O'Hara NN, Sprague SA, Patterson JP
… +4 more, Druker V, Connor JT, Marvel D, Slobogean GP
J Bone Joint Surg Am
· 2026 May · PMID 42201994
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The MAPT is clinically relevant because it provides a practical framework for rapidly identifying which treatments improve survival, mobility, and recovery in patients with musculoskeletal conditions. It can directly gui...The MAPT is clinically relevant because it provides a practical framework for rapidly identifying which treatments improve survival, mobility, and recovery in patients with musculoskeletal conditions. It can directly guide better treatment decisions regarding a leading cause of disability.
Leijs LJ, Kha ST, Lucaciu AR
… +5 more, Gholipour A, Coan J, van der Wal RJP, Xiong GX, Tobert DG
J Bone Joint Surg Am
· 2026 May · PMID 42201990
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BACKGROUND: Use of preoperative Staphylococcus aureus nasal screening and decolonization varies across orthopaedic surgery. The efficacy of universal nasal screening with regard to surgical site infection (SSI) rates rem...BACKGROUND: Use of preoperative Staphylococcus aureus nasal screening and decolonization varies across orthopaedic surgery. The efficacy of universal nasal screening with regard to surgical site infection (SSI) rates remains unclear, particularly in elective orthopaedic procedures. METHODS: We conducted a multicenter retrospective cohort study of adults who underwent elective orthopaedic surgery. Patients were stratified by S. aureus nasal screening status within 90 days prior to surgery. Deep SSI (within 90 days postoperatively) was the primary outcome, and superficial SSI (within 7 to 30 days postoperatively) was defined as the secondary outcome. We used doubly robust adjustment involving propensity-score matching on 9 variables followed by logistic regression analysis with demographic and clinical covariates. RESULTS: The cohorts comprised 25,005 patients each (mean age, 63 years; 51% female; 88% White). After adjustment, screening was associated with lower odds of developing deep SSI (odds ratio [OR], 0.52 [95% confidence interval (CI), 0.39 to 0.70]; p < 0.001) and superficial SSI (OR, 0.67 [95% CI, 0.62 to 0.73]; p < 0.001). A positive, versus negative, methicillin-resistant S. aureus (MRSA) result was associated with an increased risk of deep (1.47% versus 0.41%; OR, 3.65 [95% CI, 1.59 to 8.38]; p < 0.001) and superficial (12.96% versus 7.63%; OR, 1.80 [95% CI, 1.34 to 2.42]; p < 0.001) SSI. Among screened patients with a deep SSI, only 5.7% had tested positive for MRSA on the screening test. CONCLUSIONS: Preoperative S. aureus nasal screening was associated with a significant reduction in the odds of developing deep and superficial SSIs following elective orthopaedic surgery. However, the overall incidence of deep infection was low, and the MRSA infection rate was negligible. These findings suggest that universal S. aureus nasal screening may have limited value and support consideration of targeted screening in higher-risk surgical populations. LEVEL OF EVIDENCE: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
Rizzo M, Lin I, Murray P
… +2 more, Sotereanos D, Stern P
J Bone Joint Surg Am
· 2026 May · PMID 42189960
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The word humility is derived from the Latin word humus, meaning "ground" or "soil." Romans equated humility with being grounded. Perhaps because it contradicts our natural tendencies toward self-preservation, humility re...The word humility is derived from the Latin word humus, meaning "ground" or "soil." Romans equated humility with being grounded. Perhaps because it contradicts our natural tendencies toward self-preservation, humility remains an often misunderstood and underappreciated virtue. It is foreign to many, especially in today's society, which is so focused on self-promotion. However, it is truly one of the most important and powerful virtues that a person can possess and practice. Humility is a just assessment of ourselves and the world around us. It is not thinking less of oneself; rather, it is actually thinking less about oneself. In looking beyond ourselves, we can obtain an honest estimate of our limitations and what is needed to remain patient-centered. In approaching our profession with humility, we more closely honor the privileges of caring for patients, teaching others, innovating, and advancing science. The aim of this article is to show how humility nurtures our development in all aspects of medicine. A humble clinician maintains a steadfast focus on their patient, a humble educator emphasizes the learner, a humble researcher respects science through their honesty and integrity, and a humble innovator does not let pride blind them, recognizing that innovation without humility is doomed to fail. In addition to being a superpower in medicine, humility blesses us with the wisdom and gratitude that come from experiencing, living for, and working for something bigger than ourselves. Gratitude has been considered the father of all virtues, and our ability to be truly grateful requires a core of humility.
