The Journal Of The American Academy Of Orthopaedic Surgeons[JOURNAL]
Sun
200 papers
Distal Radius Fractures: Classifications and Contemporary Treatment.
Bronenberg Victorica P, Shapiro LM, Richard MJ … +1 more , Kamal RN
J Am Acad Orthop Surg · 2026 Apr · PMID 41930979 · Publisher ↗
Distal radius fractures are one of the most common fractures with a growing incidence in the active and aging population. The classification of these fractures is complex due to continued improvements in our understandin...
Distal radius fractures are one of the most common fractures with a growing incidence in the active and aging population. The classification of these fractures is complex due to continued improvements in our understanding of fracture patterns, their injury mechanisms, and resultant patterns of instability. This complexity has led to multiple classification systems that have not been updated with contemporary knowledge on distal radius fracture patterns and their respective treatments. We describe historical classification systems, their strengths, and limitations, and discuss gaps that may be filled by a contemporary system.
Preoperative GLP-1 Receptor Agonist Use and Postoperative Outcomes in Orthopaedic Surgery: A Scoping Review of Perioperative and Recovery Outcomes.
Strickler I, Jensen A, Cragg K … +4 more , Dean R, McNassor R, Guettler J, Bicos J
J Am Acad Orthop Surg · 2026 Jul · PMID 41930687 · Publisher ↗
INTRODUCTION: The rapid expansion of glucagon-like peptide-1 receptor agonist (GLP-1 RA) use for weight management and diabetes has raised perioperative questions, particularly regarding delayed gastric emptying and infe...
INTRODUCTION: The rapid expansion of glucagon-like peptide-1 receptor agonist (GLP-1 RA) use for weight management and diabetes has raised perioperative questions, particularly regarding delayed gastric emptying and infection risk. Emerging real-world data suggest a more nuanced perioperative profile. This scoping review synthesizes evidence on preoperative GLP-1 RA exposure and postoperative outcomes across orthopaedic procedures, with emphasis on soft-tissue sports medicine, and is intended to map associative perioperative outcomes rather than establish causality. METHODS: Following Arksey-O'Malley and Joanna Briggs Institute methodology and PRISMA-ScR reporting, we searched PubMed, Scopus, Web of Science, CINAHL Ultimate, Academic Search Premier, and Ovid Emcare (2015 to 2025). Eligible studies evaluated adult orthopaedic patients with documented GLP-1 RA use and postoperative outcomes. Three reviewers independently screened and extracted study characteristics, exposure timing, perioperative management, and outcomes. RESULTS: Of 117 records screened, 35 studies met inclusion. Most were large retrospective cohorts spanning arthroplasty, spine fusion, trauma fixation, foot/ankle fusion, shoulder arthroplasty, and rotator cuff repair. Across hip, knee, and shoulder arthroplasty, GLP-1 RA use was generally associated with similar or lower 90-day complications, reduced periprosthetic joint infection, shorter length of stay, and fewer readmissions or revisions. Spine findings were mixed: Several cohorts showed lower infection and readmission, while others noted increased pneumonia, acute kidney injury, or pseudarthrosis in long-term semaglutide users. Trauma and ankle fracture cohorts showed no increase in short-term complications and in some cases lower mortality, with isolated signals for increased late fall-related injuries. Soft-tissue cohorts (rotator cuff repair and distal radius fixation) demonstrated fewer adverse events without increased aspiration or revision surgery risk. Functional outcomes (PROMIS) were rarely reported. CONCLUSION: Preoperative GLP-1 RA exposure is not broadly associated with increased postoperative risk and often correlates with lower infection, readmission, and mortality rates-particularly in arthroplasty, spine, and ankle fracture fixation cohorts. Findings in spine surgery are more mixed and warrant cautious interpretation, especially with prolonged semaglutide exposure. Outcomes in sports-medicine procedures seem reassuring, although prospective multicenter studies with standardized perioperative protocols and PROMIS-based outcomes are needed.
Radiation Exposure and Safety in Minimally Invasive Foot and Ankle Surgery: A Comparative Analysis Between Minimally Invasive Distal First Metatarsal Transverse Osteotomy and Akin Osteotomy vs. Open Modified Lapidus Procedure.
