Orthopedics [JOURNAL]
Sun
200 papers
Anti-Leukotriene Receptor Blockers Improve Tendon-Bone Interface Healing in a Rat Model of Acute Rotator Cuff Tear.
Yoon JP, Park SJ, Kim DH … +4 more , Choi YS, Lee HJ, Kim JY, Chung SW
Orthopedics · 2025 · PMID 40052921 · Publisher ↗
BACKGROUND: Excessive expression of proinflammatory cytokines after rotator cuff (RC) surgery impairs the quality of tendon-bone interface (TBI) healing. There is evidence that the asthma drug montelukast (MS) inhibits t...
BACKGROUND: Excessive expression of proinflammatory cytokines after rotator cuff (RC) surgery impairs the quality of tendon-bone interface (TBI) healing. There is evidence that the asthma drug montelukast (MS) inhibits the expression of proinflammatory cytokines. This study was conducted to verify the effect of MS administration on TBI healing after RC repair. MATERIALS AND METHODS: Thirteen rats in the MS group were intraperitoneally administered 10 mg/kg of the drug daily for 2 weeks after RC surgery, and 13 rats in the control group were administered only 0.9% saline. The healing effect of the TBI was assessed through histologic and biomechanical analysis 4 weeks after tendon repair. RESULTS: In the MS group, the expression of interleukin-1 beta (IL-1β; <.01) and interleukin 6 (IL-6; <.01) was significantly reduced compared with the control group. In the evaluation of supraspinatus fatty infiltration, the MS group showed significant inhibition of fatty infiltration compared with the control group (<.001). Histologic analysis showed that the MS group had significant improvements in collagen density (=.035) and alignment (=.011). Biomechanical analysis after systemic administration of MS showed an increase in the cross-sectional area (<.001) and elongation (<.01) of the TBI. CONCLUSION: The use of MS improved tendon elasticity through suppressing fatty infiltration and improving TBI collagen density and arrangement. The mechanism is down-regulation of IL-1β and IL-6. These results strongly support the use of MS as an anti-inflammatory agent that does not impair tendon healing. [ 2025;48(2):e105-e112.].
Tapered, Fluted, Titanium Stems in Revision Total Hip Arthroplasty.
Zitsch BP, Byrd JJ, Buckner B … +2 more , Konigsberg BS, Hartman CW
Orthopedics · 2025 · PMID 40052900 · Publisher ↗
BACKGROUND: Establishing stable femoral component fixation in revision total hip arthroplasty (rTHA) remains challenging. Early monobloc tapered, fluted, titanium (TFT) designs were complicated by high rates of subsidenc...
BACKGROUND: Establishing stable femoral component fixation in revision total hip arthroplasty (rTHA) remains challenging. Early monobloc tapered, fluted, titanium (TFT) designs were complicated by high rates of subsidence, while modular designs were complicated by taper corrosion and junctional fractures. Newer generation monobloc stems have been designed to minimize subsidence. Therefore, the aim of this study was to present the clinical and radio-graphic results of the most recent modular and monobloc TFT designs. MATERIALS AND METHODS: Patients undergoing rTHA in which TFT femoral stems were used, whether modular or monobloc, were included in this retrospective review. Included stems had the same design characteristics and were from the same manufacturer. The only difference was neck modularity. Radiographic analysis for stem subsidence was performed. Clinical outcomes including Harris Hip Score (HHS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores, and re-revisions were collected. We examined survivorship for the endpoints of subsidence or re-revision for any reason. RESULTS: Ninety-four (66 monobloc, 28 modular) hips met inclusion criteria, with a median follow-up of 25.9 months. Mean stem subsidence was 1.9±0.2 mm in the modular group and 2.1±0.3 mm in the monobloc group (=.56), with 90 of 94 (95%) stems subsiding less than 5 mm. Twelve hips (13%) required re-revision with no difference in survival between the groups. HHS and WOMAC scores significantly improved from preoperative to last recorded follow-up in both groups (≤.01). CONCLUSION: Advances in implant design including spline geometry and more aggressive tapers in monobloc TFT femoral components offer encouraging clinical outcomes with an overall low risk of clinically significant subsidence. [. 2025;48(2):79-86.].
Rates of Revision for Progressive Deformity and Contralateral Slipped Capital Femoral Epiphysis Using a Partially Threaded Cannulated Screw: A Retrospective Review.
Siller RL, Haney KF, Lee AK … +1 more , Carmichael KD
Orthopedics · 2025 · PMID 40052877 · Publisher ↗
BACKGROUND: Slipped capital femoral epiphysis (SCFE) is a problem affecting the pediatric population, with high rates of re-slip and contralateral pinnings. The purpose of this study was to identify both rates of recurre...
