Lam AD, Sutton RM, Lizcano JD
… +4 more, Sherman MB, Brown S, Courtney PM, Krueger CA
J Am Acad Orthop Surg
· 2026 Jun · PMID 42307533
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BACKGROUND: With increasing data supporting the use of single-stage exchange over two-stage exchange for select patients with periprosthetic joint infection (PJI) after total hip arthroplasty (THA) and total knee arthrop...BACKGROUND: With increasing data supporting the use of single-stage exchange over two-stage exchange for select patients with periprosthetic joint infection (PJI) after total hip arthroplasty (THA) and total knee arthroplasty (TKA), it is important to specifically quantify cost differences between the two procedures. This study aimed to compare itemized facility costs of single-stage and two-stage exchange. METHODS: This retrospective cohort study identified 118 consecutive patients who were diagnosed with chronic PJI and underwent revision THA or TKA at a single high-volume academic institution. Of 63 hip PJI patients (53.4%), 38 (60.3%) underwent single-stage revision and 25 (39.7%) underwent two-stage revision. From 55 knee PJI patients (46.6%), 19 (34.5%) underwent single-stage revision and 36 (65.5%) underwent two-stage exchange. Patients were excluded if they had soft-tissue coverage requirements or extensive bone loss requiring endoprosthesis. Facility costs were calculated using time-driven activity-based costing methodology. Costs were combined for the two hospital admissions for a two-stage exchange. RESULTS: Patients undergoing single-stage revision TKA had lower personnel ($46,397 vs. $78,765, P < 0.001), implant ($19,822 vs. $85,605, P < 0.001), and overall costs ($79,548 vs. $171,592, P < 0.001) when compared with two-stage revision. Similarly, patients undergoing single-stage revision THA had lower personnel ($46,718 vs. 99,255, P < 0.001), implant ($19,936 vs. 73,372, P < 0.001), and overall costs ($79,349 vs. 187,251, P < 0.001) than two-staged procedures. Implant costs demonstrated the highest variation between two-stage and one-stage revisions for TKA (4.3 times) and THA (3.7 times). Total surgical time was significantly longer in two-staged THA (365 vs. 175 minutes, P < 0.001) and TKA (256 vs. 162 minutes, P < 0.001) revisions. CONCLUSION: Single-staged revisions cost markedly less than two-staged procedures for first-time, chronic PJI when using strict surgical indications. Given the growing emphasis on value-based care, if single-stage arthroplasty is at least as effective as two-stage exchange in some PJI settings, the cost savings of this procedure would be tremendous. LEVEL OF EVIDENCE: Level III.
Mastrokostas LE, Mastrokostas PG, Inzerillo S
… +13 more, Razi A, Baek G, Houten JK, Varthi A, Ahn NU, Hilibrand AS, Vaccaro AR, Schroeder GD, Kepler CK, Saleh A, Bou Monsef J, Razi AE, Ng MK
J Am Acad Orthop Surg
· 2026 Jun · PMID 42301237
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INTRODUCTION: Degenerative lumbar spine disease represents a leading global source of disability, with spondylolisthesis contributing substantially to the burden of low back pain and impaired function. Lumbar fusion rema...INTRODUCTION: Degenerative lumbar spine disease represents a leading global source of disability, with spondylolisthesis contributing substantially to the burden of low back pain and impaired function. Lumbar fusion remains a commonly performed surgical strategy for degenerative spondylolisthesis, although decompression alone versus decompression with fusion continues to be an area of active debate, particularly in select low-grade cases. This study aimed to compare inpatient complications, discharge disposition, mortality, and costs between anterior lumbar interbody fusion (ALIF) and posterolateral fusion (PLF) for degenerative lumbar spondylolisthesis. METHODS: The National Inpatient Sample was queried from 2016 to 2022 for elective admissions of adults with a primary diagnosis of lumbar spondylolisthesis undergoing ALIF or PLF. Encounters with both approaches or additional interbody techniques were excluded. Outcomes included perioperative complications, in-hospital mortality, discharge disposition, length of stay, and inflation-adjusted costs. Survey-weighted logistic regression and generalized linear models adjusted for demographics, comorbidities, and hospital factors. Significance was set at the P < 0.05 level. RESULTS: We identified 57,475 weighted admissions: 12,410 ALIF and 45,065 PLF. In adjusted models, PLF was associated with higher odds of transfusion (OR, 2.60; P < 0.001), acute posthemorrhagic anemia (OR, 1.47; P < 0.001), cerebrospinal fluid leak/dural tear (OR, 3.57; P < 0.001), and the adverse-events composite (OR, 1.68; P < 0.001). PLF also demonstrated greater odds of nonroutine discharge (OR, 1.19; P = 0.002). In-hospital mortality was exceedingly rare and not meaningfully different. ALIF was associated with higher mean costs ($43,000 vs. $31,500; P < 0.001) despite shorter length of stay (2.81 vs. 3.31 days; P < 0.001). CONCLUSIONS: ALIF for degenerative spondylolisthesis was associated with fewer perioperative complications and lower odds of nonroutine discharge than PLF, though at substantially higher inpatient costs. These findings highlight a clinical-economic tradeoff between anterior and PLF strategies at the national level. LEVEL OF EVIDENCE: III.