Rosinsky PJ, Artamonov A, Sasson T
… +3 more, Issa MA, Debbi R, Lubovsky O
J Bone Joint Surg Am
· 2026 May · PMID 42189948
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➢ On October 7, 2023, a large-scale attack in southern Israel resulted in a major mass casualty event (MCE). One of the first hospitals to receive patients was Barzilai Medical Center (BMC) in Ashkelon, located approxima...➢ On October 7, 2023, a large-scale attack in southern Israel resulted in a major mass casualty event (MCE). One of the first hospitals to receive patients was Barzilai Medical Center (BMC) in Ashkelon, located approximately 10 km north of the Gaza border. ➢ During the first 24 hours, BMC managed a substantial extremity injury burden, placing orthopaedic surgeons in central operational roles. These extended beyond surgical care to include emergency department (ED) triage, operating room (OR) prioritization, and interhospital coordination. ➢ Israel's longstanding experience with MCE preparedness enabled rapid nationwide mobilization of medical personnel, and the country's compact geography and integrated trauma network facilitated early transfer of patients across hospitals. ➢ Patient arrival did not occur immediately and only peaked several hours after the onset of the attack. This delay allowed for staff mobilization, OR preparation, and establishment of coordinated patient transfer. ➢ The preservation of operative capacity required selective surgical management. Essential stabilization measures performed in the ED, including hemorrhage control, tourniquet reassessment, vascular evaluation, wound debridement, and provisional immobilization, enabled safe stabilization and patient transfer, while reducing the risk of preventable ischemic injury. ➢ These findings support the role of frontline trauma centers as early stabilization hubs within regional trauma systems, where preserving capacity depends on rapid triage, selective intervention, and timely transfer.
Galoaa BM, Ubong SE, Girgis AG
… +2 more, Gonzalez MR, Lozano-Calderon SA
J Bone Joint Surg Am
· 2026 May · PMID 42189947
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BACKGROUND: Osteosarcoma treatment decisions require accurate prognostic assessment, yet utilization of machine learning (ML) models is problematic because performance degrades consistently when models are applied across...BACKGROUND: Osteosarcoma treatment decisions require accurate prognostic assessment, yet utilization of machine learning (ML) models is problematic because performance degrades consistently when models are applied across data sets. Current single-data-set models (single models) learn population-specific patterns rather than generalizable disease characteristics, limiting their clinical implementation. We developed a multicomponent-model (multi-model) ML framework using domain-adversarial training across 2 national registries, integrating structured clinical variables with text-based patient data to learn generalizable disease patterns and achieve reliable survival prediction across diverse populations. METHODS: We conducted a retrospective study using data from 2 national cancer registries: SEER (Surveillance, Epidemiology, and End Results; n = 4,278 patients, 2004 to 2015) and NCDB (National Cancer Database; n = 4,049 patients, 2004 to 2018). We compared the cross-data-set performance of single models versus the multi-models. Primary outcomes were performance metrics for 2-year and 5-year overall survival predictions, measured by the area under the receiver operating characteristic curve (AUC), precision, recall, F1-score, and Brier score. RESULTS: Single models achieved strong internal validation performance (AUC, 0.898 to 0.927) but performance declined substantially in cross-data-set validation (AUC, 0.563 to 0.665). The multi-model approach achieved cross-data-set AUCs of 0.708 to 0.843 for 2-year survival and 0.648 to 0.798 for 5-year survival, with improvements of 0.085 to 0.199 over single models across all evaluation metrics. CONCLUSIONS: The multi-model ML approach demonstrated improved osteosarcoma prognostic ability across health-care data sets, addressing the generalizability challenges of models based on a single data set. Enhanced cross-data-set performance suggests the potential for consistent risk stratification to guide surgical planning, adjuvant therapy selection, and patient counseling. Prospective validation is needed to evaluate clinical impact. LEVEL OF EVIDENCE: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
Sanchez-Sotelo J, Hart CM, Weir TB
… +4 more, Graden N, Gulzar M, ElHassan B, Wagner E
J Bone Joint Surg Am
· 2026 May · PMID 42166562
