Journal of the American Academy of Orthopaedic Surgeons最新文献

{"title":"Effect of Adding Stem Extension to a Short-Keeled Knee Implant on the Risk of Tibial Loosening: a Historical Cohort Study.","authors":"Hamidreza Yazdi, Sina Talebi, Mohammad Razi, Mohammad Mahdi Sarzaeem, Ataollah Moshirabadi, Mehdi Mohammadpour, Sina Seiri, Moein Ghaeini, Soroush Alaeddini, Mansour Abolghasemian","doi":"10.5435/JAAOS-D-23-00833","DOIUrl":"10.5435/JAAOS-D-23-00833","url":null,"abstract":"<p><strong>Background: </strong>Short-keeled tibial implants may be at higher risk of aseptic loosening. Stem augmentation has been suggested to improve its fixation. We aimed to assess whether this technique could decrease the loosening rate of such tibial implants.</p><p><strong>Methods: </strong>We retrospectively studied the knees receiving stemmed versus nonstemmed versions of a short-keeled prosthesis. A total of 932 patients undergoing total knee arthroplasty using a Persona prosthesis with >24-month follow-up (mean 53.7) were included, of whom 212 were at high risk of loosening due to osteoporosis or high body mass index (BMI). The rate of tibial aseptic loosening in high-risk patients and in the whole cohort was compared between those with and without stem extension. Multivariable analysis was conducted to identify the risk factors of loosening.</p><p><strong>Results: </strong>In the whole cohort, in 203 knees (21.8%), a cemented short stem was used, versus 729 knees (78.2%) without. The tibial implant revision rates for loosening were 2.06% and 0.99% for nonstemmed and stemmed cases, respectively ( P = 0.551). When the cohort was categorized based on the loosening risk factors, the loosening risk was significantly higher in the high-risk than in the low-risk group, regardless of stem status (log-rank test = 8.1, hazard ratio = 2.17, 95% CI = 1.78, 2.57, P = 0.005). 212 patients were at high risk of loosening, due to high BMI or osteoporosis, among whom the risk of aseptic loosening was higher when a stem was not used (log-rank = 32.1, hazard ratio = 4.95, 95% CI = 4.05, 5.86, P < 0.001). In multivariate analysis, osteoporosis, BMI ≥35, and smoking were correlated with loosening.</p><p><strong>Conclusion: </strong>The failure rate was markedly lower in the stemmed group of the patients at elevated risk of aseptic loosening due to osteoporosis and/or high BMI. In the entire cohort, the risk of loosening in stemmed tibial implants was similar to the nonstemmed group. The findings support a protective role for the stem in patients at high risk of failure of the cemented tibial implant.</p><p><strong>Level of evidence: </strong>III therapeutic.</p>","PeriodicalId":51098,"journal":{"name":"Journal of the American Academy of Orthopaedic Surgeons","volume":" ","pages":"187-193"},"PeriodicalIF":2.6,"publicationDate":"2025-02-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142074446","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":"2023 American Academy of Orthopaedic Surgeons Management of Osteoarthritis of the Hip Evidence-Based Clinical Practice Guideline: Case Studies.","authors":"Sumon Nandi, Charles P Hannon, Yale Fillingham","doi":"10.5435/JAAOS-D-24-00427","DOIUrl":"10.5435/JAAOS-D-24-00427","url":null,"abstract":"<p><p>The American Academy of Orthopaedic Surgeons, together with The Hip Society, American Association of Hip and Knee Surgeons, American College of Radiology, and American Physical Therapy Association, recently released the updated 2023 Management of Osteoarthritis of the Hip Evidence-Based Clinical Practice Guidelines. 8 recommendations and 9 options comprise these guidelines intended to optimize treatment outcomes in a patient population that is growing exponentially over time. In this article, we present case studies that illustrate utilization of the clinical practice guideline workgroup's evidence-based recommendations in clinical practice.</p>","PeriodicalId":51098,"journal":{"name":"Journal of the American Academy of Orthopaedic Surgeons","volume":" ","pages":"e220-e223"},"PeriodicalIF":2.6,"publicationDate":"2025-02-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142309056","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":"Reply to the Letter to the Editor: Risk Factors Associated with Thromboembolic Complications Following Total Hip Arthroplasty: An Analysis of 1,129 Pulmonary Emboli.","authors":"Kevin C Liu, Neelesh Bagrodia, Mary K Richardson, Amit S Piple, Nicholas Kusnezov, Jennifer C Wang, Jay R Lieberman, Nathanael D Heckmann","doi":"10.5435/JAAOS-D-24-00667","DOIUrl":"10.5435/JAAOS-D-24-00667","url":null,"abstract":"","PeriodicalId":51098,"journal":{"name":"Journal of the American Academy of Orthopaedic Surgeons","volume":" ","pages":"e257-e258"},"PeriodicalIF":2.6,"publicationDate":"2025-02-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142127256","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":"Clinical Outcomes of Bilateral Total Shoulder Arthroplasty.","authors":"Victoria E Bindi, Kevin A Hao, Lacie M Turnbull, Jonathan O Wright, Thomas W Wright, Kevin W Farmer, Terrie Vasilopoulos, Aimee M Struk, Bradley S Schoch, Joseph J King","doi":"10.5435/JAAOS-D-24-00325","DOIUrl":"10.5435/JAAOS-D-24-00325","url":null,"abstract":"<p><strong>Objective: </strong>The purpose of this study was to evaluate the clinical outcomes in patients who underwent bilateral total shoulder arthroplasty (TSA) at a single institution. Secondarily, we evaluated the influence of the time interval between successive TSAs on clinical outcomes of the second TSA.