J Am Acad Orthop Surg
· 2026 Jun · PMID 42299823
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INTRODUCTION: Large language models (LLMs) can generate plausible diagnoses from patient symptom descriptions and convey complex medical information in conversational, empathetic language. Given that LLMs may struggle wi...INTRODUCTION: Large language models (LLMs) can generate plausible diagnoses from patient symptom descriptions and convey complex medical information in conversational, empathetic language. Given that LLMs may struggle with the vague symptom descriptions characteristic of less healthy mindsets, discordance between LLM and clinician diagnoses might signal misinterpretation of sensations. Among new musculoskeletal outpatients, we studied factors associated with (1) diagnostic discordance between an LLM and a clinician and (2) patient rating of experience interacting with the LLM. METHODS: One hundred forty English-speaking patients described their symptoms to an LLM prompted to provide a single most likely diagnosis. Clinician diagnoses were recorded after the visit. Patients completed a survey assessing perceptions of the LLM interaction, demographics, and psychosocial factors-including measures of unhelpful thoughts and distress (eg, catastrophic thinking, misperception of pain as necessarily signifying injury, rumination about pain, and fear of losing cherished roles). Linear regression sought associations between personal factors, diagnostic concordance, and experience with the LLM. RESULTS: Discordance between clinician and LLM diagnoses was common 45% (67 of 140), but was not associated with any factors. Discordance often reflected diagnostic ambiguity (eg, knee osteoarthritis and meniscal tear) or clinician use of specific diagnoses for nonspecific symptoms (eg, myofascial pain syndrome, complex regional pain syndrome, and piriformis syndrome). Hispanic ethnicity, unmarried status, lower educational attainment, and lower annual income were associated with more favorable patient-rated experience with the LLM. CONCLUSION: Clinician use of speculative and ambiguous diagnostic labels may limit the usefulness of LLM-clinician discordance as a signal of patient unhelpful thinking and distress. LLMs may support personal health agency, particularly in the setting of social disadvantage.
J Am Acad Orthop Surg
· 2026 Jun · PMID 42296059
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Fractures of the metacarpals and phalanges are common. Inadequate management of these injuries frequently results in malunion. Although the hand is capable of adaptation to some malalignment, malunions of the metacarpals...Fractures of the metacarpals and phalanges are common. Inadequate management of these injuries frequently results in malunion. Although the hand is capable of adaptation to some malalignment, malunions of the metacarpals and phalanges are often functionally notable. In these cases, surgical correction may result in improved outcomes. Corrective osteotomies are capable of improving coronal, sagittal, and axial plane malalignment. Preoperative software-assisted osteotomy planning and 3D-printed cut guides are contemporary innovations that make treatment of these difficult problems much more approachable.
