Journal of the American Academy of Orthopaedic Surgeons最新文献

{"title":"Is Periacetabular Osteotomy With Hip Arthroscopy Superior to Periacetabular Osteotomy Alone? A Systematic Review and Meta-Analysis.","authors":"Sean C Clark, Christopher V Nagelli, Xuankang Pan, Karissa N Simon, Rafael J Sierra, Mario Hevesi","doi":"10.5435/JAAOS-D-24-00875","DOIUrl":"https://doi.org/10.5435/JAAOS-D-24-00875","url":null,"abstract":"<p><strong>Introduction: </strong>There remains ongoing controversy regarding the optimal treatment strategy of hip dysplasia, with some advocating for the addition of hip arthroscopy to periacetabular osteotomy (PAO) to address concomitant labral tears. The purpose of this systematic review was to compare the clinical outcomes, complications, and joint preservation of PAO and PAO with hip arthroscopy.</p><p><strong>Methods: </strong>A literature search was done, and studies were included if they reported outcomes of PAO with concomitant hip arthroscopy, PAO with staged hip arthroscopy, or compared outcomes of PAO alone versus PAO with hip arthroscopy. A meta-analysis was conducted with respect to studies who compared preoperative to postoperative change in modified Harris Hip Score between PAO and PAO with hip arthroscopy.</p><p><strong>Results: </strong>Twenty studies were included in this review. Most patients demonstrated preoperative labral pathology. Pooled analysis of the postoperative change in modified Harris Hip Score showed no difference between PAO with concomitant hip arthroscopy and PAO alone (P = 0.238). Three of six studies comparing both surgical techniques demonstrated a notable postoperative improvement for select outcome scores for the PAO plus hip arthroscopy group but not for the PAO alone group. Of note, no studies demonstrated a notable improvement in the PAO alone group compared with PAO plus hip arthroscopy. The rates of complications and conversion to total hip arthroplasty for both procedures were notably similar.</p><p><strong>Conclusion: </strong>Favorable and comparable clinical outcomes were observed for both PAO alone and PAO with hip arthroscopy. Although PAO with hip arthroscopy demonstrated statistically superior clinical outcomes for some measures, it was never inferior to PAO alone. Randomized controlled studies with extended follow-up are needed to better understand the potential difference in long-term outcomes and rates of conversion to total hip arthroplasty between these procedures.</p>","PeriodicalId":51098,"journal":{"name":"Journal of the American Academy of Orthopaedic Surgeons","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2024-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142820180","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":"Death of the P Value? Bayesian Statistics for Orthopaedic Surgeons.","authors":"Michael Polmear, Terrie Vasilopoulos, Nathan O'Hara, Thomas Krupko","doi":"10.5435/JAAOS-D-24-00813","DOIUrl":"https://doi.org/10.5435/JAAOS-D-24-00813","url":null,"abstract":"<p><p>Statistical interpretation is foundational to evidence-based medicine. Frequentist (P value testing) and Bayesian statistics are two major approaches for hypothesis testing. Studies analyzed with Bayesian methods are increasingly common with a 4-fold increase in the past 10 years. The Bayesian approach can align with clinical decision making by interpreting smaller differences that are not limited by P values and misleading claims of \"trends toward significance.\" Both methods follow a workflow that includes sampling, hypothesis testing, interpretation, and iteration. Frequentist methodology is familiar and common. However, the limitations are the misunderstanding, misuse, and deceptively simple utility of interpreting dichotomous P values. Bayesian approaches are relatively less common and provide an alternative approach to trial design and data interpretation. Marginal differences elucidated by Bayesian methods may be perceived as less decisive than a P value that may reject a null hypothesis. The purposes of this review are to introduce Bayesian principles and Bayes theorem, define how pretest probability and known information may inform diagnostic testing using an example from prosthetic joint infection, contrast Bayesian and frequentist approaches using an example from the VANCO orthopaedic prospective trial, and describe the criteria for critically reviewing Bayesian studies.