Orthopedics [JOURNAL]
Sun
200 papers
Postoperative Fever Following Pelvic and Acetabular Fixation: Incidence, Risk Factors, and Lack of Association With Surgical Site Infection.
Ayoub M, Curtis E, Vue Y … +2 more , Wilson D, Movassaghi K
Orthopedics · 2025 · PMID 40396663 · Publisher ↗
BACKGROUND: Despite numerous studies showing postoperative fever can be a common and benign occurrence, there is still a significant and costly workup when fevers occur after surgery, including for orthopedic patients wi...
BACKGROUND: Despite numerous studies showing postoperative fever can be a common and benign occurrence, there is still a significant and costly workup when fevers occur after surgery, including for orthopedic patients with pelvic ring and acetabular injuries. MATERIAL AND METHODS: A total of 204 patients undergoing pelvis and/or acetabular fixation were analyzed for fever, with positive fever defined as temperature >38° Celsius. Age, sex, substance use, smoking history, body mass index, diabetes, comorbidities, American Society of Anesthesiologists (ASA) score, fracture morphology, polytrauma, surgical treatment, transfusion requirements, operative time, estimated blood loss, use of vancomycin powder, and surgical site infection (SSI) were all recorded. Surgical site infection was defined as an infection at the surgical site requiring reoperation, with positive cultures at time of secondary surgery. RESULTS: SSI was not associated with postoperative fever in patients undergoing pelvic and/or acetabular fixation. Higher ASA score, polytrauma, combined pelvic ring-acetabular fractures, open pelvic ring injuries, increased intraoperative blood loss, increased surgical time, and transfusions were associated with higher rates of fevers on univariate analysis. Multivariate analysis showed transfusions were the only independent risk factor for developing fever. CONCLUSION: Surgeons and clinicians managing orthopedic patients should be aware that postoperative fever is common after pelvis and acetabular fixation and is rarely related to SSI. [. 2025;48(4):229-233.].
Connecting Lives: Honoring the Gifts by Completing the Circle of Musculoskeletal Tissue Donation for Allograft Use Across Orthopedics.
Rucinski K, Crecelius CR, Stannard JP … +9 more , Crist BD, Schweser KM, Nuelle CW, DeFroda S, Ma R, Wilson NS, Moore LM, Evans HJ, Cook JL
Orthopedics · 2025 · PMID 40396662 · Publisher ↗
BACKGROUND: Each year, more than 1 million patients in the United States receive life-changing musculoskeletal (MSK) tissue transplants. These transformative gifts save and restore lives. Unfortunately, data from organ p...
BACKGROUND: Each year, more than 1 million patients in the United States receive life-changing musculoskeletal (MSK) tissue transplants. These transformative gifts save and restore lives. Unfortunately, data from organ procurement organizations suggest that orthopedic patients rarely contact donor families to acknowledge the gift, with less than 1% of tissue donor families ever receiving communication from recipients of their loved one's gifts. MATERIALS AND METHODS: In response, our team launched the "Connecting Lives" initiative in 2015 to address this gap. Initially focused on osteochondral and meniscus allograft, it expanded to all MSK allograft recipients at our facility in 2022. RESULTS: Among osteochondral and meniscus allograft recipients, this quality improvement initiative increased the percentage of MSK tissue transplant recipients writing to donor families from less than 1% to nearly 18%, comparable to organ donation rates (approximately 20%). The main barrier for non-writers was uncertainty about what to say. Despite this improvement, further efforts are needed to close the Tissue Donation Circle. CONCLUSION: Engaging patients before and after transplant surgery can help address emotional and practical barriers, fostering connection and honoring tissue donors. Orthopedic health care teams must contribute to "closing the loop" between allograft recipients and donor families through education, advocacy, resourcing, and support that drive completion of the Tissue Donation Circle. [. 2025;48(4):234-238.].
Therapeutic Efficacy of Percutaneous Curved Kyphoplasty Compared With Percutaneous Kyphoplasty in Treatment of Osteoporotic Vertebral Compression Fractures.
He J, Zhu H, Gong W … +1 more , Dai X
Orthopedics · 2025 · PMID 40396661 · Publisher ↗
BACKGROUND: Osteoporotic vertebral compression fractures (OVCFs) frequently occur in older adults. Appropriate surgical treatment of these fractures is still not well understood. This study sought to evaluate the therape...
