Orthopedics[JOURNAL]
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200 papers
Factors Associated With Readmission and Reoperation After Total Shoulder Arthroplasty.
Cole S, Sribhashyam S, Satalich J … +3 more , Smith M, Setliff J, Vanderbeck J
Orthopedics · 2025 · PMID 40844475 · Publisher ↗
BACKGROUND: This study assessed risk factors related to 30-day unplanned readmission and reoperation after anatomic or reverse total shoulder arthroplasties (TSA). This study intends to enhance decision making for patien...
BACKGROUND: This study assessed risk factors related to 30-day unplanned readmission and reoperation after anatomic or reverse total shoulder arthroplasties (TSA). This study intends to enhance decision making for patients undergoing TSA and inform perioperative risk by identifying patient demographics, comorbidities, and procedural features linked to these outcomes. MATERIALS AND METHODS: Patients who had a primary anatomic or reverse TSA were identified using data from the American College of Surgeons National Surgical Quality Improvement Program database from 2013 to 2023 using the current procedural terminology code 23472. After categorization by 30-day unplanned readmission and reoperation, perioperative variables were compared between groups using Wilcoxon rank sum and chi-square tests, followed by multivariable logistic regression. RESULTS: The study identified 45,893 patients who underwent a primary TSA between 2013 to 2023 with 1,259 (2.74%) readmissions and 599 (1.31%) reoperations. Readmission was associated with older age, longer operative time, longer hospital stay, inpatient status, American Society of Anesthesiology classification of 4, White or Black race, dependent functional status, smoking, congestive heart failure, steroid use, bleeding disorders, insulin-dependent diabetes mellitus, and anemia. Reoperation was associated with male sex, higher body mass index, longer operative time, longer hospital stay, inpatient status, dependent functional status, smoking, and anemia. CONCLUSION: This study identified potential patient variables that can increase the risk of unplanned readmission and/or reoperation after a primary TSA. Understanding the factors that can influence these adverse events can play an important role in clinical decision making and help identify patients who may require additional postoperative monitoring.
Higher Distressed Communities Index Is Associated With Loss to Follow-up Within 6 Months of Ankle Fracture Surgery.
Bashier MM, Ferreri ED, Muñoz AM … +7 more , Chao J, DeMercurio P, Gjonbalaj E, Alvandi LM, Phen HM, Crocco L, Kahn MD
Orthopedics · 2025 · PMID 40844474 · Publisher ↗
BACKGROUND: The Distressed Communities Index (DCI) is a metric often used in the assessment of health care disparities. The purpose of this study was to investigate whether DCI correlates with aspects of presentation, cl...
BACKGROUND: The Distressed Communities Index (DCI) is a metric often used in the assessment of health care disparities. The purpose of this study was to investigate whether DCI correlates with aspects of presentation, clinical course, and postoperative events among adult ankle fracture patients who undergo surgical repair. MATERIALS AND METHODS: This retrospective cohort study included adult ankle fracture patients who underwent primary ankle open reduction internal fixation (ORIF) between August 2015 and June 2023 at a single academic tertiary-care center. Patients were separated into two DCI cohorts determined by ZIP Codes: more distressed (DCI≥75) and less distressed (DCI<75). Primary outcomes were time to presentation and time to definitive surgery. Secondary outcomes including location of presentation, admission rates, length of stay, postoperative complications (eg, infection, hardware failure, reoperation), physical therapy participation, and loss to follow-up were also assessed. RESULTS: A total of 940 patients were included. No differences were observed in time to presentation or time to definitive surgery. However, patients from more distressed communities were more likely to be lost to follow-up during the first 6 months following ankle ORIF compared to those from less distressed communities (95% CI, 1.15-2.67). No differences were found with respect to other secondary outcomes. CONCLUSIONS: Higher DCI is associated with loss to follow-up within the 6 months following ankle fracture ORIF. Interventions focused on uncovering and addressing reasons for loss to follow-up among patients from distressed communities may help ensure follow-up completion during the postoperative recovery period.
Time to Surgical Intervention for Ankle Fractures as a Factor in Perioperative and Prolonged Opioid Use.
Perez S, Laurore C, Stocchi C … +5 more , Jain M, Stern BZ, Poeran J, Kelly M, Forsh DA
Orthopedics · 2025 · PMID 40844473 · Full text
BACKGROUND: This study examined the association between time to surgery post-ankle fracture and perioperative, subacute, and prolonged opioid use. MATERIALS AND METHODS: This was a retrospective cohort study that used th...
