The Journal Of The American Academy Of Orthopaedic Surgeons[JOURNAL]
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200 papers
Medicare Advantage in Total Knee Arthroplasty: No Difference in 1-year Outcomes Among 7,267 Total Knee Arthroplasty Patients.
Jevnikar BE, Elmenawi KA, Jin Y … +4 more , Khan ST, Pasqualini I, Piuzzi NS, CCARR Corporate Authorship
J Am Acad Orthop Surg · 2025 Dec · PMID 41468584 · Publisher ↗
BACKGROUND: Medicare advantage (MA) enrollment is rising rapidly, now comprising over half of all Medicare beneficiaries. Compared with traditional medicare (TM), MA patients are more likely to be socioeconomically disad...
BACKGROUND: Medicare advantage (MA) enrollment is rising rapidly, now comprising over half of all Medicare beneficiaries. Compared with traditional medicare (TM), MA patients are more likely to be socioeconomically disadvantaged and subject to distinct care coordination barriers, yet few studies have examined how these differences affect postoperative outcomes after total knee arthroplasty (TKA). METHODS: We analyzed a prospective cohort of 7,267 Medicare beneficiaries who underwent primary TKA at a high-volume academic center between 2016 and 2023. Patients were categorized MA or TM based on insurance status at the time of surgery. Primary outcomes included postoperative healthcare utilization: prolonged length of stay (≥2 days), nonhome discharge, 90-day readmission, 90-day emergency department visit, 1-year revision surgery, and 1-year mortality. Multivariable logistic regression models adjusted for demographic, clinical, and socioeconomic covariates. RESULTS: Of the cohort, 3,293 (45.3%) were MA and 3,974 (54.7%) were TM. MA patients were more likely to be non-White (17.7% vs. 10.2%, P < 0.001), have higher area deprivation index scores (49.0 vs. 42.0, P < 0.001), and higher smoking rates (6.1% vs. 4.0%, P < 0.001). Unadjusted rates of 90-day emergency department visits (16.8% vs. 14.6%, P = 0.011) and 1-year revision surgery (4.4% vs. 3.5%, P = 0.041) were higher in the MA group. However, after adjustment, MA status was not significantly associated with increased odds of any adverse outcome, including revision surgery (odds ratio, 0.85; 95% confidence interval, 0.66 to 1.08; P = 0.181) or mortality (odds ratio, 0.89; 95% confidence interval, 0.73 to 1.10; P = 0.285). CONCLUSION: Despite greater baseline social risk, MA patients undergoing TKA at a high-volume academic center experienced comparable short-term outcomes with their TM counterparts. These findings suggest that when standardized care pathways are applied, Medicare subcategory alone does not predict postoperative healthcare utilization. As MA enrollment continues to grow, ensuring equitable outcomes will require adaptation of clinical workflows and research strategies to better reflect the evolving Medicare landscape.
Relationship Between Preoperative Pfirrmann Grading and Adjacent Segment Degeneration After Anterior Cervical Diskectomy and Fusion.
Dalton JF, Oris RJ, Mathew J … +22 more , McCurdy MA, Alexander T, Lin RT, Ng M, Lee Y, Narayanan R, Henry TW, Lee Y, Kothari P, Sarikonda A, Dean E, Cha R, Kazantsev M, Mangan JJ, Rihn JA, Cha TD, Kurd MF, Canseco JA, Hilibrand AS, Vaccaro AR, Kepler CK, Schroeder GD
J Am Acad Orthop Surg · 2025 Dec · PMID 41468578 · Publisher ↗
INTRODUCTION: To evaluate the association between preoperative adjacent segment disk health, evaluated by the Pfirrmann classification, and adjacent segment disease (ASD) risk. METHODS: Patients who underwent anterior ce...
INTRODUCTION: To evaluate the association between preoperative adjacent segment disk health, evaluated by the Pfirrmann classification, and adjacent segment disease (ASD) risk. METHODS: Patients who underwent anterior cervical decompression and fusion (2013 to 2020) with available preoperative magnetic resonance imaging and 2 years of radiographic follow-up were retrospectively identified. Patients with prior cervical surgery or malignancy/infection/trauma were excluded. Preoperative adjacent disk degeneration was evaluated with modified Pfirrmann classification (grades I to IV) and substratified as low (grades I to II) or high (grades III to IV). Radiographic degeneration 2 years postoperatively was assessed through a published radiograph scoring system based on disk height, osteophyte formation, and vertebral sclerosis. Statistical analyses were conducted to compare demographic, surgical, and radiographic outcomes between low and high degeneration groups. RESULTS: Fifty-six patients (15 with high Pfirrmann degeneration at both levels, 21 with one high level, and 20 with no high levels) and a total of 114 levels (51 with high and 63 with low Pfirrmann degeneration) were included. Age, male sex, Charlson comorbidity index, and construct length all increased consistently from patients with neither adjacent level having high degeneration to one level to both levels (P < 0.05). Linear regression showed that high preoperative adjacent Pfirrmann grade was independently predictive of decreased postoperative to preoperative adjacent disk height ratio (estimate: -0.16, P = 0.025) at 2 years postoperatively. Similarly, ordinal logistic regression showed that high preoperative adjacent Pfirrmann grade was independently predictive of more severe postoperative disk height score at 1 year (odds ratio: 3.9, P = 0.030). Both regression models included age, sex, Charlson comorbidity index, number of levels fused, indication for surgery (radiculopathy and myelopathy), and smoking status. The revision rate for ASD was similar between groups at 5 years. CONCLUSION: High preoperative Pfirrmann grade at the disk level adjacent to anterior cervical decompression and fusion is predictive of worse adjacent segment degeneration, specifically decreased disk height at 2 years postoperatively. However, revision for ASD was similar at 5 years postoperatively.
