Orthopedics[JOURNAL]
Sun
200 papers
Early Operative Management of Ballistic Humeral Shaft Fractures Is Associated With Shorter and More Predictable Course of Healing.
Hartline J, Zhang T, Langhammer CG
Orthopedics · 2026 · PMID 41557497 · Publisher ↗
BACKGROUND: This study compared fracture healing and reoperation rates between early operative versus nonoperative management of ballistic humeral shaft fractures. MATERIALS AND METHODS: A retrospective chart review was...
BACKGROUND: This study compared fracture healing and reoperation rates between early operative versus nonoperative management of ballistic humeral shaft fractures. MATERIALS AND METHODS: A retrospective chart review was conducted at an academic trauma center. Patients ≥18 years treated for ballistic humeral shaft fractures (AO 1.2) between 2015 and 2022 were identified. Exclusion criteria included periarticular/intra-articular extension, non-ballistic mechanism, or age <18 years. Patients were stratified into operative versus nonoperative cohorts based on shared decision making. Outcome measures included time of union, postoperative visits, and reoperations. Time-to-event (TTE) analysis assessed duration of follow-up and time to healing. Discrete variables were compared for patients with >12 weeks follow-up using Fisher's exact tests and Student's t tests. RESULTS: Seventy-four patients (31 nonoperative, 43 operative) were included in TTE analysis. After excluding patients with <12 weeks follow-up, 43 patients (19 nonoperative, 24 operative) were included in discrete analysis (88% male, 86% Black, mean age 31 years). Operatively treated fractures included higher percentages of male patients (100% vs 71%, < .01) and vascular injuries (25% vs 0%, = .03), and a larger percentage of fractured humerus (21% vs 15%, = .03). In TTE analysis, operative fractures demonstrated faster healing ( = .03). Nine patients (47%) in the nonoperative group underwent unplanned operations compared to two patients (8%) in the operative group ( < .01). No differences were found in follow-up visits or time to clinic discontinuation. CONCLUSION: Operatively treated ballistic humeral shaft fractures demonstrated faster healing and lower reoperation rates than nonoperatively treated ballistic fractures, despite association with more profound injury.
Total Knee Arthroplasty After Anterior Cruciate Ligament Reconstruction: A Matched-cohort Analysis.
Robertson E, Strecker SE, Witmer D … +1 more , Carangelo RJ
Orthopedics · 2026 · PMID 41557496 · Publisher ↗
BACKGROUND: Prior anterior cruciate ligament (ACL) reconstruction may introduce technical challenges during total knee arthroplasty (TKA), including altered anatomy and retained hardware. Evidence regarding how prior ACL...
BACKGROUND: Prior anterior cruciate ligament (ACL) reconstruction may introduce technical challenges during total knee arthroplasty (TKA), including altered anatomy and retained hardware. Evidence regarding how prior ACL reconstruction might change TKA outcomes remains limited. The primary objective of this study was to compare perioperative characteristics, patient-reported outcome measures (PROMs), and short-term complications in patients undergoing TKA with and without a history of ACL reconstruction. MATERIALS AND METHODS: This was a retrospective matched-cohort study of patients who underwent TKA between January 2020 and December 2023 at a high-volume orthopedic hospital. Forty-five patients with prior ACL reconstruction were matched 1:4 to 175 patients undergoing primary TKA for osteoarthritis. Demographics, operative parameters, inpatient outcomes, and PROMs were compared. RESULTS: Prior to surgery, the ACL group had higher preoperative Knee injury and Osteoarthritis Outcomes Score for Joint Replacement scores ( = .006). The operative time was longer in the ACL group (mean 103.9 vs 88.3 minutes, < .001). The ACL group reported lower inpatient pain ( = .049) and required fewer opioids ( = .028), but had similar physical therapy outcomes. By 12 weeks, PROMs and pain scores were equivalent between groups and remained similar at 1 year. No differences were observed in 90-day complications. CONCLUSION: TKA after ACL reconstruction is associated with increased operative time but yields comparable short-term outcomes to primary TKA. These findings support the safety and effectiveness of TKA in this distinct patient population. Larger, comparative studies are needed to confirm these findings and to better understand the long-term ramifications of prior ACL reconstruction on TKA outcomes.
Patient Portal Messaging to Care Teams Is Substantial and Associated With Emergency Department Visits and Hospital Readmission Following Elective Orthopedic Surgery.
Bernstein DN, Lucaciu AR, Detels K … +6 more , Chua TL, Fogel HA, Hershman SH, Bono CM, Harris MB, Tobert DG
Orthopedics · 2026 · PMID 41557495 · Publisher ↗
BACKGROUND: There has been an increase in patient use of electronic patient portal (EPP) messaging. Although it may improve communication, it can be time consuming, and its association with clinical outcomes and addition...
