Orthopedics[JOURNAL]
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200 papers
Low Complication Rates in Olecranon Fracture Fixation With Dual Plating.
Brown MJ, Vu CL, Wu CJ … +3 more , Welch JM, Richard MJ, Pidgeon TS
Orthopedics · 2025 · PMID 39699164 · Publisher ↗
BACKGROUND: Most olecranon fractures are intra-articular, affecting the extensor mechanism of the elbow, and are treated surgically with dorsal plate fixation or tension band. Due to shortcomings of dorsal plates related...
BACKGROUND: Most olecranon fractures are intra-articular, affecting the extensor mechanism of the elbow, and are treated surgically with dorsal plate fixation or tension band. Due to shortcomings of dorsal plates related to prominence, insufficient fixation of sagittal fracture lines, and difficulty matching proximal ulna dorsal angulation (PUDA), dual medial and lateral plating (DP) has been developed. We hypothesized that olecranon fractures treated with DP would have low complication rates and low incidence of hardware removal compared with those treated with traditional methods of fixation. MATERIALS AND METHODS: The database of a single institution was reviewed for the period January 2017 to April 2023 for adults with olecranon fractures receiving DP fixation. Open fractures, fracture dislocations, previous elbow injuries, and pathologic fractures were excluded. Demographics, pre- and postoperative imaging, reoperations, and range of motion were collected. PUDA and varus angulation measurements, intra-articular step off, and fracture distraction were recorded. RESULTS: A total of 42 fractures in 41 patients were reviewed. Mean follow-up was 8.7 months (range, 3-36 months). One patient reported symptomatic hardware at 6 weeks that had resolved by 3 months, and 1 reported persistent symptomatic hardware not bothersome enough to warrant removal. Five patients (11.9%) had at least 1 postoperative complication. The hardware removal rate was 2.4%. CONCLUSION: DP for olecranon fractures represents a valuable strategy in fracture treatment. We report a low hardware removal rate of 2.4%, with removal being done for infection, not symptomatic hardware. DP provides a reliable method of fixation, helps re-create native anatomy, and has a low complication rate compared with standard dorsal plating. [. 2025;48(1):30-36.].
Upper Extremity Mass as First Presentation of Metastatic Urothelial Carcinoma.
Tagliero LE, Jones TL, Sherman CE … +1 more , Aziz KT
Orthopedics · 2025 · PMID 39699163 · Publisher ↗
A 77-year-old woman presented with metastatic urothelial carcinoma as an elbow mass. To our knowledge, this is only the third reported case of urothelial carcinoma metastasizing to the upper extremity. The presence of me...
A 77-year-old woman presented with metastatic urothelial carcinoma as an elbow mass. To our knowledge, this is only the third reported case of urothelial carcinoma metastasizing to the upper extremity. The presence of metastatic disease at the time of diagnosis of urothelial carcinoma is rare, with metastases to the upper extremities even less common. This case is interesting given that the mass occurred after a direct trauma, causing a delay in diagnosis. It highlights the importance of a multidisciplinary oncology approach, and the need for more research to understand the biology of metastases. [. 2025;48(1):e52-e55.].
Direct Anterior Approach "No Trial Reduction Technique" in Bipolar Hemiarthroplasty for Treatment of Osteoporotic Femoral Neck Fracture: Surgical Techniques and Case Series.
Ongkosit C, Kosuwon W
Orthopedics · 2025 · PMID 39622072 · Publisher ↗
Bipolar hemiarthroplasty (BHA) for osteoporotic femoral neck fractures has a risk of proximal femoral fracture during trials, especially with larger trial bipolar shells. This study introduces a novel technique for BHA v...
Bipolar hemiarthroplasty (BHA) for osteoporotic femoral neck fractures has a risk of proximal femoral fracture during trials, especially with larger trial bipolar shells. This study introduces a novel technique for BHA via the direct anterior approach, aiming to reduce trial use and lower the risk of iatrogenic femoral fractures. The "no trial reduction technique" involves positioning only the trial neck segment against the acetabulum's me-dial wall, without the bipolar shell and trial head. Fluoros-copy measures limb length differences to determine optimal femoral head and bipolar shell thickness, resulting in comparable limb lengths without early complications. [. 2025;48(2):74-78.].
Regional Variation in Carpal Tunnel Release Utilization, Reimbursement, Practice Styles, and Patient Populations: A Temporal Analysis.