BACKGROUND: Slipped capital femoral epiphysis (SCFE) is a problem affecting the pediatric population, with high rates of re-slip and contralateral pinnings. The purpose of this study was to identify both rates of recurrence and contralateral slips after in situ pinning of stable and unstable SCFE. MATERIALS AND METHODS: Pediatric patients who underwent in situ and revision pinning of SCFE from January 2000 to December 2022 were reviewed for subsequent procedures, including contralateral pinning and revision procedures. All hips were pinned in situ using a technique consisting of a single, cannulated, 6.5-mm partially threaded screw. Association with age and sex were prioritized and compared with previous literature. Data analysis was performed using tests and chi-square tests. Statistical significance was set at >.05. RESULTS: Eighty-eight patients were selected for review, with a total of 124 native hips pinned and 7 revision hips (5.6% revised for progression of deformity). Twelve contralateral hips underwent sequential pinning for contralateral slip (24.0% of all unilateral procedures performed). Seventy-four percent of patients were male. The mean age at initial slip for patients who did not undergo a subsequent procedure was 13.0±1.5 years, compared with 10.8±1.6 years for contralateral slips and 11.5±1.5 years for revision hips (<.001). CONCLUSION: The rates of revision and contralateral slip were comparable to and slightly lower than those reported in the current literature. The complication rate for this procedure is low. This study demonstrates a safe and an efficient technique for management of SCFE. [. 2025;48(2):e100-e104.].
Epidemiology of Shoulder Injuries Presenting to US Emergency Departments.
Reiad TA, Peveri E, Dinh PV … +1 more , Owens BD
Orthopedics · 2025 · PMID 39933105 · Publisher ↗
BACKGROUND: Shoulder injuries are a significant cause of musculoskeletal complaints in emergency departments (EDs), but data on these injuries in the United States are limited. This study analyzed shoulder injuries repor...
BACKGROUND: Shoulder injuries are a significant cause of musculoskeletal complaints in emergency departments (EDs), but data on these injuries in the United States are limited. This study analyzed shoulder injuries reported to US EDs from 2006 to 2016, focusing on trends in injury mechanisms, diagnoses, and demographics. MATERIALS AND METHODS: Data from the National Electronic Injury Surveillance System (NEISS) database were used to analyze 6,689,422 shoulder injuries reported to US EDs during 11 years, examining injury rates, causes, diagnoses, and demographics. RESULTS: An estimated 6,689,422 shoulder injuries were reported during the study period, accounting for 4.35% of all injuries reported to US EDs. The highest injury rate was observed in individuals 15 to 24 years (3.15 per 1000 US population), while children younger than 5 years had the lowest rate (0.97 per 1000). The most common causes of injury were sports and recreation (45.84%), home structure (20.79%), and home furniture (18.91%). The most frequent diagnoses included fractures (20.30%), contusions (18.23%), and dislocations (12.92%). More than one-third of the injuries (39.2%) occurred at home. Injury rates decreased for individuals younger than 25 years but increased for those 45 to 64 years during the study period. Younger individuals and males showed greater sport-related injuries, while older populations and females more commonly presented with home-related injuries. CONCLUSION: This study revealed unique demographic patterns in the causes and mechanisms of shoulder injuries. These findings suggest that tailored prevention strategies could be particularly effective, helping to improve both injury prevention efforts and the clinical care of patients with shoulder injuries. [. 2025;48(2):e81-e87.].
Predictors of Delayed Surgery After Distal Radius Fracture: A Large National Database Study.
Ratnasamy PP, Allam O, Kammien AJ … +3 more , Joo PY, Luo X, Grauer JN
Orthopedics · 2025 · PMID 39933104 · Publisher ↗
BACKGROUND: Surgical timing after distal radius fracture may impact patient outcome. This retrospective study assessed the timing of surgery after distal radius fracture and predictors of delayed surgery. MATERIALS AND M...
BACKGROUND: Surgical timing after distal radius fracture may impact patient outcome. This retrospective study assessed the timing of surgery after distal radius fracture and predictors of delayed surgery. MATERIALS AND METHODS: Patients who had distal radius fractures were identified from the PearlDiver M161Ortho dataset. Those who went on to have surgery in the subsequent 52 weeks were identified, with immediate surgery designated as occurring in weeks 0 to 2 after fracture and delayed surgery designated as occurring in weeks 3 to 52 after fracture. Demographics of patients with immediate and delayed surgery, including age, sex, comorbidity burden (measured by Elixhauser Comorbidity Index [ECI]), region of the country where surgery was performed, insurance (commercial, Medicare, Medicaid), and smoking status (non-smoker, cannabis, tobacco, both), were assessed and compared by multivariate analyses. RESULTS: A total of 90,570 patients undergoing surgery for distal radius fractures were identified, of whom immediate surgery was performed for 76,683 (88.0%) and delayed surgery was performed for 10,887 (12.0%). Independent predictors of delayed surgery included non-clinical factors (Medicaid [vs commercial insurance]: odds ratio [OR], 1.62, <.0001; and region [vs Midwest]: West, OR, 1.39, <.0001; Northeast, OR, 1.37, =.0115; and South, OR, 1.21, =.0001) as well as clinical factors (smoking tobacco [vs non-smoker]: OR, 1.31, <.0001; and increased ECI: OR, 1.14 per 2-point increase, <.0001). CONCLUSION: In a large cohort of patients, 12% of distal radius fracture surgeries occurred outside the 2-week window. These cases were predicted by non-clinical and clinical factors that deserve attention to limit the delay of such surgeries. [. 2025;48(2):e75-e80.].
