracture and 90-day complications (secondary outcome measures). Multivariable Cox proportional hazards regression was used to adjust for potential confounders.</p><p><strong>Results: </strong>Overall, there were 9,828 cemented hemiarthroplasties (69.0% female, 78.9% White), including 3,713 low-demand stems and 6,115 standard stems. In the adjusted analysis, low-demand stems were associated with a higher risk of aseptic revision compared with standard designs (hazard ratio [HR] 1.53, 95%CI 1.06-2.22, P = 0.024). This difference was driven primarily by a higher risk of periprosthetic fracture in the low-demand stems (HR 3.40, 95%CI 1.54-7.51, P = 0.003). Similar findings were observed when separately comparing Summit Basic with Summit and Versys LD/Fx to Versys Advocate, and when restricting to procedures performed by experienced total hip arthroplasty surgeons.</p><p><strong>Conclusions: </strong>In this study of 9,828 hip fracture patients treated with cemented hemiarthroplasty, low-demand stems were associated with a higher risk of aseptic revision as compared with their standard counterparts. Further research is required to determine the features of the low-demand stems which could be contributing to this finding, as well as the circumstances under which usage of low-demand stems could still be justified based on cost.</p>","PeriodicalId":51098,"journal":{"name":"Journal of the American Academy of Orthopaedic Surgeons","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-01-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143015562","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}