Gill VS, Holle AM, Lin E … +3 more , Tummala SV, Haglin JM, Renfree KJ
Orthopedics · 2025 · PMID 39622071 · Publisher ↗
BACKGROUND: The purpose of this study was to evaluate changes in open carpal tunnel release (OCTR) and endoscopic carpal tunnel release (ECTR) utilization, reimbursement, and patient demographics in the Medicare populati...
BACKGROUND: The purpose of this study was to evaluate changes in open carpal tunnel release (OCTR) and endoscopic carpal tunnel release (ECTR) utilization, reimbursement, and patient demographics in the Medicare population from 2013 to 2021 at national and regional levels. MATERIALS AND METHODS: The Medicare Physician & Other Practitioners database from 2013 to 2021 was queried to extract all instances of OCTR and ECTR. Utilization per 10,000 beneficiaries, inflation-adjusted reimbursement, and patient characteristics were extracted for OCTR and ECTR each year. Data were stratified by region based on US Census guidelines. Kruskal-Wallis tests and multivariable linear regressions were performed. RESULTS: From 2013 to 2021, national utilization per 10,000 beneficiaries increased by 6% for OCTR and by 50% for ECTR. In 2021, the Midwest had the greatest utilization of OCTR (29 of 10,000) and the lowest utilization of ECTR (7 of 10,000). Inflation-adjusted reimbursement declined for both OCTR and ECTR during the study period (10.3% and 11.8%, respectively), with the South having the lowest reimbursement for both procedures. The severity of patient comorbidity profiles and dual Medicare-Medicaid enrollees decreased for both procedures as well. CONCLUSION: Both OCTR and ECTR utilization have increased, while inflation-adjusted reimbursement has decreased. Patient populations encompassed fewer dual Medicare-Medicaid enrollees, indicating surgeons may be more selective in operative indications. These findings should be addressed to ensure the economic sustainability of carpal tunnel release procedures and equitable access to quality hand care for all patients with Medicare. [. 2025;48(1):e45-e51.].
Differences in Volume, Reimbursement, Practice Styles, and Patient Characteristics Between Male and Female Surgeons for Open and Endoscopic Carpal Tunnel Release.
Holle AM, Gill VS, Lin E … +4 more , Cancio-Bello AM, Iturregui JM, Haglin JM, Renfree KJ
Orthopedics · 2025 · PMID 39622070 · Publisher ↗
BACKGROUND: The goal of this study was to evaluate differences in carpal tunnel release volume, reimbursement, practice styles, and patient populations between male and female surgeons from 2013 to 2021. MATERIALS AND ME...
BACKGROUND: The goal of this study was to evaluate differences in carpal tunnel release volume, reimbursement, practice styles, and patient populations between male and female surgeons from 2013 to 2021. MATERIALS AND METHODS: The Medicare Physician & Other Practitioners database was queried from 2013 to 2021. Procedure volume, reimbursement, surgeon information, and patient demographic characteristics were collected for any surgeon who performed at least 10 open carpal tunnel release (OCTR) or endoscopic carpal tunnel release (ECTR) procedures that year. The Welch test, the Kruskal-Wallis test, and multivariable linear regressions were conducted to compare male and female surgeons and analyze geographic and annual differences. RESULTS: From 2013 to 2021, the proportion of carpal tunnel releases performed by female surgeons increased for OCTR by 4.5% (7.1% to 11.6%) and for ECTR by 3.3% (4.8% to 8.1%). Female OCTR surgeons on average had fewer beneficiaries per surgeon (443.37 vs 354.20, <.001), performed fewer billable services per beneficiary (6.37 vs 5.35, =.03), and performed fewer unique billable services (91.13 vs 77.79, <.001) compared with male surgeons. Female OCTR surgeons also saw a lower percentage of White patients (88.14 vs 86.48, =.003) and a higher percentage of female patients (60.06 vs 61.70, <.001) and dual-enrolled Medicare-Medicaid patients (10.54 vs 11.22, =.046). CONCLUSION: Female representation among OCTR and ECTR surgeons increased across the country. Male OCTR surgeons billed for more services and performed more services per beneficiary and also treated a higher proportion of White patients and dual Medicare-Medicaid enrollees compared with female surgeons. Future studies are required to identify reasons for and ways to address these disparities. [. 2025;48(1):57-63.].