</p>","PeriodicalId":51098,"journal":{"name":"Journal of the American Academy of Orthopaedic Surgeons","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2024-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142814839","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":"Letter to the Editor: The Frailty of Fragility Index, Orthopaedic Paradigms and Practice.","authors":"Aleksi Reito, Teemu Karjalainen","doi":"10.5435/JAAOS-D-23-00862","DOIUrl":"https://doi.org/10.5435/JAAOS-D-23-00862","url":null,"abstract":"","PeriodicalId":51098,"journal":{"name":"Journal of the American Academy of Orthopaedic Surgeons","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2024-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142814899","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":"Characterizing the Rotational Profile of the Distal Femur: A Roadmap for Distal Femoral Replacement Surgery.","authors":"Matthew S Chen, Kevin C Liu, Matthew C Gallo, Nicholas Kusnezov, Brian C Chung, Darryl Hwang, Alexander B Christ, Nathanael D Heckmann","doi":"10.5435/JAAOS-D-24-00207","DOIUrl":"https://doi.org/10.5435/JAAOS-D-24-00207","url":null,"abstract":"<p><strong>Introduction: </strong>Standard references for determining rotational alignment are often unavailable when performing distal femoral replacement (DFR) surgery. This study aimed to describe the rotational profile of the distal femoral osteology at common resection levels.</p><p><strong>Methods: </strong>Adults with CT scans of the bilateral legs were included. Exclusion criteria included fractures, congenital deformity, prior arthroplasty, or inadequate imaging. Referencing the transepicondylar axis, angles were measured in the axial plane using the following reference lines: anterior condylar axis or anterior femoral cortex axis (AFCA), posterior condylar axis or posterior femoral cortex axis (PFCA), lateral projection of the linea aspera (LAA), and Whiteside line (WL). These rotational measurements were assessed at 3, 5, 7, and 9 cm proximal of the joint line. External and internal rotation were denoted as positive and negative, respectively.</p><p><strong>Results: </strong>Fifty-one patients (102 femora) were included (mean age: 62.6 ± 13.4 years; mean body mass index: 26.0 ± 6.7 kg/m2). Proximally, the anterior condylar axis/anterior femoral cortex axis became increasingly internally rotated (3-cm: -13.1 ± 3.5°, 9-cm: -21.2 ± 6.6°), whereas the posterior condylar axis/PFCA became increasingly externally rotated (3-cm: -6.7 ± 2.3°, 9-cm: 9.6 ± 6.1°). WL remained nearly perpendicular (3-cm: 88.8 ± 2.3°, 5-cm: 89.8 ± 3.7°) but was not reliably measured beyond 5 cm. The LAA was measurable proximal to 5 cm from the joint line and was internally rotated (5-cm: -58.5 ± 14.3°, 9-cm: -45.6 ± 13.4°).</p><p><strong>Conclusion: </strong>Distally, WL is a reliable anatomic landmark for femoral implant rotation. At more proximal resection levels, the posterior cortex may be a valuable landmark as referencing the linea aspera may lead to gross internal rotation of the femoral implant.</p>","PeriodicalId":51098,"journal":{"name":"Journal of the American Academy of Orthopaedic Surgeons","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2024-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142814835","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":"Biportal Endoscopic Transforaminal Interbody Fusion: Comparing Primary Versus Revision Cases.","authors":"Ju-Eun Kim, Eugene J Park, Daniel K Park","doi":"10.5435/JAAOS-D-23-01031","DOIUrl":"https://doi.org/10.5435/JAAOS-D-23-01031","url":null,"abstract":"<p><strong>Background: </strong>The safety and efficacy of biportal endoscopic lumbar interbody fusion (BELIF) has been supported by many articles. Advantages include earlier rehabilitation and equal or superior fusion rates compared with other lumbar interbody fusion techniques.</p><p><strong>Purpose: </strong>To compare the clinical and radiological outcomes of primary and revision biportal endoscopic interbody fusion.</p><p><strong>Methods: </strong>Seventy-two consecutive patients who underwent primary and revision BELIF and had at least 2-year follow-up were investigated. Clinical outcomes, including Oswestry Disability Index, the visual analog system (VAS), MacNab's criteria, surgical time, and length of hospital stay, were recorded. Radiological outcome was assessed by CT and graded according to Bridwell system.