The Role of ACS NSQIP in Orthopaedic Surgery Practice, Research, and Quality Evaluation.
Sullivan MH, Hannon CP, Shin AY … +1 more , Pulos N
J Am Acad Orthop Surg · 2026 May · PMID 41461075 · Publisher ↗
The American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) is a multicenter variable-based data registry that facilitates surgical quality tracking, hospital benchmarking, and outcome pred...
The American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) is a multicenter variable-based data registry that facilitates surgical quality tracking, hospital benchmarking, and outcome predictions. ACS NSQIP data within Orthopaedic Surgery consist primarily of the 30 most common orthopaedic procedures and collect demographic and 30-day complication metrics for inpatient and outpatient procedures. Although the original intent of this large database was quality improvement, it has also been used extensively in orthopaedic research since 2010 to evaluate risk factors in orthopaedic surgery, despite systematic reviews demonstrating weaknesses in reproducibility and impact. Comparisons of ACS NSQIP to orthopaedic surgery-specific databases demonstrate a shortcoming of NSQIP in identifying patients, prevalence of complications, and tracking complications. Although ACS NSQIP provides a chance for large-scale data analysis in quality tracking and research, its reliability and usefulness in orthopaedic surgery remain to be established.
Changes in Clinical Practice After Publication of the Prophylactic Antibiotic Regimens in Tumor Surgery (PARITY) Randomized Controlled Trial.
Sabharwal S, Becker RG, Monument MJ … +4 more , Schneider P, Schubert T, Ghert M, Morris CD
J Am Acad Orthop Surg · 2026 Jun · PMID 41461074 · Publisher ↗
BACKGROUND: The Prophylactic Antibiotic Regimens in Tumor Surgery (PARITY) trial was a multicenter randomized clinical trial comparing a 1-day with a 5-day postoperative intravenous antibiotic regimen after lower extremi...
BACKGROUND: The Prophylactic Antibiotic Regimens in Tumor Surgery (PARITY) trial was a multicenter randomized clinical trial comparing a 1-day with a 5-day postoperative intravenous antibiotic regimen after lower extremity bone tumor resection and endoprosthetic reconstruction. The trial found no difference in surgical site infections between groups, but a markedly increased risk for antibiotic-related complications in the 5-day group. The study was published in January 2022. The objective of this study was to assess the effect of these findings on the clinical practice of musculoskeletal oncologists. METHODS: We developed an anonymous survey exploring changes in clinical practice after the publication of the PARITY trial and electronically distributed the survey to practicing musculoskeletal oncologists through REDCap in March 2024. Data were analyzed descriptively, and changes in practice from before to after the publication of the PARITY study were analyzed through the Pearson chi-square test. RESULTS: We obtained 101 responses from surgeons across six continents. Nearly all respondents (94 of 101, 93%) were aware of the PARITY trial results. Forty respondents (40%) reported a meaningful change in clinical practice after PARITY, most frequently a reduction of antibiotic administration in >75% of patients. After PARITY, the proportion of respondents who reported limiting antibiotics to 24 hours increased from 25% to 51% ( P < 0.001), and the proportion prescribing oral antibiotics after discharge from the hospital declined from 23% to 16% ( P < 0.001). Among those who did not change their practice, personal experience/professional opinion was the most frequently cited reason. Adherence to institutional standards was cited as an additional barrier. CONCLUSIONS: Many respondents reported meaningful change in their clinical practice after the publication of the PARITY trial, most notably limiting perioperative antibiotics to 24 hours. The complexities influencing the personal decision to adopt a notable change in clinical practice in response to new evidence warrant additional study. LEVEL OF EVIDENCE: IV.
Assessing the Third Wave of Generative AI: Performance of Advanced Models on Text-based Questions From the 2024 Orthopaedic In-training Examination.
Hayes DS, Barré A, Muchow RD
J Am Acad Orthop Surg · 2026 Jun · PMID 41461073 · Publisher ↗
INTRODUCTION: Learners are rapidly using generative artificial intelligence (AI) models in their education. We assessed the performance of recently released or updated models on the 2024 American Academy of Orthopaedic S...