Primary Cuff Repair Augmented With a Balloon Spacer in a Large and Massive Rotator Cuff Tear Series: A Technique and Short-term Outcome and Imaging Study.
Wong SJ, Lie HM, Bin Massuryono MD … +2 more , Wong NHP, Lie DTT
Orthopedics · 2025 · PMID 39622069 · Publisher ↗
Massive rotator cuff tears are a challenge for patients and surgeons. We explored the outcomes of patients with massive rotator cuff tears primarily treated with primary cuff repair augmented with a subacromial balloon s...
Massive rotator cuff tears are a challenge for patients and surgeons. We explored the outcomes of patients with massive rotator cuff tears primarily treated with primary cuff repair augmented with a subacromial balloon spacer. The mean age of the patients was 64.3 years, with 24 (71%) having massive cuff tears and the remaining 29% having large cuff tears. Most patients (61%) exhibited significant fatty atrophy (at least grade 3 Goutallier). At 6 months, patients showed improved Constant score, UCLA score, and Oxford Shoulder Score. Pain scores also significantly decreased. A phase 1 study of postoperative imaging indicated balloon disintegration in 50% of cases at 6 weeks. Augmenting primary cuff repair with a subacromial balloon spacer demonstrates promising short-term outcomes. Our postoperative images suggest that balloon disintegration may occur as early as 6 weeks. We recommend caution in using a balloon spacer as a standalone therapy. [. 2025;48(1):e56-e61.].
Erratum for "Site of Service Disparities Exist for Total Joint Arthroplasty".
Orthopedics · 2024 · PMID 39576069 · Publisher ↗
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An Eponymous History of Hemostatic, Tissue, and Reduction Clamps in Orthopedic Surgery.
Derry KH, Dayan I, Morgan AM … +3 more , Lehane K, Fisher ND, Bi AS
Orthopedics · 2024 · PMID 39509579 · Publisher ↗
Eponyms are widely used in the field of orthopedic surgery, including for surgical instruments. Although their use is at times controversial, an appreciation of the history behind eponymous terms allows one to both recog...
Eponyms are widely used in the field of orthopedic surgery, including for surgical instruments. Although their use is at times controversial, an appreciation of the history behind eponymous terms allows one to both recognize the shortcomings of the past and simultaneously be inspired by ingenious inventors. The primary purpose of this review is to provide a historical perspective of clamps and forceps commonly used in orthopedic surgery, to better appreciate the evolution of their use over time, and to inspire innovation to constantly improve upon surgical instrumentation as the field of orthopedic surgery advances. [. 2024;47(6):e287-e291.].
Evaluating the References of Insurance Policies for Computer-Assisted Navigation in Total Knee Arthroplasty Compared With the American Academy of Orthopaedic Surgeons Clinical Practice Guideline.
Lin EH, Kotlier JL, Fathi A … +4 more , Feingold CL, Heckmann ND, Liu JN, Petrigliano FA
Orthopedics · 2025 · PMID 39509578 · Publisher ↗
BACKGROUND: This study aimed to investigate the quality and quantity of sources cited by insurance payers for computer-assisted navigation (CAN) in total knee arthroplasty (TKA) and to compare these sources with those ci...
BACKGROUND: This study aimed to investigate the quality and quantity of sources cited by insurance payers for computer-assisted navigation (CAN) in total knee arthroplasty (TKA) and to compare these sources with those cited by the American Academy of Orthopaedic Surgeons (AAOS) Clinical Practice Guideline (CPG). MATERIALS AND METHODS: References were included from insurance payer policies on CAN that discussed the use of CAN in TKA, while every reference from the AAOS CPG for surgical navigation in TKA was included. RESULTS: Fifty-four unique articles from insurance payers met criteria, with 68.5% being primary journal articles and 18.5% being reviews. The quality of cited studies was relatively evenly distributed between level of evidence (LOE) I/II (42.6%) and LOE III and below (50.0%). The 14 references cited in the AAOS CPG were 100% primary articles and 100% LOE I/II. Only 16.3% of cited insurance references were AAOS CPG articles. Nine of the 14 AAOS CPG studies were not cited by any of the insurance payer policies. CONCLUSION: Compared with the AAOS CPG, insurance policies cited older articles with lower LOE. We recommend continued updating of the AAOS CPG and insurance policies as more research into the use of CAN in TKA is published. [. 2025;48(1):8-11.].