BACKGROUND: Osteoporotic vertebral compression fractures (OVCFs) frequently occur in older adults. Appropriate surgical treatment of these fractures is still not well understood. This study sought to evaluate the therapeutic effectiveness of percutaneous curved kyphoplasty (PCKP) compared to percutaneous kyphoplasty (PKP) for OVCFs. MATERIALS AND METHODS: This study retrospectively analyzed 68 OVCF patients who underwent surgeries from July 2021 to June 2022 in Sheyang County People's Hospital. Patients were categorized into two groups based on surgical procedure (PCKP group = 35 patients, PKP group = 33 patients). Surgery duration, amount of x-ray imaging sessions conducted intraoperatively, bone cement injection dose, and outflow rate were compared between the two groups. Visual analogue scale (VAS), anterior vertebral height (AVH), and Cobb angle were measured at 1 week and 12 months after surgery. RESULTS: Compared with the PKP group, the amount of intraoperative x-ray imaging sessions (<0.05) and bone cement outflow rate (<0.05) were noticeably reduced in the PCKP group. The results identified no variation between groups in cement injection dose (>0.05). No meaningful statistical variation was found in VAS scores (>0.05), anterior border height of the injured vertebra (>0.05), or Cobb angle (>0.05) between two groups at 1 week and 12 months. CONCLUSION: This research suggests both PKP and PCKP are efficient and secure for pain relief, restoring vertebral body height, and correcting the Cobb angle. However, PCKP has advantages in reducing surgery duration, amount of intraoperative x-ray imaging sessions, and bone cement outflow rate. [. 2025;48(4):210-214.].
Radial Head Fractures: Current Trends in Treatment and Outcomes, A Retrospective Review.
Renfro KN, Patrick C, Parnes N … +2 more , Yoon A, Dunn J
Orthopedics · 2025 · PMID 40396660 · Publisher ↗
BACKGROUND: Radial head fractures are common elbow fractures in adults, and their treatment algorithm remains controversial. Particularly with displaced Mason III or IV radial head fractures, studies have shown mixed res...
BACKGROUND: Radial head fractures are common elbow fractures in adults, and their treatment algorithm remains controversial. Particularly with displaced Mason III or IV radial head fractures, studies have shown mixed results when comparing outcomes between radial head arthroplasty (RHA) and open reduction internal fixation (ORIF). Although multifactorial, patient characteristics often play a large role in treatment modality. The purpose of this study was to analyze the current trend in the management of radial head fractures, complications, and need for repeat operation among these groups. MATERIALS AND METHODS: We conducted a retrospective database review using the IBM Truven MarketScan Databases and analyzing all available patients treated for radial head fractures between 2015 to 2020. Patients were grouped by treatment modality, including nonoperative, ORIF, radial head excision (RHE), and RHA. Patient characteristics, complication rates, reoperation rates, and predictive factors for undergoing surgery were assessed. RESULTS: Our search yielded 18,945 cases of radial head fractures that underwent treatment. The majority of patients were managed nonoperatively (16,035), and fewer were treated via ORIF, RHA, and RHE (1,636, 1,174, and 100, respectively). Of these, between 1% and 2.5% of patients in each group underwent revision surgery. CONCLUSION: We found that patients who undergo RHA or RHE are typically older and have more comorbidities compared to patients who are treated nonoperatively or undergo ORIF. We found no significant difference in reoperation rates based on initial mode of treatment. Male sex, osteoporosis, coronary artery disease, and a displaced fracture are predictive of undergoing surgery for a radial head fracture. [. 2025;48(4):e169-e176.].
Patient-reported Outcomes of Direct Anterior Approach Hip Arthroplasty After Previous Hip Arthroscopy: A Matched Case-control Study With a Minimum 5-year Follow-up.
Quesada-Jimenez R, Kahana-Rojkind AH, Walsh EG … +2 more , Sikligar D, Domb BG
Orthopedics · 2025 · PMID 40396659 · Publisher ↗
BACKGROUND: The primary aim of this study was to evaluate the impact of prior hip arthroscopy on direct anterior approach (DAA) total hip arthroplasty (THA) midterm outcomes, with a secondary analysis based on time to co...
BACKGROUND: The primary aim of this study was to evaluate the impact of prior hip arthroscopy on direct anterior approach (DAA) total hip arthroplasty (THA) midterm outcomes, with a secondary analysis based on time to conversion to THA. MATERIALS AND METHODS: Data were retrospectively reviewed for all patients who underwent THA by the DAA from 2009 to 2018. Eligible patients completed minimum 5-year follow-up patient-reported outcomes (PROs) questionnaires. Patients with a previous hip arthroscopy (THA-PA) were propensity matched in a 1:2 ratio to a control group of primary arthroplasty patients (THA-N-PA). A secondary analysis based on time to conversion to THA from the previous hip arthroscopy was conducted within the study group. RESULTS: A total of 402 patients were included. Favorable and comparable (>0.05) outcomes were observed at minimum 5-year follow-up for all PROs evaluated except Visual Analogue Scale pain scale, where the THA-PA group had significantly higher scores (<0.05). Importantly, the groups reported similar complications and revision surgery rates. Furthermore, the secondary analysis found patients that converted within one year from the previous hip arthroscopy showed significantly lower patient satisfaction. CONCLUSION: Patients with a history of hip arthroscopy who underwent THA using the DAA demonstrated comparable and sustainable outcomes across all PROs, with similar complication and revision rates to the control group at midterm follow-up. However, patients who underwent THA within one year of prior hip arthroscopy reported significantly lower satisfaction levels. Careful patient selection and indication for hip arthroscopy are essential to avoid early conversion to THA. [. 2025;48(4):203-209.].