INTRODUCTION: Learners are rapidly using generative artificial intelligence (AI) models in their education. We assessed the performance of recently released or updated models on the 2024 American Academy of Orthopaedic Surgeons Orthopaedic In-training Examination for their potential applications in orthopaedic education. METHODS: Eleven models with recent enhancements in reasoning and research capabilities were evaluated. A total of 119 text-based questions were entered verbatim into each model. Model outputs were recorded as correct or incorrect. Additional analyses included reasoning time, citation accuracy, confidence in answer selection, and comparison with orthopaedic resident performance. References generated by the top performing model were compared with American Academy of Orthopaedic Surgeon Recommended Readings for incorrectly answered questions. RESULTS: Ten of 11 AI models exceeded the American Board of Orthopaedic Surgery minimal passing standard (67.7%). Eight models surpassed PGY5 resident performance. OpenAI's o1Pro with Deep Research achieved the highest accuracy (90.8%), outperforming the mean performance of PGY5 residents by 17.8%. More than half of the ResStudy Recommended Readings were cited as supporting references by the top performing model on questions it answered incorrectly. Subspecialty performance varied, with highest accuracy in Shoulder and Elbow and Sports Medicine questions. Longer reasoning times generally correlated with improved accuracy. DISCUSSION: Advanced AI models demonstrated substantial improvements over previous generations, with more than half of the tested models exceeding senior orthopaedic resident performance. Improved reasoning and research capabilities highlight the evolving capabilities of AI in medical education, although increased understanding of their utilization by learners is needed. Variability among subspecialties may suggest differences in training data or reasoning capabilities. CONCLUSIONS: Modern AI models exhibit high proficiency on the Orthopaedic In-training Examination and may serve as valuable supplemental educational tools. Ongoing evaluation is warranted to understand their optimal integration into orthopaedic training while recognizing limitations in clinical reasoning, lived experience, and imaging interpretation.
The Impact of Preoperative Cannabis Use on Postoperative Pain and Opioid Use in Orthopaedic Surgery Patients: A Scoping Review.
Ashkar AF, Chan DH, Seta J … +1 more , Srikumaran U
J Am Acad Orthop Surg · 2026 Jun · PMID 41461072 · Publisher ↗
BACKGROUND: The use of cannabis for medical and recreational purposes has become increasingly prevalent. Emerging evidence suggests that postoperative cannabis-based medications influence postoperative opioid use for ana...
BACKGROUND: The use of cannabis for medical and recreational purposes has become increasingly prevalent. Emerging evidence suggests that postoperative cannabis-based medications influence postoperative opioid use for analgesia, although the impact of preoperative cannabis use on acute orthopaedic surgical outcomes remains unclear. The purpose of this study was to explore current literature regarding the associations of preoperative cannabis use with pain and opioid requirements after undergoing orthopaedic surgery. METHODS: A scoping review was conducted through a search of the PubMed, EMBASE, and Scopus databases. Two independent reviewers extracted information on population, measure of cannabis use, and postoperative outcomes, including Patient-Reported Outcomes Measurement Information System scores, pain, and morphine milligram equivalents. RESULTS: We identified 1,025 studies for potential inclusion. After screening all abstracts and titles, 19 orthopaedic studies were included, comprising 19,719 patients. Most were retrospective cohort studies, with 11 evaluating opioid use, three evaluating postoperative pain outcomes, and five evaluating both. Among the pain-related studies, three reported higher pain scores in their cannabis-user cohorts, one reported lower pain scores among cannabis users, and the remaining found no differences in pain. The studies evaluating opioid use found no notable difference in morphine milligram equivalent consumption between cannabis users and nonusers. DISCUSSION: Most evidence suggests that preoperative cannabis use has no effect on opioid use after orthopaedic surgery. Few articles investigated the associations of preoperative cannabis use with postoperative pain, and results were mixed, with only one study evaluating cannabis use in upper extremity surgical patients, suggesting the need for further exploration in some fields. No studies were able to measure duration of cannabis use, method of consumption, or potency because the use was either self-reported or based on a diagnosis of cannabis use disorder, indicating the need for future studies to stratify preoperative cannabis use by methods of ingestion and amount consumed.
Understanding Acetabular Fractures: A Comprehensive Review.
Mauffrey C, Bellas N, David G … +1 more , Le Baron M
J Am Acad Orthop Surg · 2026 Apr · PMID 41461069 · Publisher ↗
Acetabular fractures are complex injuries that demand a precise understanding of fracture morphology, radiographic interpretation, and surgical strategies. Although the Judet and Letournel classification system remains t...
Acetabular fractures are complex injuries that demand a precise understanding of fracture morphology, radiographic interpretation, and surgical strategies. Although the Judet and Letournel classification system remains the benchmark, it poses notable challenges due to its complexity and learning curve. A narrative review was conducted synthesizing key concepts in classification, imaging interpretation, surgical planning, and fracture-specific considerations, with a focus on clinical utility. Established and novel classification systems were evaluated alongside reduction techniques and management pathways. The Judet and Letournel classification system remains clinically relevant, despite limitations in inter- and intraobserver reliability and transitional fracture classification. Surgeons benefit from reframing acetabular fractures into two major pattern families to streamline decision making. This paradigm improves recognition of displacement vectors, constant fragments, and optimal approaches. Ongoing refinement of educational tools and imaging strategies will support better outcomes. Surgical indications, including marginal impaction and geriatric management, are reviewed in detail. A simplified, concept-driven approach to acetabular fracture classification enhances clinical decision making and educational clarity. Integrating this approach with modern imaging and tailored fixation strategies offers a pathway toward improved outcomes in acetabular fracture care.
A Preliminary, Three-Arm, Randomized, Double-Blinded, Placebo-Controlled Trial Comparing the Efficacy of Adductor Canal Pain Catheters Following Total Knee Arthroplasty.
Wilke BK, Sherman C, Ledford CK … +4 more , Heckman MG, White LJ, Howe B, Clendenen SR
J Am Acad Orthop Surg · 2025 Dec · PMID 41461068 · Publisher ↗
INTRODUCTION: The United States has experienced a notable increase in opioid abuse over the past several years, with orthopaedic surgeons reported as the third-highest prescribers by specialty. Several studies have addre...