The Fragility of Statistical Findings Regarding Hemiarthroplasty Versus Total Hip Arthroplasty for Displaced Femoral Neck Fractures.
Giakas AM, Hohmann AL, Mehta NN … +2 more , Dambly JM, Lonner JH
Orthopedics · 2025 · PMID 39933103 · Publisher ↗
There is debate over the treatment of displaced femoral neck fractures with either hemiarthroplasty or total hip arthroplasty. This study aimed to evaluate the fragility index (FI) of randomized controlled trials (RCTs)...
There is debate over the treatment of displaced femoral neck fractures with either hemiarthroplasty or total hip arthroplasty. This study aimed to evaluate the fragility index (FI) of randomized controlled trials (RCTs) comparing these methods. We queried for these RCTs containing dichotomous outcomes, finding 11 RCTs with 63 dichotomous outcomes. The median FI for all outcomes was 6, signifying that 6 event reversals would change the statistical significance of an outcome. The median FI was 2 for significant outcomes and 6 for nonsignificant outcomes, indicating that outcomes favoring one surgical method are more statistically fragile than those demonstrating equivalency. [. 2025;48(2):69-73.].
Usefulness of an Extensible Trial Neck in Total Hip Arthroplasty.
Suzuki T, Kojima K, Aoki S … +2 more , Kubomura T, Ryu K
Orthopedics · 2025 · PMID 39933102 · Publisher ↗
BACKGROUND: Maintaining appropriate soft tissue tension is essential in total hip arthroplasty (THA). Surgeons generally achieve this by altering the neck length. However, experimenting with different neck lengths is tim...
BACKGROUND: Maintaining appropriate soft tissue tension is essential in total hip arthroplasty (THA). Surgeons generally achieve this by altering the neck length. However, experimenting with different neck lengths is time-consuming, as it requires repeated hip dislocations. To address this, we have used a new extensible trial neck device that allows for easy adjustment of neck length during surgery. This device can help surgeons avoid the need for repeated hip dislocations to determine the correct neck size. The objective of this research was to investigate whether this device could help shorten operative times and decrease surgical invasion for patients. MATERIALS AND METHODS: Patients undergoing THA were randomly separated into two groups. The first group used the extensible trial neck during trial reduction after the stem and cup were placed (group M), while the second group used a conventional trial neck (group C). Operative time, blood loss, number of additional dislocations needed during the operation, and C-reactive protein (CRP) and creatine phosphokinase (CPK) levels after the operation were compared. RESULTS: Operative time was significantly shorter and the number of additional dislocations required to choose the final neck size was significantly lower in group M compared with group C. No significant difference in blood loss was observed. CRP and CPK levels days 3 and 7 after surgery decreased in group M compared with group C. CONCLUSION: The extensible trial neck was useful for THA by greatly reducing operative time and stress on the patient. [. 2025;48(2):e88-e93.].
Factors Influencing Early Return to Driving in a Contemporary Arthroplasty Population.
Wilson EJ, Olson NR, Parks NL … +3 more , Seem ME, Ho PH, Engh CA
Orthopedics · 2025 · PMID 39933101 · Publisher ↗
BACKGROUND: As arthroplasty techniques become more advanced, patients recover more rapidly. Is this same trend observed with patients' ability to drive after hip and knee replacement? The purpose of this study was to eva...
BACKGROUND: As arthroplasty techniques become more advanced, patients recover more rapidly. Is this same trend observed with patients' ability to drive after hip and knee replacement? The purpose of this study was to evaluate the impact of various factors on patients' ability to drive within 4 weeks after primary hip or knee arthroplasty to better counsel patients on their return to driving postoperatively. MATERIALS AND METHODS: This retrospective cohort study investigated 1146 patients who underwent primary joint arthroplasty. These patients were surveyed 3 to 4 weeks after surgery, and 851 patients were included in the analysis. Univariate and multivariate analyses were performed to determine which factors were associated with return to driving. RESULTS: Among the patients, 47.0% (n=382) returned to driving within 4 weeks of their procedure, with a mean postoperative time of 16.0±6.3 days. Factors significantly correlated with an early return to driving based on univariate analysis included younger age at surgery, lower body mass index, male sex, prior daily driving, same-day discharge, higher scores on patient-reported outcome measures, left-sided procedure, unicompartmental knee arthroplasty (UKA), no walking aids, and no use of narcotic pain medication. Multivariate Cox regression analysis revealed that male sex (hazard ratio [HR], 2.19), same-day discharge (HR, 1.86), prior daily driving (HR, 1.81), left-sided surgery (HR, 1.62), and type of procedure (UKA: HR, 1.65; total hip arthroplasty by the direct anterior approach: HR, 1.50) were associated with early return to driving. CONCLUSION: Many patient, surgical, and rehabilitation factors can impact the ability of primary arthroplasty patients to return to driving within 4 weeks of surgery. This large cohort incorporating current surgical techniques can support surgeons to better counsel patients on their expected return to driving. [. 2025;48(2):e94-e99.].
