Journal of Clinical Orthopaedics and Trauma最新文献

{"title":"Characteristics of pelvic injuries in a health region of New Zealand","authors":"Anna Sayers ,&nbsp;Sheena Moosa ,&nbsp;Ishani Soysa ,&nbsp;Grant Christey","doi":"10.1016/j.jcot.2025.103022","DOIUrl":"10.1016/j.jcot.2025.103022","url":null,"abstract":"<div><h3>Background</h3><div>Pelvic fractures involve a high volume of patients with low injury severity yet they are rarely described in the literature despite placing a considerable burden on hospital resources. This study aims to describe the demographics, mechanisms of injury, management and outcomes in patients who sustained pelvic trauma of all severities in a health region in New Zealand.</div></div><div><h3>Methods</h3><div>A retrospective analysis of Te Manawa Taki Trauma Registry data between January 1, 2014 and December 31, 2023 was conducted. Included are patients admitted to hospital with injuries to the pelvic ring and/or acetabula classified with the Abbreviated Injury Scale.</div></div><div><h3>Results</h3><div>A total of 3163 events were recorded and 53.5 % sustained severe pelvic injuries. The mean age was 45.9 years, 52 % male and 83.2 % non-Māori. The incidence throughout the study period averaged 33.7 per 100,000; however, in the final 3 years, the average incidence decreased to 25.9. Incidents most commonly occurred on streets/highways (46.5 %) and in the home (24.6 %). The mechanism of injury was blunt in 99.5 % of cases. Of the total, 76 % involved the pelvic ring, while 23.8 % were acetabular injuries. Additionally, 2.1 % of injuries were open. Posterior arch disruption was seen in 54 % of pelvic ring fractures, with 6.1 % showing complete disruption. The overall mortality rate for trauma admissions was 1.1 %, and 53.6 % of these patients had concurrent pelvic injuries. The case fatality rate of patients with pelvic injuries was 4.96 %. The mean length of stay was 12.1 days.</div></div><div><h3>Conclusion</h3><div>Pelvic fractures of different severities are frequently associated with high energy mechanisms of injury and represent a significant burden on patients, their families/whānau and healthcare services. Clear preventative measures and care pathways are needed to reduce incidence and minimise morbidity and mortality.</div></div>","PeriodicalId":53594,"journal":{"name":"Journal of Clinical Orthopaedics and Trauma","volume":"67 ","pages":"Article 103022"},"PeriodicalIF":0.0,"publicationDate":"2025-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143924710","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Anatomic MPFL reconstruction with Gracillis autograft using all suture anchors","authors":"Rahul Grover,&nbsp;Jaskaran Singh,&nbsp;Skand Sinha","doi":"10.1016/j.jcot.2025.103016","DOIUrl":"10.1016/j.jcot.2025.103016","url":null,"abstract":"","PeriodicalId":53594,"journal":{"name":"Journal of Clinical Orthopaedics and Trauma","volume":"66 ","pages":"Article 103016"},"PeriodicalIF":0.0,"publicationDate":"2025-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143854899","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Management and clinical outcomes of Dubberley type A capitellar fractures","authors":"Prateek A. Saxena ,&nbsp;Abhinandan Kotian ,&nbsp;Faris Ali ,&nbsp;Tamara Mertz ,&nbsp;Andrew P. Dekker ,&nbsp;Neil Ashwood","doi":"10.1016/j.jcot.2025.102926","DOIUrl":"10.1016/j.jcot.2025.102926","url":null,"abstract":"<div><h3>Aims</h3><div>Capitellar fractures are uncommon, accounting for 0.5–1 % of all elbow fractures. These fractures are best managed surgically to restore articular congruity. Dubberley type A fractures treated with anterolateral or lateral surgical approaches have been associated with high complication rates. The ‘Global’ approach to elbow has been conceptualised in order to comprehensively approach elbow injuries. The aim of this study was to evaluate the clinical outcomes of fractures of the capitellum treated using global surgical approach.</div></div><div><h3>Methods</h3><div>Data was prospectively collected for all patients presenting between 1998 and 2020.Patient's demographics, mechanism of injury, Mayo Elbow Performance Index MEPI, Grip Strength and radiographs were retrospectively collected and analysed.</div></div><div><h3>Results</h3><div>31 patients met the inclusion criteria with a mean age of 47yrs (IQR 12–81yrs) years, 18 males: 13 female patients. According to Dubberley classification, 24 were type I, 5 were type II and 2 were type III. 4 patients sustained associated collateral ligament injuries and 2 patients had radial head fractures. Global approach with an inside Kaplan approach was used in 26 patients, others were treated with an inside Kocher or anterior approaches. Almost all fractures were fixed using headless screws alone (n = 25),6 patients had fixation augmented with bioabsorbable rods or a posterior buttress plate. Mean follow up was 46 months. Mean MEPI was 89 (SD8), Extension 9.35 ± 5.32, Flexion 130.29 ± 8.7, Pronation 59.16 ± 7.034, Supination 63.97 ± 7.1. Mean Grip strength was 22.94 ± 4.5. These were significantly better following surgery (p &lt; 0.001). Further surgery was only required in 1 case for stiffness. Overall complication rate was 9.6 %. There were no infections or cases of instability following fixation.