An Analysis of the Complication Reports of Expandable Lumbar Interbody Cages in the Food and Drug Administration Manufacturer and User Facility Device Experience Database.
ElNemer W, Kim A, Silva-Aponte J … +6 more , Raad M, Azad T, Durand WM, Hassanzadeh H, Kebaish K, Jain A
Orthopedics · 2025 · PMID 39509577 · Publisher ↗
BACKGROUND: Expandable lumbar interbody cages (ELICs) are commonly used for interbody fusion and provide lordotic correction by lengthening the anterior column of the vertebral spine. We sought to identify unique failure...
BACKGROUND: Expandable lumbar interbody cages (ELICs) are commonly used for interbody fusion and provide lordotic correction by lengthening the anterior column of the vertebral spine. We sought to identify unique failure mechanisms and significant differences in the types of complications associated with ELICs as reported to the Food and Drug Administration (FDA) Manufacturer and User Facility Device Experience (MAUDE) Database. MATERIALS AND METHODS: The MAUDE Database was analyzed for complication reports submitted for ELIC systems between January 2013 and July 2023. Reports were categorized by manufacturer, brand name, type of expandable cage, type of complication, year of complication, and reporter identity. Reports that were duplicated or had insufficient information were excluded from analysis. The top 5 manufacturers with the most implant-related complications were independently analyzed and compared. RESULTS: A total of 821 reports were analyzed. The top 5 complications reported across all manufacturers were cage breakage during insertion (25.7%), postoperative migration without collapse (16.0%), postoperative collapse (15.6%), inserter breakage (11.1%), and tubing problems (3.0%). A significant difference was detected in complication type between manufacturers (=557, <.001). The largest number of reports (120, 14.6%) was in 2016. CONCLUSION: With FDA approval of novel ELIC systems and the adoption of newer surgical techniques, understanding the range of potential complications is paramount in ensuring patient safety. This study of the MAUDE Database provides a comprehensive summary of adverse reported events associated with ELICs during the past decade. [. 2025;48(1):e7-e14.].
Biologic Augmentation of Rotator Cuff Repair: Current Concepts Review.
Uyeki CL, Ford BT, Shuman ME … +3 more , Hawthorne BC, Wellington IJ, Mazzocca AD
Orthopedics · 2024 · PMID 39495158 · Publisher ↗
Rotator cuff tears are common in an aging population. Thus far, primary repairs have shown high re-tear rates suggesting the need for improved healing modalities. Current augmentations of rotator cuff repairs include syn...
Rotator cuff tears are common in an aging population. Thus far, primary repairs have shown high re-tear rates suggesting the need for improved healing modalities. Current augmentations of rotator cuff repairs include synthetic and biological scaffolds, surgical bone marrow venting, and infusing the repair with a variety of stem cells and growth factors aimed at restoring the native cellular structure and function of the repaired tissue. This current concepts review discusses the anatomy, physical presentation, diagnosis, and treatment of rotator cuff tears; biological adjuvants for rotator cuff repairs; and the current literature on outcomes after biologically augmented rotator cuff repairs. [. 2024;47(6):e282-e286.].
Trends in Location of Death for Individuals With Primary Bone Tumors in the United States.
Jain B, Sekhar TC, Rudisill SS … +4 more , Hammond A, Jain U, Deveza LD, Amen TB
Orthopedics · 2025 · PMID 39495157 · Publisher ↗
BACKGROUND: Given the significant morbidity and mortality associated with primary bone cancer, provision of high-quality end-of-life care concordant with patient preferences is critical. This study aimed to evaluate tren...
BACKGROUND: Given the significant morbidity and mortality associated with primary bone cancer, provision of high-quality end-of-life care concordant with patient preferences is critical. This study aimed to evaluate trends in use of dedicated end-of-life care settings and investigate sociodemographic disparities in location of death among individuals with primary bone cancer. MATERIALS AND METHODS: A retrospective, population-based review of patients who died of primary bone cancer-related causes was performed using the Underlying Cause of Death public use record from the Centers for Disease Control and Prevention Wide-ranging ONline Data for Epidemiologic Research (WONDER) database for the years 2003 through 2019. A total of 24,557 patients were included. RESULTS: Over the study period, the proportion of primary bone cancer-related deaths occurring at home and in hospice increased, whereas those occurring in hospital, nursing home, and outpatient medical facility/emergency department settings decreased. Several sociodemographic factors were found to be associated with location of death, including age, marital status, and level of education. Moreover, patients of racial and ethnic minority groups were at significantly lower risk of experiencing death at home or in outpatient medical facility/emergency department settings relative to a hospital compared with White patients. CONCLUSION: Although rates of in-hospital death from primary bone cancer are decreasing, marked racial and ethnic disparities in use of dedicated end-of-life care settings exist. These gaps must be addressed to ensure all patients with primary bone cancer have equitable access to high-quality end-of-life care regardless of racial, ethnic, or socioeconomic status. [. 2025;48(1):44-50.].
