Journal of the American Academy of Orthopaedic Surgeons最新文献

{"title":"Metal Suppression Magnetic Resonance Imaging Techniques in Orthopaedic and Spine Surgery.","authors":"Katharina Ziegeler, Daehyun Yoon, Michael Hoff, Alekos A Theologis","doi":"10.5435/JAAOS-D-24-01057","DOIUrl":"https://doi.org/10.5435/JAAOS-D-24-01057","url":null,"abstract":"<p><p>Implantation of metallic instrumentation is the mainstay of a variety of orthopaedic and spine surgeries. Postoperatively, imaging of the soft tissues around these implants is commonly required to assess for persistent, recurrent, and/or new pathology (ie, instrumentation loosening, particle disease, infection, neural compression); visualization of these pathologies often requires the superior soft-tissue contrast of magnetic resonance imaging (MRI). As susceptibility artifacts from ferromagnetic implants can result in unacceptable image quality, unique MRI approaches are often necessary to provide accurate imaging. In this text, a comprehensive review is provided on common artifacts encountered in orthopaedic MRI, including comparisons of artifacts from different metallic alloys and common nonpropriety/propriety MR metallic artifact reduction methods. The newest metal-artifact suppression imaging technology and future directions (ie, deep learning/artificial intelligence) in this important field will be considered.</p>","PeriodicalId":51098,"journal":{"name":"Journal of the American Academy of Orthopaedic Surgeons","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143598336","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":"Development of a Drawing Application to Evaluate Hand and Wrist Function: A Pilot Study.","authors":"Jay Chandra, Charlotte L E Laane, Oscar Shen, Mark Stam, Jason Z Shang, Nicole F Yu, Neal C Chen, Abhiram R Bhashyam","doi":"10.5435/JAAOS-D-24-00817","DOIUrl":"https://doi.org/10.5435/JAAOS-D-24-00817","url":null,"abstract":"<p><strong>Introduction: </strong>We developed a custom digital drawing application to assess hand function. We conducted an initial validation study of this technique to (1) assess which drawing features are associated with hand function, (2) differentiate patients from control subjects for both dominant and nondominant hands, and (3) assess the correlation of drawing features with previously validated patient-reported outcome measures (PROMs).</p><p><strong>Methods: </strong>In this prospective study, participants were asked to draw shapes on an Apple iPad with a digital pen using a custom app. Drawings from 142 hands in 73 participants were categorized based on hand dominance and patient/control subject. We calculated kinematic/geometric and pressure-based features from raw drawing data. Random forest models were used to classify patients and control subjects and to identify correlation with validated PROMs. Model performance for classification was assessed using accuracy, precision, recall, F1 score, and area under the curve.</p><p><strong>Results: </strong>Patients and control subjects could not be differentiated by visual inspection; however, many drawing features were different (P < 0.05) between patients and control subjects for both dominant (78 features) and nondominant (27 features) hand drawings. Circle drawings were most informative, and pressure features were most important. The classification metrics including area under the curve (0.82 to 0.84), accuracy (0.75 to 77), and F1 score (0.78 to 0.81) suggest that hand function is reasonably assessed through drawing. Drawing features were correlated with patient-rated wrist evaluation, 12-Item Short Form Health Survey, and Quick Disabilities of the Arm, Shoulder and Hand scores (P < 0.001).</p><p><strong>Discussion: </strong>We developed a new technique to objectively measure hand function using drawing. Drawing features were correlated with validated PROMs and could differentiate patients from control subjects, regardless of hand dominance.</p>","PeriodicalId":51098,"journal":{"name":"Journal of the American Academy of Orthopaedic Surgeons","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143607119","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":"Investigation of Orthopaedic Surgery Resident Education Regarding the Management of Unintentional Durotomies.","authors":"Austin H Carroll, Sarah Lucas, Michael M Covell, Zachary Backstrom, Douglass Johnson, Joseph Ferguson","doi":"10.5435/JAAOS-D-24-01155","DOIUrl":"https://doi.org/10.5435/JAAOS-D-24-01155","url":null,"abstract":"<p><strong>Introduction: </strong>Unintentional durotomies occur in 2% to 5% of spine surgeries and in 20% of patients with spinal trauma. While neurosurgeons have historically managed intradural pathology, it is critical that all spine surgeons receive adequate training in the intraoperative and postoperative management of durotomies. Previous literature indicates notable interprogram heterogeneity regarding the quality of spinal surgery experience orthopaedic residents receive in their residency programs, however. To our knowledge, no study has previously studied orthopaedic resident education and experience regarding the management of unintentional durotomies. The purpose of this study was to evaluate resident education with management of unintentional durotomies in spine surgery.