INTRODUCTION: The United States has experienced a notable increase in opioid abuse over the past several years, with orthopaedic surgeons reported as the third-highest prescribers by specialty. Several studies have addressed opioid use after major orthopaedic procedures but largely focused on prescribing practices. There is limited data on the utility of adding adductor canal pain catheters to multimodal regimens following total knee arthroplasty for improved pain control and reduced opioid dependence. The purpose of this preliminary study was to compare single-shot adductor canal blocks to continuous infusion or intermittent bolus catheters, evaluating postoperative pain levels and duration of opioid use. METHODS: Sixty opioid-naive patients participated in a prospective, randomized, double-blinded, placebo-controlled trial. Following total knee arthroplasty, patients were randomized into one of three cohorts based on preoperative pain levels: (1) single-shot adductor canal block with placebo catheter, (2) continuous infusion catheter, or (3) intermittent bolus catheter. Postoperative protocols were similar except for the catheter. Patient outcomes were recorded for 60 days postoperatively. RESULTS: We found no difference in length of stay, oral morphine equivalents, use of on-demand medication, or pain scores (all P > 0.05) between the groups. Although the single-shot cohort trended toward a longer duration of opioid use (median 21 days) compared with the catheter groups (median 14 days for both), this did not approach statistical significance ( P = 0.59). We found no difference in Knee Injury and Osteoarthritis Outcome Score Jr scores between the groups at 30 or 60 days postoperatively (all P > 0.05). CONCLUSION: In our preliminary study, we found no differences in clinical outcomes, pain scores, or patient-reported scores between a single-shot adductor canal block, a continuous infusion adductor canal catheter, and an intermittent bolus adductor catheter following total knee arthroplasty. Larger studies are needed to more definitively assess differences in outcomes between the treatment groups, particularly in the opioid-tolerant population.
The Current State of Orthopaedic Educational Leadership: A 5-Year Update.
Bi AS, Richardson MA, Fisher ND … +3 more , Strauss EJ, Egol KA, Zuckerman JD
J Am Acad Orthop Surg · 2026 Jun · PMID 41461057 · Publisher ↗
BACKGROUND: It is valuable to understand the changing landscape of leadership in orthopaedic surgery given its effect on medical school education, residency and fellowship training, and patient care. The purpose of this...
BACKGROUND: It is valuable to understand the changing landscape of leadership in orthopaedic surgery given its effect on medical school education, residency and fellowship training, and patient care. The purpose of this study was to provide a 5-year update on the current characteristics of orthopaedic educational leadership. METHODS: Based on the initial study, 159 accredited orthopaedic surgery residency programs were identified through cross-referencing the Accreditation Council for Graduate Medical Education (ACGME) website with the Electronic Residency Application Service Data, including training locations, academic rank, H-index, and publications for both program directors (PDs)and chairs, were obtained from public websites. RESULTS: One hundred fifty-nine PDs and 151 chairs were identified. Overall, 82 (51.6%) and 55 (36.4%) changes in PD and chairs, respectively, were observed. In addition, there were 18 (11.1%) female PDs in 2020 compared with 23 (14.5%) in 2025 ( P = 0.379), and 3 (2.0%) female chairs in 2020 compared with 12 (7.9%) in 2025 ( P = 0.016). Chairs were in practice for longer than PDs (26.8 versus 16.6 years [ P < 0.001]) and in their position for longer (9.3 versus 7.8 years [ P = 0.066]). Chairs were more likely to be professors (75.5% versus 22.6% [ P < 0.001]), have higher H-index (30.4 versus 14.2 [ P < 0.001]), and have more publications (95.9 versus 35.4 [ P < 0.001]). PDs were more likely to have completed residency at their current institution. The most common subspecialties were trauma for PDs and sports for Chairs. CONCLUSION: There have been notable changes in orthopaedic surgery leadership positions within the past 5 years, with a significant increase in female Chairs. Those who are interested in pursuing leadership positions or in the changing landscape of orthopaedic leadership may benefit from the findings of this study.
Thoracolumbar Spine Trauma Outcomes: Effect of Ankylosing Spondylitis and Diffuse Idiopathic Skeletal Hyperostosis.
Callaway J, Shahzad H, Bhale R … +11 more , Zhao A, Lu S, Mace W, Hideshima K, Higginbotham D, Javidan Y, Khan SN, Vander Voort W, Roberto R, Klineberg E, Le H
J Am Acad Orthop Surg · 2025 Dec · PMID 41453026 · Publisher ↗
INTRODUCTION: Ankylosing spondylitis (AS) and diffuse idiopathic skeletal hyperostosis (DISH) are chronic conditions associated with altered spine architecture that can potentially influence the outcomes of spine trauma....