BACKGROUND: There has been an increase in patient use of electronic patient portal (EPP) messaging. Although it may improve communication, it can be time consuming, and its association with clinical outcomes and additional health care use is not well known in orthopedic surgery. MATERIALS AND METHODS: Patients undergoing elective orthopedic procedures at an academic medical center between January 2016 and June 2023 were included. Chi-squared and t tests were used to compare characteristics between postoperative messengers and non-messengers for categorical and continuous variables, respectively. Two multivariable logistic regression analyses were conducted to assess factors associated with emergency department (ED) visits without readmission and any readmission. RESULTS: Overall, 56,427 patients who underwent 64,709 surgeries were included; 580,531 messages were sent within 90 days of surgery. Postoperative EPP messaging was associated with increased odds of ED visits without readmission (odds ratio [OR], 1.22; 95% CI, 1.13-1.31; < .001). Black race (OR, 1.82; 95% CI, 1.59-2.10; < .001), Medicaid insurance (OR, 2.21; 95% CI, 1.93-2.53; < .001), hand procedures (OR, 2.84; 95% CI, 2.55-3.15; < .001), and foot and ankle procedures (OR, 3.26; 95% CI, 2.52-4.22; < .001) had the highest odds of ED visits without readmission. Postoperative EPP messaging was associated with increased odds of any readmission (OR, 1.50; 95% CI, 1.41-1.59; < .001). Hand procedures (OR, 2.26; 95% CI, 2.06-2.47; < .001) and Medicaid patients (OR, 1.42; 95% CI, 1.24-1.64; < .001) had the highest odds of any readmission after sending a postoperative message. CONCLUSION: Postoperative EPP messages are frequently sent to orthopedic surgeons and their care teams. This research helps to identify those who may be at risk for increased health care use postoperatively. Optimizing postoperative EPP messaging engagement and care is critical to not only patients but health professional team well-being.
The Impact of Osseous Erosions on Intraarticular Tenosynovial Giant Cell Tumors of the Knee and Local Recurrence.
Olson J, LiBrizzi CL, Gross J … +3 more , Ahlawat S, Schaefer RA, Levin AS
Orthopedics · 2025 · PMID 41337552 · Publisher ↗
BACKGROUND: Tenosynovial giant cell tumor (TGCT) is a rare, mostly benign neoplasm originating in the synovium of joints, tendon sheaths, and bursae that can locally recur after excision and cause osseous erosions. Studi...
BACKGROUND: Tenosynovial giant cell tumor (TGCT) is a rare, mostly benign neoplasm originating in the synovium of joints, tendon sheaths, and bursae that can locally recur after excision and cause osseous erosions. Studies have suggested increased local recurrence with diffuse TGCT, but few have assessed associations of local recurrence or erosions in TGCT of the knee. Our aim was to determine associations of erosions and local recurrence with patient and tumor characteristics in knee TGCT. MATERIALS AND METHODS: A retrospective chart review was performed on 53 patients with intraarticular, biopsy-proven TGCT of the knee diagnosed at our institution from December 2002 to December 2020. Bivariate analysis assessed the significance of associations between patient and tumor characteristics, surgical management, erosions, and local recurrence. RESULTS: Of 53 patients with intra-articular, biopsy-proven TGCT of the knee, 24 (45%) patients had diffuse, intra-articular TGCT, and 7 (13%) patients had radiographic evidence of osseous erosions. In the diffuse, intra-articular subgroup, 12 (50%) patients had local recurrence, but 5 of 5 patients with erosions had local recurrence. Of the 19 patients with diffuse, intra-articular TGCT without erosion, 7 (37%) had local recurrence ( = .037). Of the 24 patients with diffuse, intra-articular TGCT, both those who had and did not have local recurrence had similar surgical treatment (75% arthroscopic, 25% open). The average recurrent-free survival was 936 days. CONCLUSION: Patients with diffuse, intra-articular TGCT of the knee with osseous erosions had a greater incidence of local recurrence than those without. Using erosions as a positive prognostic indicator for local recurrence may assist physicians in risk stratification of patients with diffuse, intra-articular TGCT.
Testosterone Replacement Therapy in Total Hip Arthroplasty Patients: A Propensity-matched Cohort Analysis of 90-day Outcomes.
Jing C, Deckey DG, Rosas S … +3 more , Stein MK, Bolognesi MP, Ryan SP
Orthopedics · 2025 · PMID 41337551 · Publisher ↗
BACKGROUND: Testosterone replacement therapy (TRT) has increased in popularity over the past decade. However, TRT has been associated with medical risks, such as venous thromboembolism. The aim of this study was to chara...