Accelerometer-Assisted Physical Activity Outcomes During the First Year of Recovery After Anterior Cruciate Ligament Reconstruction: A Prospective Cohort Pilot Study.
Dwyer T, Gordey E, Ajrawat P … +6 more , Lameire DL, Theodoropoulos J, Ogilvie-Harris D, Faulkner G, Sabiston C, Chahal J
Orthopedics · 2025 · PMID 39879626 · Publisher ↗
BACKGROUND: Wearable activity-measurement devices are increasingly popular among the public, but there is little information regarding their use among patients undergoing sports medicine procedures. The purpose of this s...
BACKGROUND: Wearable activity-measurement devices are increasingly popular among the public, but there is little information regarding their use among patients undergoing sports medicine procedures. The purpose of this study was to compare accelerometer-measured data with traditional patient-reported measures and to determine the trajectory of physical activity from before surgery to 1 year after anterior cruciate ligament reconstruction. MATERIALS AND METHODS: Adult patients undergoing primary anterior cruciate ligament reconstruction were enrolled in this prospective cohort pilot study. The Tegner activity scale, Marx activity scale, International Physical Activity Questionnaire Short Form (IPAQ-SF), Knee injury and Osteoarthritis Outcome Score (KOOS), and EuroQoL-5D were administered preoperatively and 3, 6, and 12 months postoperatively. At these intervals, each patient was asked to wear an accelerometer for 7 consecutive days. Time spent in moderate-to-vigorous physical activity (MVPA min/wk), metabolic equivalents of physical activity, and average daily steps were calculated from the accelerometer output and correlated with patient-reported measures. RESULTS: Twenty-eight patients were included in this study. Of the 28 patients, 20 remained, and at the 12-month analysis, 18 patients were analyzed. There were significant improvements in Tegner activity scale score, KOOS symptoms, sports/recreation, and quality of life subscales, and IPAQSF MVPA min/wk at final follow-up. All accelerometer-based outcomes had improvements at 3, 6, and 12 months. CONCLUSION: The accelerometer may be a useful tool for understanding patients' activity levels at different time points during their recovery and for providing tangible targets for patients to achieve at least an average recovery. [. 2025;48(2):e62-e68.].
Health Care Costs After Lumbar Fusion and Disk Replacement for Diskogenic Pain.
Nin DZ, Chen YW, Kim DH … +4 more , Niu R, Travers H, Chang DC, Hwang RW
Orthopedics · 2025 · PMID 39879625 · Publisher ↗
BACKGROUND: Lumbar fusion is the most common surgical intervention for chronic or severe low back pain. However, lumbar disk replacement (LDR) may be appropriate for certain patients. The objective of this study was to d...
BACKGROUND: Lumbar fusion is the most common surgical intervention for chronic or severe low back pain. However, lumbar disk replacement (LDR) may be appropriate for certain patients. The objective of this study was to describe the postoperative management costs associated with both lumbar fusion and LDR in the 2-year period after surgery. MATERIALS AND METHODS: An observational cohort study was conducted using the Merative MarketScan databases. Patients who underwent lumbar fusion or LDR between January 1, 2017, and December 31, 2017, were identified and included in the study. The primary outcome was the cost of payments for physical therapy, pain medication, injections, and bladder management in the 2-year period after surgery. RESULTS: A total of 1660 patients (mean age, 50.1±10.6 years; lumbar fusion, 99%; LDR, 1%) were included in the study. The mean total cost of postoperative interventions identified was $2832±$5461 per patient, with no differences found between patients for identified interventions. The mean 30-day episode-of-care cost was $65,777±$40,869 and was similar (=.894) between the two groups of patients. The main driver of cost was physical therapy for both groups of patients (lumbar fusion, 53.7%; LDR, 64.9%). CONCLUSION: Patients who underwent lumbar fusion and LDR had similar postoperative management costs. The shorter recovery periods associated with LDR may not necessarily translate into reduced long-term health care expenditure. [. 2025;48(2):117-120.].
Evaluating the Evolution of ChatGPT as an Information Resource in Shoulder and Elbow Surgery.
Nieves-Lopez B, Bechtle AR, Traverse J … +3 more , Klifto C, Schoch BS, Aziz KT
Orthopedics · 2025 · PMID 39879624 · Publisher ↗
BACKGROUND: The purpose of this study was to evaluate the performance and evolution of Chat Generative Pre-Trained Transformer (ChatGPT; OpenAI) as a resource for shoulder and elbow surgery information by assessing its a...