The Relationship Between Surgeon Volume and Major Surgical Complications After Total Shoulder Arthroplasty: An Evaluation of 3177 US Orthopedic Surgeons.
Liu KC, Mayfield CK, Richardson MK … +7 more , Bolia IK, Kotlier JL, Heckmann ND, Gamradt SC, Weber AE, Liu JN, Petrigliano FA
Orthopedics · 2025 · PMID 39495156 · Publisher ↗
BACKGROUND: Total shoulder arthroplasty (TSA), which includes anatomic total shoulder arthroplasty (aTSA) and reverse total shoulder arthroplasty (rTSA), is a technically demanding procedure and limited data exist on the...
BACKGROUND: Total shoulder arthroplasty (TSA), which includes anatomic total shoulder arthroplasty (aTSA) and reverse total shoulder arthroplasty (rTSA), is a technically demanding procedure and limited data exist on the relationship between case volume and complications. We sought to identify volume thresholds for TSA, aTSA, and rTSA at which risk of a major surgical complication decreased and to compare complications of patients treated by high-volume surgeons with those of patients treated by low-volume surgeons. MATERIALS AND METHODS: Primary, elective TSAs (aTSA and rTSA) from January 1, 2016, to December 31, 2019, were identified in the Premier Healthcare Database. Multivariable logistic regression with restricted cubic splines modeled the relationship between annual TSA, aTSA, and rTSA surgeon volume and 90-day risk of major surgical complications. The 90-day complications of patients treated by high- and low-volume surgeons were compared. RESULTS: From 2016 to 2019, 3177 surgeons performed 78,639 TSAs. Increasing annual volume was associated with decreasing major surgical complication risk (thresholds: 50 TSAs, 25 aTSAs, and 36 rTSAs). High- and low-volume surgeons performed 24,595 and 54,044 TSAs, respectively. Patients of high-volume surgeons had lower risk of major surgical complications (adjusted odds ratio [aOR], 0.69; 95% CI, 0.56-0.84), myocardial infarction (aOR, 0.59; 95% CI, 0.36-0.97), and readmission (aOR, 0.71; 95% CI, 0.62-0.81). Importantly, 74.9% of high-volume and 93.0% of low-volume surgeon-year units had major surgical complication rates below the mean of all recorded surgeons. CONCLUSION: While most high- and low-volume surgeons had major surgical complication rates below the cohort average, increasing TSA volume was associated with a decreased risk of complications. [. 2025;48(1):e15-e21.].
Age-Related Association Between Unilateral Single-Channel and Double-Channel Surgery and Postoperative Multifidus Muscle Atrophy and Fat Infiltration.
Li GH, Ito Z, Shibayama M … +3 more , Nakamura S, Zhu L, Ito F
Orthopedics · 2025 · PMID 39436031 · Publisher ↗
BACKGROUND: Unilateral biportal endoscopic laminotomy (UBE) and percutaneous endoscopic laminotomy (PEL) are minimally invasive spinal surgery (MISS) techniques used for unilateral and dual-channel endoscopic laminectomy...