BACKGROUND: Testosterone replacement therapy (TRT) has increased in popularity over the past decade. However, TRT has been associated with medical risks, such as venous thromboembolism. The aim of this study was to characterize perioperative and postoperative complications in total hip arthroplasty (THA) patients taking TRT in the perioperative period. MATERIALS AND METHODS: A retrospective review of patients from a large academic medical center was performed to identify primary THA patients who underwent TRT within 3 months prior to surgery. Cohorts were propensity score matched with controls using nearest-neighbor method with age, American Society of Anesthesiologists score, and body mass index as covariates. Outcomes studied included 90-day readmissions, emergency department (ED) encounters, infections, myocardial infarctions (MI), deep venous thrombosis (DVT), and pulmonary embolism (PE). Twenty-four-month revision rates were also collected. RESULTS: One hundred forty-six patients on TRT were evaluated with 294 consecutive control patients not on TRT. There was a significantly greater proportion of 90-day periprosthetic joint infection in the TRT cohort compared to the No TRT cohort (3.4%, n = 5, vs 0.3%, n = 1; = .017). There was no significant difference in all other postoperative complications between TRT and No TRT cohorts. Ninety-day postoperative ED encounters, readmission rates, DVT, MI, and PE were similar and low between cohorts ( > .05). Twenty-four-month revision rates were also similar between study groups ( > .05). CONCLUSION: This study found that TRT was associated with greater periprosthetic joint infection in THA. Further studies will need to be performed to identify optimal discontinuation of treatment prior to joint replacement.
The National Epidemiology of Ankle Sprains in the United States: Updates From 2010 to 2024.
Tyler JR, Sandler AB, Albagli A … +3 more , Gilat R, Scanaliato JP, Parnes N
Orthopedics · 2025 · PMID 41337550 · Publisher ↗
BACKGROUND: Ankle sprains are among the most common musculoskeletal injuries presenting to United States (US) emergency departments (EDs) and contribute substantially to health care use. This study provides updated natio...
BACKGROUND: Ankle sprains are among the most common musculoskeletal injuries presenting to United States (US) emergency departments (EDs) and contribute substantially to health care use. This study provides updated national incidence rate estimates and characterizes trends in demographic and injury-related risk factors. MATERIALS AND METHODS: The National Electronic Injury Surveillance System was queried for all ankle sprain cases treated in US EDs from 2010 to 2024. Incidence rates were calculated per 1,000 person-years using US Census data, and relevant stratified analyses were conducted. RESULTS: From 2010 to 2024, an estimated 7.4 million ankle sprains presented to US EDs, yielding an incidence of 1.53 per 1,000 person-years. Annual incidence declined from 2.12 in 2010 to 1.19 in 2024, with the lowest rate observed in 2020 (0.89) during the peak of the COVID-19 pandemic. Peak incidence occurred in adolescents aged 15 to 19 years (2.60 per 1,000), with over half of all sprains occurring in individuals aged 10 to 24. Female patients had a higher overall incidence than male patients (1.62 vs 1.44 per 1,000), peaking at ages 10 to 14 compared to 15 to 19, respectively. Athletic activity accounted for 33.2% of all sprains, with basketball alone responsible for 15.8% of cases. Most patients (99.5%) were treated and released without admission. CONCLUSION: Ankle sprain incidence in US EDs has declined over the past 15 years but remains highest among adolescents, female patients, and athletes. A significant decline was observed during the COVID-19 pandemic. These findings provide updated national benchmarks and underscore the importance of preventive strategies in high-risk populations.
The Future of Medical Leadership: Humanity, Expertise, and the Fight Against Ideology.
Brown LC
Orthopedics · 2025 · PMID 41337549 · Publisher ↗
Abstract loading — click title to view on PubMed.
Endoscopic Hip Abductor Repair: A Comparative Outcomes Study of Two Anchors.
Byrd JWT, Jones KS, Duncan SP
Orthopedics · 2025 · PMID 41337548 · Publisher ↗
BACKGROUND AND OBJECTIVE: The aim of this study was to compare outcomes of endoscopic hip abductor repair with Healicoil Regenesorb (RG) vs Q-FIX anchors at 2-year follow-up. MATERIALS AND METHODS: The 2-year follow-up m...
BACKGROUND AND OBJECTIVE: The aim of this study was to compare outcomes of endoscopic hip abductor repair with Healicoil Regenesorb (RG) vs Q-FIX anchors at 2-year follow-up. MATERIALS AND METHODS: The 2-year follow-up modified Harris Hip Score of 51 consecutive hips (49 patients) repaired with Healicoil RG anchors were compared to that of 38 consecutive hips (35 patients) repaired with Q-FIX anchors. RESULTS: There was no statistically significant difference between the two groups in terms of age, sex, partial vs full thickness tears, one vs two tendon involvement, single vs double row repair, or concomitant correction of femoroacetabular impingement (FAI). For Healicoil, the mean improvement was 38.6 points, with 98% achieving minimal clinically important difference (MCID) of 6.8 points vs Q-FIX with mean improvement of 29.5 points and 92.1% achieving MCID of 7.5 points. The mean improvement was statistically superior for Healicoil. Within each of the two groups, there was no statistically significant difference in outcomes for partial vs full thickness tears, one vs two tendon involvement, single vs double row repairs, or concomitant correction of FAI. There were no complications in either group. One patient in the Healicoil group subsequently underwent total hip arthroplasty at 11 months following repair. CONCLUSION: The Healicoil RG resulted in statistically significant greater improvement over the Q-FIX for endoscopic tendon repair. These two products demonstrate differing features, offering versatility in decision making for a variety of tear types, and both provide successful outcomes in terms of average improvement in modified Harris Hip Scores and percentage of patients achieving MCID with low likelihood of complications or need for further surgery.