BACKGROUND: This study examined the association between time to surgery post-ankle fracture and perioperative, subacute, and prolonged opioid use. MATERIALS AND METHODS: This was a retrospective cohort study that used the Merative MarketScan Commercial Claims and Encounters Database. It included patients aged 18 to 64 with an ankle fracture between April 1, 2016, and June 30, 2021, who underwent open reduction and internal fixation within 21 days. Time to surgery was categorized as 0 to 3 days, 4 to 7 days, and 8 to 21 days. Multivariable logistic regression models assessed associations between time to surgery and perioperative (fracture through 7 days after surgery), subacute (31 to 90 days), and prolonged (91 to 180 days) opioid use, adjusting for relevant covariates. RESULTS: The cohort included 20,642 patients (61.7% female, median age 48); 47.5% had surgery 0 to 3 days after fracture, 25.1% 4 to 7 days, and 27.4% 8 to 21 days. Later surgery (versus 0 to 3 days) was associated with increased perioperative opioid use (4 to 7 days: odds ratio [OR] 2.39, 95% CI 2.13-2.69, <0.001; 8 to 21 days: OR 2.53, 95% CI 2.25-2.84, <0.001). Having surgery at 8 to 21 (versus 0 to 3) days was significantly associated with increased prolonged use in those who filled a perioperative opioid prescription after adjusting for perioperative medications (OR 1.20, 95% CI 1.03-1.42, =0.02). CONCLUSION: The study highlights the role of surgical timing in opioid use after ankle fractures. Surgery beyond 7 days after fracture was associated with increased perioperative opioid use and slightly elevated prolonged use in those who filled perioperative opioids. Orthopedic surgeons should consider timely interventions to mitigate prolonged opioid use, thus promoting safer postoperative care in ankle fracture patients.
Understanding the Carbon Footprint of the American Academy of Orthopaedic Surgeons Annual Meeting.
Simcox TG, Tishad A, Popp R … +6 more , Cruz JD, DelliCarpini G, King JJ, Wright JO, Wright TW, Roach RP
Orthopedics · 2025 · PMID 40844472 · Publisher ↗
BACKGROUND: This study's aim was to quantify the carbon footprint of the 2023 American Academy of Orthopaedic Surgeons (AAOS) Annual Meeting and compare it to an alternative meeting structure. MATERIALS AND METHODS: We c...
BACKGROUND: This study's aim was to quantify the carbon footprint of the 2023 American Academy of Orthopaedic Surgeons (AAOS) Annual Meeting and compare it to an alternative meeting structure. MATERIALS AND METHODS: We conducted a retrospective analysis of estimated greenhouse gas emissions from the AAOS 2023 Annual Meeting in Las Vegas, NV. We also modeled theoretical meetings held in locations including Chicago, IL, New Orleans, LA, and New York City, NY, as well as a hybrid meeting occurring across four regional hubs. Emissions for air travel were determined by computing emissions of direct flights to Las Vegas and the closest major airport for each state, using an emissions calculator. Attendees were assumed to use ground travel if they lived within a 250-mile radius of the meeting location. Travel by international attendees was also calculated. We also determined the geographic density of surgeons by state using data from the Association of American Medical Colleges workforce report. RESULTS: The 2023 AAOS Annual Meeting was estimated to have generated 9,458 metric tons of travel-related CO equivalents compared with 7,073 (Chicago), 7,678 (New York City), and 7,396 (New Orleans) metric tons. The hybrid regional hub model, which excluded intercontinental travel, was estimated to generate only 1,368 metric tons. CONCLUSION: Total miles traveled had the most significant impact on carbon emissions. This may aid meeting planners in selection of future meeting locations that minimize air travel. In addition, adoption of a regional hub structure with interactive videoconferencing is a potential option for reducing the carbon footprint of the AAOS Annual Meeting.
Assessing the Impact of Robotic-assisted Total Knee Arthroplasty on Quality of Life and Mental Health: A Matched Cohort Study.
Lizcano JD, Villa JM, Pannu TS … +1 more , Patel PD
Orthopedics · 2025 · PMID 40788833 · Publisher ↗
BACKGROUND: Whether the implementation of robotic-assisted technology in total knee arthroplasty (Ra-TKA) translates into better clinical results remains uncertain. We investigated the impact of Ra-TKA on quality of life...
BACKGROUND: Whether the implementation of robotic-assisted technology in total knee arthroplasty (Ra-TKA) translates into better clinical results remains uncertain. We investigated the impact of Ra-TKA on quality of life and mental health as measured by patient-reported outcome measures (PROMs). MATERIALS AND METHODS: In this retrospective review, a consecutive series of 204 patients who underwent Ra-TKA were matched by age, sex, and body mass index in a 1:1 ratio to conventional TKAs. The primary outcome was improvement in Knee Injury and Osteoarthritis Outcome Score (KOOS) and Veterans RAND 12-Item Health Survey (VR-12) as measured by minimal clinically important difference (MCID) and patient acceptable symptom state (PASS) scores. Secondary outcomes included hospital length of stay (LOS), skin-to-skin time, tourniquet time, and active knee range of motion. Bivariate analyses were performed between groups. RESULTS: A total of 314 patients (Ra-TKA=156; TKA=158) had 1-year PROMS available and were included in the study. Conventional TKA patients had significantly longer LOS and shorter skin-to-skin time and tourniquet time (all <0.001) than Ra-TKA patients. More patients achieved full extension in the Ra-TKA cohort, but both groups ended up with similar postoperative PROMs at 1-year follow-up. A higher number of patients achieved the VR-12 mental component score MCID in the conventional TKA group compared to the Ra-TKA group (50.3% vs 29.5%, <0.001). CONCLUSION: Our results suggest Ra-TKA results in shorter LOS and better short-term knee extension but no improvement in joint-specific PROMs. Additionally, the association between lower quality of life, mental health outcomes, and Ra-TKA may be mediated by patient expectations. Therefore, documenting the use of Ra-TKA is important when reporting these quality metrics.