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BACKGROUND: The purpose of this study was to describe, and report the outcomes of, a surgical technique that combines reverse shoulder arthroplasty (RSA) using an allograft-prosthetic composite (APC) with a lower trapezi...BACKGROUND: The purpose of this study was to describe, and report the outcomes of, a surgical technique that combines reverse shoulder arthroplasty (RSA) using an allograft-prosthetic composite (APC) with a lower trapezius transfer (LTT) to the infraspinatus of the allograft extended with the inferior capsule. METHODS: Between 2019 and 2023, 2 surgeons performed a total of 27 RSAs using an APC in conjunction with an LTT. Once the RSA APC reconstruction had been performed, cuff-capsule allograft tissue was passed posterior to the glenosphere and secured to the harvested lower trapezius. One shoulder was resected for periprosthetic joint infection; the remaining 26 shoulders were followed for a minimum of 2 years (mean, 2.7 years; range, 2 to 5 years). RESULTS: The rate of revision or reoperation for humeral complications was 15% and included secondary bone grafting (2 shoulders), resection for infection (1 shoulder), and internal fixation of a periprosthetic fracture (1 shoulder). Other complications requiring surgery included hematoma treated with evacuation (2 shoulders), dislocation (1 shoulder), and glenosphere disassociation (1 shoulder). Preoperatively, 11 shoulders presented with pseudoparalysis, and the mean active elevation of the remaining 16 shoulders was 43°, with only 1 shoulder demonstrating >90° of active elevation. At the most recent follow-up, 3 shoulders were pseudoparalytic, 11 had <90° of active elevation, 8 had >90° of active elevation, and 3 had active elevation to 90°. The overall mean active elevation of the 25 shoulders that could be assessed was 79°. Preoperatively, only 4 (15%) of the 27 shoulders demonstrated active external rotation past neutral; at the most recent follow-up, 80% of surviving shoulders had active external rotation past neutral. CONCLUSIONS: LTT at the time of RSA using an APC has the potential to restore active external rotation in shoulders with proximal humeral bone loss and posterosuperior cuff deficiency. LEVEL OF EVIDENCE: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
Lam AD, Parikh N, Leipman JH
… +7 more, Abe EA, Hoffman E, Linton AA, Bido J, Purtill JJ, Fillingham YA, Krueger CA
J Bone Joint Surg Am
· 2026 May · PMID 42166561
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BACKGROUND: With evolving patient expectations and practice models, perioperative communication through telephone and web encounters, termed "touchpoints," gains further importance. This study quantifies the workload cre...BACKGROUND: With evolving patient expectations and practice models, perioperative communication through telephone and web encounters, termed "touchpoints," gains further importance. This study quantifies the workload created by telephone calls and electronic messages during patient episodes of care and analyzes their change over time. METHODS: We retrospectively reviewed 277,729 telephone calls and 16,966 electronic messages within the 30-day preoperative periods and the 90-day postoperative periods of 45,216 patients who underwent primary total hip arthroplasty (THA) or total knee arthroplasty (TKA) from January 1, 2016, to December 31, 2022. Touchpoints were temporally trended by year to characterize utilization over time. Regression analysis was performed to determine factors predictive of increased touchpoint utilization. RESULTS: Preoperatively, patients had a mean of 2.2 telephone calls (2.2 for THA and 2.1 for TKA) and 2.3 electronic messages (2.3 for both THA and TKA). Postoperatively, patients had a mean of 4.4 telephone calls (4.1 for THA and 4.6 for TKA) and 2.8 electronic messages (2.8 for both THA and TKA). From 2016 to 2022, the total perioperative touchpoints increased by 105% (8.7 to 17.8 touchpoints) for patients who underwent TKA and by 121% (7.3 to 16.1 touchpoints) for patients who underwent THA. Medicare insurance was independently associated with fewer touchpoints compared with commercial insurance (beta estimate, -0.31 [95% confidence interval, -0.41 to -0.21]; p < 0.001). CONCLUSIONS: Practices can now expect to handle a mean of 17.8 touchpoints for patients who undergo TKA and 16.1 for patients who undergo THA. The increase in touchpoint utilization underscores a growing strain on orthopaedic practices' resources as reimbursement for these procedures continues to decrease. Future policy discussions must acknowledge and remunerate the time spent communicating via telephone calls and electronic messages to offset their increasing frequency. CLINICAL RELEVANCE: As orthopaedic care begins to extend beyond the operating room into patient communication pathways, understanding how the growing touchpoint utilization can strain resources and adversely affect high-quality patient care is essential.