Harrison P, Kiriluk SH, Lee K … +9 more , Mustafa M, O'Keefe J, Guirau S, Vulcano E, Johnson AH, Kaplan JRM, Schipper ON, Jackson JB, Gonzalez TA
J Am Acad Orthop Surg · 2026 Apr · PMID 41919621 · Publisher ↗
BACKGROUND: Intraoperative fluoroscopy has become essential in orthopaedic surgery, particularly with the rise of minimally invasive surgery (MIS) techniques. As MIS techniques depend more on intraoperative imaging, MIS...
BACKGROUND: Intraoperative fluoroscopy has become essential in orthopaedic surgery, particularly with the rise of minimally invasive surgery (MIS) techniques. As MIS techniques depend more on intraoperative imaging, MIS techniques may necessitate increased fluoroscopy use compared with open procedures. Despite the advantages of minimally invasive foot and ankle surgery, MIS techniques raise concerns about radiation exposure to both patients and surgical staff. The purpose of this study was to evaluate fluoroscopy time and radiation dose (cumulative air kerma) associated with open versus MIS bunion correction, comparing the open modified Lapidus procedure and the minimally invasive distal first metatarsal transverse osteotomy and akin osteotomy (META). It was hypothesized that the META procedure would be associated with increased radiation dose and fluoroscopy time compared with the open modified Lapidus procedure. METHODS: A retrospective review was conducted for patients who underwent bunion surgery between January 2021 and June 2025 by two fellowship-trained orthopaedic foot and ankle surgeons at a single academic institution. A total of 294 patients met inclusion criteria. Of these, 258 patients underwent a META procedure and 36 underwent an open modified Lapidus procedure. Fluoroscopy time (minutes) and radiation dose (mGy) were compared between the groups. RESULTS: A mean fluoroscopy time of 2.13 ± 1.27 (range, 0.06 to 7.05) minutes and a radiation dose of 2.02 ± 1.30 (range, 0.05 to 7.52) mGy were observed in the META cohort. An average fluoroscopy time of 1.63 ± 1.83 (range, 0.08 to 7.70) minutes and a radiation dose of 1.31 ± 1.43 (range, 0.07 to 5.98) mGy were observed in the open modified Lapidus cohort. Fluoroscopy time between the cohorts did not differ markedly ( P = 0.123); however, the META group demonstrated a higher radiation dose than the open modified Lapidus group ( P = 0.007). CONCLUSION: The META procedure had a markedly higher radiation dose compared with the open modified Lapidus procedure, although both remain substantially below the International Commission on Radiological Protection recommended occupational exposure of less than 20.00 mSv per year. Despite the META procedure generating an average radiation dose of 2.02 mGy per case, surgeons receive only 0.50% of the dose; thus, nearly 1,980 procedures would be required to exceed the 20.00 mSv annual occupational limit. These findings suggest that concerns about radiation exposure should not necessarily deter providers from performing the META technique for bunion correction. LEVEL OF EVIDENCE: III (Retrospective Comparative Study).
What Is the Role of American College of Surgeons National Surgical Quality Improvement Program's Risk Calculator in Fracture Surgery?
Martinez FA, Shin AY, Wright BH … +2 more , Hannon CP, Pulos N
J Am Acad Orthop Surg · 2026 Mar · PMID 41914902 · Publisher ↗
IMPORTANCE: The American College of Surgeons (ACS) created the National Surgical Quality Improvement Program (NSQIP) risk calculator and database for use across surgical subspecialties and is frequently cited in surgical...
IMPORTANCE: The American College of Surgeons (ACS) created the National Surgical Quality Improvement Program (NSQIP) risk calculator and database for use across surgical subspecialties and is frequently cited in surgical subspecialty peer-reviewed journals. In addition, Medicare has endorsed clinically using this risk calculator. This risk calculator has not been formally evaluated for use in distal radius fracture surgery. OBJECTIVE: This study aimed to assess the utility of the ACS-NSQIP risk calculator in hand surgery by comparing complication rates predicted by the ACS-NSQIP risk calculator against those observed from an institutional database. DESIGN: Retrospective cohort study between May 2000 and May 2020. SETTING: Academic level 1 trauma center. PARTICIPANTS: Seven hundred sixty-seven patients who underwent of open reduction and internal fixation of 790 distal radius fractures were prospectively enrolled into an institutional database. Patients aged 18 years or older who underwent volar plate fixation within 2 weeks following a distal radius fracture. MAIN OUTCOMES AND MEASURES: The primary study outcomes were the rate of "any" complications, as defined by ACS-NSQIP, and the rate of "hand-related" complications, as defined by a peer-reviewed journal publication. RESULTS: Overall, 767 patients were identified who sustained 790 distal radius fractures treated with volar plating to make up the cohort of the study. Mean age was 56.9 years, 77.0% were female, and 33.0% were type 23C1 distal radius fractures. ACS-NSQIP predicted an "any" complication rate of 1.85% (confidence interval [CI], 1.75 to 1.95). Institutional data observed "any" complication rate of 2.15% (CI, 1.01-2.91) within 30 days and 11.14% (CI, 8.99-13.42) for "long-term" any. Institutional data observed "hand-related" complication rate of 6.84% (CI, 5.18-8.83) within 30 days and 27.72% (CI, 24.56 to 30.89) for "long-term" any. CONCLUSIONS AND RELEVANCE: ACS-NSQIP fails to accurately predict the number of "hand-related" complications from distal radius fracture surgery. From a health policy, quality control, and clinical standpoint, ACS-NSQIP should be used cautiously with distal radius fracture surgery.