Prescription Trends by Orthopedic Surgery Provider: Review of the Medicare Part D Prescribers - by Provider and Drug, 2013-2021.
Bartoletta J, Kubsad S, Fernando N … +3 more , Chansky H, Manner P, Hernandez N
Orthopedics · 2025 · PMID 40788832 · Publisher ↗
BACKGROUND: We characterize outpatient prescribing trends of orthopedic surgery providers in the United States. MATERIALS AND METHODS: A retrospective analysis of the Medicare Part D Prescribers - by Provider and Drug wa...
BACKGROUND: We characterize outpatient prescribing trends of orthopedic surgery providers in the United States. MATERIALS AND METHODS: A retrospective analysis of the Medicare Part D Prescribers - by Provider and Drug was conducted between 2013 and 2021, including anti-osteoporotic medications (AOMs), antibiotics, opioids, and nonsteroidal anti-inflammatory drugs (NSAIDs). Outcomes included claims, claims per 1,000 prescribers, combined annual growth rate, and percentage growth. RESULTS: Claims for AOMs decreased from 29,024 in 2013 to 12,500 in 2021. Claims for alendro-nate, ibandronate, risedronate, and teriparatide all significantly decreased, whereas claims for abaloparatide and romosozumab significantly increased (<0.05). Antibiotic claims increased from 304,817 (2013) to 580,736 (2021). Claims for amoxicillin, amoxicillin/clavulanic acid, cefadroxil, cephalexin, clindamycin, doxycycline, mupirocin, penicillin V, and sulfamethoxazole/trimethoprim significantly increased, whereas use of azithromycin, ciprofloxacin, levofloxacin, and vancomycin significantly decreased (<0.05). Claims for opioids decreased from 3,224,572 (2013) to 2,070,423 (2021). Use of hydrocodone/acetaminophen, oxycodone/acetaminophen, and tramadol/acetaminophen also significantly decreased (<0.05). Use of oxycodone and oxycodone myristate significantly increased (<0.05). Claims for fentanyl, methadone, and morphine all significantly decreased (<0.05). Claims for NSAIDs increased from 1,300,279 (2013) to 1,796,419 (2021). Claims for celecoxib, diclofenac, ibuprofen, ketorolac, and meloxicam all significantly increased, whereas claims for etodolac, indomethacin, nabumetone, naproxen, piroxicam, and sulindac all significantly decreased (<0.05). CONCLUSION: In line with national guidelines, claims for NSAIDs are increasing and claims for opioid pain medications and AOMs are decreasing. Claims for outpatient antibiotics are increasing, which is of significant concern, given renewed focus on antibiotic stewardship.
Severe Acute Localized Reaction/Pseudosepsis in Patients With Knee Osteoarthritis Receiving Injections of Hyaluronic Acid: A Targeted Literature Review.
Sherman SL, Ngai W, Steele K … +2 more , Collet JP, Kelly JDA
Orthopedics · 2025 · PMID 40788831 · Publisher ↗
BACKGROUND: Hyaluronic acid injections for knee osteoarthritis patients can result in pseudosepsis. A targeted literature review was conducted to determine the rate of pseudosepsis in patients receiving intra-articular h...
BACKGROUND: Hyaluronic acid injections for knee osteoarthritis patients can result in pseudosepsis. A targeted literature review was conducted to determine the rate of pseudosepsis in patients receiving intra-articular hyaluronic acid, particularly hylan G-F 20 (SYNVISC). MATERIALS AND METHODS: Articles were identified through Embase using predefined search strategies. Pseudosepsis event rate was calculated by dividing the number of reported events by the total number of intra-articular injections. RESULTS: The pseudosepsis event rate ranged from 0% to 5.6% per injection; most treatment groups had an event rate of ≤2% per injection. CONCLUSION: Pseudosepsis event rates were low across studies for patients treated with hyaluronic acid, including hylan G-F 20.
Pathological Rupture of the Quadriceps Tendon in a Patient With Osteogenesis Imperfecta With Leg-length Discrepancy: A Case Report.
Lee DN, Nam CH, Baek JH … +3 more , Ryu S, Ahn HS, Lee SC
Orthopedics · 2025 · PMID 40788830 · Publisher ↗
Quadriceps tendon rupture is typically caused by severe trauma, such as a fall, leading to substantial restriction of knee joint movements. However, pathological ruptures (one third of all quadriceps ruptures) can occur...