</p><p><strong>Methods: </strong>This study was an anonymous eight-question survey sent to all 207 accredited orthopaedic residency programs investigating resident experience with the intraoperative and postoperative management of unintentional durotomies.</p><p><strong>Results: </strong>Two hundred thirty-one residents responded to the survey, with 43.7% being senior residents (PGY4-5). Of the 231 respondents, 28.1% (65/231) reported feeling comfortable with the intraoperative management of durotomies. Regarding primary suture repair, 2.6% (6/231) stated that they have completed the procedure as lead surgeon, with 62.8% (145/231) having assisted an attending. 34.6% (80/231) of residents reported having never seen a suture repair. Regarding fibrin glue or muscle patch, 7.4% (17/231) reported performing the procedure as lead surgeon, with 48.1% (111/231) having partially completed or assisted (Figure 2). 44.6% (103/231) reported having never seen a patch repair. Of the 231, 52.8% (122/231) reported feeling comfortable with postoperative management of unintentional durotomies. 37.2% (86/231) stated that they do not feel comfortable managing lumbar drains. 59.7% (138/231) believed that they would benefit from additional experience during training.</p><p><strong>Discussion: </strong>Unintentional durotomies occur frequently with notable morbidity. In this survey study of all accredited orthopaedic programs, residents reported limited experience with the management of unintentional durotomies with most reporting that they would benefit from additional experience during training.</p>","PeriodicalId":51098,"journal":{"name":"Journal of the American Academy of Orthopaedic Surgeons","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143598334","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":"Wide-Awake Partial Fasciectomy for Dupuytren Contracture: A Nationwide Analysis of Adverse Events and Reimbursement.","authors":"Alexander J Kammien, K Lynn Zhao, Catherine T Yu, Jonathan N Grauer, David L Colen","doi":"10.5435/JAAOS-D-24-00674","DOIUrl":"https://doi.org/10.5435/JAAOS-D-24-00674","url":null,"abstract":"<p><strong>Background: </strong>Single-institution studies demonstrate reduced cost and similar outcomes for wide-awake fasciectomy compared with those with standard anesthesia. This retrospective cohort study examines these findings on a national level, comparing adverse events and cost for partial fasciectomies performed wide-awake and with standard anesthesia.</p><p><strong>Methods: </strong>Partial fasciectomies were identified in the 2010-2022 PearlDiver database. Exclusion criteria were age younger than 18 years, <2 years of follow-up, inpatient surgery, and previous needle aponeurotomy or collagenase injection. Patients were stratified by anesthesia type and then matched by age, sex, Elixhauser Comorbidity Index score, geographic region, insurance, and number of fingers treated. The following postoperative events were identified: intraoperative digital nerve/vessel injury; 30-day wound complications; emergency department visits and returns for admission; and repeat fasciectomy, needle aponeurotomy, and collagenase injection within 2 years postoperatively. Total surgical reimbursement was determined by insurance type.</p><p><strong>Results: </strong>Each matched cohort included 15,689 patients with no differences in age, sex, Elixhauser Comorbidity Index score, geographic region, insurance, or number of fingers treated. Patients with wide-awake surgery had fewer 30-day emergency department visits but no differences in intraoperative nerve/vessel injury, wound complications, or returns for admission. Wide-awake patients had slightly greater rate of subsequent interventions for Dupuytren contracture within 2 years of index surgery. Wide-awake surgery was associated with markedly reduced total reimbursement.</p><p><strong>Conclusion: </strong>There is much debate about and investigation of the costs and benefits of the different treatment modalities for Dupuytren contracture. The ability to perform fasciectomies wide-awake can reduce the cost of fasciectomy without sacrificing safety. This may play an important role in treatment decisions because fasciectomy is generally considered the benchmark, yet most expensive, treatment option.