Acute Alcohol Intoxication and Chronic Alcohol Use Increase Risk of Infection After Open Tibia Fractures.
Soni C, Druten EJ, Orcutt M … +3 more , Slaven J, Lopas LA, Jang Y
Orthopedics · 2025 · PMID 41337547 · Publisher ↗
BACKGROUND: Alcohol use is a known risk factor for impaired wound healing. This study evaluated the impact of acute and chronic alcohol use on fracture-related infection (FRI) incidence in open tibia fractures. MATERIALS...
BACKGROUND: Alcohol use is a known risk factor for impaired wound healing. This study evaluated the impact of acute and chronic alcohol use on fracture-related infection (FRI) incidence in open tibia fractures. MATERIALS AND METHODS: A retrospective review of skeletally mature patients with open tibia fractures at a level I trauma center from 2017 to 2021 was conducted. Six-month follow-up was required. Missing blood toxicology results were excluded. Ethanol levels >10 mg/dL on admission defined acute alcohol use, and daily alcohol use or documented history defined chronic alcohol use. The primary outcome was FRI. Bivariate and multivariate analyses identified associations between alcohol use and infection rates. RESULTS: Among 190 fractures (187 patients), 70 (36.8%) developed positive FRI criteria: 15 suggestive, 55 confirmatory. Acute alcohol use and chronic alcohol use were independently associated with suggestive FRI in multivariate analysis (acute: = .044, odds ratio [OR] 2.96, 95% CI [1.03-8.50]; chronic: = .022, OR 4.70, 95% CI [1.25-17.70]). In chronic alcohol users, acute alcohol use further increased suggestive FRI risk ( = .036, OR 11.05, 95% CI [1.85-65.86]). Smoking, compartment syndrome, and increasing open fracture severity increased the risk of confirmatory FRI ( = .007, OR 2.30, 95% CI [1.26-4.20]; = .023, OR 2.75, 95% CI [1.15-6.58]; = .003, OR 1.57, 95% CI [1.16-2.12], respectively). CONCLUSION: Acute and chronic alcohol use significantly increased suggestive FRI risk in open tibia fractures, with compounded risk when both were present. This study examined the relationship between acute alcohol use and FRI in orthopedic trauma, underscoring the need for targeted interventions in this high-risk population.
Appearance of False Leg Length Discrepancy Based on the Side Patients Use to Get on the Examination Table and Its Correlation With Their Height.
Lyrtzis C, Malasidis V, Lazaridis N … +2 more , Paraskevas G, Chytas D
Orthopedics · 2025 · PMID 41187275 · Publisher ↗
BACKGROUND: There is lack of studies to investigate if the side that a patient uses to lie on the examination table induces functional leg length discrepancy (LLD). We aimed to explore this possible correlation, along wi...
BACKGROUND: There is lack of studies to investigate if the side that a patient uses to lie on the examination table induces functional leg length discrepancy (LLD). We aimed to explore this possible correlation, along with the influence of the patient's height and sex. MATERIALS AND METHODS: Eighty participants, 40 men and 40 women, aged 18 to 50 years with no pre-existing LLD, also known as anisomelia, were included. The difference between leg lengths was assessed in the supine position by measuring the distance from the umbilicus to the medial malleolus when the participants used the right or left side of the table to lie on it. After the technique known as the Weber-Barstow maneuver was performed, leg lengths were found to be equal. Nine participants who still exhibited a length discrepancy even after the corrective maneuver were excluded from the study, as they had true LLD. RESULTS: There was a significant relationship between the side of the examination table used by the participants and functional LLD. The participants who used the right side of the table to lie on it had a longer left leg, and vice versa. It was observed that taller participants exhibited a significantly greater functional LLD, whereas this difference was not significantly affected by sex. CONCLUSION: The side the patient uses to lie on the examination table may create functional LLD, which can be corrected with the Weber-Barstow maneuver. This discrepancy is related to the patient's height but not their sex.
Outpatient Orthopedic Conditions in the Pregnant Patient: A Review of the Literature.