</p><p><strong>Results: </strong>No notable difference was found in preoperative baselines between the groups. Both groups demonstrated similar clinical improvement in VAS, Oswestry Disability Index, and MacNab criteria. Durotomies were more common in the revision setting (4/33 vs. 0/39 in primary), and surgical time was statistically longer (121.4 ± 21.5 minutes primary versus 179 ± 23.7 minutes revision; P < 0.001). However, no difference was observed in fusion rates at all times points graded by CT scan (94.87% vs. 93.93% primary versus revision at the final follow-up, P = 0.51).</p><p><strong>Conclusion: </strong>Revision BELIF demonstrate similar clinical and radiographic outcomes compared with primary BELIF, yet surgical time and durotomy risks are increased.</p><p><strong>Study design: </strong>Retrospective study.</p>","PeriodicalId":51098,"journal":{"name":"Journal of the American Academy of Orthopaedic Surgeons","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2024-12-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142814829","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":"https://doi.org/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":""},"PeriodicalIF":2.6,"publicationDate":"2024-12-06","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":"Segmental Lordosis Restoration During Lumbar Degenerative Spinal Fusion: Surgical Techniques and Outcomes.","authors":"Alan H Daniels, Christopher L McDonald, Bassel G Diebo","doi":"10.5435/JAAOS-D-24-00749","DOIUrl":"https://doi.org/10.5435/JAAOS-D-24-00749","url":null,"abstract":"<p><p>The science of spinal alignment has progressed rapidly since Jean Doubousset described the cone of economy in the 1970s. It is now clearly established that global and regional spinal alignment are associated with improved patient-reported outcome and rates of success of lumbar spinal fusion. Evidence has now emerged that segmental level-by-level alignment is also associated with positive patient outcomes. As such, restoring sagittal alignment matched to spinopelvic morphology during degenerative lumbar surgery can optimize surgical outcomes by preventing adjacent segment pathology. This review focuses on the vital importance of spinal alignment in different spinal conditions, provides a guide for measurement of spinopelvic parameters, and outlines literature regarding lumbar restoration in degenerative spinal fusion.</p>","PeriodicalId":51098,"journal":{"name":"Journal of the American Academy of Orthopaedic Surgeons","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2024-12-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142814903","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 Letter to the Editor: \"Correlation Between Patient-reported and Clinician-measured Shoulder Range of Motion in Patients Undergoing Shoulder Surgery\".","authors":"Amin Razi, David Ring","doi":"10.5435/JAAOS-D-24-00795","DOIUrl":"https://doi.org/10.5435/JAAOS-D-24-00795","url":null,"abstract":"","PeriodicalId":51098,"journal":{"name":"Journal of the American Academy of Orthopaedic Surgeons","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2024-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142787564","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-Reported Outcome Measures in Hip Preservation Surgery: Are They All the Same?","authors":"Luke Sang, Kian Niknam, Ishaan Swarup","doi":"10.5435/JAAOS-D-24-00150","DOIUrl":"https://doi.org/10.5435/JAAOS-D-24-00150","url":null,"abstract":"<p><strong>Introduction: </strong>Historically, for hip procedures, the Hip Outcome Score (HOS) and the International Hip Outcome Tool 12 (iHOT-12) have been commonly usedas instruments for patient-reported outcome measures (PROMs). However, these tools are often influenced by other factors, such as concurrent illnesses, making more standardized tools a preferable choice. Patient-Reported Outcomes Measurement Information System-25 (PROMIS-25) is a standardized, validated PROMs metric that has correlated well with several other anatomy-specific PROMs tools. In this study, we aim to assess and compare the correlations between iHOT-12 and HOS with PROMIS-25 in adult and pediatric hip preservation patients.