Yin C, Ghilzai UM, Mohammed ZJ
… +2 more, Pham KT, Bell BR
J Am Acad Orthop Surg
· 2026 Jun · PMID 42284582
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INTRODUCTION: Although 10% of ganglia occur in children, data on effective treatment modalities and recurrence rates remain sparse, and costs of treatment remain unknown. This study aims to characterize the treatment cos...INTRODUCTION: Although 10% of ganglia occur in children, data on effective treatment modalities and recurrence rates remain sparse, and costs of treatment remain unknown. This study aims to characterize the treatment costs and rates of revision in pediatric ganglia managed surgically versus with percutaneous ultrasound-guided ganglion fenestration (PUGG). METHODS: This nonclinical retrospective cohort examined patients treated for wrist ganglia at a tertiary pediatric referral center from December 1, 2011, to March 15, 2023. Data were collected from billing records regarding procedure type and date, primary payor, and total treatment costs. Patients were stratified into two cohorts: those undergoing surgery and those undergoing PUGG. Patient data were analyzed for treatment choice, associated rates of revision, and episodic and total costs of care. RESULTS: Five hundred eighty-nine patients comprised our cohort with 710 procedures performed. PUGG was markedly less expensive than surgery ($2,217 vs. $116,456; P < 0.001), a trend noted across both public (P < 0.001) and private (P < 0.001) insurers. Patients undergoing PUGG had markedly lower revision rates (15% vs. 22%; P < 0.001) but shorter mean time to revision (303 days vs. 1,610; P < 0.001) compared with surgical intervention. Overall treatment costs were markedly lower in patients treated initially with PUGG ($3,713 vs. $13557; P < 0.001). CONCLUSION: This study provides much-needed data on treatment-related costs of pediatric ganglia. PUGG presents as an alternative option for pediatric wrist ganglia management due to its cost-effectiveness and comparable revision rates. Overall, PUGG can serve as a cost-effective management strategy for pediatric wrist ganglia.
J Am Acad Orthop Surg
· 2026 Jun · PMID 42283472
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The prevalence of tick-borne disease continues to rise in the United States. Lyme disease is the most prevalent, classically presenting as monoarthralgia or polyarthralgia and effusions. Although most cases of Lyme arthr...The prevalence of tick-borne disease continues to rise in the United States. Lyme disease is the most prevalent, classically presenting as monoarthralgia or polyarthralgia and effusions. Although most cases of Lyme arthritis are well managed with antibiotics, in some cases, refractory symptoms and arthritis persist. In addition, the tick-borne disease, alpha-gal syndrome (AGS), can have long-term sequelae, including immunoglobulin E-mediated hypersensitivity to mammalian products. Classically, AGS presents as a new onset of food allergy or intolerance to bovine products. As interest in biologics and xenografts for medical devices grows, AGS raises concerns about implant complications and perioperative anesthesia risks. It is imperative that the orthopaedic surgeon be aware of Lyme disease and AGS, and this review provides a concise overview of the pathogenesis, epidemiology, clinical presentation, diagnostic evaluation, and management of joint effusions as they pertain to tick-borne disease. We highlight the management pathway for AGS and tools for streamlining the preoperative pathway.
Lawrie C, Burnikel A, Riesgo A
… +1 more, Suarez J
J Am Acad Orthop Surg
· 2026 Jun · PMID 42274252
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Fluoroscopy has become an increasingly valuable adjunct in performing total hip arthroplasty (THA) through the direct anterior approach (DAA). Its intraoperative use allows surgeons to confirm acetabular cup inclination...Fluoroscopy has become an increasingly valuable adjunct in performing total hip arthroplasty (THA) through the direct anterior approach (DAA). Its intraoperative use allows surgeons to confirm acetabular cup inclination and anteversion, optimize femoral offset and leg length, and recognize potential sources of malposition or complications intraoperatively. This review outlines the principles of fluoroscopic imaging during DAA THA, including optimal C-arm positioning, image orientation, and techniques to minimize parallax and distortion. Emphasis is placed on radiation safety and workflow integration to maintain surgical efficiency. Current evidence supports fluoroscopy as a reliable tool for improving component accuracy and reducing leg length discrepancies without compromising surgical time or increasing complication rates. Understanding common pitfalls such as magnification error and inconsistent limb positioning remains critical to accurate interpretation. When properly applied, fluoroscopy enhances intraoperative decision making and allows surgeons to achieve consistent, reproducible outcomes. This review provides practical guidance and evidence-based insights to help orthopaedic surgeons safely and effectively incorporate fluoroscopy into DAA THA practice.