</p><p><strong>Methods: </strong>A single-institution shoulder arthroplasty database was reviewed for patients undergoing bilateral primary anatomic TSA (aTSA) or reverse TSA (rTSA) between 2000 and 2022. Clinical outcomes, including outcome scores, range of motion, and shoulder strength, were assessed in patients with minimum 2-year follow-up. Postoperative complications and achievement of the minimal clinical important difference, substantial clinical benefit (SCB), and patient acceptable symptomatic state (PASS) were evaluated. Statistical comparisons were made between first and second TSAs, between TSA variations, and based on time between TSAs (<1, 1 to 5, >5 years).</p><p><strong>Results: </strong>We identified 180 bilateral TSA patients (68 aTSA/aTSA, 29 aTSA/rTSA, three rTSA/aTSA, 80 rTSA/rTSA). When evaluating side-to-side differences, the second rTSA in the aTSA/rTSA group had more favorable postoperative Shoulder Pain and Disability Index ( P = 0.032) and forward elevation strength ( P = 0.028) compared with the first aTSA. No other side-to-side comparisons were statistically significant or exceeded the minimal clinical important difference, SCB, or PASS. Patients undergoing second aTSA after first aTSA or undergoing first rTSA had superior SCB and PASS for active external rotation ( P = 0.009 and P = 0.005, respectively). Complications were similar between strata, but revision rates were lowest after first rTSA in rTSA/rTSA patients. The time interval between successive TSAs did not influence the clinical outcome.</p><p><strong>Conclusion: </strong>All bilateral TSA combinations demonstrated excellent outcomes with most patients achieving clinically relevant benchmarks, with no influence of timing between arthroplasties.</p><p><strong>Level of evidence: </strong>III, retrospective comparative cohort study.</p>","PeriodicalId":51098,"journal":{"name":"Journal of the American Academy of Orthopaedic Surgeons","volume":" ","pages":"e224-e233"},"PeriodicalIF":2.6,"publicationDate":"2025-02-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142787014","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":"Osteoporotic Fragility Fracture Is Associated With an Increased Rate of New Mental Disorder Diagnosis.","authors":"Jacob S Budin, Julianna E Winter, Bela P Delvadia, Olivia C Lee, William F Sherman","doi":"10.5435/JAAOS-D-24-00378","DOIUrl":"10.5435/JAAOS-D-24-00378","url":null,"abstract":"<p><strong>Introduction: </strong>Fragility fractures can be substantially life-altering with notable effects on patient well-being and mental health. The purpose of this study was to evaluate the risk of developing a new mental disorder diagnosis within 2 years following osteoporotic fragility fracture.</p><p><strong>Methods: </strong>A retrospective cohort study was conducted using a large national insurance claims database. Patients with proximal humerus, wrist, pelvis, hip, and spine fractures were matched in a 1:4 ratio with nonfracture control patients. Rates of mental disorders after primary fragility fractures were compared using multivariable logistic regression. Mental disorders evaluated included alcohol use disorder, generalized anxiety disorder, bipolar disorder, major depressive disorder, drug use disorder, panic disorder, posttraumatic stress disorder, and suicide attempt.</p><p><strong>Results: </strong>Elderly patients who sustained fragility fractures had a statistically significant increased risk of being diagnosed with many of the queried mental disorders within 2 years following fracture compared with control patients with no fracture. Comparing each individual fragility fracture demonstrated that hip fractures had the greatest risk of developing any of the queried mental disorders (OR:1.88, CI: 1.74-2.03).</p><p><strong>Conclusion: </strong>There is an increased risk of being diagnosed with a new mental disorder following fragility fracture in patients older than 65 years. Mental health screening and potential psychiatric evaluation should be considered for patients following fragility fracture.</p><p><strong>Study design: </strong>Original Research (Level III).