BACKGROUND: The purpose of this study was to evaluate the performance and evolution of Chat Generative Pre-Trained Transformer (ChatGPT; OpenAI) as a resource for shoulder and elbow surgery information by assessing its accuracy on the American Academy of Orthopaedic Surgeons shoulder-elbow self-assessment questions. We hypothesized that both ChatGPT models would demonstrate proficiency and that there would be significant improvement with progressive iterations. MATERIALS AND METHODS: A total of 200 questions were selected from the 2019 and 2021 American Academy of Orthopaedic Surgeons shoulder-elbow self-assessment questions. ChatGPT 3.5 and 4 were used to evaluate all questions. Questions with non-text data were excluded (114 questions). Remaining questions were input into ChatGPT and categorized as follows: anatomy, arthroplasty, basic science, instability, miscellaneous, nonoperative, and trauma. ChatGPT's performances were quantified and compared across categories with chi-square tests. The continuing medical education credit threshold of 50% was used to determine proficiency. Statistical significance was set at <.05. RESULTS: ChatGPT 3.5 and 4 answered 52.3% and 73.3% of the questions correctly, respectively (=.003). ChatGPT 3.5 performed significantly better in the instability category (=.037). ChatGPT 4's performance did not significantly differ across categories (=.841). ChatGPT 4 performed significantly better than ChatGPT 3.5 in all categories except instability and miscellaneous. CONCLUSION: ChatGPT 3.5 and 4 exceeded the proficiency threshold. ChatGPT 4 performed better than ChatGPT 3.5, showing an increased capability to correctly answer shoulder and elbow-focused questions. Further refinement of ChatGPT's training may improve its performance and utility as a resource. Currently, ChatGPT remains unable to answer questions at a high enough accuracy to replace clinical decision-making. [. 2025;48(2):e69-e74.].
Impact of a Recently Accredited Orthopedic Surgery Residency on Patient Outcome Scores in Total Shoulder Arthroplasty: A Retrospective Study.
Sogard OT, Lachance AD, San Crant CL … +3 more , Shahsavarani S, Zlupko TJ, Choi JY
Orthopedics · 2025 · PMID 39835848 · Publisher ↗
BACKGROUND: Patient-reported outcome measures are a valuable tool to evaluate an intervention from a patient's perspective. Previous evidence shows that, while resident involvement may increase operative times, it does n...
BACKGROUND: Patient-reported outcome measures are a valuable tool to evaluate an intervention from a patient's perspective. Previous evidence shows that, while resident involvement may increase operative times, it does not affect complications or patient-reported outcomes. This study sought to assess the impact of a new residency program on patient-reported outcome measures, operative time, and complication rates in total shoulder arthroplasty. MATERIALS AND METHODS: A retrospective cohort study was performed of patients who underwent total shoulder arthroplasty at a single health care system. Demographic data, resident presence during shoulder arthroplasty, arthroplasty type, procedure duration, complications, and American Shoulder and Elbow Surgeons (ASES) score change were collected. Patients 18 years or older who underwent primary anatomic or reverse total shoulder arthroplasty were included. Patients who did not meet the inclusion criteria, had a preoperative diagnosis other than primary osteoarthritis, lacked preoperative and postoperative ASES scores, and canceled procedures were excluded. RESULTS: A total of 139 patients were identified and included in our analysis. Ninety-seven total shoulder arthroplasties were performed with a resident not present, and 42 with a resident present. This study showed no significant effects of the presence or absence of a resident on ASES scores, complication rates, or surgery times. CONCLUSION: This study adds to previous evidence indicating that attending orthopedic surgeons can support resident learning and surgical skill development while maintaining patient-reported outcome measures, surgical time, and complication rates similar to those without resident involvement when performing shoulder arthroplasty. [. 2025;48(2):104-110.].
Orthopedic Patients Are Highly Amenable to Cannabis-Based Products for the Treatment of Musculoskeletal Pain.
Karakash WJ, Bolia IK, Levian BA … +6 more , Chu TN, Kim DR, Fathi A, Liu JN, Petrigliano FA, Weber AE
Orthopedics · 2025 · PMID 39835847 · Publisher ↗
BACKGROUND: Tetrahydrocannabinol (THC)-based and cannabidiol (CBD)-based products are increasing in popularity for the management of pain. Cannabis-based products may serve as a valuable alternative to traditional analge...
BACKGROUND: Tetrahydrocannabinol (THC)-based and cannabidiol (CBD)-based products are increasing in popularity for the management of pain. Cannabis-based products may serve as a valuable alternative to traditional analgesics such as opioids for pain management among orthopedic patients. The purpose of this study was to investigate the perspective of orthopedic sports medicine patients regarding the use of THC- and CBD-based products for the management of musculoskeletal pain. MATERIALS AND METHODS: A short, 11-question survey was distributed to orthopedic sports medicine patients in clinic and via email. Survey participation was voluntary. Retrospective chart review was conducted for participating patients to collect additional data such as visit diagnosis. RESULTS: A total of 182 patients completed the survey. Most were familiar or somewhat familiar with THC (61%) and CBD (63.2%) products and their use for musculoskeletal pain. Of the patients, 53.3% were aware of friends and family currently using CBD products to help manage musculoskeletal pain. Of the patients, 81.3% were amenable to receiving THC-based products and 90.1% were amenable to receiving CBD-based products for the management of their musculoskeletal pain. The patients were statistically more amenable to receiving CBD-based products than THC-based products (=.017). Among the patients, 85.3% believed cannabis-based products would help in the fight against the opioid epidemic. CONCLUSION: Orthopedic patients are aware of THC- and CBD-based products, and the majority are willing to receive these products to help manage their musculoskeletal pain and orthopedic-related issues. Orthopedic surgeons should be aware of the increasing popularity of CBD-based products and educate themselves and their patients regarding the appropriate use of them. [. 2025;48(2):98-103.].