</div></div><div><h3>Conclusion</h3><div>This study is one of the largest case series reporting good functional outcomes in Dubberley type A fractures treated with headless screws using global surgical approach. We report lowest complication rate,100 % fracture union rate and good MEPI scores.</div></div>","PeriodicalId":53594,"journal":{"name":"Journal of Clinical Orthopaedics and Trauma","volume":"66 ","pages":"Article 102926"},"PeriodicalIF":0.0,"publicationDate":"2025-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143900023","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Advancing spinal care excellence: A specialized training series for trauma nurse practitioners","authors":"Sari Wathiq Al Hajaj ,&nbsp;Karthic Swaminathan ,&nbsp;K.C. Mohan ,&nbsp;Hameed Malik ,&nbsp;Girish Swamy ,&nbsp;Sriram Harish Srinivasan","doi":"10.1016/j.jcot.2025.103019","DOIUrl":"10.1016/j.jcot.2025.103019","url":null,"abstract":"<div><h3>Background</h3><div>Trauma nurse practitioners (TNPs) play an essential role in trauma and orthopaedic care domains. Their contributions extend beyond the mere provision of patient care; they also serve to mitigate physician shortages. TNPs deliver comprehensive post- and pre-operative care and assist patients in their healing process, from the initial stages following fractures through to the various stages of treatment. This study focuses on developing a teaching series to improve their knowledge and skills in managing spine trauma. <strong>Materials and methods</strong>: We developed a structured educational program integrating theoretical instruction, interactive workshops, and practical sessions. The curriculum encompasses spinal anatomy, injury assessment, radiological imaging, and management strategies. Following these sessions, we gathered feedback through surveys to evaluate participants' confidence, knowledge enhancement, and overall satisfaction.</div></div><div><h3>Results</h3><div>A thorough statistical analysis of the collected surveys revealed a significant enhancement in TNP confidence, as indicated by a P value of 7.45 × 10⁻⁹, thus confirming the effectiveness of the training program. Approximately 82 % of respondents reported a considerable increase in their knowledge, while 85 % indicated that the outcomes of these sessions met their expectations. Furthermore, a substantial majority of participants, 96 %, expressed a desire for additional education and training.</div></div><div><h3>Conclusion</h3><div>The educational series has enhanced the confidence and expertise of Trauma Nurse Practitioners (TNPs) in managing spinal trauma. Our findings underscore the importance of implementing structured training programs to maximise TNPs' contributions, improve patient care, and reduce the burden on orthopaedic surgeons. Future research may investigate the long-term impacts, broaden training, and incorporate additional topics. Ultimately, this underscores the significance of continuous education for orthopaedic nursing.</div></div>","PeriodicalId":53594,"journal":{"name":"Journal of Clinical Orthopaedics and Trauma","volume":"66 ","pages":"Article 103019"},"PeriodicalIF":0.0,"publicationDate":"2025-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143852118","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Time-related predictors for adverse events in polytrauma patients undergoing stand-alone definitive surgery","authors":"Philipp Vetter,&nbsp;Cédric Niggli,&nbsp;Jan Hambrecht,&nbsp;Hans-Christoph Pape,&nbsp;Ladislav Mica","doi":"10.1016/j.jcot.2025.103017","DOIUrl":"10.1016/j.jcot.2025.103017","url":null,"abstract":"<div><h3>Background</h3><div>Timely triage is crucial for polytrauma patients. Those with lower injury severity and physiological stress typically undergo isolated definitive surgery, but predictors for adverse events (AEs) in this group remain unclear. This study aims to identify time-related predictors of AEs in polytrauma patients undergoing stand-alone definitive surgery, excluding damage control interventions.</div></div><div><h3>Methods</h3><div>We analyzed a trauma database spanning from 1996 to 2022, including 3653 patients. The focus was on individuals aged ≥16 years with an Injury Severity Score (ISS) ≥16 who underwent definitive orthopedic surgery. Injury and physiological parameters were recorded at admission and on the first and second days post-admission. Documented AEs included systemic inflammatory response syndrome (SIRS), sepsis, and mortality.