</p>","PeriodicalId":51098,"journal":{"name":"Journal of the American Academy of Orthopaedic Surgeons","volume":" ","pages":"202-209"},"PeriodicalIF":2.6,"publicationDate":"2025-02-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142814900","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":"Current Concepts of the Management of Painful Traumatic Peripheral Nerve Neuromas.","authors":"Ellen Y Lee, Mimi C Sammarco, Robert J Spinner, Alexander Y Shin","doi":"10.5435/JAAOS-D-24-00581","DOIUrl":"10.5435/JAAOS-D-24-00581","url":null,"abstract":"<p><p>Painful neuromas are a complex clinical condition that results in notable disability and functional impairment after injury to a peripheral nerve. When regenerating axons lack a distal target, they form a stump neuroma. Up to 60% of neuromas are painful because of mechanical sensitivity and crosstalk between nerve fibers. Clinical evaluation includes a thorough history and physical examination followed by directed diagnostic imaging and procedures to assess pain generators and their effect on quality of life. Nonsurgical management options may include pharmacological interventions, desensitization strategies, injections, and therapies to reduce pain perception and improve function. Surgical interventions, such as nerve reconstruction by direct repair or grafting, redirection to alternative targets, and containment of regenerating axons by relocation into innervated tissues or in grafts, are considered when conservative measures fail. A comprehensive and individualized treatment plan is crucial for optimizing patient outcomes with painful neuromas. The plan should consider the underlying pathology, pain generators, and psychosocial factors contributing to the patient's pain.</p>","PeriodicalId":51098,"journal":{"name":"Journal of the American Academy of Orthopaedic Surgeons","volume":" ","pages":"178-186"},"PeriodicalIF":2.6,"publicationDate":"2025-02-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143015524","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":"Diagnosis and Management of Orthopaedic Conditions Associated With Hereditary Sensory Autonomic Neuropathies.","authors":"Hans Kristian Nugraha, Arun Ramaswamy Hariharan, Aaron Joseph Huser, David Steven Feldman","doi":"10.5435/JAAOS-D-24-00237","DOIUrl":"10.5435/JAAOS-D-24-00237","url":null,"abstract":"<p><p>Hereditary sensory and autonomic neuropathies (HSANs) encompass a diverse group of inherited neuropathies characterized by notable sensory and autonomic involvement that affects musculoskeletal structures and systemic function. There are 8 recognized types of HSAN. The orthopaedic manifestations of HSAN are complex and diverse, including spinal deformity, Charcot arthropathy, osteomyelitis, fractures, osteonecrosis, osteoporosis, and skeletal deformities. The sensory neuropathy with involvement of small nerve fibers can lead to unnoticed burns, fractures, and joint trauma. Spinal involvement includes progressive scoliosis/kyphosis and acute neurologic compromise. Diagnosis is dependent on clinical suspicion and confirmed with genetic analysis. Treatment is focused on the eradication of infection, stabilization of fractures, and prevention of joint instability in the spine and extremities. This review focuses on the orthopaedic manifestations to aid healthcare professionals in the recognition and treatment of these conditions.</p>","PeriodicalId":51098,"journal":{"name":"Journal of the American Academy of Orthopaedic Surgeons","volume":" ","pages":"e205-e219"},"PeriodicalIF":2.6,"publicationDate":"2025-02-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142741154","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":"Does Tranexamic Acid Improve Early Postoperative Shoulder Motion After Total Shoulder Arthroplasty?","authors":"Logan T Wright, Robert J Cueto, Kevin A Hao, Reed Popp, Joseph B Hartman, Keegan M Hones, Jonathan O Wright, Thomas W Wright, Kevin W Farmer, Tyler J LaMonica, Bradley S Schoch, Joseph J King","doi":"10.5435/JAAOS-D-24-00737","DOIUrl":"10.5435/JAAOS-D-24-00737","url":null,"abstract":"<p><strong>Purpose: </strong>Although the hematologic benefits of tranexamic acid (TXA) have been thoroughly evaluated, an additional value demonstrated in knee arthroplasty and rotator cuff repair is improved early postoperative range of motion (ROM). This study aims to evaluate whether TXA given during total shoulder arthroplasty (TSA) confers improved early postoperative ROM or pain.</p><p><strong>Methods: </strong>We did retrospective review of 653 TSAs (223 anatomic TSA [aTSA] and 430 reverse TSA [rTSA]) performed in 596 patients at a single institution from 2007 to 2022. Intraoperative TXA use was implemented on a case-by-case basis starting in 2014 then became standard practice in 2016. Pre- to postoperative improvement in ROM was evaluated at 6 weeks, 3 months, 6 months, 1 year, and 2-years of follow-up. Mixed-effects models were used to evaluate whether administration of TXA intraoperatively improved ROM or pain at each follow-up time point.