Causal Association Between Primary Biliary Cholangitis and Osteoporosis: A Mendelian Randomization Study.
Yan W, Dongkai G, Wenhan S … +4 more , Quanjing L, Huangxing L, Ye Y, Zhaomin Z
Orthopedics · 2025 · PMID 39835846 · Publisher ↗
BACKGROUND: As the prevalence of osteoporotic fractures increases, impacting the health of the aging population significantly, understanding the genetic link between chronic diseases such as primary biliary cholangitis (...
BACKGROUND: As the prevalence of osteoporotic fractures increases, impacting the health of the aging population significantly, understanding the genetic link between chronic diseases such as primary biliary cholangitis (PBC) and osteoporosis (OP) is crucial. Despite existing research, the direct genetic relationship between these conditions remains unclear. MATERIALS AND METHODS: This study used a two-sample Mendelian randomization approach, drawing on the largest available genome-wide association studies. Instrumental variables were selected based on single nucleotide polymorphisms to explore the genetic correlations affecting the association between PBC and OP. This method helps overcome the limitations of traditional observational studies by reducing confounding factors and preventing reverse causation. RESULTS: The results, primarily derived from the inverse variance weighted method along with MR-Egger and weighted median supplementary methods, demonstrated a significant causal link between the genetic markers associated with PBC and an increased risk of OP. Sensitivity analyses reinforced these findings, affirming the robustness of the genetic associations. CONCLUSION: These findings highlight the genetic underpinnings that potentially link PBC to an increased risk of OP, suggesting that genetic factors play a significant role in the progression of chronic diseases. This knowledge could lead to better prevention and treatment strategies for OP, emphasizing the need for integrated treatment approaches that account for genetic predispositions of patients with chronic conditions. Future research should focus on validating these genetic links further and exploring them as potential therapeutic targets. [. 2025;48(2):111-115.].
Telemedicine in Orthopedic Oncology: An Opportunity for Cost Savings Without Compromising Clinical Outcomes.
Arpey NC, Conway DJ, Kass JD … +3 more , Gibbs CP, Scarborough MT, Spiguel AR
Orthopedics · 2025 · PMID 39724078 · Publisher ↗
BACKGROUND: Prior work has demonstrated that telemedicine in orthopedic surgery is cost-effective and can yield good clinical outcomes with high patient satisfaction. However, few studies have investigated the use of tel...
BACKGROUND: Prior work has demonstrated that telemedicine in orthopedic surgery is cost-effective and can yield good clinical outcomes with high patient satisfaction. However, few studies have investigated the use of telemedicine in orthopedic oncology. In this study, we assessed the effect of telemedicine on (1) potential cost savings for orthopedic oncologic patients and (2) clinical outcomes as measured by unexpected in-person clinic visits and missed complications. MATERIALS AND METHODS: A total of 308 patients who had 528 telemedicine visits in the orthopedic oncology clinic from May 2020 to August 2023 were identified. Demographic and clinical information, travel distance/time to clinic, complications, and instances where a telemedicine visit prompted an in-person evaluation were collected and reported with descriptive statistics. Cost savings were calculated based on travel distance and lost productivity. Patients with and without a complication or an unexpected in-person clinic visit were compared to identify risk factors for these clinical outcomes. RESULTS: Cost analysis demonstrated that telemedicine offers patients a potential cost savings of up to $475.2±$242.9 per visit. For 4.5% of the patients, a telehealth visit prompted an in-person evaluation. A complication was experienced by 5.5% of the patients. No complications were missed because of telemedicine. A diagnosis of a malignant tumor was associated with a higher rate of complications (=.01) and unexpected in-person clinic visits (=.03). CONCLUSION: Telemedicine can reduce the financial burden of treatment for orthopedic oncologic patients without negatively impacting clinical outcomes. Care should be taken when considering telehealth for patients with malignant tumors given their higher risk for adverse outcomes. [. 2025;48(1):e27-e32.].
Interpositional Bioresorbable Scaffold-Anchor Appears Non-inferior to a Standard Anchor in the Treatment of Rotator Cuff Tears.
Angerett N, Krasney L, Lutz R … +4 more , Maurer T, Michelitch S, Lin A, Kelly M
Orthopedics · 2025 · PMID 39724077 · Publisher ↗
BACKGROUND: Failure after rotator cuff repair is typically due to a loss of integrity of the bone-tendon interface. The BioWick anchor (Zimmer-Biomet) is an interpositional scaffold-anchor that was developed to improve t...