Pinch Strength and Electromyography in Cubital Tunnel Syndrome: Nerve Stability Pre- and Postsurgery.
Cha JY, Jung KJ, Nho JH … +5 more , Kim SH, Seo KI, Choi SW, Moon JE, Kim BS
Orthopedics · 2025 · PMID 40353755 · Publisher ↗
BACKGROUND: Cubital tunnel syndrome (CuTS) is a prevalent compressive neuropathy with various surgical treatments but no established consensus on the optimal technique. This study compared outcomes and electromyography (...
BACKGROUND: Cubital tunnel syndrome (CuTS) is a prevalent compressive neuropathy with various surgical treatments but no established consensus on the optimal technique. This study compared outcomes and electromyography (EMG) findings between in situ decompression (ISD) and anterior ulnar nerve transposition (AT) and assessed correlations between preoperative EMG parameters and muscle strength. MATERIALS AND METHODS: We retrospectively analyzed 81 patients with unilateral idiopathic CuTS. Thirty-three underwent ISD and 48 underwent AT, determined by intraoperative ulnar nerve stability. Outcomes included pinch strength, 2-point discrimination, and functional scores (disabilities of the arm, shoulder and hand [DASH], visual analog scale, Bishop). Preoperative EMG measures were compound muscle action potential (CMAP) amplitude and conduction velocity. Correlations were analyzed with adjustment for age. RESULTS: Both ISD and AT improved DASH scores, pinch strength, and 2-point discrimination (<.05), with no significant differences in postoperative outcomes. Preoperative CMAP amplitude correlated moderately with pinch strength in ISD (<.05) but weakly or not at all in AT. Postoperatively, no strong correlations between EMG and pinch strength were observed. CONCLUSION: Both ISD and AT yield comparable improvements in CuTS. Preoperative EMG, particularly CMAP amplitude, may predict muscle strength in ISD but is less predictive in AT, emphasizing the role of pathophysiology in interpreting results. Larger prospective studies are needed to refine surgical decision-making. [ 2025;48(3):159-165.].
Differences in Incidence of Preoperative Deep Vein Thrombosis and Coagulation Function at Admission in Younger and Older Adults With Hip Fracture.
Shi LT, Gu R, Duan LJ
Orthopedics · 2025 · PMID 40353754 · Publisher ↗
BACKGROUND: The objectives of this study were to analyze differences in deep vein thrombosis (DVT) incidence in both lower extremities before operation and blood coagulation function at admission in younger and older adu...
BACKGROUND: The objectives of this study were to analyze differences in deep vein thrombosis (DVT) incidence in both lower extremities before operation and blood coagulation function at admission in younger and older adults with hip fracture and to guide DVT prevention in these patients. MATERIALS AND METHODS: The 505 hip fracture patients enrolled in this research were sorted into an older adult (≥60 years) group (424 cases) and a younger adult group (81 cases) based on age. Preoperative DVT incidence in both lower extremities was analyzed. Differences in demographic characteristics, comorbidities, and preoperative DVT incidence in both lower extremities, blood coagulation function, and platelet count at admission were compared. RESULTS: Preoperative DVT incidence in both lower extremities in hip fracture patients increased with age. Compared with the younger adult group, preoperative DVT incidence in both lower extremities was higher, the ratio of women was higher, the ratio of patients with comorbidities (eg, hypertension, diabetes) was higher, fibrinogen was higher, and antithrombin III was lower in the older adult group. CONCLUSION: Preoperative DVT incidence in both lower extremities in these patients increased with age. Compared with the younger adult group, preoperative DVT incidence was higher, hypercoagulable state was more obvious, and anticoagulant activity was weaker in the older adult group. This may be related to more patients of advanced age, a higher ratio of female patients, and more comorbidities. Advanced age (≥60 years) is the independent risk factor for preoperative DVT. [. 2025;48(3):139-145.].
Percutaneous Clamp-assisted Reduction Before Intramedullary Nailing for Tibial Shaft Fractures to Improve Reduction Outcomes: A Retrospective Cohort Study.
Niu Z, Lian Y, Sun H … +3 more , Cheng Y, Wu Z, Shi C
Orthopedics · 2025 · PMID 40353753 · Publisher ↗
BACKGROUND: This retrospective cohort study aimed to compare the clinical outcomes of percutaneous clamp-assisted reduction (PCR) and conventional direct reduction (DR) techniques prior to intramedullary nailing (IMN) in...