INTRODUCTION: Ankylosing spondylitis (AS) and diffuse idiopathic skeletal hyperostosis (DISH) are chronic conditions associated with altered spine architecture that can potentially influence the outcomes of spine trauma. This study aims to compare demographic characteristics, clinical outcomes, and surgical interventions among thoracolumbar spine trauma patients with a concomitant diagnosis of AS or DISH with those with no underlying ankylosing spinal conditions. Our aim is to better understand how these diseases may affect the prognosis and treatment in the context of thoracolumbar spine trauma. METHODS: A retrospective analysis of patients presenting with thoracolumbar spine trauma at a single-level I trauma center between 2015 and 2024 was conducted (n = 189). The patients were categorized into three groups: those with AS (n = 20), those with DISH (n = 32), and those without either condition (n = 137). Primary outcomes included neurologic status at admission, neurologic outcomes, number of levels fused, postoperative complications, length of hospital stay, in-hospital mortality, and readmission rates. RESULTS: Patients with AS and DISH were generally older (>70 years old) with more comorbidities such as diabetes and osteoporosis (P < 0.001). Mechanisms of injury differed, with motor vehicle collisions more common in the control group and ground-level falls or falls from height being more frequent in patients with AS/DISH. Regarding trauma outcomes, no significant differences in neurologic status or improvement were observed, but patients with AS/DISH required more extensive surgical intervention and more levels fused (P < 0.05). Postoperatively, patients in the AS/DISH groups had higher rates of long-term care admission and in-hospital mortality, although readmission rates and intensive care unit admissions were similar across groups. CONCLUSION: Although their immediate postoperative outcomes are comparable with those of unaffected individuals, patients with AS and DISH required more extensive surgical interventions and had higher rates of long-term care admissions and in-hospital mortality. These findings underscore the need for tailored management strategies for spine trauma patients with AS and DISH.
Characterization and Time-delay in Issuing High-risk Recalls of Orthopaedic Devices From 2002 to 2023.
Gedik CC, Walker C, Bouloussa H … +4 more , Krumme JW, Cheng AL, Cil A, Dubin JR
J Am Acad Orthop Surg · 2026 Jun · PMID 41453025 · Publisher ↗
INTRODUCTION: Orthopaedic devices constitute nearly 20% of all medical devices, with approximately 12% of implants recalled within 10 years of Food and Drug Administration (FDA) clearance. Class I recalls represent the F...
INTRODUCTION: Orthopaedic devices constitute nearly 20% of all medical devices, with approximately 12% of implants recalled within 10 years of Food and Drug Administration (FDA) clearance. Class I recalls represent the FDA's highest level of concern, indicating that device use could result in serious injury or death. Despite their severity, class I orthopaedic device recalls have not been systematically characterized, and concerns remain regarding delayed responsiveness to safety signals. METHODS: The FDA recall database was reviewed for class I medical device recalls from November 2002 to December 2023, and orthopaedic-related events were identified. Devices were categorized by subspecialty (arthroplasty, spine, other), authorization pathway (510(k) vs. Premarket Approval (PMA)), and recall cause. FDA-designated root causes were reclassified into clinically relevant categories. Annual Manufacturer and User-facility Device Experience files were reviewed for associated adverse event reports (AERs), and the interval between the earliest AER and formal recall was calculated. Statistical comparisons were made using the Fisher exact test and Mann-Whitney U test. RESULTS: Sixteen class I recall events affecting 20 orthopaedic devices were identified: 50% arthroplasty, 44% spine, and 6% other. Only 13% of recalled devices underwent PMA; the rest were 510(k)-cleared. Most recalls (69%) were due to intrinsic device design flaws. Surgeon consensus reached through reconciliation of differences on root cause-matched FDA categorization in only 30% of non-design-designated recalls. The median AER-to-recall interval was significantly longer for arthroplasty devices (5.8 years) than spine devices (1.8 years, P = 0.014). CONCLUSION: Most class I orthopaedic device recalls involved design flaws in 510(k)-cleared implants and were subject to notable delays between initial adverse reports and recall, particularly in arthroplasty implants. Discrepancies between FDA classifications and clinical judgment, as well as inconsistent recall labeling, highlight the need for more robust and specific postmarket surveillance. This includes collaboration with surgeons and potential linkages with existing registries, such as the American Academy of Orthopedic Surgeons' American Joint Replacement Registry, to facilitate early identification of problematic devices.
Calcaneus Fractures: A Review of Management, Treatment, and Recent Advances.
Schneiderman BA, Carlson BA, Johnson JP … +1 more , Elsissy JG
J Am Acad Orthop Surg · 2026 Mar · PMID 41429043 · Publisher ↗
Calcaneus fractures remain challenging fractures that are prone to complications. Surgery was previously restricted only to those with soft-tissue envelopes amenable to the extensile lateral approach. However, with the d...
Calcaneus fractures remain challenging fractures that are prone to complications. Surgery was previously restricted only to those with soft-tissue envelopes amenable to the extensile lateral approach. However, with the development of the sinus tarsi approach and other percutaneous techniques, more prompt surgical interventions with lower complication rates have become possible. Restoration of hindfoot morphology and facet congruity are the primary goals of surgery. Complications including posttraumatic subtalar arthritis, infection, wound dehiscence, and malunion can be minimized with deliberate treatment decisions.
Patient Encounter Cards Improve Physician and Patient Engagement for New Patient Visits in Orthopaedic Oncology.
Wahle CF, Newman-Hung NJ, Mefford MR … +5 more , Sridharan M, Christ AB, Bernthal NM, Fufa DT, Wessel LE
J Am Acad Orthop Surg · 2026 May · PMID 41429017 · Publisher ↗
INTRODUCTION: New patient visits in the orthopaedic oncology clinic are medically complex and emotionally nuanced. Previous orthopaedic literature has shown that clear communication of the diagnosis and plan can be diffi...