BACKGROUND: Failure after rotator cuff repair is typically due to a loss of integrity of the bone-tendon interface. The BioWick anchor (Zimmer-Biomet) is an interpositional scaffold-anchor that was developed to improve tendon-bone healing. The purpose of this study was to determine the clinical efficacy of this novel anchor compared with a standard anchor with respect to retear rates and patient outcomes. MATERIALS AND METHODS: We enrolled 99 patients in a double-anonymized, prospective, randomized controlled trial who underwent rotator cuff repair. Fifty patients were randomized to the novel anchor group and 49 patients were randomized to the standard anchor group. The primary outcome was rotator cuff repair integrity assessed via ultrasound at 6 months postoperatively. Secondary outcomes included visual analog scale (VAS) pain score, American Shoulder and Elbow Surgeons (ASES) score, Simple Shoulder Test (SST), strength, and active range of motion (AROM) assessed preoperatively and postoperatively at 3 and 6 months. RESULTS: There were no statistically significant differences in demographic data, mean rotator cuff tear size, tobacco use, workers' compensation status, or operative side between the groups. At 6-month follow-up, the retear rate was 22% (n=9) for the novel anchor group vs 23% (n=10) for the standard anchor group (=.8864). Secondary outcomes, including VAS pain score, ASES score, SST, strength, and AROM measurements, did not differ significantly between the groups at 3- or 6-month follow-up. There were no complications identified in either group. CONCLUSION: This study did not demonstrate superior clinical improvements or decreased retear rates with the use of this novel anchor compared with a standard anchor. [. 2025;48(1):e33-e39.].
The Visual Assessment of Cup Position on Anteroposterior Pelvis Radiographs Before Revision Total Hip Arthroplasty for Instability Is Highly Deceiving.
Lin S, Villa JM, Rajschmir K … +2 more , Higuera CA, Grieco P
Orthopedics · 2025 · PMID 39724076 · Publisher ↗
BACKGROUND: Is "eyeballing" enough to determine cup malposition on anteroposterior (AP) pelvis radiographs before revision total hip arthroplasty (rTHA) for instability? We aimed to determine the following: (1) the relia...
BACKGROUND: Is "eyeballing" enough to determine cup malposition on anteroposterior (AP) pelvis radiographs before revision total hip arthroplasty (rTHA) for instability? We aimed to determine the following: (1) the reliability of eyeballing cup inclination/anteversion on AP pelvis radiographs vs geometrical measurements and (2) whether visual assessments are affected by surgeon experience. MATERIALS AND METHODS: Fifteen de-identified standing AP pelvis radiographs obtained before rTHA for instability were evaluated by one orthopedic surgeon who measured inclination/anteversion of the cups (n=15) using a new simplified method based on basic geometry. Subsequently, 4 orthopedic surgeons and 4 fellows (postgraduate year 6) assessed inclination/anteversion by eyeballing. A modified Lewinnek safe zone range was employed to categorize each value (in degrees) by geometrical measurements or by raters' eyeballing as within or outside the safe zones. Cohen's kappa () statistics were performed. Mean values of attending surgeons and fellows were compared. RESULTS: According to geometrical measurements, 8 and 12 cups were in malposition (for inclination and anteversion, respectively). By just eyeballing, no attending surgeon or fellow attained an excellent (>0.8) level of agreement when compared with geometrical measurements. Only 1 attending surgeon attained a substantial (=0.6-0.8) level of agreement (=0.737, for inclination, =.003). Mean values of attending surgeons and fellows were 0.476 and 0.187, respectively, for inclination (=.2) and 0.416 and 0.428, respectively, for anteversion (=.9). CONCLUSION: Eyeballing cup position on AP pelvis radiographs before rTHA for instability is extremely misleading, regardless of surgeon experience. It is imperative to always measure the inclination and anteversion of the cup. [. 2025;48(1):e22-e26.].
The Associations Between Individual Anthropometric Measurements and Fracture Risk: A Mendelian Randomization Study.
Song Y, Zhou J, Tang G
Orthopedics · 2025 · PMID 39699167 · Publisher ↗
BACKGROUND: The primary objective of this study was to investigate and substantiate the possible causal connections between measurements of body dimensions and the likelihood of experiencing fractures. MATERIALS AND METH...
BACKGROUND: The primary objective of this study was to investigate and substantiate the possible causal connections between measurements of body dimensions and the likelihood of experiencing fractures. MATERIALS AND METHODS: We employed a two-sample Mendelian randomization (MR) analysis to examine the associations between anthropometric measurements and two specific traits-bone mineral density and fracture risk. To ensure the credibility of our causal conclusions, we used the inverse variance weighted (IVW) method along with various sensitivity analyses. RESULTS: Our findings suggest a notable link between increased height and the likelihood of fractures. Specifically, employing the IVW method revealed that for every 10-cm increase in height, there was a 6.0% rise in fracture risk (odds ratio [OR], 1.06; 95% CI, 1.06-1.13; =.0001). This outcome was further supported by both the weighted-median method and the MR-Egger method, with an OR of 1.10 (95% CI, 1.03-1.16; =.0003) and an OR of 1.11 (95% CI, 1.08-1.17; =.0020), respectively. No statistically significant associations were observed between other measurements, such as body mass index (BMI), waist-to-hip ratio adjusted for BMI, hip circumference adjusted for BMI, and waist circumference adjusted for BMI, and fracture risk. Sensitivity analyses, including MR-Egger regression's intercept test and multivariate testing, indicated no substantial presence of directional pleiotropy in instrumental variables, ensuring the stability and reliability of our analysis results. CONCLUSION: Our study used MR to present genetic evidence supporting height as a distinct causal factor in fracture susceptibility. Our findings underscore the importance of incorporating anthropometric measurements into the development of strategies for preventing and treating osteoporosis. [. 2025;48(1):25-29.].