BACKGROUND: This retrospective cohort study aimed to compare the clinical outcomes of percutaneous clamp-assisted reduction (PCR) and conventional direct reduction (DR) techniques prior to intramedullary nailing (IMN) in the management of tibial shaft fractures. MATERIALS AND METHODS: The medical records of 68 consecutive patients treated via IMN via the infrapatellar approach between January 2020 and December 2023 were retrospectively reviewed. After the inclusion/exclusion criteria were applied, patients were divided into PCR (n=37) and DR (n=31) groups. Demographic data, fracture characteristics, surgical data, and prognostic outcomes were analyzed. RESULTS: Baseline characteristics showed no significant intergroup differences. PCR demonstrated a longer reduction time (25.3±1.9 min vs 21.4±1.4 min, <0.01) but required less fluoroscopic exposure (18.0±1.4 vs 22.0±1.4, <0.01), shorter surgical duration (73.0±3.1 min vs 88.7±8.6 min, <0.01), and reduced blood loss (101.6±17.2 mL vs 153.2±52.9 mL, <0.01). No open reductions occurred in the PCR group, whereas five cases occurred in the DR group (16.1%, <0.05). Approximate anatomical union rates significantly favored PCR (62.2% vs 16.1%, <0.01). No statistically significant differences were observed between the two groups in terms of American Orthopaedic Foot and Ankle Society score, union time, delayed union rate, or malunion rate. CONCLUSION: Compared with conventional DR, PCR prior to IMN improves fracture reduction quality, reduces intraoperative invasiveness, and enhances procedural efficiency, with superior anatomical alignment outcomes. [. 2025;48(3):e147-e152.].
Treatment and Clinical Outcomes of Tibial Spine Fractures in Adults: A Systematic Review and Meta-Analysis.
Khela HS, Khela MS, Jose J … +3 more , Madi R, Kelly JD, Miller L
Orthopedics · 2025 · PMID 40272029 · Publisher ↗
BACKGROUND: Adult tibial spine fractures (TSFs) are rare but can cause significant morbidity. MATERIALS AND METHODS: A systematic review identified studies on adult TSFs. Patient demographics, fracture characteristics, s...
BACKGROUND: Adult tibial spine fractures (TSFs) are rare but can cause significant morbidity. MATERIALS AND METHODS: A systematic review identified studies on adult TSFs. Patient demographics, fracture characteristics, surgical details, outcomes, and complications were analyzed using descriptive statistics and meta-analysis. RESULTS: Twenty-eight studies (691 cases) were included. Most fractures were type III, treated arthroscopically with sutures or screws. Fracture type showed no significant differences in outcomes. Suture fixation yielded better functional scores and fewer complications than screws. CONCLUSION: No definitive advantage was observed for either fracture type or fixation method. Further research is needed to establish optimal treatments. [. 2025;48(3):174-187.].
Effect of the USMLE Step 1 Grading Change on Orthopedic Surgery Residency Applications: National Resident Matching Program Charting Outcomes From 2011 to 2024.
Lin EH, Feingold CL, Jagasia AA … +3 more , Tercyak SC, Agarwalla A, Liu JN
Orthopedics · 2025 · PMID 40272028 · Publisher ↗
BACKGROUND: This study evaluated differences in orthopedic surgery residency applicant statistics in the 2024 National Resident Matching Program (NRMP) Charting Outcomes, the first report to include applicants with a pas...
BACKGROUND: This study evaluated differences in orthopedic surgery residency applicant statistics in the 2024 National Resident Matching Program (NRMP) Charting Outcomes, the first report to include applicants with a pass/fail designation on the United States Medical Licensing Examination (USMLE) Step 1. MATERIALS AND METHODS: Data were collected from the NRMP reports, which are released every 2 to 3 years, for 2011, 2014, 2016, 2018, 2020, 2022, and 2024. The number of research items (abstracts, presentations, and publications), USMLE Step 2 scores, volunteer experiences, and work experiences for matched and unmatched applicants were recorded. Linear regression analyses were performed with data from before 2024 to predict expected outcomes for the 2024 match. The percentage of change was calculated for each characteristic of matched and unmatched applicants. RESULTS: In 2024, a statistically significant increase was seen in the observed number of research items per matched applicant (23.8) compared with the predicted number (18.4; =.009). The observed mean USMLE Step 2 score (257) for matched applicants was lower than the expected score (259.3), but was still higher than the 2022 score of 256 and the unmatched applicant score of 246. Volunteer and work experiences decreased to the lowest of any report since 2011. CONCLUSION: Since the USMLE Step 1 examination became pass/fail, research productivity significantly increased and work and volunteer experiences decreased. These changes may reflect a perceived increased emphasis on research productivity because of the grading change or may be the result of various causes, including an increase in the number of applicants who take research gap years. [ 2025;48(3):e139-e146.].