</p><p><strong>Methods: </strong>This study included patients indicated for a hip preservation procedure at our institution. All patients completed the iHOT-12, HOS, and PROMIS instruments through an electronic PRO platform before surgery. Spearman correlations were calculated separately for adult and pediatric patients between the various domains in each tool. A rho-to-z transformation analysis was conducted to assess whether there are differences in PROMs correlations between demographic factors.</p><p><strong>Results: </strong>A total of 62 patients were enrolled in this study from July 2020 to July 2023. The average age was 20.1 years (SD: 6.7 years), and more pediatric patients (64.5%) were enrolled than adult patients (35.4%). Multiple PROMIS domains, such as functional mobility, had strong or strong-moderate correlations with other hip PROMs in both adult (HOS activities of daily living: ρ = 0.76, P < 0.01; HOS Sports: ρ = 0.84, P < 0.01; iHOT-12: ρ = 0.85, P < 0.01) and pediatric (HOS activities of daily living: ρ = 0.79, P < 0.01; HOS Sports: ρ = 0.88, P < 0.01; iHOT-12: ρ = 0.66, P < 0.01) patients. Notable effects of age and sex were observed on correlations between PROMs (P< 0.05).</p><p><strong>Conclusion: </strong>There are strong correlations between iHOT-12, HOS, and PROMIS domains designed to measure similar constructs in both age groups. However, certain demographic differences may markedly influence the correlation between iHOT-12/HOS and PROMIS. PROMIS-25 can accurately capture outcomes for both adult and pediatric patients undergoing hip preservation surgery.</p>","PeriodicalId":51098,"journal":{"name":"Journal of the American Academy of Orthopaedic Surgeons","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2024-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142830283","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":"Risk Factors for Venous Thromboembolism Following Total Knee Arthroplasty: An Analysis of 3,052 Pulmonary Emboli.","authors":"Nicholas Kusnezov, Avinash Iyer, Mary K Richardson, Amit S Piple, Jennifer C Wang, Kevin C Liu, Alexander B Christ, Jay R Lieberman, Nathanael D Heckmann","doi":"10.5435/JAAOS-D-23-00426","DOIUrl":"https://doi.org/10.5435/JAAOS-D-23-00426","url":null,"abstract":"<p><strong>Introduction: </strong>Identifying risk factors for pulmonary embolism (PE) and deep vein thrombosis (DVT) following primary total knee arthroplasty (TKA) may improve risk stratification and guide surgeons in prophylaxis selection. This study aimed to identify factors associated with postoperative venous thromboembolism (VTE) following TKA.</p><p><strong>Methods: </strong>A national healthcare database was queried for adults who underwent primary, elective TKA from January 1, 2015 to December 31, 2020. Patients who developed PE or DVT within 90 days postoperatively were compared with patients who did not. Demographics, comorbidities, hospital factors, perioperative medications, and blood transfusion needs were assessed. A multivariate model was used to identify independent risk factors for VTE. Overall, 847,496 patients were identified, of whom 8,002 (0.94%) developed a VTE postoperatively (3,052 PE, 5,294 DVT).</p><p><strong>Results: </strong>After controlling for confounders, an elevated risk of VTE was associated with increased age (adjusted odds ratio [aOR]: 1.01, 95% confidence interval [CI] = 1.01-1.01, P < 0.001), Black patients (aOR: 1.30, 95% CI=1.28-1.47, P < 0.001), and patients enrolled in Medicare (aOR: 1.18, 95% CI = 1.13-1.24, P < 0.001) or Medicaid (aOR: 1.24, 95% CI = 1.12-1.37, P < 0.001). Independent risk factors for PE included obesity (aOR: 1.25, 95% CI = 1.16-1.35, P < 0.001), pulmonary hypertension (aOR: 3.64, 95% CI = 3.05-4.35, P < 0.001), and history of VTE (aOR: 1.71, 95% CI = 1.54-1.91, P < 0.001). Risk factors associated with an increased risk of DVT included iron deficiency anemia (aOR:1.38, 95% CI = 1.14-1.66, P < 0.001) and abnormal weight loss (aOR: 1.67, 95% CI = 1.07-2.60, P = 0.023).</p><p><strong>Conclusion: </strong>Increasing age, Black race, Medicare, or Medicaid insurance were associated with increased risk of VTE. Obesity, history of VTE, and pulmonary hypertension were risk factors for both PE and DVT. These data can assist surgeons in the selection of a prophylactic regimen after TKA.</p>","PeriodicalId":51098,"journal":{"name":"Journal of the American Academy of Orthopaedic Surgeons","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2024-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142830462","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}