Emergency Department Use Within 90 Days After Single-Level Posterior Cervical Foraminotomy.
Jayaram RH, Oghenesume OP, Day W … +2 more , Kammien AJ, Grauer JN
Orthopedics · 2025 · PMID 39699166 · Publisher ↗
BACKGROUND: This study sought to characterize the incidence of, timing of, predictive factors for, and reasons for emergency department (ED) visits within 90 days of single-level posterior cervical foraminotomy (PCF). Th...
BACKGROUND: This study sought to characterize the incidence of, timing of, predictive factors for, and reasons for emergency department (ED) visits within 90 days of single-level posterior cervical foraminotomy (PCF). These visits, after PCF, have received limited attention. MATERIALS AND METHODS: The 2010-2022 M161 PearlDiver database was queried for elective single-level PCFs, excluding multilevel procedures, midline laminectomies, fusions, or other posterior/anterior procedures, as well as indications of trauma, infection, or neoplasm. Patient age, sex, Elixhauser Comorbidity Index (ECI), insurance, and region were extracted. Weekly ED use after PCF was calculated. Multivariate analyses were used to identify predictive factors for ED use, and primary ED diagnoses were categorized. RESULTS: Of 10,588 PCF patients, 9.09% (n=962) visited the ED within 90 days after surgery, mostly in the first 4 weeks. Multivariate analysis identified that predictors included younger age (odds ratio [OR], 1.02 per decade decrease), female sex (OR, 1.19), higher ECI (OR, 1.28 for ECI 1-2; OR, 1.41 for ECI 3-4; OR, 1.51 for ECI ≥5), Midwest (OR, 1.16) or Northeast (OR, 1.19) region, and Medicare (OR, 1.09) or Medicaid (OR, 1.57) coverage. In the first 4 weeks, 69.9% of ED visits were related to the surgical site; this decreased to 27.1% thereafter. CONCLUSION: Almost one-tenth of PCF patients visited the ED within 90 days after surgery. Specific patient characteristics were associated with ED visits, with surgical site-related diagnoses predominating in the acute postoperative period. Tailoring health care interventions based on timing of, risk factors for, and causes of ED visits may enhance outcomes and reduce costs. [. 2025;48(1):51-56.].
Outcomes of Simultaneous Correction of Adult Hallux Valgus and Flexible Pes Planus Deformities.
Gu W, Fu S, Wang C … +3 more , Song G, Shi Z, Zhang H
Orthopedics · 2025 · PMID 39699165 · Publisher ↗
BACKGROUND: There is a high correlation between hallux valgus and pes planus deformity. We sought to evaluate the outcomes of simultaneous Scarf osteotomy and extraosseous talotarsal stabilization (EOTTS) for correcting...
BACKGROUND: There is a high correlation between hallux valgus and pes planus deformity. We sought to evaluate the outcomes of simultaneous Scarf osteotomy and extraosseous talotarsal stabilization (EOTTS) for correcting adult hallux valgus with flexible pes planus deformity. MATERIALS AND METHODS: This retrospective study enrolled patients who had hallux valgus deformity with flexible pes planus and underwent combined Scarf osteotomy and EOTTS from January 2018 to October 2021. The hallux valgus angle (HVA), intermetatarsal angle (IMA), Meary's angle, calcaneal pitch, and lateral talocalcaneal angles were assessed preoperatively and at 1-year follow-up. Clinical outcomes were evaluated using the visual analog scale (VAS) score for pain, the American Orthopaedic Foot and Ankle Society (AOFAS) forefoot score, and the Maryland foot score (MFS). Complications were recorded. RESULTS: This study included 25 patients, 19 women and 6 men, with a mean age of 44.3 years. The mean follow-up period was 14.6 months. The mean HVA, IMA, Meary's angle, calcaneal pitch, and lateral talocalcaneal angles improved significantly at 1-year follow-up (<.001). The mean VAS score decreased from 5.8 to 1.0, whereas the mean AOFAS forefoot score and MFS increased from 52.3 to 88.9 and 61.2 to 89.3, respectively, at 1-year follow-up (<.001). Two patients had arthroereisis implant removal as a consequence of sinus tarsi pain. No other complications were seen during the follow-up. CONCLUSION: Management of hallux valgus with flexible pes planus deformity with combined Scarf osteotomy and EOTTS can achieve satisfactory clinical and radiologic results with low complication and recurrence rates. [ 2025;48(1):37-43.].
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