Gardner-Wells Tongs Are a Safe Alternative for Intraoperative Positioning and Spine Surgery.
Chmait HR, Patel D, Roy G … +1 more , Ziino C
Orthopedics · 2025 · PMID 40272027 · Publisher ↗
BACKGROUND: Gardner-Wells tongs (GWT) are commonly used in cervical spine trauma for closed and open treatment of the cervical spine and for patient positioning and reduction, aiding in fracture reduction and providing t...
BACKGROUND: Gardner-Wells tongs (GWT) are commonly used in cervical spine trauma for closed and open treatment of the cervical spine and for patient positioning and reduction, aiding in fracture reduction and providing temporary stabilization. Tongs are less commonly used for nontraumatic spine surgery, and a paucity of literature exists assessing the rates of complications associated with the use of GWT. The purpose of this study was to elucidate the incidence of major and minor complications associated with the use of GWT in traumatic and nontraumatic spine surgeries performed by a single surgeon at a single tertiary care academic institution. MATERIALS AND METHODS: Adult patients who underwent traumatic or nontraumatic spinal surgery at any spine level with the use of GWT from a single surgeon between 2020 and 2023 met inclusion criteria for this retrospective case series. Major complications were defined as medial table breech, deep infection/abscess, pin pullout, neurovascular injury, and vision disturbances (ie, increased intraocular pressure) at any time point. Minor complications were defined as pin loosening, minor bleeding requiring staples, and superficial infection at any time point. RESULTS: Data from 322 patients, including 171 (53.1%) men and 151 (46.9%) women, were reviewed and analyzed. Mean patient age at the time of surgery was 57 years (range 18 to 89). Mean operative time was 165 minutes, and average traction weight applied was 14.7 pounds. Incidence of major complications was 0.3% and included just one instance of visual disturbance 6 weeks postoperatively that spontaneously resolved. Incidence of minor complications was 4.66% (15/322) and involved 14 cases (4.35%) of minor bleeding managed with staples and one occurrence of pin loosening. CONCLUSION: The use of GWT in a variety of traumatic and nontraumatic spine surgeries was found to be safe and effective in this single-surgeon, single-institution study cohort. Only one patient developed a major complication, and the incidence of minor complications was less than 5%. [. 2025;48(3):153-158.].
Fragility of Statistical Differences Between Surgical Approaches in Total Hip Arthroplasty.
Giakas AM, Hohmann AL, Boyajieff E … +2 more , Sellig M, Lonner JH
Orthopedics · 2025 · PMID 40239052 · Publisher ↗
BACKGROUND: Total hip arthroplasty (THA) is a successful treatment for hip osteoarthritis, but the optimal surgical approach for this procedure is a topic of debate. This review uses fragility analysis to determine the s...
BACKGROUND: Total hip arthroplasty (THA) is a successful treatment for hip osteoarthritis, but the optimal surgical approach for this procedure is a topic of debate. This review uses fragility analysis to determine the statistical fragility of randomized controlled trials (RCTs) comparing the 3 most common surgical approaches for THA: direct anterior, direct lateral, and posterior. MATERIALS AND METHODS: A systematic review was conducted to identify RCTs comparing 2 of the 3 surgical approaches for THA. Dichotomous outcomes and study characteristics were extracted from each study that met the inclusion criteria. Fragility index (FI) and fragility quotient (FQ) were calculated for each significant outcome (≤.05), and reverse fragility index and quotient (rFI and FQ) were calculated for each nonsignificant outcome (>.05). RESULTS: Our search yielded 20 studies in total, with 146 identified dichotomous outcomes. In total, the outcomes had a median FI of 5 and a median rFI of 5. Significant outcomes that favored the anterior approach had a median FI of 6, and significant outcomes that favored the posterior or lateral approach both had a median FI of 1. CONCLUSION: The RCTs comparing approaches to THA had a median FI of 5, signifying that the reversal of 5 events would be sufficient to change the significance of the entire outcome. This value is comparable to other FI values within the orthopedic literature, but subgroup analyses elucidated areas of greater statistical fragility, particularly in outcomes favoring either the lateral or posterior approach in THA. [ 2025;48(3):166-173.].
Functional Outcomes for Elderly Patients After ORIF for Distal Femur Fractures Are Similar to Outcomes for Patients After Primary Total Knee Arthroplasty.
Zingas N, Munley J, O'Toole RV … +1 more , Manson TT
Orthopedics · 2025 · PMID 40239051 · Publisher ↗
BACKGROUND: The long-term clinical outcomes after open reduction and internal fixation (ORIF) for distal femoral fractures, both native and peri-prosthetic, are not yet well established in the literature. MATERIALS AND M...