Weckerly M, Cohen A, Grubman O … +1 more , Cooper AR
Orthopedics · 2025 · PMID 41187274 · Publisher ↗
Pregnancy induces a range of physiological and musculoskeletal changes that can lead to orthopedic issues. This article examines etiologies and management strategies for outpatient orthopedic problems encountered during...
Pregnancy induces a range of physiological and musculoskeletal changes that can lead to orthopedic issues. This article examines etiologies and management strategies for outpatient orthopedic problems encountered during pregnancy. Hormonal changes, weight gain, and altered biomechanics contribute to common musculoskeletal complaints such as low back pain, pelvic girdle pain, and carpal tunnel syndrome. Although less common, osteoporosis can present during pregnancy. Additionally, domestic violence and interpartner violence are disproportionately more frequent in this population. This review highlights evidence-based approaches for diagnosis and treatment and emphasizes the importance of multidisciplinary care, including obstetricians, orthopedic surgeons, endocrinologists, primary care physicians, and physical therapists.
Poor Outcomes of Lateral Tibial Plateau Fractures in Women Aged 50 and Older: A Case Series.
Khanna A, Thompson AL, Anderson ML … +3 more , Sems SA, Hidden KA, Yuan BJ
Orthopedics · 2025 · PMID 41187273 · Publisher ↗
BACKGROUND: This study assessed the long-term clinical outcomes of women (≥50 years of age) who undergo operative management of lateral tibial plateau fractures, with particular focus on risk of conversion to total knee...
BACKGROUND: This study assessed the long-term clinical outcomes of women (≥50 years of age) who undergo operative management of lateral tibial plateau fractures, with particular focus on risk of conversion to total knee arthroplasty (TKA). MATERIALS AND METHODS: A retrospective review was conducted on female patients aged 50 and older who sustained lateral tibial plateau fractures treated with open reduction and internal fixation (ORIF) at a level 1 trauma center between January 2003 and July 2023. The primary outcome measure was conversion to TKA. Secondary outcome measures included lateral joint subsidence, arthrosis progression, surgical complications, and reoperations for any reason. RESULTS: Forty-one women underwent ORIF of lateral tibial plateau fractures during the study period with an average age of 63.5 ± 9.0 years. The mechanism of injury for most patients was a ground-level fall (n = 24, 58.5%). At final follow-up, lateral joint subsidence was present in 22 women (53.7%), and patients progressed an average of 1.0 Kellgren-Lawrence grade in terms of arthrosis. A total of 7 women (17.1%) underwent conversion to TKA at a mean of 4.0 years after ORIF. CONCLUSION: Women 50 years and older demonstrated a 17.1% rate of conversion to TKA following operative management of laterally impacted tibial plateau fractures, more than two times higher than rates seen in the general population affected by these fractures. Appropriate counseling should be offered preoperatively for these patients.
Perioperative Angiotensin-receptor Blocker Use Shows Decreased Rates of Manipulation Under Anesthesia and Revisions After Total Knee Arthroplasty: A Systematic Review.
Carpenter ML, Cruz E, Hirpara A … +3 more , Sidrak J, Dayton M, Hogan C
Orthopedics · 2025 · PMID 41187272 · Publisher ↗
BACKGROUND: The purpose of this study was to compare rates of manipulation under anesthesia (MUA) and revision total knee arthroplasty (TKA) in patients undergoing TKA with and without perioperative use of an angiotensin...
BACKGROUND: The purpose of this study was to compare rates of manipulation under anesthesia (MUA) and revision total knee arthroplasty (TKA) in patients undergoing TKA with and without perioperative use of an angiotensin-receptor blocker (ARB). MATERIALS AND METHODS: Embase and PubMed/MEDLINE were searched, and peer-reviewed studies with a minimum follow-up period of 90 days comparing rates of MUA and revision surgery in patients undergoing TKA with and without perioperative use of an ARB were included. Studies that were not available in English and/or used animal models or cadavers, as well as case reports, non-full text articles, review articles, letters to the editor, and studies reporting data that was non-comparative or lacked outcome measures were excluded. Included studies were evaluated for quality using the Methodological Index for Non-Randomized Studies criteria. Patient demographics, comorbidities, and outcomes were extracted from the included studies. RESULTS: Six studies consisting of 997,086 control patients and 129,874 patients who received perioperative ARB were included. All included studies were at level III evidence. Patients taking an ARB had higher rates of diabetes (42% vs 28%), hypertension (87% vs 58%), obesity (34% vs 23%), and hyper-cholesterolemia (63% vs 35%) compared to the control groups. The rate of MUA across control patients ranged from 2.8% to 7.6%, compared to 2.5% to 6% in patients taking an ARB. The rate of revision TKA across control patients ranged from 1.4% to 7.6%, whereas the rate for patients taking an ARB ranged from 1.14% to 1.3%. CONCLUSION: Perioperative ARB use may decrease rates of MUA and revisions after TKA. This study can guide risk stratification and counseling for patients undergoing TKA. Higher-level studies need to be conducted to determine whether ARBs should be prescribed for the sole purpose of preventing arthrofibrosis.