</p>","PeriodicalId":51098,"journal":{"name":"Journal of the American Academy of Orthopaedic Surgeons","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143616702","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":"Disparities in Social Determinants of Health Associated With Decreased Likelihood of Receiving Total Joint Arthroplasty.","authors":"Lucas Y Kim, Nicole Nishime, Jeremy Ansah-Twum, Jonathan N Grauer, Daniel H Wiznia","doi":"10.5435/JAAOS-D-24-00945","DOIUrl":"https://doi.org/10.5435/JAAOS-D-24-00945","url":null,"abstract":"<p><strong>Introduction: </strong>Knee osteoarthritis and hip osteoarthritis (OA) are orthopaedic conditions for which total joint arthroplasty (TJA) is the definitive treatment. The correlation of social determinants of health (SDOH) disparities with access to specialized health care such as TJA is of increasing interest. At our institution, SDOH screening was implemented in 2020. The purpose of this study was to identify whether patients with OA who screened positive for SDOH hardship (SDOH positive) were less likely to receive a subsequent TJA.</p><p><strong>Methods: </strong>Patients with diagnosis of knee or hip OA who underwent SDOH screening from 2020 to 2023 were identified from our institutional record. The correlation of SDOH-positive screening relative to not screening positive (SDOH negative) with the likelihood of receiving TJA was assessed. The incidence of TJA in these two cohorts was evaluated using multivariable logistic regression controlling for age, sex, race, and ethnicity.</p><p><strong>Results: </strong>A total of 2,981 patients were identified fitting the study criteria. The number of SDOH-positive patients was 1,122 (37.6%), and the number of SDOH-negative patients was 1,859 (62.4%). The SDOH-positive group had a significantly lower rate of TJA (9.9% vs. 14.8%, P < 0.0001). When individual SDOH were assessed, transportation insecurity, financial strain, and food insecurity were associated with decreased TJA incidence, with increasing financial strain corresponding to additional decreases in TJA incidence. On multivariable analysis, SDOH-positive status was identified as an independent negative predictor of TJA.</p><p><strong>Discussion: </strong>Patients with knee or hip OA screening positive for SDOH disparities had decreased odds of receiving a subsequent TJA. As screening becomes increasingly more common, these findings illustrate how SDOH disparities correlate with access to orthopaedic care and demonstrate the need for intervention after screening, especially in SDOH categories where organizations can provide resources and support, such as access to transportation and food.</p>","PeriodicalId":51098,"journal":{"name":"Journal of the American Academy of Orthopaedic Surgeons","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143598332","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 Research Productivity and Step 2 Score Among Matched Orthopaedic Surgery Residents: A Forecasting Analysis to 2040.","authors":"Benjamin M Varieur, Ryan C White, Christopher M Bono","doi":"10.5435/JAAOS-D-24-01106","DOIUrl":"https://doi.org/10.5435/JAAOS-D-24-01106","url":null,"abstract":"<p><strong>Background: </strong>Orthopaedics has consistently been among the most competitive residency specialties in which to match. The purpose of this study was to evaluate trends in important data as provided by the National Resident Matching Program regarding orthopaedic surgery residency and to project future averages for successful applicants.</p><p><strong>Methods: </strong>\"Charting Outcomes in the Match\" are biennial reports published by the National Resident Matching Program, listing applicant characteristics stratified by specialty. We collected data between 2014 and 2024 for allopathic medical school seniors from the United States that successfully matched into orthopaedic surgery residency. Regression analysis was performed to predict research productivity and United States Medical Licensing Examination Step 2 scores to the year 2040.</p><p><strong>Results: </strong>Research productivity and Step 2 score have shown notable trends among matched orthopaedic surgery residency applicants, with research productivity following an exponential increase (R2 = 0.988, P < 0.001) and Step 2 scores following a linear trend (R2 = 0.925, P = 0.002). In accordance with these models, by the year 2040, matched applicants are projected to have an average of 165.6 (95% prediction interval, 107.8 to 254.5) publications, posters, abstracts, and presentations and an average Step 2 score of 266 (95% prediction interval, 261 to 271) points, outperforming the 87th percentile. Specifically, Step 2 score is projected to increase by 1.1 point every 2 years with the limitation that the upper limit score is 300.</p><p><strong>Conclusion: </strong>Research productivity and USMLE Step 2 scores among matched orthopaedic surgery residency applicants are projected to increase in the coming years. These findings can inform medical school administration, residency programs, and orthopaedic leadership to optimize their programs for student, resident, and organizational success. Moreover, it may be time to reconsider the importance of these metrics as a perpetual increase in scores and research activity is not sustainable nor equitable.