BACKGROUND: The long-term clinical outcomes after open reduction and internal fixation (ORIF) for distal femoral fractures, both native and peri-prosthetic, are not yet well established in the literature. MATERIALS AND METHODS: We used the clinically validated Western Ontario and McMaster Universities Arthritis Index (WOMAC) score to make the functional outcomes after ORIF comparable with the well-characterized results achieved after total knee arthroplasty (TKA) for osteoarthritis. After long-term clinical follow-up and prospectively collected WOMAC scores were obtained, pain, stiffness, and function were evaluated for 68 elderly patients with distal femur fractures (34 periprosthetic, 34 native; median follow-up time, 2.43 years). RESULTS: Although pain and stiffness scores were significantly lower than those achieved after TKA, functional and total WOMAC scores were similar. Pain and function continued to improve with greater time to follow-up. Although 32% (22/68) of patients had a return to the operating room (3 for infection, 11 for nonunion, and 7 for implant prominence), total WOMAC scores at long-term follow-up were not different for the patients who returned to the operating room. Although stiffness may persist for some patients, the functional outcomes after this procedure are similar to outcomes for patients after primary TKA. The rate of fracture-related re-operations was 32%, but was not associated with poor clinical outcomes. CONCLUSION: The 91% rate of good to excellent outcomes seen in our cohort suggests ORIF is likely to provide a favorable result for distal femur fractures, both native and periprosthetic, among elderly patients. [ 2025;48(3):e124-e130.].
Atraumatic Scaphoid Avascular Necrosis After Repeated Steroid Injections.
Zermeno-Salinas JL, Henderson AP, Aziz KT
Orthopedics · 2025 · PMID 40239050 · Publisher ↗
Atraumatic avascular necrosis of the scaphoid is an extremely rare pathology. We present a case of avascular necrosis of the scaphoid following repeat local glucocorticoid injections. A 70-year-old, right-handed woman pr...
Atraumatic avascular necrosis of the scaphoid is an extremely rare pathology. We present a case of avascular necrosis of the scaphoid following repeat local glucocorticoid injections. A 70-year-old, right-handed woman presented to our clinic with 2 years of atraumatic, progressively worsening left wrist pain and loss of range of motion. Imaging demonstrated fragmentation and avascular necrosis of the scaphoid. The patient underwent uncomplicated scaphoid excision, pisiform excision, and intercarpal arthrodesis, with a good functional outcome. This case highlights both the risk of repeated intra-articular steroid injections and the importance of obtaining serial radiographs when providing intra-articular steroid injections. [. 2025;48(3):188-191.].
Periacetabular Osteotomy Leads to Improved Long-term Patient-reported Outcomes: A Systematic Review.
MacLeod JS, Zhu JR, Lee MS … +8 more , Surucu S, Gagné J, Patel SM, Klug T, Park N, Norman M, Moran J, Jimenez AE
Orthopedics · 2025 · PMID 40239049 · Publisher ↗
BACKGROUND: Periacetabular osteotomy (PAO) has shown favorable outcomes. The goal of this study was to conduct a systematic review to assess the reoperation rates and long-term patient-reported outcomes (PROs) of PAO for...
BACKGROUND: Periacetabular osteotomy (PAO) has shown favorable outcomes. The goal of this study was to conduct a systematic review to assess the reoperation rates and long-term patient-reported outcomes (PROs) of PAO for the treatment of hip dysplasia. MATERIALS AND METHODS: A systematic review was conducted. Studies that reported PROs with a minimum mean of 10-year follow-up were included. RESULTS: The 8 studies (984 hips) that were included reported a significant improvement between preoperative and postoperative PROs. CONCLUSION: Patients who underwent PAO surgery showed significant improvement in PROs at a minimum mean 10-year follow-up. [ 2025;48(3):e113-e123.].
Knee Injury and Osteoarthritis Outcome Score for Tibial Shaft Fractures: Validity, Reliability, Responsiveness, and Minimal Clinically Important Difference.
Stokholm R, Larsen P, Petruskevicius J … +4 more , Rölfing JD, Rasmussen MK, Jensen SS, Elsoe R
Orthopedics · 2025 · PMID 40152659 · Publisher ↗
BACKGROUND: This study evaluated the relevance, construct validity, test-retest reliability, and responsiveness and estimate the minimal clinically important difference in the Knee Injury Osteoarthritis outcome score (KO...