BACKGROUND: Unilateral biportal endoscopic laminotomy (UBE) and percutaneous endoscopic laminotomy (PEL) are minimally invasive spinal surgery (MISS) techniques used for unilateral and dual-channel endoscopic laminectomy. However, limited research has been conducted on lumbosacral multifidus muscle injuries in elderly individuals undergoing MISS for lumbar spinal canal stenosis. The objective of this study was to investigate the impact of single-channel and double-channel MISS on the multifidus muscle in elderly patients. MATERIALS AND METHODS: A total of 107 patients who underwent MISS were stratified into two cohorts: group A (<65 years) and group B (≥65 years). Preoperative imaging data, including magnetic resonance imaging, were gathered to classify the degree of stenosis based on the nerve root compression. The extent of multifidus muscle atrophy and fat infiltration was assessed by calculating the fat-free cross-sectional area (FCSA)/cross-sectional area (CSA) ratio before and after surgery through measurements of CSA and FCSA. Total cross-sectional area/FCSA were calculated using MRI cross-sectional T2WI. RESULTS: The degree of atrophy and fat infiltration did not change between procedures in group A (>.05), but changed significantly in group B (<.05). CONCLUSION: Unilateral single-channel and double-channel surgery had no significant effect on the degree of multifidus muscle atrophy and fat infiltration in patients younger than 65 years. However, in patients 65 years and older, the degree of multifidus muscle atrophy and fat infiltration significantly increased with the increasing incidence of lateral recess stenosis, which was positively correlated with the duration of surgery. [. 2025;48(1):12-19.].
Clinical and Radiographic Outcomes With Minimum 2-Year Follow-up and Sub-Analysis of Navigation vs Non-Navigation for Hip Resurfacing.
Quesada-Jimenez R, Kahana-Rojkind AH, Walsh EG … +3 more , McCarroll TR, Schinsky MF, Domb BG
Orthopedics · 2025 · PMID 39436030 · Publisher ↗
BACKGROUND: The purpose of this study was to report the short-term clinical outcomes of hip resurfacing with navigation and the impact on accuracy of acetabular implant placement in both the frontal and sagittal planes....
BACKGROUND: The purpose of this study was to report the short-term clinical outcomes of hip resurfacing with navigation and the impact on accuracy of acetabular implant placement in both the frontal and sagittal planes. MATERIALS AND METHODS: Data were retrospectively analyzed for patients who received hip resurfacing between 2010 and 2021. Eligible patients had postoperative radiographs and completed a minimum 2-year follow-up questionnaire for the following patient-reported outcomes: modified Harris Hip Score (mHHS), Harris Hip Score (HHS), Forgotten Joint Score (FJS), visual analog scale (VAS) score, satisfaction, and Hip Disability and Osteoarthritis Outcome Score, Joint Replacement (HOOS-JR). Hips were propensity matched in a 1:1 ratio based on the use of navigation, age, and body mass index. The percentage of hips that met the minimal clinically important difference (MCID) for mHHS and VAS score was noted. Component placement analysis was conducted based on the safe zones defined by Lewinnek and Callanan and the Relative Acetabular Inclination Limit. RESULTS: Seventy-six hips were matched, 38 per group. No differences were observed in patient-reported outcomes or the percentage of hips reaching MCID between the groups. The navigation group was 28.8 and 6.8 times more likely to be within the Callanan and Lewinnek safe zones, respectively. Based on the Relative Acetabular Inclination Limit, the navigation group was 3.1 and 6.4 times more likely to be within the 95% and 99% CI safe zones, respectively. CONCLUSION: Comparable improvements in patient-reported outcomes were observed in the two groups during a minimum 2-year follow-up. Navigation-assisted surgery enhances the accuracy of acetabular component positioning, with a higher likelihood of cup placement within the safe zones. [. 2025;48(1):e1-e6.].
Bizarre Parosteal Osteochondromatous Proliferation With Malignant Transformation and Metastases.
Ulrich G, Wood R, Pearson J … +2 more , Jiganti M, Tedesco N
Orthopedics · 2024 · PMID 39436029 · Publisher ↗
A patient with a benign bizarre parosteal osteochondromatous proliferation (BPOP) located in the anterior knee was treated with resection in preparation for total knee arthroplasty (TKA). The BPOP reoccurred and was trea...
A patient with a benign bizarre parosteal osteochondromatous proliferation (BPOP) located in the anterior knee was treated with resection in preparation for total knee arthroplasty (TKA). The BPOP reoccurred and was treated with re-resection at the time of TKA. The BPOP reoccurred a second time and underwent malignant transformation to a fungating high-grade pleomorphic sarcoma with metastatic lesions. This case highlights the rare potential of a previously benign BPOP to undergo malignant transformation after recurrence. A wide margin resection may be considered primarily when surgery is indicated to prevent recurrence and its potential sequelae. [. 2024;47(6):e322-e326.].
The Minimum Patient Acceptable Symptom State for the ACL-Return to Sport after Injury Scale Among Patients Treated With Anterior Cruciate Ligament Reconstruction.