</p>","PeriodicalId":51098,"journal":{"name":"Journal of the American Academy of Orthopaedic Surgeons","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143558660","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 Cruciate Ligament Injury in Skeletally Immature Patients.","authors":"Anthony C Egger, Shital N Parikh","doi":"10.5435/JAAOS-D-23-00848","DOIUrl":"10.5435/JAAOS-D-23-00848","url":null,"abstract":"<p><p>The incidence of anterior cruciate ligament (ACL) injury continues to increase in the skeletally immature population. These injuries were historically treated with nonsurgical measures in this age group due to concerns for iatrogenic damage to the physis during ACL reconstruction. However, delayed surgery often led to recurrent instability, meniscal tears, and chondral damage. With the development of newer and safer surgical techniques with satisfactory outcomes, ACL reconstruction has become much more common in this age group. The patient's skeletal age is often used to determine remaining growth, which helps to decide the surgical technique chosen. These techniques include physeal sparing, partial transphyseal, and transphyseal surgical options, using soft-tissue autografts. Each technique has been shown to have favorable patient-reported outcomes, but no technique is without the risk of complications. This article will review the management of skeletally immature ACL injuries, including relevant anatomy, risk factors for injury, assessment of skeletal age, and different treatment options and outcomes.</p>","PeriodicalId":51098,"journal":{"name":"Journal of the American Academy of Orthopaedic Surgeons","volume":" ","pages":"e259-e273"},"PeriodicalIF":2.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142512548","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":"Representation Matters: A Higher Percentage of Women Orthopaedic Surgery Faculty Is Associated With an Increased Number of Women Residents.","authors":"Rachel Ranson, Kassidy Webber, Christopher Saker, Isabella Cashin, Josie L Bunstine, Aaditya P Patel, Julia Kirkland, Arianna L Gianakos, Mia V Rumps, Mary K Mulcahey","doi":"10.5435/JAAOS-D-24-00469","DOIUrl":"10.5435/JAAOS-D-24-00469","url":null,"abstract":"<p><strong>Introduction: </strong>Orthopaedic surgery has been recognized as one of the least diverse surgical specialties. Previous studies have demonstrated that women are heavily underrepresented within orthopaedic surgery. The purpose of this study was to determine whether orthopaedic surgery residency programs with a higher presence of women faculty had a higher proportion of women residents.</p><p><strong>Methods: </strong>The Fellowship and Residency Electronic Interactive Database was used to identify all orthopaedic surgery residency programs in the United States. Resident and faculty's sex and degree were recorded in addition to faculty administrative title (eg, program director, chair) and academic rank (clinician, professor, etc). Pearson correlation coefficients were used to compare the number of women residents with the number of women faculty.</p><p><strong>Results: </strong>A total of 192 orthopaedic surgery programs were analyzed. Of the 5,747 faculty members and 4,268 residents identified, 13.1% (n = 752) and 22.6% (n = 963) were women, respectively. The number of women residents markedly correlated with the number of women faculty in leadership positions (r = 0.516, P < 0.001), such as chief or chair. The most significant correlations were among women with the academic role of \"professor\" (r = 0.575, P < 0.001), \"assistant professor\" (r = 0.555, P < 0.001), and women who held faculty positions but held no higher academic appointment (r = 0.509, P < 0.001). Program directors and assistant program directors were not found to have significant correlations with the number of women residents.</p><p><strong>Conclusion: </strong>This study demonstrates a positive correlation between women faculty and residents at orthopaedic surgery residencies. Some academic positions, such as division chief, held more significant associations, whereas other positions, such as professor emeritus, were not held by any women, thereby limiting statistical analysis. Further investigation into minority representation in orthopaedic surgery and initiatives to address the observed disparities is paramount.</p>","PeriodicalId":51098,"journal":{"name":"Journal of the American Academy of Orthopaedic Surgeons","volume":" ","pages":"253-260"},"PeriodicalIF":2.