Ng MK, Mastrokostas LE, Mastrokostas PG
… +5 more, Razi A, Monas A, Bou Monsef J, Razi AE, Jazayeri R
J Am Acad Orthop Surg
· 2026 Jun · PMID 42246762
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Poor nutritional status is a modifiable risk factor that has been shown to have adverse outcomes in spine surgery, including higher rates of complications, poorer functional outcomes, longer hospital stays, and increased...Poor nutritional status is a modifiable risk factor that has been shown to have adverse outcomes in spine surgery, including higher rates of complications, poorer functional outcomes, longer hospital stays, and increased healthcare costs. As such, interest has emerged in clinical practice regarding the use of tools and important nutrient profiles that can be used to assess nutritional status both pre- and postoperatively. The purpose of this review is to synthesize the current evidence surrounding the clinical utility of various nutritional screening tools, as well as to evaluate the importance of targeted interventions. These strategies include protein and amino acid supplementation, vitamin D optimization, and preoperative carbohydrate loading; prior studies have associated these interventions with improved fusion rates, lower infection risk, and accelerated recovery. Furthermore, economic analyses in the setting of nutritional optimization are explored. Despite these benefits, substantial barriers like inconsistent protocols and patient nonadherence remain. In addition, reliance on single markers like albumin may be misleading due to inflammatory confounding, highlighting the need for multifactorial assessment that incorporates surrogates of bone quality and baseline health status. As the spine surgical population ages and procedures grow more complex, preoperative nutritional optimization represents a low-risk strategy with potential for substantial advancements in patient recovery. This review advocates for the standardization of multidisciplinary nutritional protocols as a key component of comprehensive perioperative spine care.
Li S, Zhang H, Guo C
… +4 more, Wang Y, Deng A, Liu S, Tang M
J Am Acad Orthop Surg
· 2026 Jun · PMID 42240340
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PURPOSE: The purpose of this study was to evaluate the efficacy of multirod constructs in the treatment of young patients (<20 years) with scoliosis accompanied by lumbosacral deformity and to compare the corrective outc...PURPOSE: The purpose of this study was to evaluate the efficacy of multirod constructs in the treatment of young patients (<20 years) with scoliosis accompanied by lumbosacral deformity and to compare the corrective outcomes and postoperative quality of life between 3-rod and 4-rod techniques. METHODS: Thirty-nine adolescent patients with lumbosacral anomalies underwent surgical treatment at our institution. Following application of the inclusion/exclusion criteria, 17 young patients with severe scoliosis and concomitant lumbosacral deformities were enrolled in this study. Preoperative, 1-week postoperative, and final follow-up standing whole-spine anterior-posterior/lateral radiographs were retrospectively analyzed. The following parameters were assessed: major curve Cobb angle, lumbosacral curve Cobb angle, trunk shift, thoracic kyphosis angle, lumbar lordosis angle, and sagittal vertical axis (SVA), In addition, Scoliosis Research Society-22 (SRS-22) questionnaire scores were collected and analyzed preoperatively and at the final follow-up. RESULTS: The lumbosacral Cobb angle improved from 33.6° ± 4.5° to 7.7° ± 2.8° postoperatively (P < 0.05), maintained at 8.6° ± 2.6° during follow-up. The major curve decreased from 62.1° ± 8.3° to 19.6° ± 6.5° (P < 0.05), with slight correction loss to 23.3° ± 6.1° at follow-up. Trunk shift reduced from 3.0 ± 1.5 cm to 1.1 ± 0.7 cm (P < 0.05), stabilizing at 1.4 ± 0.6 cm. Sagittal measurements showed TK improved from 29.8° ± 6.0° to 33.3° ± 5.0° postoperatively (P > 0.05), whereas lumbar lordosis increased from 34.2° ± 19.4° to 43.0° ± 7.3° (P > 0.05). SVA changes were notable (P < 0.05). SRS-22 self-image scores improved from 2.21 ± 0.64 to 3.79 ± 0.50 (P < 0.001), with pain scores also enhanced from 4.02 ± 0.58 to 4.71 ± 0.17 (P < 0.001). No statistically significant differences were observed in correction rates or final follow-up SRS-22 scores between 3-rod and 4-rod constructs (P > 0.05). CONCLUSION: The multiple-rod technique effectively addresses severe scoliosis with lumbosacral deformities in young patients, providing sustained radiographic correction, reduced implant failure risk, and improved clinical outcomes. In long-segment lumbosacral fixation constructs, bilateral supplementary rod configuration may reduce rod fracture risk compared with unilateral reinforcement.