Quadriceps tendon rupture is typically caused by severe trauma, such as a fall, leading to substantial restriction of knee joint movements. However, pathological ruptures (one third of all quadriceps ruptures) can occur spontaneously or caused by minor trauma. Pathological ruptures are usually caused by chronic systemic diseases, such as systemic lupus erythematosus, chronic renal failure, and rheumatoid arthritis, and rarely by osteogenesis imperfecta (OI), a genetic disorder that affects the musculoskeletal system. Defective type 1 collagen formation in OI leads to bone fragility, ligamentous laxity, tendon rupture, and short stature. Here, we report the case of a 55-year-old man diagnosed with OI who experienced a pathological rupture of the right quadriceps tendon. The patient also had a leg-length discrepancy in the left leg due to the malunion of several femoral fractures. The rupture was repaired using the Krackow suture technique. The patient regained preinjury range of motion within 3 months postoperatively and could walk without pain.
Robotic-assisted Unicompartmental Knee Arthroplasty: A Comparative Study of Image-based and Image-free Systems on Two-year Postoperative Complications and Costs.
Najafi F, Guild GN, McConnell MJ … +4 more , Ross BJ, DeCook CA, Naylor BH, Bradbury TL
Orthopedics · 2025 · PMID 40690455 · Publisher ↗
BACKGROUND: Unicompartmental knee arthroplasty (UKA) is an increasingly popular surgical option, constituting approximately 10% of knee arthroplasty operations, with an anticipated upward trend. However, UKA presents tec...
BACKGROUND: Unicompartmental knee arthroplasty (UKA) is an increasingly popular surgical option, constituting approximately 10% of knee arthroplasty operations, with an anticipated upward trend. However, UKA presents technical challenges and higher revision rates compared to total knee arthroplasty (TKA). This study evaluates the outcomes and economic implications of using two robotic systems for UKA: the image-based (IBRA-UKA) and image-free (IFRA-UKA) robotic-assisted systems. We hypothesized that the image-free system, while incurring lower costs, would demonstrate clinical outcomes comparable to the image-based system. MATERIALS AND METHODS: We conducted a retrospective study using the PearlDiver™ Database, selecting patients older than 40 years without previous knee surgeries who underwent robotic-assisted UKA (RA-UKA). Individuals with contralateral knee arthroplasty within 2 years were excluded. The procedures were divided into two cohorts, matched one-to-one for demographics and clinical characteristics. We compared 90-day, 1-year, and 2-year postoperative complications, along with cost analysis of preoperative computed tomography imaging and surgical expenses. RESULTS: A total of 2,490 patients were evaluated, with 1,245 in each cohort. No statistical differences were observed in postoperative complications, including revision rates, between the two cohorts. However, preoperative and surgical costs were significantly higher for the IBRA-UKA cohort compared to the IFRA-UKA cohort. Preoperative computed tomography scan costs averaged $916±$1,092 versus $0 (<0.001), and surgical costs averaged $5,675±$9,436 versus $3,056±$5,419 (<0.001). CONCLUSION: The similar complication rates highlight the value of robotic technique in UKA regardless of system choice. However, the higher costs of IBRA-UKA raise financial concerns amid diminishing health care reimbursements. Further research is needed to evaluate robotic systems, focusing on intraoperative, postoperative, and functional outcomes.
Fluoroscopy Use and Radiation Exposure in Distal Radius Fracture Fixation.
Liu C, Zhang D, Chruscielski CM … +3 more , Benavent K, Blazar P, Earp BE
Orthopedics · 2025 · PMID 40690454 · Publisher ↗
BACKGROUND: The primary aim of this study was to quantify radiation exposure during the surgical fixation of distal radius fractures (DRF). Secondary aims included determining patient and surgeon factors associated with...
BACKGROUND: The primary aim of this study was to quantify radiation exposure during the surgical fixation of distal radius fractures (DRF). Secondary aims included determining patient and surgeon factors associated with higher intraoperative fluoroscopic use. MATERIALS AND METHODS: This retrospective study included 342 patients with DRF who underwent acute surgical fixation between January 1, 2017, and June 1, 2019. Inclusion criteria were patient age older than 18 years with acute DRF undergoing surgical fixation. Exclusion criteria were patient age younger than 18 years, additional fractures undergoing simultaneous fixation, and bilateral DRF requiring fixation. Patient demographics, surgeon factors, and fluoroscopy data were collected through chart reviews. Univariate and bivariate analyses were performed, and <0.05 was considered significant. RESULTS: The median patient age was 59 years, and 77.8% were women. The median dose area product (DAP) was 9.24 cGy*cm per case. The median number of images obtained per case was 36, and the median fluoroscopy time was 60 seconds, equating to a dose of 0.39 mGy/min. Higher radiation exposure was associated with male patients, more complex fracture morphology, type of implant chosen, junior attendings as primary surgeon, surgeon subspecialty, and surgical assistant training level. CONCLUSION: Intraoperative fluoroscopic use during DRF surgical fixation is associated with both patient injury characteristics as well as surgeon factors. Male patients and fracture morphology, as well as surgeon experience and the presence of trainees, all increase fluoroscopic use and radiation exposure.