Surgeon-patient Communication Using the Electronic Portal: Effect on Postoperative Outcomes and Patient-reported Outcome Measures Following Total Knee Arthroplasty.
Alpert Z, Habibi A, Ward SA … +5 more , Kennedy MF, Meftah M, Cohen-Rosenblum A, Schwarzkopf R, Rozell JC
Orthopedics · 2025 · PMID 41114691 · Publisher ↗
BACKGROUND: Electronic medical record portals enable real-time communication between patients and surgeons after total knee arthroplasty (TKA). This study evaluated the impact of message timing and frequency on postopera...
BACKGROUND: Electronic medical record portals enable real-time communication between patients and surgeons after total knee arthroplasty (TKA). This study evaluated the impact of message timing and frequency on postoperative outcomes and patient-reported outcome measures (PROMs). MATERIALS AND METHODS: We retrospectively reviewed 9,353 primary TKAs performed at a single academic institution. Of these, 1,219 patients sent messages within 2 weeks of surgery (early), 507 sent messages between 2 and 8 weeks (late), and 7,627 did not message. RESULTS: Patients who messaged within 2 weeks following surgery had shorter hospital length of stay (LOS) (41.2 vs 47.45 vs 53.40 hours, < .001) and were more likely to be discharged home (99.5% vs 97.6% vs 96.8%, < .001) compared to both late messengers and non-messengers. Patients who messaged late were more likely to experience a 90-day readmission surgery (3.2% vs 5.3% vs 3.3%, = .05). Most messages were sent within 2 weeks (1.76 vs 1.48; < .001). There was no difference in PROMs regardless of message timing, and there was no association between the number of messages sent and perioperative outcomes or PROMs. CONCLUSION: Older age and longer LOS were associated with less patient-initiated contact after TKA. Older patients may be less familiar with digital platforms and less likely to send messages. Early messaging may reflect heightened recognition of postoperative issues, enabling counseling or intervention and reducing readmissions. These findings underscore the importance of preoperative education and equitable access, though long-term effects of messaging warrant further study.
Prevalence of Cannabidiol (CBD) Use in an Outpatient Hand Surgery Clinic.
Iturregui JM, Deckey DG, Ishimoto A … +3 more , Renfree SP, Noland SS, Renfree KJ
Orthopedics · 2025 · PMID 41114690 · Publisher ↗
BACKGROUND: The aim of this study was to evaluate the prevalence and perceived efficacy of cannabidiol (CBD) products in patients presenting to an orthopedic hand and upper extremity clinic. MATERIALS AND METHODS: New pa...
BACKGROUND: The aim of this study was to evaluate the prevalence and perceived efficacy of cannabidiol (CBD) products in patients presenting to an orthopedic hand and upper extremity clinic. MATERIALS AND METHODS: New patients seen for an initial surgical consultation between July and December 2022 were surveyed regarding CBD use, pain, and function. Pain was measured with the Numeric Pain Rating Scale (NPRS, 0-10) and function with the Single Assessment Numeric Evaluation (SANE, 0-100). Demographic and clinical factors were collected via chart review. RESULTS: A total of 918 patients completed the survey (53% female; mean age 63 years, range 18-97). Joints involved included elbows (106), wrists (335), and hands/fingers (667). Common diagnoses included arthritis (199), tendinopathy (273), and nerve-related conditions (160). Overall, 15% (135/918) reported prior CBD use, and 39% (53/135) perceived pain relief. CBD users were more likely to be female (65% vs 51%; =0.003), to present with wrist pathology (44% vs 35%; =0.038), and to have arthritis (36% vs 19%; <0.001). Compared to non-users, CBD users reported higher pain scores (mean NPRS 6.2 vs 5.1; <0.001) and lower contralateral function (mean SANE 77.3 vs 87.4; <0.001). CONCLUSIONS: In this cohort, CBD use was uncommon, and only a minority of users reported subjective benefit. CBD users tended to report higher pain and worse function, particularly in the setting of wrist arthritis. CBD products did not appear to provide measurable objective improvement in pain or function. Further studies are needed to clarify optimal dosing, administration, and potential role in upper extremity care.
Comparison of Hounsfield Unit Value and Vertebral Bone Quality Score in Predicting Cage Subsidence After Zero-P Fusion Surgery.
Pu HY, Wang JZ, Guo JW … +3 more , Luo SW, Yu JD, Zeng R
Orthopedics · 2025 · PMID 41114689 · Publisher ↗
BACKGROUND: This study compared the predictive performance of the Hounsfield unit (HU) value and vertebral bone quality (VBQ) score based on cage subsidence after anterior cervical discectomy and Zero-P fusion. MATERIALS...