INTRODUCTION: New patient visits in the orthopaedic oncology clinic are medically complex and emotionally nuanced. Previous orthopaedic literature has shown that clear communication of the diagnosis and plan can be difficult, resulting in worse outcomes. This study aimed to validate the use of a novel patient encounter card (PEC) to improve patient/physician postencounter satisfaction. METHODS: All new patients who presented to the clinics of three fellowship-trained orthopaedic oncologists from September 2023 to March 2025 were included. In the preintervention phase, visits were conducted without modification. Patients were queried on satisfaction, whether concerns were addressed, understanding of the treatment plan, and perceived patient/physician connection. During the intervention phase, a PEC was implemented. The "patient" side was completed in the waiting room; the "physician" side during the visit. Patients then completed the same postvisit survey. Residents and fellows were surveyed at the end of each clinic. All statistical analysis was done using STATA V18. RESULTS: A total of 245 patients were surveyed. During the intervention phase, patient scores improved across all 12 patient satisfaction and competency metrics. Following the intervention, 94% of patients strongly agreed that the doctor listened to what they had to say and 93% felt that their main concern had been addressed. Compared with the control group, markedly more patients reported being "very satisfied" with their visit ( P = 0.048) and "very confident" that they made the most of their visit ( P = 0.041). Markedly more patients also reported that they were involved in their treatment plan as much as they wanted to be ( P = 0.046). Finally, 100% of surveyed physicians believed that the intervention improved clinical efficiency. CONCLUSION: PECs improve patient experience and strengthen patient-physician communication while maintaining clinical efficiency in orthopaedic oncology consultations. This simple, low-cost intervention may be effective across a range of medical and surgical specialties.
The Impact of Glucagon-Like Peptide-1 Receptor Agonists on Fracture Risk in Overweight or Obese, Nondiabetic Patients.
Constantine E, Enthoven L, Kahan R … +2 more , Pflug EM, Lauder A
J Am Acad Orthop Surg · 2026 Jun · PMID 41429015 · Publisher ↗
INTRODUCTION: Glucagon-like peptide-1 receptor agonists (GLP-1RA) are prescribed for glycemic control and weight reduction. Little is known regarding the impact of GLP-1RAs on bone health in patients without diabetes. ME...
INTRODUCTION: Glucagon-like peptide-1 receptor agonists (GLP-1RA) are prescribed for glycemic control and weight reduction. Little is known regarding the impact of GLP-1RAs on bone health in patients without diabetes. METHODS: This retrospective case-control study was conducted using data from TriNetX database between 2015 and 2022. The primary objective was to assess fracture risk in overweight and obese patients without diabetes following GLP-1RA use. Patients with an ICD-10 diagnosis of overweight or obesity were included. Patients with diabetes or an increased risk of fragility fractures were excluded. An initial query resulted in 1,155,496 patients with 606,364 available for analysis. This cohort was divided into (1) those with GLP-1RA prescriptions (n = 33,220) and (2) those without GLP-1RA prescriptions (n = 593,748). Propensity matching was done for these groups (n = 33,210 each) at the time of prescription. The primary outcome was fracture diagnosis within 1 year of GLP-1RA prescription. Risk and odds ratio (OR) with 95% confidence intervals (CIs) were estimated using multiple logistic regression. RESULTS: Fracture risk was significantly increased in overweight and obese patients without diabetes who were prescribed a GLP-1RA compared with patients who were not (3.05% vs. 2.61%, number needed to harm [NNH] = 227, OR 1.19, CI [1.09 to 1.31]; risk ratio 1.09 CI [1.04 to 1.14]). Subanalyses based on body mass index (BMI) and age group demonstrated increased fracture risk in the GLP-1RA group in patients with a BMI ≥40 (3.15% vs. 1.91%, NNH = 81, OR 1.26, CI [1.04 to 1.52]) and those older than 67 years, including those aged 68 to 77 years (5.61% vs. 3.65%, NNH = 51, OR 2.25, CI [1.62 to 3.13]) and 78 to 88 years (9.28% vs. 5.10%, NNH = 24, OR 4.99, CI [2.68 to 9.26]). CONCLUSION: GLP-1RA use was associated with increased fracture risk in nondiabetic patients who were overweight or obese. Subgroup analysis demonstrated that only those with BMI ≥40 and age ≥68 years were found to have a significant increase in fracture risk. Further research is necessary to guide GLP-1RA prescriptions.
Identifying Risk Factors for Emergency Department Return and Readmission After Pediatric Orthopaedic Surgery: A Retrospective Cohort Study.
Shenoy DA, Zirbes CF, Therien AD … +3 more , DeBaun MR, Pean CA, Catanzano AA
J Am Acad Orthop Surg · 2026 Apr · PMID 41429014 · Publisher ↗
BACKGROUND: Unplanned returns to the emergency department (RTED) and hospital readmissions after surgery are notable burdens on the healthcare system and markers of potential gaps in patient care. The objective of this s...