J Am Acad Orthop Surg
· 2026 Jun · PMID 42240330
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INTRODUCTION: The purpose of this study was to determine whether CT Hounsfield units (HUs) as a proxy for bone quality can predict postoperative mechanical complications following surgical treatment of distal humerus fra...INTRODUCTION: The purpose of this study was to determine whether CT Hounsfield units (HUs) as a proxy for bone quality can predict postoperative mechanical complications following surgical treatment of distal humerus fractures. METHODS: One hundred fifty-three patients with both column distal humerus fractures who underwent surgical fixation at single institution and had complete radiographic data available were included. Radiographic measurements included the HU value from the surgical distal humerus as determined by measuring the metaphyseal/supracondylar at the midaxial/coronal/sagittal CT image an average of 1 cm from the articular surface using a freehand region of interest. Zones with fracture lines and cortical impaction were avoided for all measurements. Postoperative complications recorded were implant failure, nonunion, and acute periprosthetic fracture. Patients with and without complications were statistically compared, and binary logistic regression was done to determine if CT HU measurements from the distal humerus were predictive of complications. RESULTS: Five patients (3.3%) developed five mechanical complications, including peri-prosthetic humerus fracture (one), implant failure (two), and nonunion (two). Patients with mechanical complications were more likely to be current smokers (40% vs. 6.8%, P = 0.010). Otherwise, no difference was observed in demographics or AO/Orthopedic Trauma Association classification between the cohorts. Patients with complications had markedly lower HU in the coronal plane ( P = 0.031). Regression analysis found that current smoking was associated with an increased risk of mechanical complications ( P = 0.041, OR = 1.102, 95% confidence interval [CI], 1.087 to 1.710), whereas a higher coronal HU was associated with a decreased risk of complications ( P = 0.048, OR = 0.973, 95% CI, 0.961 to 0.991). CONCLUSION: A thorough smoking history and CT HU measurements in the coronal plane may identify patients with poorer bone quality at higher risk for postoperative mechanical complications following distal humerus fracture fixation.
INTRODUCTION: Ethnic, racial, and socioeconomic disparities are well-documented in orthopaedics, including pediatric scoliosis. Spanish-speaking patients face compounding disparities in accessing linguistically and cultu...INTRODUCTION: Ethnic, racial, and socioeconomic disparities are well-documented in orthopaedics, including pediatric scoliosis. Spanish-speaking patients face compounding disparities in accessing linguistically and culturally concordant physician-patient interactions and patient resources. This study contributes to existing literature by providing an updated and extended analysis of the quality, credibility, and readability of online Spanish-language patient educational materials on pediatric scoliosis. METHODS: A search for the top 50 results of "escoliosis en los niños" (scoliosis in children) was conducted across search engines. Spanish-speaking patients are likely to interact with Google, Yahoo, and Bing. Duplicates were removed, primary review assessed inclusion and exclusion criteria, and secondary review evaluated relevance. Each source was assessed independently by two reviewers for the following: categorization, Journal of American Medical Association Benchmark Criteria, Brief DISCERN questionnaire, and the Fernández-Huerta Index for credibility, quality, and readability, respectively. Scores were compared using Wilcoxon rank-sum tests. RESULTS: Of the 61 sources, most were categorized as Physician/Community Hospital, Industry, and News. The median readability score aligned with an eighth-grade to ninth-grade reading level. No websites achieved the recommended reading level (<6th grade) for patient educational materials. The median Journal of American Medical Association Benchmark score was 2 (interquartile range, 1 to 3), with only four websites meeting all criteria. The median Brief DISCERN score was 14 (interquartile range, 11 to 18), with only 36% meeting the >16 threshold for adequate quality. No statistical differences were observed in quality, credibility, or readability between the two most common categories: Physician/Community Hospital and Industry. DISCUSSION AND CONCLUSION: These findings revealed an insufficient standard of resources on pediatric scoliosis that Spanish-speaking patients are likely to access through online search engines. Given disparities in orthopaedic care for Spanish-speaking patients, this highlights a need for increased awareness among healthcare professionals and institutions to create accessible, credible, transparent, and readable resources on pediatric scoliosis in Spanish.