BACKGROUND: This study compared the predictive performance of the Hounsfield unit (HU) value and vertebral bone quality (VBQ) score based on cage subsidence after anterior cervical discectomy and Zero-P fusion. MATERIALS AND METHODS: We conducted a retrospective analysis of 104 patients who underwent Zero-P fusion surgery for cervical spondylosis in our hospital. Before surgery, the VBQ of each patient's C2-C7 vertebral body was measured by cervical magnetic resonance imaging, while the HU value was measured by cervical computed tomography. The maximum loss distance of vertebral height was measured immediately after surgery and at final follow-up. Patients were divided into a subsidence group (≥3 mm) and a non-subsidence group (<3 mm). Single-factor analysis was used to preliminarily determine the risk factors for Zero-P cage (ZPC) subsidence. For variables with statistical differences, logistic regression was further used for multivariate analysis to determine independent risk factors. Receiver operating characteristic (ROC) and area under the curve (AUC) were used to evaluate the ability of VBQ score and HU value to predict ZPC subsidence. RESULTS: Interbody ZPC subsidence was observed in 20 of 104 patients. Significant differences in HU value and VBQ score were found between the two groups. HU value (odds ratio [OR]=0.987, 95% CI 0.978-0.997, =0.006) and VBQ score (OR=4.462, 95% CI 1.721-11.373, =0.002) were independent risk factors for ZPC subsidence. On the ROC curve, the AUC of VBQ score was 0.776 (95% CI 0.669-0.883), and the optimal threshold of VBQ score was 3.860 (sensitivity: 60.0%, specificity: 86.9%). The AUC of HU was 0.757 (95% CI 0.645-0.869), and the optimal threshold of HU value was 298.44 (sensitivity: 60.7%, specificity: 90.0%). The AUC of HU value and VBQ score showed no statistical difference, whereas the AUC of the joint index of HU value and VBQ score was 0.833, which was higher than that of the single indicator, and the difference was statistically significant (<0.05). CONCLUSION: Higher VBQ score and lower HU value are independent predictors of ZPC subsidence in patients following Zero-P fusion. The joint index of HU value and VBQ score is more predictive of Zero-P fusion than a single indicator.
Immediate Weight-bearing for Distal Femur Fractures Fixed With a Lateral Locking Plate Is Associated With Decreased Short-term Complications Without Increased Failure Rates.
Trout SM, Duvvuri P, Aziz H … +5 more , Indukuri S, Collins L, Linn MS, McKean JM, Goldman AT
Orthopedics · 2025 · PMID 41114688 · Publisher ↗
BACKGROUND: Distal femur fractures historically required prolonged weight-bearing restrictions following fixation. Allowing immediate weight-bearing is gaining traction due to the benefits of early mobilization. This stu...
BACKGROUND: Distal femur fractures historically required prolonged weight-bearing restrictions following fixation. Allowing immediate weight-bearing is gaining traction due to the benefits of early mobilization. This study compares postoperative complications of immediate weight-bearing as tolerated (WBAT) versus restricted weight-bearing (RWB) in distal femur fractures fixed with a lateral locking plate. MATERIALS AND METHODS: A retrospective analysis was conducted on all patients who underwent lateral locking plate fixation for distal femur fractures between October 2011 and April 2022 at four hospitals. Data collected included fracture characteristics, weight-bearing status, 30-day complications, and 1-year mortality. Radiographic outcomes including implant failure, malunion, nonunion, and time to union were assessed. RESULTS: One hundred twenty-four patients met inclusion criteria. Immediate weight-bearing was permitted in 76 (61.3%). The WBAT group was older (83.2 vs 68.9 years, < .001), had a lower body mass index (BMI) (28.1 vs 30.8, = .037), and had fewer 30-day complications (7.9% vs 25.0%, = .008). There was no difference in 30-day (6.3% vs 2.6%, = .374) or 1-year mortality (14.6% vs 17.1%, .468). There was no difference in implant failure, malunion, nonunion, and time to union between groups. Logistic regression demonstrated lower 30-day complications with WBAT (OR 0.207, = .041), lower BMI (OR 1.095, = .040) and lower Charlson Comorbidity Index. (OR 1.547, = .023). CONCLUSION: Immediate weight-bearing after lateral locking plate fixation for distal femur fractures is associated with fewer early postoperative complications compared to RWB. WBAT did not increase the rate of fixation failure, malunion, or nonunion.
Preoperative Knee Templating Accuracy Does Not Predict Radiographic or Clinical Outcome in Total Knee Arthroplasty.
Mrutyunjaya S, Bosch LC, Bonano JC … +4 more , Pham NS, Hwang K, Goodman SB, Amanatullah DF
Orthopedics · 2025 · PMID 40957004 · Publisher ↗
BACKGROUND AND OBJECTIVE: The purpose of this study was to evaluate the accuracy of digital templating for primary total knee arthroplasty (TKA) and to evaluate whether accurate templating affects the clinical or radiogr...