BACKGROUND: Unplanned returns to the emergency department (RTED) and hospital readmissions after surgery are notable burdens on the healthcare system and markers of potential gaps in patient care. The objective of this study was to identify the risk factors associated with RTED and unplanned readmissions after pediatric orthopaedic surgery. METHODS: A retrospective cohort study was conducted between 2017 and 2023 and included patients younger than 18 who underwent orthopaedic surgery at a single, large academic institution. Patient data included current procedural terminology code, demographics, body mass index, insurance, language, and case complexity proxied by work relative value units. Procedural categories were defined by Accreditation Council for Graduate Medical Education case log guidelines for pediatric orthopaedics using current procedural terminology codes. The primary outcomes were RTED and hospital readmission within 7, 30, and 90 days of the index procedure. Univariable and multivariable logistic regression analyses were done to identify notable predictors for each outcome. RESULTS: In total, 3,044 pediatric patients were included. In multivariable analysis, patients with Medicaid insurance had a higher odd of RTED at 30 days (odds ratio [OR] 2.26, P = 0.007) and 90 days (OR 2.39, P < 0.001), and a higher odd of readmission at 90 days (OR 3.82, P = 0.002). Hispanic ethnicity was associated with 90-day RTED (OR 1.54, P = 0.023). Black or African American race was associated with 7-day (OR 9.24, P = 0.012) and 30-day (OR 4.00, P = 0.013) readmission. After controlling for demographic variables, operations for infection (OR 15.3, P = 0.002) and soft tissue reconstruction (OR 5.45, P = 0.046) were associated with 7-day RTED. Spine deformity surgery was associated with 30-day (OR 12.0, P = 0.006) and 90-day (OR 5.19, P = 0.031) readmission. CONCLUSION: Medicaid insurance status and the type of surgical procedure (infection, spine deformity, or soft tissue reconstruction) may represent high-risk populations for postoperative RTED and readmission. These findings underscore the need for enhanced postoperative patient support programs to mitigate adverse outcomes.
Psychiatric and Somatic Sequelae After Total Hip Arthroplasty in Patients With Major Depressive Disorder: A Propensity-Matched Analysis.
Wahid M, Zaidi Z, Nasser E … +2 more , Meza C, Chen AF
J Am Acad Orthop Surg · 2025 Dec · PMID 41429013 · Publisher ↗
INTRODUCTION: This study evaluated whether major depressive disorder (MDD), a common comorbidity affecting outcomes after total hip arthroplasty (THA), is independently associated with new-onset psychiatric and somatic m...
INTRODUCTION: This study evaluated whether major depressive disorder (MDD), a common comorbidity affecting outcomes after total hip arthroplasty (THA), is independently associated with new-onset psychiatric and somatic morbidity. METHODS: Adults undergoing primary THA (2015-2024) were identified from a multi-institutional database, excluding patients with prior hip pathology or psychiatric diagnoses other than MDD. Propensity score-matched cohorts were compared at 90 days and 1 year using odds ratios (OR) with 95% confidence intervals (CI). RESULTS: After exclusions, 5,864 patients with MDD and 144,640 control subjects were identified, yielding 3,412 matched pairs. P < 0.001 unless otherwise noted. MDD was associated with significantly higher odds of new-onset psychiatric disorders at 90 days and 1 year, including generalized anxiety disorder (OR90d, 22.48: 95% CI, 14.6-34.5; OR1yr, 16.53: 95% CI, 12.0-22.8), adjustment disorder (OR90d, 5.81: 95% CI, 3.9-8.6; OR1yr, 5.40: 95% CI, 3.9-7.4), posttraumatic stress disorder (OR90d, 4.14: 95% CI, 2.8-6.1; OR1yr, 7.33: 95%, CI 5.4-9.9), schizophrenia (OR90d, 2.21: 95% CI, 1.1-4.6: P = 0.03; OR1yr, 2.22: 95% CI, 1.3-3.8: P = 0.002), alcohol use disorder (OR90d, 3.73: 95% CI, 2.6-5.4; OR1yr, 2.61: 95% CI, 1.9-3.6), opioid use disorder (OR90d, 2.31: 95% CI, 1.2-4.3: P = 0.02; OR1yr, 2.69: 95% CI, 1.7-4.2), dementia (OR90d, 12.24: 95% CI, 8.2-18.3; OR1yr, 9.27: 95% CI, 6.6-13.0), and suicide (OR1yr, 6.71: 95% CI, 3.7-12.0). Somatic risks included mortality (OR90d, 2.26: 95% CI, 1.1-4.5: P = 0.02; OR1yr, 1.96: 95% CI, 1.4-2.7), chest pain (OR90d, 1.74: 95% CI, 1.3-2.3; OR1yr, 1.25: 95% CI, 1.1-1.5, P = 0.007), shortness of breath (OR90d, 1.28: 95% CI, 1.0-1.7: P = 0.0498; OR1yr, 1.28: 95% CI, 1.1-1.5, P = 0.002), dizziness (OR1yr, 1.49: 95% CI, 1.2-1.8), and postoperative emergency department visits (OR1yr, 1.27: 95% CI, 1.1-1.5). CONCLUSION: In patients with isolated MDD, the condition independently increased psychiatric, cognitive, somatic, and mortality risks after THA.
Impact of Obstructive Sleep Apnea on Outcomes Following Anterior Cervical Discectomy and Fusion.
Tummala S, Avramis I, Rizkalla JM
J Am Acad Orthop Surg · 2025 Dec · PMID 41429010 · Publisher ↗
STUDY DESIGN: Retrospective cohort study; level III level of evidence. BACKGROUND: Obstructive sleep apnea (OSA) is a prevalent comorbidity associated with increased perioperative risks. Although its influence on posteri...