Metastatic Lymphoma of the Ulnar Nerve: A Case Report.
Peresuh SJ, Johnson JM, Arcand PH … +2 more , Arcand MA, Izzi JA
Orthopedics · 2025 · PMID 40690453 · Publisher ↗
Metastatic peripheral nerve lymphomas are rare, often mimicking benign neurogenic tumors or neuropraxic injuries. While some report on the involvement of nerves in the upper and lower extremities, the majority of lymphom...
Metastatic peripheral nerve lymphomas are rare, often mimicking benign neurogenic tumors or neuropraxic injuries. While some report on the involvement of nerves in the upper and lower extremities, the majority of lymphomas involve the lower extremities, with the sciatic nerve being the most common. Furthermore, involvement of the ulnar nerve is exceedingly rare, with only four reported cases, each of which indicated a primary lesion. In this article, we report a unique case of recurrent B-cell lymphoma with metastatic disease of the ulnar nerve in a nonagenarian with a remote history of diffuse high-grade large B-cell lymphoma. The patient presented with 2 months of numbness, tingling, and weakness in her left ring and small fingers. Additionally, she reported a left distal forearm mass. Examination revealed sensory loss, atrophy, and clawing of the hand. Magnetic resonance imaging showed a mass involving the ulnar nerve, confirmed as lymphoma via biopsy. Treatment included radiotherapy and capsulodeses, given her desire for a functional return to her independent activities of daily living. She was satisfied with the outcome of her management. While uncommon, this case highlights the importance of considering metastatic disease as a presentation mimicking cubital tunnel syndrome for timely diagnosis and improved outcomes. By documenting this presentation, this report aims to raise awareness among orthopedic surgeons to enhance diagnostic and management strategies for similar cases of metastatic nature and advanced patient age.
Simultaneous Occurrence of Anterior Cruciate Ligament Avulsion and Adjacent Anterior Meniscal Root Tear Not Uncommon in Patients With Tibial Posterior Condyle Fracture, Particularly Those With a Long Vertical Split.
Huang FT, Lin KC, Lin CY
Orthopedics · 2025 · PMID 40662918 · Publisher ↗
BACKGROUND: Tibial posterior condyle fractures (PCFs) are caused by shearing injuries. This mechanism results in anterior cruciate ligament (ACL) avulsions, which may involve adjacent anterior meniscal roots. The simulta...
BACKGROUND: Tibial posterior condyle fractures (PCFs) are caused by shearing injuries. This mechanism results in anterior cruciate ligament (ACL) avulsions, which may involve adjacent anterior meniscal roots. The simultaneous occurrence of ACL avulsion and anterior meniscal root tears (AMRTs) in patients with PCF remains unclear. Therefore, we reported the pattern of simultaneous ACL avulsion and AMRT in patients with PCF. Additionally, we investigated which morphological characteristics of PCFs can predict the occurrence of these combined injuries. MATERIALS AND METHODS: This study included 77 patients with PCF and ACL avulsion. AMRT was diagnosed through arthroscope. PCF morphologies-fragment rotation angle, fragment-plateau ratio, fragment length, and fragment sagittal angle-were measured through computed tomography. RESULTS: Of the 77 patients, 24 (31%) had AMRT. Patients with AMRT had a longer fragment length than did those without AMRT (5.6±1.0 cm vs 4.2±0.7 cm, respectively; <.001). A receiver operating characteristic curve revealed a threshold fragment length of 4.4 cm for predicting simultaneous ACL avulsion and AMRT. Multivariate logistic regression indicated a fragment length of ≥4.4 cm was associated 12-fold increased risk of simultaneous ACL avulsion and AMRT (95% CI: 3.29-45.67; <.001). CONCLUSIONS: AMRT occurs in 31% of all patients with PCF plus ACL avulsion and is an obstacle to ACL reduction. A PCF fragment length of ≥4.4 cm is a significant independent predictor of simultaneous ACL avulsion and AMRT. Our findings may facilitate relevant risk assessment and counseling in patients requiring an intra-articular intervention. [. 2025;48(4):215-222.].
Comparison of Industry and National Institutes of Health Funding for Orthopedic Surgery Research.
Ng MK, Rullan-Oliver P, Magruder M … +5 more , Mastrokostas PG, Krebs VE, Parvizi J, Mont MA, Piuzzi NS
Orthopedics · 2025 · PMID 40662917 · Publisher ↗
BACKGROUND: The aims of this study were to analyze trends in National Institutes of Health (NIH) funding for musculoskeletal (MSK) research from 2012 to 2021, compare private industry funding to NIH funding, determine th...