BACKGROUND: This study evaluated the relevance, construct validity, test-retest reliability, and responsiveness and estimate the minimal clinically important difference in the Knee Injury Osteoarthritis outcome score (KOOS) for patients with tibial shaft fractures. MATERIALS AND METHODS: This prospective cohort study included adult patients who were surgically treated after tibial shaft fracture (AO 42-). The primary outcome measure was the score on the KOOS subscales of pain, symptoms, activities of daily living, sport and recreational activities, and knee-related quality of life. Scores were obtained at 14 days, 15 days, 6 weeks, and 3, 6, and 12 months postoperatively. Relevance was evaluated by patients' ranking all KOOS items; construct validity was evaluated by comparing KOOS scores with the Health-Related Quality of Life questionnaire; test-retest reliability was evaluated by comparing KOOS scores over a 24-hour period; and responsiveness was evaluated based on predefined hypotheses and effect size. RESULTS: Sixty patients (mean age, 47.1 years; range, 18-84 years) were included. Results showed acceptable relevance and construct validity for all KOOS subscales. Test-retest reliability was high for all 5 subscales, with an intraclass correlation coefficient of 0.9. Responsiveness was observed with moderate to high correlations (r≥0.3) for the predefined hypotheses and moderate to large effect sizes, ranging from 0.5 to 1.3, for the subscales of pain, activities of daily living, symptoms, and sport and recreational activities. CONCLUSION: The KOOS showed acceptable relevance, construct validity, and responsiveness and moderate to high test-retest reliability for patients with tibial shaft fractures. Further validation of the psychometric properties of the KOOS for tibial shaft fractures may expand its usefulness for this patient group. [ 2025;48(3):146-152.].
Effectiveness of an All-arthroscopic Procedure for Terrible Triad Injuries at 5-Year Follow-up.
Lim GH, Joo MS, Lee SH … +3 more , Cho HG, Sim GW, Kim JW
Orthopedics · 2025 · PMID 40152658 · Publisher ↗
BACKGROUND: This study evaluated the clinical and radiologic results of allarthroscopic treatment of terrible triad of the elbow over a minimum of 5 years. MATERIALS AND METHODS: We retrospectively reviewed consecutive p...
BACKGROUND: This study evaluated the clinical and radiologic results of allarthroscopic treatment of terrible triad of the elbow over a minimum of 5 years. MATERIALS AND METHODS: We retrospectively reviewed consecutive patients with terrible triad injury who underwent all-arthroscopic surgery between January 2011 and June 2018. We performed all-arthroscopic treatment for these patients, excluding those with a Regan-Morrey type III coronoid process fracture, involvement of the anteromedial facet, or a radial head fracture involving >50% of the articular surface. Elbow stability, range of motion, Mayo Elbow Performance Score, and radiologic outcomes were assessed at least 5 years postoperatively. RESULTS: Thirty-two patients met the inclusion criteria, and mean age was 49.5±15.9 years. At a mean follow-up of 6.9±1.8 years, mean arc of flexion for the affected elbow was 7.1°±7.4° to 132.4°±10.0°. Mean visual analog scale and Mayo Elbow Performance Score were 1.4±0.6 and 91±15.7 points, respectively. Clinical scores and range of motion showed no significant differences between the affected and contralateral elbows. Nonunion of the coronoid process occurred in 4 cases, but none led to instability or required reoperation. Heterotopic ossification was observed for 15 patients (47%), grade 1 arthritis for 7 patients (22%), and grade 3 arthritis for 3 patients (9%), but none progressed to joint stiffness or required reoperation. Two complications required reoperation: 1 case of pin site irritation that resolved after pin removal and 1 case of worsening arthritic degeneration leading to total elbow arthroplasty at 5-year follow-up. No other complications, such as infection or neurovascular injury, were observed. CONCLUSION: In terrible triad elbow injuries, all-arthroscopic treatment restores elbow joint stability and achieves good clinical and radiologic outcomes compared with open treatment. We recommend this procedure as a treatment option for patients if the indications are met, such as Regan-Morrey type I or II coronoid process fractures and radial head fractures involving <50% of the articular surface. [ 2025;48(3):e131-e138.].
From Sidelines to Center Stage: Increasing Public Interest in Anterior Cruciate Ligament Reconstruction.
Khan IA, Siddiqui S, Yagnik GP
Orthopedics · 2025 · PMID 40152657 · Publisher ↗
BACKGROUND: Anterior cruciate ligament reconstruction (ACLR) is being performed at increasing volumes. However, it is unknown whether public interest in ACLR has also increased over time. Google Trends provides the relat...