</div></div><div><h3>Results</h3><div>Among the 276 patients (mean age: 45.0 years with confidence interval, CI, 42.7–47.2 years; 71.7 % male; median ISS: 27 with interquartile range: 20–34), the incidence of SIRS was 79 % (n = 218), sepsis 13.8 % (n = 38), and mortality 4 % (n = 11). Upon admission, severe head and facial injuries and elevated leucocyte count (LC) predicted SIRS. Predictors for sepsis included ISS, heart rate, pH, and prothrombin time (PT), while non-survivors were older, with more severe head injuries and lower base excess (BE). On day one, elevated lactate levels were noted in both septic patients and non-survivors; LC predicted sepsis. By day two, higher lactate persisted in both groups, with non-survivors also showing reduced BE and PT. Primary (admission day) and multiple surgeries correlated with SIRS, whereas delayed surgeries were associated with sepsis. No surgical factors were correlated with mortality.</div></div><div><h3>Conclusion</h3><div>Injury severity, physiological and surgical factors are associated with AEs in polytrauma patients undergoing definitive surgery. These findings with re-evaluation may help guide decision-making to minimize the risk of AEs.</div></div><div><h3>Level of evidence</h3><div>Cohort-study, Level of Evidence = III.</div></div><div><h3>Trial registration</h3><div>No. StV: 1-2008.</div></div>","PeriodicalId":53594,"journal":{"name":"Journal of Clinical Orthopaedics and Trauma","volume":"66 ","pages":"Article 103017"},"PeriodicalIF":0.0,"publicationDate":"2025-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143859660","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comprehensive systematic-review and meta-analysis: Treatment outcomes of unipedicular vs bipedicular approaches in vertebroplasty and kyphoplasty for osteoporotic vertebral compression fractures","authors":"Tharun Teja Aduri ,&nbsp;Mehar Dhillon ,&nbsp;Parth Bansal ,&nbsp;Arvind Vatkar ,&nbsp;Sarvdeep Singh Dhatt ,&nbsp;Vishal Kumar","doi":"10.1016/j.jcot.2025.103010","DOIUrl":"10.1016/j.jcot.2025.103010","url":null,"abstract":"<div><h3>Background</h3><div>Vertebroplasty or kyphoplasty is a safe and effective procedure to treat persistent pain and correct deformity for early mobilisation in an osteoporotic vertebral compression fracture. However, there is conflicting evidence supporting the unipedicular or bipedicular approach in terms of the outcomes and complications with a recent increase in literature and no meta-analysis in this decade. This review is aimed at providing insight into the comparison between unipedicular and bipedicular approaches for making clinical decisions.</div></div><div><h3>Methods</h3><div>Multiple databases were screened using the keywords: “kyphoplasty”, “vertebroplasty”, “unipedicular”, “bipedicular”, “osteoporotic fracture”, and “compression fracture”, and all the results were reviewed for inclusion of 20 articles and data analysis done to look for significant differences between the two approaches. The quality of the studies included is evaluated using MINORS criteria. This review is registered in the International Prospective Register of Systematic Reviews (PROSPERO) with ID: CRD4202511004028.</div></div><div><h3>Results</h3><div>We found no significant difference between the two groups in terms of patient-related outcomes (Visual Analogue scale and Oswestry Disability Index), radiological outcomes (kyphotic angle correction or vertebral height restoration), complications (cement leakage or adjacent vertebral fractures), fluoroscopy frequency with significantly less operative time in the unipedicular group.</div></div><div><h3>Conclusion</h3><div>Vertebroplasty and kyphoplasty, irrespective of unipedicular or bipedicular approach, are effective procedures providing pain relief and adequate functional outcomes with comparable complications, with the unilateral approach taking less operative time. However, in a clinical setting, the approach of kyphoplasty or vertebroplasty should depend on a patient's condition, fracture type and symmetry, along with the levels affected.</div></div>","PeriodicalId":53594,"journal":{"name":"Journal of Clinical Orthopaedics and Trauma","volume":"66 ","pages":"Article 103010"},"PeriodicalIF":0.0,"publicationDate":"2025-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143833541","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prevalence of extra-articular deformity (EAD) and tibia vara (TV) in patients undergoing total knee arthroplasty (TKA) in Indian population","authors":"Pathik Shah ,&nbsp;Anjali Tiwari ,&nbsp;Ishan Shah ,&nbsp;Lokesh Naik ,&nbsp;Aashiket Sable ,&nbsp;Vaibhav Bagaria","doi":"10.1016/j.jcot.2025.103015","DOIUrl":"10.1016/j.jcot.2025.103015","url":null,"abstract":"<div><h3>Background</h3><div>Varus deformity is the predominant knee deformity observed in osteoarthritic patients undergoing Total Knee Replacement (TKR). Extra-articular deformities (EADs) have been identified as one of the significant contributors to postoperative dissatisfaction and suboptimal functional outcomes.