Dwyer T, Ajrawat P, Lameire DL … +6 more , Betsch M, Whelan D, Shahrokhi S, Theodoropoulos J, Hoit G, Chahal J
Orthopedics · 2025 · PMID 39312746 · Publisher ↗
BACKGROUND: Despite most patients reporting optimal knee function after anterior cruciate ligament reconstruction (ACLR), not all return to their pre-injury level of sport, often due to psychological factors. The ACL-Ret...
BACKGROUND: Despite most patients reporting optimal knee function after anterior cruciate ligament reconstruction (ACLR), not all return to their pre-injury level of sport, often due to psychological factors. The ACL-Return to Sport after Injury Scale (ACL-RSI) was developed to measure the emotions, confidence in performance, and risk appraisal among athletes returning to sport. The purpose of this study was to determine the Patient Acceptable Symptom State (PASS) threshold for the ACL-RSI in patients undergoing ACLR. MATERIALS AND METHODS: Patients with an ACL injury that required surgical reconstruction were included in this prospective study. All patients underwent ACLR with a bone-patellar tendon-bone autograft and completed the ACL-RSI 12 months postoperatively. An anchor-based approach was used to generate a receiver operating characteristic curve and establish the PASS threshold. Multivariable regression analyses were used to evaluate the effect of age, sex, and baseline score on likelihood of achieving PASS. RESULTS: A total of 113 patients (37% female) with a mean age of 28.1±8.2 years and a mean body mass index of 24.7±3.5 kg/m were included. At 12 months postoperatively, the threshold value for the PASS of the ACL-RSI was 40 (robust area under the curve: 0.89; sensitivity: 81%; specificity: 85%). Baseline score, sex, and age had no significant influence on achieving PASS at 12 months postoperatively. CONCLUSION: In a group of patients undergoing ACLR with bone-patellar tendon-bone autograft, the PASS threshold value was 40 for the ACL-RSI at 12 months postoperatively. The PASS value for the ACL-RSI established from this study can be useful for designing future clinical trials. [. 2025;48(1):20-24.].
Preoperative Mental Health Disorders Affect Opioid Consumption and Perioperative Complications After Total Shoulder Arthroplasty.
Mayfield CK, Abu-Zahra MS, Bolia IK … +6 more , Kotlier JL, Lin EH, Gamradt SC, Weber AE, Liu JN, Petrigliano FA
Orthopedics · 2024 · PMID 39312745 · Publisher ↗
BACKGROUND: Limited evidence exists regarding the influence of mental health disorders (MHDs) on opioid use and complications after total shoulder arthroplasty (TSA). We aimed to identify the prevalence of common MHDs am...
BACKGROUND: Limited evidence exists regarding the influence of mental health disorders (MHDs) on opioid use and complications after total shoulder arthroplasty (TSA). We aimed to identify the prevalence of common MHDs among patients undergoing anatomic TSA (aTSA) and reverse TSA (rTSA). MATERIALS AND METHODS: The Premier Healthcare Database was queried for patients undergoing primary aTSA and rTSA from 2016 to 2020. diagnosis codes were used to identify MHDs. Primary outcomes included the prevalence of MHDs, perioperative opioid consumption, and 90-day risk of postoperative complications, revision, and readmission. Bivariate and multivariate regression analyses were performed to assess 90-day risk of primary endpoints while controlling for potential confounders. Statistical significance was defined as <.05. RESULTS: From 2016 to 2020, 49,997 of 144,725 (34.55%) patients undergoing primary TSA had at least one diagnosed MHD. The most prevalent were depression (17.03%), anxiety (16.75%), and substance use disorder (10.20%). Patients with a MHD had higher mean hospital costs ($75,984±$43,129 vs $73,316±$39,046, <.0001), longer mean length of stay (1.95±2.25 days vs 1.61±1.51 days, <.0001), and higher mean total postoperative opioid use (72.00±231.55 morphine milligram equivalents [MMEs] vs 59.32±127.31 MMEs, <.0001). Periprosthetic fractures (odds ratio, 1.20; =.041), dislocation (odds ratio, 1.12; =.042), and 90-day readmission rates (odds ratio, 1.26; <.001) were significantly higher among patients with a MHD. CONCLUSION: This study found that MHDs are associated with significantly increased perioperative opioid consumption, medical and surgical complication rates, and risk of readmission after TSA. Recognition and optimization of MHDs is critical to minimizing complications and opioid consumption after TSA. [. 2024;47(6):e303-e310.].