STUDY DESIGN: Retrospective cohort study; level III level of evidence. BACKGROUND: Obstructive sleep apnea (OSA) is a prevalent comorbidity associated with increased perioperative risks. Although its influence on posterior and lumbar spinal procedures has been studied, data on its impact following anterior cervical diskectomy and fusion (ACDF) remain limited. OBJECTIVE: The purpose of this study was to determine whether preoperative OSA is associated with increased short- and long-term postoperative complications, including structural surgical failure, following ACDF. METHODS: A retrospective cohort study was conducted using the TriNetX national database. Adults undergoing elective ACDF between 2003 and 2020 were identified and stratified by OSA status. Propensity-score matching was applied (1:1) to control for baseline differences across 18,800 patients. Postoperative outcomes were assessed at 30 and 90 days (short term) and at 2 and 5 years (long term). Primary outcomes included respiratory failure, mechanical ventilation, dysphagia, opioid use, pseudarthrosis, implant failure, and revision surgery. RESULTS: OSA was associated with markedly higher rates of dysphagia, mechanical ventilation, respiratory failure, and persistent opioid use across multiple time points (all P < 0.05). However, no notable differences were observed in pseudarthrosis, implant failure, or revision surgery rates at long-term follow-up. Healthcare utilization metrics (readmissions, ED visits) also remained comparable across all time points. CONCLUSION: Although OSA was associated with increased risks of respiratory failure, mechanical ventilation, dysphagia, and long-term opioid use following ACDF, it was not linked to elevated rates of major structural complications, namely, implant failure, pseudarthrosis, or revision surgery, supporting the long-term fusion success and procedural safety of ACDF in this population. This study suggests that a preoperative OSA diagnosis may not represent a strict contraindication to ACDF; however, perioperative strategies such as preoperative counseling, vigilant monitoring, and tailored risk mitigation remain essential to improving patient outcomes and addressing the elevated medical morbidity observed.
Patient-level Value Analysis: A Model for Implementing the Concept of Value-based Healthcare Into Clinical Practice.
Jayakumar P, Puckett HD, Kleinsmith RM … +1 more , Cunningham BP
J Am Acad Orthop Surg · 2026 May · PMID 41428989 · Publisher ↗
As interest in incorporating value-based healthcare (achieving better health outcomes for patients relative to costs) into clinical practice and policy expands, there is a growing need for a well-understood and easily im...
As interest in incorporating value-based healthcare (achieving better health outcomes for patients relative to costs) into clinical practice and policy expands, there is a growing need for a well-understood and easily implemented methodological approach. Patient-level value analysis (PLVA) quantifies patient outcomes (using patient-reported outcome measures [PROMs]) in the context of total costs of care (using time-driven activity-based costing). When both aspects are paired, optimal value is achieved. There are six steps to perform PLVA: (1) defining the care pathway, (2) identifying low- and high-value interventions, (3) defining PROMs of interest, (4) determining costs, (5) evaluating the relationship between PROMs and total costs of care, and (6) identifying potential value drivers. This approach equips users with information on how to minimize variation, implement best practices, and encourage the delivery of high-value care. The primary objectives of this article are (1) to compile a synthesis of PLVA literature and (2) to use the Capability, Opportunity, Motivation-Behavior model and the Theoretical Domains Framework to provide orthopaedic surgeons with tactical guidance for implementation of PLVA.
Distal Interphalangeal Joint Fractures of the Hand.
Rabinovich RV, Polatsch DB, Beldner S
J Am Acad Orthop Surg · 2026 Jan · PMID 41417266 · Publisher ↗
Fingertip fractures are some of the most common traumas encountered by hand surgeons. The distal interphalangeal joint is frequently involved and encompasses a spectrum of injury that can require simple splinting to open...
Fingertip fractures are some of the most common traumas encountered by hand surgeons. The distal interphalangeal joint is frequently involved and encompasses a spectrum of injury that can require simple splinting to open reduction and internal fixation procedures. Fractures can be classified into those that involve mainly dorsal or mainly volar articular fragments versus those that involve a combination of the two with comminution. Fractures can be either closed or open, associated with joint instability and/or involve inserting tendon disruption. Anatomic reduction of the articular surface is desirable but often not necessary to achieve a good outcome. Optimal outcome is governed by a timely diagnosis with initiation of appropriate treatment, restoration of tendon insertion integrity (when applicable), and improvement of joint concentricity.
Expanding Indications for Temporary Dorsal Wrist Spanning Plate Fixation.
Bachoura A, Hirsch D, Kachooei A … +1 more , Beredjiklian P
J Am Acad Orthop Surg · 2026 Jan · PMID 41417265 · Publisher ↗
Dorsal wrist spanning plating has proven to be an effective, reliable, and versatile tool in the treatment of distal radius fractures and numerous other carpal conditions. Despite its shortcomings including a necessary s...
Dorsal wrist spanning plating has proven to be an effective, reliable, and versatile tool in the treatment of distal radius fractures and numerous other carpal conditions. Despite its shortcomings including a necessary second procedure for implant removal, this technique remains a very useful option in the upper extremity surgeon's toolbox. This article reviews the historical development, expanding indications, and technical details of temporary wrist spanning plate fixation.
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