</div></div><div><h3>Methods</h3><div>This study analyzed 500 preoperative knee scannograms from 371 patients. Standing scannograms of both lower limbs were assessed by a trained orthopaedic surgeon to calculate several angular measurements: Hip-Knee-Ankle (HKA), Mechanical Lateral Distal Femoral Angle (mLDFA), Mechanical Medial Proximal Tibial Angle (mMPTA), Joint Line Congruence Angle (JLCA), Center Of Rotation of Angulation (CORA) for both femur and tibia, Epiphyseo-Diaphyseal Angle (EDA), and Tibia Vara Angle (TVA). An EAD was defined based on the CORA location being greater than 7 cm from the knee joint line for the tibia and greater than 3 cm for the femur.</div></div><div><h3>Results</h3><div>The mean age of patients was 66.58 ± 8.19 years, with a male-to-female ratio of 1:2.28. Varus deformities were present in the femur in 279 knees (55.80 %), in the tibia in 206 knees (41.20 %), and in both femur and tibia in 127 knees (25.40 %). Notably, 498 knees (99.60 %) demonstrated increased JLCA, indicating significant joint line alteration. EADs were identified in 51 patients (10.2 %), signifying that approximately 1 in 10 patients operated on for TKA exhibited significant extra-articular deformities.</div></div><div><h3>Conclusions</h3><div>This study establishes that 10.20 % of knees in an Indian cohort displayed significant EADs. Varus deformities were primarily associated with alterations in LDFA, MPTA, and JCLA measurements. The almost universal alteration of joint lines among patients scheduled for TKR underscores the importance of precise preoperative planning. Embracing advanced technologies such as robotics and enhancing our understanding of varus deformity could facilitate a more tailored approach to deformity correction, potentially elevating surgical outcomes.</div></div>","PeriodicalId":53594,"journal":{"name":"Journal of Clinical Orthopaedics and Trauma","volume":"66 ","pages":"Article 103015"},"PeriodicalIF":0.0,"publicationDate":"2025-04-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143833442","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Choosing the right treatment for degenerative cervical myelopathy","authors":"Jong-Beom Park ,&nbsp;Gun Woo Lee","doi":"10.1016/j.jcot.2025.103014","DOIUrl":"10.1016/j.jcot.2025.103014","url":null,"abstract":"<div><div>Degenerative cervical myelopathy (DCM) is a progressive degenerative disorder of the spinal cord that can lead to significant and irreversible neurological deficits if left untreated. Determining the most appropriate treatment strategy requires a thorough assessment of disease severity, patient-specific factors, and comparative benefits of surgical versus non-surgical interventions.</div><div>Conservative treatment, including physical therapy, pharmacological treatment, and lifestyle modifications, might be considered for patients with mild symptoms and those deemed unsuitable for surgery. However, for cases with moderate to severe myelopathy or progressive neurological deterioration, surgical treatment remains the gold standard. Surgical options—including anterior cervical discectomy and fusion (ACDF), anterior cervical corpectomy and fusion (ACCF), laminoplasty, and laminectomy with or without fusion—should be selected based on the pattern of spinal cord compression, sagittal alignment, and patient comorbidities. ACDF and ACCF are preferred for focal anterior compression at limited levels, whereas laminoplasty is generally indicated for multilevel posterior compression in patients with preserved cervical lordosis. For cases with cervical kyphosis or significant instability, laminectomy with fusion is often required. In certain complex cases, a combined anterior-posterior approach may be necessary to achieve adequate decompression, restore spinal alignment, and enhance stability, particularly in patients with severe deformities or multilevel involvement.</div><div>Recent advances in minimally invasive spine surgery and motion-preserving techniques, such as cervical disc arthroplasty (CDA), have broadened the spectrum of treatment options, offering potential benefits for reducing perioperative morbidity and preserving segmental motion. Additionally, acute spinal cord injury due to trauma in a spondylotic spine, particularly central cord syndrome (CCS), represents a critical consideration in treatment planning. The role of anterior versus posterior surgery, including the rationale for decision-making, has been expanded to highlight key factors such as sagittal vertical axis, T1 slope, and spinal alignment. Moreover, we discuss the role of laminectomy without fusion in DCM management, evaluating its indications and limitations. Decision-making must carefully weigh patient-reported outcomes, complication risks, and long-term functional prognosis. This review provides an expert synthesis of current evidence and guidelines for DCM treatment, integrating the latest surgical innovations and a patient-centered approach to optimize clinical outcomes.