BACKGROUND: Anterior cruciate ligament reconstruction (ACLR) is being performed at increasing volumes. However, it is unknown whether public interest in ACLR has also increased over time. Google Trends provides the relative search volume (RSV) for Google search terms. This study was performed to evaluate through Google Trends whether public interest in ACLR has increased over time and to evaluate the readability of articles obtained through Google searches. MATERIALS AND METHODS: A retrospective longitudinal study of public interest in anterior cruciate ligament (ACL) reconstruction was conducted from January 2004 to April 2023 with Google Trends. The RSV ranges from 0 to 100 and represents interest in a keyword at a specific point during the selected time frame; 0 indicates minimal interest and 100 indicates peak interest. Four terms were evaluated: "ACL surgery," "ACL reconstruction," "ACL repair," and "ACL procedure." Additionally, a Google search with the term "ACL surgery" was conducted and the readability of the first 25 articles was assessed. RESULTS: Between 2004 and 2023, there was a significant increase in mean RSV for "ACL surgery" (2004, 33.7; 2023, 93.6). Among the 4 search terms explored ("ACL surgery," "ACL reconstruction," "ACL repair," and "ACL procedure"), "ACL surgery" had a significantly higher mean RSV (57.7 vs 20.7 vs 9.7 vs 0, respectively). Among 25 articles, the mean Flesch-Kincaid reading level was 9.4, and only 12% of the articles were at or below the recommended 6th grade reading level. CONCLUSION: Public interest in ACLR is increasing significantly. Despite this increase, articles in Google searches do not adhere to recommended reading levels. Virtual patient resources must be optimized to improve education and facilitate improved outcomes. [ 2025;48(3):133-138.].
Difference in Postoperative Outcomes and Satisfaction Between Men and Women After Total Knee Arthroplasty.
Lee SH, Ryoo JH, Lee HD … +1 more , Choi YS
Orthopedics · 2025 · PMID 40085154 · Publisher ↗
BACKGROUND: This study was conducted to determine the difference in clinical outcomes and satisfaction between men and women after total knee arthroplasty (TKA) and whether the relationship between postoperative outcomes...
BACKGROUND: This study was conducted to determine the difference in clinical outcomes and satisfaction between men and women after total knee arthroplasty (TKA) and whether the relationship between postoperative outcomes and satisfaction differs between the 2 groups after TKA. MATERIALS AND METHODS: This retrospective study included 324 patients who underwent TKA. The participants were divided by sex as follows: male (n=130) and female (n=194). The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score, Knee Society Score (KSS), and satisfaction score and their correlation coefficients at 1 and 2 years after TKA were compared between the groups. RESULTS: The satisfaction scores of the male and female patients were 27.1 and 22.7, respectively (<.001), 1 year after TKA and 29.7 and 29.2, respectively (=.575), 2 years after TKA. No significant differences in the WOMAC score or KSS were observed between the 2 groups. The correlation coefficients between the satisfaction score and WOMAC score or KSS (function scores) were higher for women than for men 1 and 2 years after TKA (1-year WOMAC score: men, -0.682; women, -0.724; 1-year KSS function score: men, 0.500; women, 0.795) (2-year WOMAC score: men, -0.536; women, -0.778; 2-year KSS function score: men, 0.444; women, 0.702). CONCLUSION: The early postoperative satisfaction of female patients was lower than that of male patients but eventually improved to the satisfaction level of male patients, and the association between outcomes and satisfaction within 2 years after TKA was higher for female patients than for male patients. [. 2025;48(2):121-127.].
A Retrospective Study of the Implementation of Enhanced Recovery After Unicompartmental Knee Arthroplasty.
Yu ZQ, Huang DK, Guo S … +1 more , Wang K
Orthopedics · 2025 · PMID 40085153 · Publisher ↗
BACKGROUND: The goal of this study is to report our findings on the application of the enhanced recovery after surgery (ERAS) protocol for patients undergoing unicompartmental knee arthroplasty (UKA) and to evaluate the...
BACKGROUND: The goal of this study is to report our findings on the application of the enhanced recovery after surgery (ERAS) protocol for patients undergoing unicompartmental knee arthroplasty (UKA) and to evaluate the benefits and drawbacks of this approach. MATERIALS AND METHODS: Sixty patients with medial unicompartmental knee osteoarthritis (UKOA) who underwent UKA were the subject of a retrospective investigation. The patients were categorized into 2 groups based on the use of ERAS protocols. Among the metrics that were measured and statistically analyzed were Kellgren-Lawrence grade, femorotibial angle (FTA), Tegner activity score, Lysholm knee score, University of California at Los Angeles (UCLA) activity score, Berg Balance Scale (BBS), numeric pain rating scale (NPRS) score, forgotten joint score, range of motion (ROM), hospital length of stay (LOS), procedure duration, intraoperative bleeding volume, time to ambulation, time to resume normal walking, duration of urinary catheter retention, time to resume a regular diet, and postoperative satisfaction. RESULTS: The patients allocated to the ERAS cohort showed distinct characteristics compared with the control cohort, including faster resumption of regular dietary intake, ambulation, and gait patterns. The ERAS group showed a decreased FTA and improved BBS scores. On final evaluation, the ERAS group had lower UCLA scores, indicative of superior overall outcomes. CONCLUSION: The initial application of ERAS showed promising results in enhancing patient rehabilitation outcomes, reducing the impact of hospitalization, and improving efficient allocation of health care resources. Nevertheless, additional research is necessary to assess the feasibility and effectiveness of widespread implementation for patients undergoing UKA. [ 2025;48(2):87-97.].
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