BACKGROUND: The aims of this study were to analyze trends in National Institutes of Health (NIH) funding for musculoskeletal (MSK) research from 2012 to 2021, compare private industry funding to NIH funding, determine the proportion of total MSK research funding from public versus private sources, and examine how private industry research and development (R&D) spending has evolved in relation to net sales. MATERIALS AND METHODS: Public research funding from 2012 to 2021 was aggregated using NIH data for MSK conditions with >$10M in funding. Private R&D funding was obtained from the top five orthopedic companies by revenue and compared to net sales to calculate R&D as a percentage of total sales. Annually reported financial statements from Securities Exchange Commission filings were used. Private funding was summed annually and compared to National Institute of Arthritis and Musculoskeletal and Skin Diseases spending using descriptive statistics. RESULTS: Annual research funding from the top five orthopedic companies is 10.0 times that of the NIH, an increase from 9.2 times in 2017. The top five companies spent a mean of 7.2% of their net sales on R&D. Overall, $7.7 billion is allocated to MSK research annually, with only 9.1% from public sources. CONCLUSION: Given this disparity, efforts should assess public investment in orthopedic research while recognizing the critical role of industry in funding musculoskeletal research. [. 2025;48(4):e182-e186.].
Measuring Decisional Regret in Orthopedic Surgery: Tools, Time Points, and Score Interpretation.
Jeffko M, Younus I, Bansal A … +5 more , Lipson P, Sedwick J, Cherel M, Reynolds L, Louie P
Orthopedics · 2025 · PMID 40662916 · Publisher ↗
BACKGROUND: As shared decision-making models gain prominence, patients are taking on more responsibility in deciding whether to undergo surgery. Decisional regret is a key patient-reported outcome (PRO) to evaluate quali...
BACKGROUND: As shared decision-making models gain prominence, patients are taking on more responsibility in deciding whether to undergo surgery. Decisional regret is a key patient-reported outcome (PRO) to evaluate quality of care and surgical success. With increased emphasis on decisional regret, determining the tools to measure regret is of increasing importance. The objectives of this study were to (1) investigate and identify the tools used to measure decisional regret in elective orthopedic surgery and (2) examine the time frame in which regret is measured postoperatively. MATERIALS AND METHODS: The authors conducted a systematic literature review of PubMed/MEDLINE and Embase databases from database inception until September 5, 2024. All studies that discussed a patient's decisional regret in the context of elective orthopedic surgery were eligible. RESULTS: Initial results yielded 1,002 articles, and 26 were chosen for inclusion. The Decisional Regret Scale (DRS) was the most used tool, appearing in 54% of the articles. Novel, study-specific questions were used in 19% of the studies, while 15% used question 22 of the Scoliosis Research Society-22 tool and 11% used non-standardized patient interviews. Regret was assessed postoperatively at >24 months in 15% of studies, at 24 months in 17%, at 12 months in 22%, at 6 months in 26%, at multiple time frames in 4%, and was not stated in 8%. CONCLUSION: Decisional regret is an increasingly important PRO that can help optimize medical interventions. The DRS, used in more than half of the studies analyzed, is the most widely adopted and validated tool for quantifying regret and should be prioritized in future research. While timing of regret assessment varied, the 6-month and 12-month postoperative intervals were the most common and are suggested as standard time points for measuring regret. Additionally, establishing clinical stratifications for regret scores will facilitate meta-analysis and improve risk factor identification, enhancing shared decision-making and patient care. [. 2025;48(4):e153-e161.].
Outcomes of Staphylococcal Periprosthetic Joint Infections Treated With Rifampin and the Potential Role of Rifabutin as a Substitute When High-risk Drug-drug Interactions Exist.
Leal J, Kugelman DN, Shah S … +6 more , Mackowiak A, Wrenn R, Jiranek WA, Seyler TM, Ryan SP, Seidelman J
Orthopedics · 2025 · PMID 40607753 · Publisher ↗
BACKGROUND: This study evaluated outcomes of patients meeting Infectious Disease Society of America guidelines for rifampin therapy in treating staphylococcal periprosthetic joint infection (PJI) and explored the role of...