Assessing the Accuracy and Reliability of the Fluoroscopic Ruler for Comminuted Femur Fractures: A Cadaveric Study.
Wahlig BD, Kuttner NP, Kouzel-Martinez FA … +4 more , Broida SE, Sems SA, Hidden KA, Yuan BJ
Orthopedics · 2024 · PMID 39312744 · Publisher ↗
BACKGROUND: Fixation of comminuted femur fractures may result in limb length discrepancy. Intraoperative fluoroscopic measurement of the contralateral femur with a ruler is commonly performed to establish a reference for...
BACKGROUND: Fixation of comminuted femur fractures may result in limb length discrepancy. Intraoperative fluoroscopic measurement of the contralateral femur with a ruler is commonly performed to establish a reference for femoral length. No evidence regarding the reliability and accuracy of this technique exists. This study aimed to assess the accuracy and interrater reliability of a fluoroscopic ruler in obtaining correct femoral length in a comminuted femoral shaft fracture model. MATERIALS AND METHODS: Approximately 5 cm of bone was removed from the left femoral diaphyses of 8 cadavers. Seven orthopedic surgery residents and 2 attendings measured the length of the intact contralateral femur using a ruler under fluoroscopy. The ruler was then applied to the "fractured" femur with manual traction applied until femoral length matched the measured length of the contralateral femur. The resulting gap in the "fractured" femur was compared with the length of bone that had been resected. Data were analyzed using means, SDs, and intraclass correlation coefficients (ICCs). RESULTS: Fifty-seven measurements were collected. The mean difference between the measured fracture gap and the length of bone removed was 8.0±5.8 mm (range, 0-22 mm). Femoral length was accurate to 5 mm in 40% of cases, 10 mm in 70%, 15 mm in 81%, 20 mm in 98%, and 25 mm in 100%. The overall interrater reliability was poor (ICC, 0.11; 95% CI, 0.001-0.44). CONCLUSION: Despite poor interrater reliability, the fluoroscopic ruler resulted in a mean leg length discrepancy of 8.0±5.8 mm in this cadaveric study. [. 2024;47(6):327-331.].
Epidemiology of Lumbar Spine Fractures: Twenty-Year Assessment of Nationwide Emergency Department Visit Data.
Kuharski MJ, Daher M, Zhou JJ … +12 more , Ikwuazom CP, Andrews C, Alam J, Scheer RC, Lou M, Alsoof D, Balmaceno-Criss M, Shah NV, Bou Monsef J, Diebo BG, Paulino CB, Daniels AH
Orthopedics · 2024 · PMID 39312743 · Publisher ↗
BACKGROUND: Lumbar spine fractures are common injuries associated with substantial morbidity for patients and socioeconomic burden. This study sought to epidemiologically analyze lumbar spine fractures by mechanism of in...
BACKGROUND: Lumbar spine fractures are common injuries associated with substantial morbidity for patients and socioeconomic burden. This study sought to epidemiologically analyze lumbar spine fractures by mechanism of injury and identify temporal trends in patient demographics and disposition, which few studies have previously evaluated. MATERIALS AND METHODS: A retrospective analysis was done of the US National Electronic Injury Surveillance System (NEISS) database between 2003 and 2022. The sample contained all patients 2 to 101 years old with product-related lumbar fractures presenting to participating institutions' emergency departments. A total of 15,196 unweighted injuries (642,979 weighted injuries) were recorded. RESULTS: Overall, there was a 20-year incidence rate of 10.14 cases per 100,000 person-years with a 2-fold increase in fracture incidence. Females were more prone to lumbar fracture than males (=.032). Injuries primarily stemmed from a fall (76.6%). The incidence of lumbar fracture increased most significantly in older patients, with patients 80 years and older showing the greatest annual increase (β=8.771, =0.7439, <.001) and patients 60 to 69 years showing the greatest percent increase with a 3.24-fold increase in incidence. Most (58.9%) of the fractures occurred at home. Females were more often injured at home compared with males (<.001), who more often sustained lumbar fractures during recreational or athletic activity (<.001). All patients older than 40 years showed at least a doubling in incidence rate of lumbar fracture between 2003 and 2022. CONCLUSION: These data demonstrate the pressing need to address poor bone health in the aging population, shown here to have an increasing fracture burden. [. 2024;47(6):e297-e302.].
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