Heiting C, Wu Y, Goodman SM
… +6 more, Sculco P, Wang F, Ibrahim S, Cram P, Caruana R, Mehta B
J Am Acad Orthop Surg
· 2026 Jun · PMID 42233637
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INTRODUCTION: With evolving lifestyles and improvements in surgical techniques, the utilization of total hip arthroplasty (THA) is growing across patients of all ages. Although complication rates are low, they are still...INTRODUCTION: With evolving lifestyles and improvements in surgical techniques, the utilization of total hip arthroplasty (THA) is growing across patients of all ages. Although complication rates are low, they are still a key consideration in THA planning. In this study, we explore the optimal ages for THA with the lowest risk of adverse outcomes. METHODS: Patients who underwent primary elective THA were retrospectively identified from the Pennsylvania Health Care Cost Containment Council Database, 2012 to 2018. We trained a supervised model learning model-explainable boosting machines-with a 70% train to 30% test split to predict risk for 90-day readmission, 90-day mortality, 1-year revision, and longer length of stay (LOS). Using this "glass box" model, we assessed risk for these adverse outcomes as they change with age. We then visualized two-way interactions between age and other patient-level covariates in the models to further understand risks. RESULTS: Our cohort included 105,336 patients with rates of 8.0% readmission, 0.3% mortality, and 1.5% revision. The median LOS was 2 days (interquartile range [1, 3]). We demonstrated a nonlinear relationship between age and THA outcomes, and identified age as one of the most important factors in prediction of adverse outcome. Risk for 90-day readmission increased between 48.5 and 71.5 years, and 90-day mortality risk increased after 79.5 years. Risk for 1-year revision increased before 46.5 years, and risk for longer LOS decreased between 52.5 and 74.5 years. Multiple factors influenced the relationship between age and THA outcomes, such as discharge location and comorbidities. CONCLUSIONS: Risk for adverse THA outcomes changes in a nonlinear manner with age. Our models suggest that the optimal age for lowest risk of adverse outcomes after THA is between 52.5 and 71.5 years. This study may provide nuanced risk quantification when considering age in THA, and inform planning and election of THA.
Grosso MJ, Patton LL, Nelson SB
… +4 more, Urish KL, Kagan R, Manner P, Higuera Rueda CA
J Am Acad Orthop Surg
· 2026 Jun · PMID 42228903
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Controversies exist regarding the appropriateness of antibiotic prophylaxis in patients undergoing a dental procedure following joint replacement surgery. The American Academy of Orthopaedic Surgeons has developed an App...Controversies exist regarding the appropriateness of antibiotic prophylaxis in patients undergoing a dental procedure following joint replacement surgery. The American Academy of Orthopaedic Surgeons has developed an Appropriate Use Criteria (AUC) for the Prevention of Orthopaedic Implant Infection in Patients Undergoing Dental Procedures. Evidence-based information, in conjunction with the clinical expertise of physicians, was used to develop criteria to determine the appropriateness of antibiotic prophylaxis to reduce the theoretical risk of post-surgical prosthetic joint infection in patients seeking dental care. The AUC algorithmic decision support tool was derived by identifying clinical indications typical of patients undergoing dental procedures following total knee or hip arthroplasty. Four patient scenarios and two treatment options were developed by the writing panel to cover appropriate scenarios related to this topic. Next, a separate, multidisciplinary voting panel rated the appropriateness of each scenario using a nine-point scale. The purpose of this article is to highlight the findings of this AUC and summarize the usage of the AUC for determining appropriateness of antibiotic prophylaxis for post-surgical joint replacement patients in various scenarios.
Mohiuddin MM, Ruffer JE, Siddiqi A
… +1 more, Makda J
J Am Acad Orthop Surg
· 2026 May · PMID 42224645
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Low-dose radiation therapy is increasingly used for benign orthopaedic conditions, including osteoarthritis and enthesopathies, with typical regimens of 0.5 to 1 Gy per fraction and total doses of 3 to 6 Gy. Clinical stu...Low-dose radiation therapy is increasingly used for benign orthopaedic conditions, including osteoarthritis and enthesopathies, with typical regimens of 0.5 to 1 Gy per fraction and total doses of 3 to 6 Gy. Clinical studies demonstrate notable pain relief and functional improvement, particularly in patients refractory to traditional therapies, with minimal acute and long-term toxicity. Mechanistic insights reveal anti-inflammatory and immunomodulatory effects, supporting its use in degenerative and hyperproliferative musculoskeletal disorders. However, randomized trials and systematic reviews highlight ongoing controversies regarding efficacy and optimal dosing, emphasizing the need for additional high-quality trials. Consensus statements from major radiation societies recommend low-dose radiation therapy as a noninvasive adjunct for many patients, with careful patient selection and multidisciplinary collaboration.