BACKGROUND: This study evaluated outcomes of patients meeting Infectious Disease Society of America guidelines for rifampin therapy in treating staphylococcal periprosthetic joint infection (PJI) and explored the role of rifabutin as a substitute when rifampin was contraindicated due to drug-drug interaction (DDI). MATERIALS AND METHODS: An institutional database at a tertiary referral center was queried for patients who had staphylococcal PJI and underwent debridement and implant retention procedure (DAIR) or one-stage revision from January 1, 2013, to April 30, 2023. Patients were stratified by rifampin treatment, and their rates of successful PJI treatment were compared. Rifampin and rifabutin DDIs were collected for all patients and compared. RESULTS: Of 935 total patients screened, 87 patients with a mean follow-up time of 4.4 years met IDSA guidelines for rifampin therapy. Of the 35 patients who completed rifampin therapy, 71.4% were successfully treated. Logistic regression analysis showed that those who did not initiate rifampin therapy were less likely to have successful treatment (odds ratio: 0.76 [0.60 to 0.97]; =0.031). Cox-proportional hazard regression showed that those who did not initiate rifampin therapy were at higher risk of requiring revision for infection (hazard ratio: 2.22 [1.06 to 4.68]; =0.035). Of the 87 patients in this study, 18.4% had a DDI that contraindicated rifampin; however, only 3.4% had a DDI that contraindicated rifabutin. CONCLUSION: This study supports that rifampin as combination therapy with DAIR or one-stage revision in staphylococcal PJI leads to better outcomes; however, its implementation is limited by DDIs. [. 2025;48(4):239-247.].
Variation in Technique Influences Surgical Cost in Thumb Carpometacarpal Joint Arthroplasty.
Reiners N, Kleinsmith RM, Doxey SA … +3 more , Sibley A, Husband JB, Cunningham BP
Orthopedics · 2025 · PMID 40607752 · Publisher ↗
BACKGROUND: Thumb carpometacarpal (CMC) arthritis is common in the community. There are a variety of ways to perform CMC arthroplasty with the basic technique revolving around trapeziectomy. The purpose of this study was...
BACKGROUND: Thumb carpometacarpal (CMC) arthritis is common in the community. There are a variety of ways to perform CMC arthroplasty with the basic technique revolving around trapeziectomy. The purpose of this study was to identify key factors in the determination of cost of CMC arthroplasty and if procedure type affects cost. MATERIALS AND METHODS: Patients from 2018 to 2022 from a single health care system who received primary CMC arthroplasty using ligament reconstruction tendon interposition (LRTI), simple suture suspensionplasty, or suture tape-based reconstruction techniques were identified. Surgical costs were determined using time-driven activity-based cost accounting. RESULTS: A total of 173 patients were included. The average age was 63.6 years and 70.5% (n=122) were women. The most common technique was suture suspensionplasty (n=142, 82.1%). The average surgical cost was $2,830.36±$619.41. Suture suspensionplasty had the shortest operative time, followed by LRTI, and lastly suture tape-based reconstruction (62.9±16.0, 70.7±19.6 and 102.7±16.6 minutes, respectively, <0.001). Procedure type and anchor use predicted surgical costs (R=0.85, <0.001). CONCLUSION: Suture suspensionplasty had the shortest operative time and had the lowest cost of CMC arthroplasty techniques. The use of an anchor was associated with increased cost. Surgeons should keep these cost drivers in mind as they develop treatment plans. Surgeons and organizations should collaborate to provide high-value and economically-responsible care. [. 2025;48(4):e177-e181.].
Do the Skin Colors Depicted in Orthopedic Literature Reflect the Population?
Ferrell D, Klyce W, Liu RW
Orthopedics · 2025 · PMID 40607751 · Publisher ↗
BACKGROUND: Depictions of skin color in medical journals have been observed to misrepresent the population in other fields but have not been studied in orthopedics. We assessed whether the spectrum of skin color depicted...
BACKGROUND: Depictions of skin color in medical journals have been observed to misrepresent the population in other fields but have not been studied in orthopedics. We assessed whether the spectrum of skin color depicted in orthopedic literature appropriately reflects the population and whether that representation has changed over time. MATERIALS AND METHODS: We examined images of human patients published in four journals: (JBJS), (CORR), (JAAOS), and (AJSM) in 2010 and 2020. Fitzpatrick skin phototypes were used to categorize images as "lighter skin tone" (types I-III) or "darker skin tone" (types IV-VI), with the latter attributed to Black, Asian, Native American, and multiracial individuals. We compared published skin tones to 2020 United States census data (38% of the population being Fitzpatrick types IV-VI) using chi-square analysis. RESULTS: Of 649 eligible images, 13% depicted Fitzpatrick skin types IV-VI. There was no significant change from 2010 to 2020 (11% vs 16%, =0.07) in depictions of Fitzpatrick types IV and above. Darker skin tones were underrepresented compared to the US population (13% vs 38%, <0.001). In US-based articles representation increased from 11% to 18% (=0.045), but no change was observed in non-US articles (12% vs 12%, =0.9). CONCLUSION: While there has been a mild improvement over time in the diversity of skin colors represented, the depiction of darker skin types in orthopedic literature still falls well short of that seen in the general population. [. 2025;48(4):197-202.].
Comparison of Outcomes in Surgical Treatment of Pyogenic Flexor Tenosynovitis: Hand Surgeons Versus Other Orthopedic Subspecialists.
Kelley N, Holy T, Wells L … +2 more , Imada A, Morrell NT
Orthopedics · 2025 · PMID 40476769 · Publisher ↗
BACKGROUND: Call patterns among hospital systems vary. At our institution, most pyogenic flexor tenosynovitis (FTS) patients receive irrigation and debridement (I&D) from non-hand-trained orthopedic specialists on call....