Perry AJ, Kalva S, Fucich D
… +5 more, Muppidi S, Aggarwal M, Virk MS, Zuckerman JD, Yao JJ
J Bone Joint Surg Am
· 2026 May · PMID 42166556
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BACKGROUND: The use of large language models (LLMs) is increasingly common. However, LLMs may exhibit sycophancy, echoing users' beliefs while avoiding contradiction. In the present study, we describe sycophancy in gener...BACKGROUND: The use of large language models (LLMs) is increasingly common. However, LLMs may exhibit sycophancy, echoing users' beliefs while avoiding contradiction. In the present study, we describe sycophancy in general-purpose LLMs when applied to orthopaedic contexts. METHODS: We investigated sycophancy in 2 general-purpose LLMs. We evaluated performance on 3 tasks: (1) accuracy on benchmark answering: LLMs were tested on validated benchmark orthopaedic questions, with correct and incorrect cues, and the change in accuracy and sycophancy error rate were determined; (2) user belief agreement: LLMs were provided with ambiguous statements and a user belief, and LLM agreement, contradiction, and uncertainty were described; and (3) false information detection: false information was placed within a task prompt to measure noncontradiction and propagation rates. RESULTS: Baseline factual accuracy on benchmark questioning was 78%, decreasing with correct hints (71%) (p = 0.49). With incorrect hints, LLM accuracy declined significantly (48%) (p < 0.001), with a sycophancy error rate of 52%. Presented with user beliefs about an indefinite, controversial statement, models echoed user beliefs in 56%, expressed uncertainty in 12%, and contradicted users in 32% of statements. In noncontradiction tasks, models perpetuated incorrect attributions 99% of the time yet reliably corrected statistical distortions 97% of the time. CONCLUSIONS: Although popular general-purpose LLMs have useful orthopaedic applications, they exhibit sycophancy, with a tendency toward agreement and without recognition of ambiguity. This is a key weakness to be addressed. Findings should be interpreted cautiously given the variability in model design, prompting, and models evaluated. CLINICAL RELEVANCE: The tendency of general-purpose LLMs to agree without recognizing clinical ambiguity may limit their reliability in orthopaedic applications.
Nassar JE, Ammar LA, Toavs TL
… +5 more, Kim J, Knebel A, Daher M, Shaffrey CI, Daniels AH
J Bone Joint Surg Am
· 2026 Jul · PMID 42166544
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➢ Implant surface characteristics play a critical role in promoting osseointegration and long-term spinal fusion success. ➢ Titanium and polyetheretherketone (PEEK) are the most commonly utilized materials in interbody c...➢ Implant surface characteristics play a critical role in promoting osseointegration and long-term spinal fusion success. ➢ Titanium and polyetheretherketone (PEEK) are the most commonly utilized materials in interbody cages, each with distinct advantages and limitations. ➢ Surface modifications such as roughening, porosity, and hydroxyapatite coatings enhance osseointegration and early fusion outcomes. ➢ Emerging materials, including silicon nitride and porous tantalum, demonstrate favorable biological and mechanical properties but require further clinical validation. ➢ No single implant material or surface technology has shown consistent clinical superiority, highlighting the need for ongoing research and evidence-based selection.
Kibsgård TJ, Gerdhem P, Diarbakerli E
… +1 more, Randers EM
J Bone Joint Surg Am
· 2026 May · PMID 42154897
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Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.