Subramanian T, Oles A, Halayqeh S
… +5 more, Mazzucco M, Jolissaint J, Mallett K, Debbi EM, Gausden EB
J Am Acad Orthop Surg
· 2026 Jun · PMID 42224471
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BACKGROUND: Wound complications after direct anterior approach (DAA) total hip arthroplasty (THA) are an important source of postoperative morbidity. Although several risk factors and management strategies have been prop...BACKGROUND: Wound complications after direct anterior approach (DAA) total hip arthroplasty (THA) are an important source of postoperative morbidity. Although several risk factors and management strategies have been proposed, data remain heterogeneous. This systematic review aims to characterize the incidence, risk factors, and management of wound complications after DAA THA. METHODS: A systematic review was done across eight databases (PubMed, Embase, Scopus, Cochrane Library, CINAHL, Web of Science, Ovid MEDLINE, and ClinicalKey) according to Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. Studies were included if they reported wound complications after primary DAA THA. Data were extracted on complication incidence, risk factors, closure and dressing techniques, and management strategies. A meta-analysis comparing wound complication rates between transverse (bikini) and longitudinal incisions was done using a common-effects model. RESULTS: Thirty-six studies encompassing 35,300 DAA THA were included. The most common wound complications were superficial dehiscence/drainage (1.41%), superficial surgical site infection (1.34%), delayed wound healing (1.15%), and hematoma/seroma (0.80%). Obesity and female sex were the most frequently identified risk factors. Pooled analysis demonstrated that transverse (bikini) incisions were associated with a significantly lower risk of wound complications compared with longitudinal incisions (relative risk 0.45, 95% confidence interval, 0.23 to 0.89; P = 0.0219). Closure technique and dressing choice showed variable influence on complication rates. Most wound complications were successfully managed with local wound care, avoiding the need for revision surgery. CONCLUSION: Wound complications after DAA THA are relatively uncommon and often manageable with conservative measures. Obesity, female sex, and longitudinal incisions are associated with higher complication risk. Surgical technique, including consideration of incision type and appropriate postoperative wound management, may help minimize complications.
Snowden J, Gaeth C, Penner A
… +4 more, Kshir S, Burke J, Fellows K, Cognetti DJ
J Am Acad Orthop Surg
· 2026 May · PMID 42212818
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INTRODUCTION: Celecoxib is commonly used for postoperative analgesia because of its favorable adverse effect profile compared with other nonsteroidal anti-inflammatory drugs. However, its use is often restricted in patie...INTRODUCTION: Celecoxib is commonly used for postoperative analgesia because of its favorable adverse effect profile compared with other nonsteroidal anti-inflammatory drugs. However, its use is often restricted in patients labeled as sulfonamide ("sulfa") allergic due to persistent electronic health record warnings, despite contemporary evidence showing minimal risk of immunologic cross-reactivity. The purpose of this study was to evaluate the safety of postoperative celecoxib administration in orthopaedic patients with documented sulfonamide allergies. METHODS: A retrospective cohort study was conducted at a single tertiary academic center. Orthopaedic surgery patients from January 1, 2020, to December 31, 2022, with a documented sulfonamide allergy who received celecoxib postoperatively were included. All postoperative clinic notes, telephone encounters, and emergency department records from surgery through the second follow-up visit were reviewed to identify allergic reactions. RESULTS: Sixty-one patients met inclusion criteria (mean age, 52.6 ± 15.7 years; 67.2% female). The mean time to the first and second postoperative visits was 17 ± 7 and 49 ± 19 days, respectively. Thirteen patients (21.3%) presented to the emergency department during follow-up for issues, including postoperative pain or swelling, gastrointestinal complaints, constipation, unrelated trauma, or noncardiac chest pain. Two patients experienced allergic reactions attributed to perioperative antibiotics or surgical adhesive. One patient (1.6%) sustained a gastrointestinal bleed while also taking aspirin for thromboprophylaxis. No allergic reactions were attributable to celecoxib. CONCLUSIONS: Celecoxib was safely administered to patients with documented sulfonamide allergies, with no evidence of cross-reactivity. Given its analgesic benefits and overall safety profile, routine avoidance of celecoxib in sulfa-allergic patients appears unnecessary. Updating electronic health record decision-support logic to reflect current evidence may reduce alert fatigue and support more effective multimodal pain management.