</div></div>","PeriodicalId":53594,"journal":{"name":"Journal of Clinical Orthopaedics and Trauma","volume":"66 ","pages":"Article 103014"},"PeriodicalIF":0.0,"publicationDate":"2025-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143854881","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"What is the most advantageous lavage solution to use for fungal prosthetic joint infections","authors":"Maggie Manchester ,&nbsp;James B. Doub","doi":"10.1016/j.jcot.2025.103013","DOIUrl":"10.1016/j.jcot.2025.103013","url":null,"abstract":"<div><h3>Background</h3><div>Fungal prosthetic joint infections (PJI) are increasing yet we have a poor understanding on the proper treatment of these complex infections especially with respect to most advantageous lavage solutions to use clinically. Consequently, the objective of this study was to determine which commonly used lavage solutions are most advantageous at dispersing fungal biofilms.</div></div><div><h3>Methods</h3><div>Nine clinical isolates from past fungal prosthetic joint infections were used to form biofilms in 24 microwell plates. Then different lavage solutions were instilled, and residual biofilm were measured and compared to normal saline lavage solutions. Moreover, fungal biofilms were directly observed with scanning electron microscopy.</div></div><div><h3>Results</h3><div>All lavage solutions evaluated significantly (p &lt; 0.05) reduced fungal biofilms compared to normal saline. However, chlorhexidine gluconate and sodium hypochlorite were able to disperse fungal biofilms significantly (p˂0.05) more than the other lavage solutions. As well, scanning electron microscopy showed fungal biofilms are typically composed of hyphae and yeast forms for most Candidal species.</div></div><div><h3>Conclusion</h3><div>All lavage solutions can reduce Candidal biofilms, but chlorhexidine gluconate and sodium hypochlorite were the most advantageous agents in disrupting Candidal biofilms. Yet given the potential tissue toxicity associated with sodium hypochlorite should prioritize the use of chlorohexidine as lavage solutions in the clinical treatment of fungal PJI to help degrade biofilms on retained hardware and tissues. However, further studies are needed to determine the mechanism associated with degradation of fungal biofilms as well as evaluating novel ways to prevent Candidal hyphae formation in PJI.</div></div>","PeriodicalId":53594,"journal":{"name":"Journal of Clinical Orthopaedics and Trauma","volume":"66 ","pages":"Article 103013"},"PeriodicalIF":0.0,"publicationDate":"2025-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143833538","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Extended oral antibiotics in primary and revision total joint arthroplasty: An update","authors":"Charlie Yoo ,&nbsp;R. Michael Meneghini","doi":"10.1016/j.jcot.2025.103011","DOIUrl":"10.1016/j.jcot.2025.103011","url":null,"abstract":"<div><div>Periprosthetic joint infections (PJI) are a significant healthcare and economic burden after joint replacement surgery. Extended oral antibiotic prophylaxis (EOAP) has been highlighted as a safe, efficacious, and cost-effective measure to mitigate the risk of infection against the increasing demands for total joint arthroplasty (TJA). Several studies have demonstrated substantial reductions in PJI rates, particularly among high-risk populations receiving a 7-day course of antibiotics, mainly with use of cefadroxil. Conversely, other studies have found no significant differences or even increased infection rates, highlighting concerns over antimicrobial resistance, Clostridium difficile infections (CDI), and other antibiotic-related adverse events. Additionally, recent trends show a substantial rise in EOAP utilization across the United States, demonstrating need for clear and evidence-based guidelines. There is a need for high quality randomized controlled trials to help identify optimal patient selection criteria, antibiotic type, and duration to effectively balance the benefits of EOAP against potential risks. Although there is limited evidence of significant antibiotic associated complications with the use of EOAP, care should be utilized prior to widespread adoption with antibiotic stewardship in mind.</div></div>","PeriodicalId":53594,"journal":{"name":"Journal of Clinical Orthopaedics and Trauma","volume":"66 ","pages":"Article 103011"},"PeriodicalIF":0.0,"publicationDate":"2025-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143833439","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}