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142741225","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 Path to Success: An Analysis of the Subjective and Objective Characteristics of Orthopaedic Surgery Applicants With Program Director Insight.","authors":"Abtahi Tishad, Jonathan D Kass, Griffin Stinson, Andre Spiguel","doi":"10.5435/JAAOS-D-24-00421","DOIUrl":"10.5435/JAAOS-D-24-00421","url":null,"abstract":"<p><p>At present, there is uncertainty regarding the objective and subjective characteristics of competitive applicants for orthopaedic surgery residency (OSR). With the hope of enlightening future applicants and their orthopaedic surgeon mentors on what factors they ought to emphasize to successfully match into an OSR program, we summarized and analyzed the characteristics of OSR applicants between the 2020 and 2023 residency application cycles using data from the Texas Seeking Transparency in Application to Residency (STAR) database and insights from the 2020 National Resident Matching Program (NRMP) program director (PD) Survey. Factors considered in our analysis include standardized examination scores, class quartile, research output, extracurricular activities, and application characteristics, such as number of programs applied to, number of interviews attended, and match outcome. To elucidate the importance of more nonquantifiable metrics, we analyzed 423 subjective comments from OSR applicants found in the STAR database and compared them with relevant findings from the 2020 NRMP PD Survey. Of the 1,094 OSR applicants identified, 926 matched and 168 did not match, yielding a match rate of 84.64%. Matched applicants had markedly higher board examination scores, were more likely to be in the first and second quartiles of their class, had a higher number of honored clerkships, were more likely to have Alpha Omega Alpha (AOA) membership, and overall had more research, volunteer, and leadership experiences. Our logistics regression analysis showed that being in the first quartile had the greatest effect on odds of matching, sequentially followed by having a United States Medical Licensing Examination step 2 score above 250, having more leadership opportunities, and finally, more total research output. With respect to nonquantifiable metrics, applicants and PDs alike heavily emphasized performing well on subinternships and having desirable personal attributes such as a strong work ethic, willingness to learn, and understanding the importance of teamwork.</p>","PeriodicalId":51098,"journal":{"name":"Journal of the American Academy of Orthopaedic Surgeons","volume":" ","pages":"e274-e290"},"PeriodicalIF":2.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142781925","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":"Is Dexamethasone Administration During Total Hip and Knee Arthroplasty Safe in Diabetic Patients?","authors":"Kareem J Kebaish, Jennifer C Wang, Amit S Piple, Julian Wier, Kevin C Liu, Alexander B Christ, Nathanael D Heckmann","doi":"10.5435/JAAOS-D-23-00513","DOIUrl":"10.5435/JAAOS-D-23-00513","url":null,"abstract":"<p><strong>Introduction: </strong>Dexamethasone is used extensively during total hip and knee arthroplasty total joint arthroplasty (TJA) to control pain and decrease the risk of nausea and vomiting. However, the safety of dexamethasone utilization in diabetic patients is poorly understood. Therefore, this study aims to evaluate complications associated with perioperative dexamethasone administration during primary TJA in diabetic patients.</p><p><strong>Methods: </strong>The Premier Healthcare Database was queried for all patients with diabetes mellitus who underwent primary elective TJA from 2015 to 2020. Patients who received intravenous dexamethasone on the day of surgery were compared with those who did not. Patient characteristics, hospital factors, and rates of medical comorbidities were assessed and compared between the cohorts. Multivariate logistic regression was done to assess the 90-day risk of infectious and noninfectious postoperative complications.</p><p><strong>Results: </strong>Overall, 261,474 diabetic patients were included for analysis, 122,631 (46.9%) of whom received dexamethasone. The two cohorts were similar in patient demographics, hospital characteristics, and comorbidity burden (absolute range of differences: 0.00 to 2.33%). Diabetic patients who received dexamethasone had decreased odds of periprosthetic joint infection (adjusted odds ratio 0.82, 95%-CI: 0.75 to 0.90, P < 0.001) and sepsis (aOR: 0.80, 95%-CI: 0.72 to 0.89, P < 0.001) compared with those who did not. Patients who received dexamethasone had shorter length of stay compared with those who did not (1.87 ± 1.60 days vs. 2.27 ± 1.88 days, P < 0.001). The adjusted odds of postoperative hyperglycemia were markedly higher in the dexamethasone group (aOR: 1.14, 95%-CI: 1.10 to 1.18, P < 0.001).</p><p><strong>Conclusion: </strong>Use of perioperative dexamethasone was not associated with the increased risk of infectious complications among diabetic patients undergoing TJA, supporting its safety in this high-risk population.</p>","PeriodicalId":51098,"journal":{"name":"Journal of the American Academy of Orthopaedic Surgeons","volume":" ","pages":"242-252"},"PeriodicalIF":2.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142563002","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}