BACKGROUND AND OBJECTIVE: The purpose of this study was to evaluate the accuracy of digital templating for primary total knee arthroplasty (TKA) and to evaluate whether accurate templating affects the clinical or radiographic outcome of TKA. MATERIALS AND METHODS: We retrospectively reviewed 178 primary TKAs performed by a single surgeon with preoperative templating available and minimum 2-year clinical follow-up. Templated size was compared to the implanted size. Postoperative coronal alignment was measured on standing long-leg radiographs by two independent observers. UCLA Activity Scale and Knee Society scores (KSS) were evaluated after 2 years. Categorical variables are reported as number and percentage. Correlative data were analyzed using Spearman's correlation tests and reported as coefficients (r) with 95% CI. Significance was set at <0.05. RESULTS: Preoperative templating accurately estimated the tibia within one size in 95% of cases (169 TKAs), while the femur was templated within one size in 99% of cases (176 TKAs). Templating accuracy did not correlate with postoperative coronal alignment within 3° of the mechanical axis (tibial accuracy: r=0.10, =0.120; femoral accuracy: r= -0.07, =0.338). Templating accuracy did not correlate with the postoperative UCLA Activity Scale score (tibia =0.177; femur =0.354), KSS function (tibia =0.587; femur =0.637), KSS expectation (tibia =0.764; femur =0.817), or KSS satisfaction (tibia =0.760; femur =0.811) at 2 years. CONCLUSION: Preoperative digital templating for TKA reliably estimates the implanted femoral and tibial component sizes within one size; however, templating did not correlate with radiographic or clinical outcomes at 2 years.
No Difference in 90-day Complication Rates Between Patients With and Without Obstructive Sleep Apnea Undergoing Total Joint Arthroplasty.
Birbara B, Bauer JA, Hahn AK … +3 more , Torre BB, Wakefield DB, Grosso MJ
Orthopedics · 2025 · PMID 40957003 · Publisher ↗
BACKGROUND: Obstructive sleep apnea (OSA) has shown significant effects on complication rates in total joint arthroplasty (TJA) patients. Current research lacks appropriate propensity score matching of this comorbidity a...
BACKGROUND: Obstructive sleep apnea (OSA) has shown significant effects on complication rates in total joint arthroplasty (TJA) patients. Current research lacks appropriate propensity score matching of this comorbidity as well as data surrounding treated OSA compared to untreated OSA among TJA patients. This study examined if patients with treated and untreated OSA were at higher risk for 90-day postoperative complications following TJA. MATERIALS AND METHODS: 17,272 patient charts were retrospectively examined, with 3,876 having OSA and 13,396 not. Following propensity score matching of 7,014 patients, 3,507 were identified to have OSA and 3,507 not. Patients were matched based on age, sex, body mass index, American Society of Anesthesiologists (ASA) class, and type of surgery, then further divided into untreated versus treated OSA based on continuous positive airway pressure use. Chi-square analyses compared patient characteristics, and a multivariable logistic regression model assessed the effect of OSA on 90-day complication rates. RESULTS: OSA alone was not an indicator for 90-day postoperative complications in our propensity-matched sample. Higher ASA classes (<0.01) and higher Charlson Comorbidity Index (CCI; <0.01) were associated with a significant increase in 90-day complication rates compared with patients with ASA classes I-II and lower CCI, respectively. There was no significant difference in complications between patients with untreated and treated OSA (=0.29). CONCLUSION: Using propensity score matching, this study indicates that OSA alone is not associated with an increased risk of 90-day postoperative complications in primary TJA. While associated comorbidities of OSA may contribute to increased complication rates, surgeons can be reassured that OSA alone may not be a significant factor in short-term postoperative outcomes.
An Evidence-based Review of Challenges Faced in Personalized Alignment Strategies in Total Knee Arthroplasty.
Geiselmann MT, Stelmach JP, Germano JA … +1 more , Scuderi GR
Orthopedics · 2025 · PMID 40844476 · Publisher ↗
Restoring knee alignment is critical to total knee arthroplasty (TKA) success. Mechanical alignment offers reliable outcomes by standardizing component positioning, but it may neglect individual anatomy. In response, per...
Restoring knee alignment is critical to total knee arthroplasty (TKA) success. Mechanical alignment offers reliable outcomes by standardizing component positioning, but it may neglect individual anatomy. In response, personalized alignment techniques-such as kinematic, inverse kinematic, and functional alignment-aim to replicate native biomechanics using technologies like robotics and patient-specific instrumentation. While promising, these approaches raise concerns about alignment precision, long-term outcomes, and technique selection. As personalized alignment techniques gain traction, evidence is needed to determine optimal patient-specific strategies and implant compatibility. Long-term data will clarify the clinical value and durability of these individualized techniques in TKA.
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