</p><p><strong>Results: </strong>TXA was administered to 26% (n = 58) of aTSAs and 43% (n = 179) of rTSAs. Patients with a history of hypertension received TXA at a higher rate for both aTSA ( P = 0.009) and rTSA ( P = 0.005). Intraoperative TXA was not associated with improved ROM or pain for aTSA or rTSA at any time point investigated. Average estimated intraoperative blood loss was markedly less in the TXA group for both aTSA [250 to 300 mL] ( P < 0.001) and rTSA [200 to 300 mL] ( P < 0.001) when compared with the non-TXA groups [300 to 400 mL for both].</p><p><strong>Conclusion: </strong>Intraoperative TXA does not improve ROM or pain after TSA. However, intraoperative blood loss was reduced, further supporting the routine use of TXA to reduce hematologic complications and improve intraoperative visibility.</p>","PeriodicalId":51098,"journal":{"name":"Journal of the American Academy of Orthopaedic Surgeons","volume":" ","pages":"e234-e243"},"PeriodicalIF":2.6,"publicationDate":"2025-02-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142741149","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":"Effect of Acromioclavicular Joint Injuries on the Acromioclavicular Joint Complex and Scapulohumeral Rhythm: A Functional and Mechanical Perspective.","authors":"W Ben Kibler, Austin V Stone, Jeffrey Grantham, Aaron Sciascia","doi":"10.5435/JAAOS-D-24-00360","DOIUrl":"https://doi.org/10.5435/JAAOS-D-24-00360","url":null,"abstract":"<p><p>This overview approaches the acromioclavicular joint (ACJ) and ACJ injuries from a mechanical perspective that places the ACJ complex-the scapula, clavicle, ACJ, AC and coracoclavicular ligaments, and periscapular muscles-into the context of its ability to facilitate scapulohumeral rhythm (SHR) functions of scapula placement and humeral mobility. Mechanical concepts underlying this perspective include linkage of the scapula and clavicle into a single segment, the \"claviscapula,\" the role of the AC and coracoclavicular ligaments in torque transduction and horizontal and vertical stability, and the deleterious effects of decoupling the claviscapular segment. The clinical examination and surgical treatment should address anatomic restoration of individual structures and the effect on the functional integrity of the entire ACJ complex within SHR. This context, which unifies anatomic injury with functional consequences, can be used to create a more comprehensive understanding of the clinical presentation and effect on ACJ function and SHR.</p>","PeriodicalId":51098,"journal":{"name":"Journal of the American Academy of Orthopaedic Surgeons","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143450903","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 Discordance Between Pain and Imaging in Knee Osteoarthritis.","authors":"Brandon G Hill, Stephanie Eble, Wayne E Moschetti, Peter L Schilling","doi":"10.5435/JAAOS-D-24-00509","DOIUrl":"https://doi.org/10.5435/JAAOS-D-24-00509","url":null,"abstract":"<p><strong>Introduction: </strong>Clinicians use imaging studies to help gauge the degree to which structural factors within the knee account for patients' pain and symptoms. We aimed to determine the degree to which commonly used structural features predict a patient's knee pain and symptoms.</p><p><strong>Methods: </strong>Using Osteoarthritis Initiative data, a 10-year study of 4,796 patients with knee osteoarthritis (KOA), participants' KOA was characterized by radiographs and MRI scans of the knee. Salient features were quantified with two established grading systems: (1) individual radiographic features (IRFs) and (2) MRI Osteoarthritis Knee Scores (MOAKS) from MRI scans. We paired participants' IRFs (24,256 readings) and MOAKS (2,851 readings) with side-specific Knee Injury and Osteoarthritis Outcome Scores (KOOS). We trained generalized linear models to predict KOOS from features measured in IRF and MOAKS. We repeated the analysis on four subsets of the cohort. The models' predictive performance was evaluated using root mean square errors and coefficient of determination (R2).</p><p><strong>Results: </strong>Neither radiographic features used to determine IRF grades nor MOAKS were predictive of patient pain or symptoms. MOAKS's performance was slightly more predictive of KOOS than IRF's. IRF's prediction of KOOS achieved a maximum R2 of 0.15 and 0.28 for MOAKS, indicating a low level of accuracy in predicting the target variable.</p><p><strong>Discussion: </strong>Commonly used structural features from radiographs and MRI scans cannot predict KOA pain and symptoms-even when imaging features are codified by established grading systems like IRF or MOAKS. The predictive performance of these models is even worse as symptom severity worsens.</p><p><strong>Level of evidence: </strong>IV.</p>","PeriodicalId":51098,"journal":{"name":"Journal of the American Academy of Orthopaedic Surgeons","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143450905","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}