BACKGROUND: Call patterns among hospital systems vary. At our institution, most pyogenic flexor tenosynovitis (FTS) patients receive irrigation and debridement (I&D) from non-hand-trained orthopedic specialists on call. Our hypothesis was that there would be no outcome differences among patients managed by hand surgeons versus non-hand surgeons. MATERIALS AND METHODS: This was a retrospective cohort study of patients who underwent I&D for FTS over a six-year period. Demographic data, mechanism of injury, past medical history, laboratory results indicating inflammation, time to the operating room, and Kanavel signs were collected. Outcomes were range of motion (ROM) and pain at last follow-up, return to OR (RTOR) rate, and need for amputation. A significance level of <0.05 was used. RESULTS: There were 128 patients and 153 digits with a postoperative diagnosis of FTS that underwent I&D. The most common medical comorbidities were diabetes, peripheral vascular disease, and end-stage renal disease. The most common presenting signs were pain with passive extension and resting digital flexion, but most patients presented with all four Kanavel signs. The RTOR rates for non-hand-and hand-trained surgeons were 22% and 26%, respectively (>0.05). There were no significant differences when comparing postoperative pain and ROM, as well as RTOR rates. Amputation rates among non-hand and hand surgeons were similar at 7% and 5%, respectively (>0.05). CONCLUSIONS: There were no significant differences in outcomes, RTOR rates, or amputations among non-hand-versus hand-trained orthopedic surgeons acutely managing FTS. Surgical treatment for FTS should not be delayed if a hand surgeon is unavailable. [. 2025;48(4):e162-e168.].
Increasing Substitutions in European Football Is Associated With Decreased Injury Rates Among Elite Athletes.
Qureshi I, Jenkins R, Faccone R … +4 more , Hinnenkamp G, Heffelfinger M, Acampa D, Ruotolo C
Orthopedics · 2025 · PMID 40476768 · Publisher ↗
BACKGROUND: In the 2019/2020 football season, an increase from three to five substitutions was implemented in European football to help players manage a congested match calendar following lockdown due to the COVID-19 pan...
BACKGROUND: In the 2019/2020 football season, an increase from three to five substitutions was implemented in European football to help players manage a congested match calendar following lockdown due to the COVID-19 pandemic. In this study, we aimed to determine injury rates before and after implementation of five substitutions. Secondary objectives included characteristics and duration of injury and associated risk factors. MATERIALS AND METHODS: A retrospective review of players injured while playing in the first division of the Spanish professional football league (La-Liga) during the 2017/2018, 2018/2019, 2022/2023, and 2023/2024 seasons were identified from an online database, Transfermarkt. Injury- and player-related characteristics, as well as game play before and after the implementation of five substitutions, were studied. Multivariate regression models were used to assess complications, adjusting for age, minutes played, and appearances. RESULTS: The overall incidence during the study period was 0.76 injuries per player-season. A total of 1,268 injuries were reported prior to the rule change with an incidence of 0.94 injuries per player-season compared to 711 reported injuries with an incidence of 0.57 injuries per player-season after. There were significantly decreased odds of multiple injuries (odds ratio [OR]: 0.68; 95% CI [0.56, 0.82]; <0.001) and muscle injuries (OR: 0.72; 95% CI [0.59, 0.87]; <0.001) after the increase in substitutions. CONCLUSION: Implementation of five substitutions was associated with significantly decreased injury rates in LaLiga. Additionally, players had significantly lower odds of sustaining multiple injuries and muscle injuries. [. 2025;48(4):223-228.].
Tension Band Suturing Versus Tension Band Wiring for Management of Pediatric Olecranon Fractures: Systematic Review and Meta-analysis.
Zouhbi AE, Hamdan K, El Abiad JM … +2 more , Saghieh S, Nassereddine M
Orthopedics · 2025 · PMID 40476767 · Publisher ↗
BACKGROUND: Pediatric olecranon fractures require optimal fixation to prevent long-term morbidity. Tension band wiring (TBW) has been the gold standard, but tension band suturing (TBS) has emerged as a potential alternat...
BACKGROUND: Pediatric olecranon fractures require optimal fixation to prevent long-term morbidity. Tension band wiring (TBW) has been the gold standard, but tension band suturing (TBS) has emerged as a potential alternative. This study systematically reviews and compares outcomes of TBS and TBW in pediatric olecranon fractures. MATERIALS AND METHODS: A systematic review and meta-analysis were conducted per Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines. Nine studies were included, with three directly comparing TBS to TBW. RESULTS: No statistically significant differences were found in pain, non-union, revision fixation, or extension loss (>0.05). TBS demonstrated fewer hardware-related complications. CONCLUSION: TBS is a viable alternative to TBW, offering similar outcomes with reduced hardware complications. Further high-quality studies are needed. [. 2025;48(4):248-255.].
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