Stimulant Usage in Attention-Deficit/Hyperactivity Disorder Is Associated With Decreased Rates of Arthrofibrosis and Postoperative Complications Following Anterior Cruciate Ligament Reconstruction.
Sasaki J, Mrazik S, Hand C … +4 more , Cutler K, Koltenyuk V, Fuller SI, MacFarlane AJ
J Am Acad Orthop Surg · 2026 Jun · PMID 41914889 · Publisher ↗
INTRODUCTION: Anterior cruciate ligament (ACL) tears are one of the most common orthopaedic injuries, and ACL reconstruction is often considered the standard of care for the active individual. Recently, attention-deficit...
INTRODUCTION: Anterior cruciate ligament (ACL) tears are one of the most common orthopaedic injuries, and ACL reconstruction is often considered the standard of care for the active individual. Recently, attention-deficit/hyperactivity disorder (ADHD) has been shown to be a risk factor for adverse postoperative outcomes in patients undergoing ACL reconstruction. However, no studies have looked at the effect of stimulant medications on ACL reconstruction outcomes in patients with ADHD. This study aimed to compare postoperative outcomes between ADHD patients using stimulant medications and those not using stimulants following ACL reconstruction at 3- and 6-month follow-up. METHODS: This retrospective cohort study used the TriNetX database to identify patients with ADHD who underwent ACL reconstruction surgery and divided them into cohorts based on the presence or absence of stimulant medication usage. Patient cohorts were 1:1 propensity score matched on age, sex, obesity, mood disorders, anxiety disorders, and nicotine dependence. Postoperative complications were analyzed within 3 and 6 months postoperatively, evaluating arthrofibrosis, infection, wound disruption, revision surgery, emergency department (ED) visits, hospital readmission, and deep vein thrombosis. RESULTS: Within 3 and 6 months postoperatively, ADHD patients not taking stimulants were markedly more likely to return to the ED and be readmitted to a hospital compared with those who were taking stimulants. In addition, at the 6-month time point, a statistically significant increase in arthrofibrosis was seen in nonstimulant users compared with stimulant users in patients with ADHD. CONCLUSION: This study found that patients with ADHD not taking stimulant medications are at an increased risk of returning to the ED, being readmitted to the hospital, and developing arthrofibrosis compared with those patients taking stimulants following ACL reconstruction. The results display the importance of identifying modifiable risk factors for ACL reconstruction surgery so that physicians can adequately adjust treatment regimens to each patient.
From Birth to Practice: Characterizing the Geographic Migration of US Orthopaedic Surgeons.
Duffett BE, Chinthala AS, Jines ST … +2 more , Wurtz LD, Collier CD
J Am Acad Orthop Surg · 2026 Jul · PMID 41873752 · Publisher ↗
INTRODUCTION: Healthcare access varies dramatically across the United States, with rural and underserved populations facing notable barriers to timely, specialized care. The proximity of physician training affects the ov...
INTRODUCTION: Healthcare access varies dramatically across the United States, with rural and underserved populations facing notable barriers to timely, specialized care. The proximity of physician training affects the overall workforce distribution; however, this trend has not been assessed within orthopaedic surgery. This study investigates the impact birthplace and training location have on future practice location among US orthopaedic surgeons and characterizes the per-capita workforce distribution. METHODS: Eight thousand, six hundred seventy-six orthopaedic surgeons who completed residency training between 2004 and 2017 were identified from the American Medical Association Physician Masterfile. Demographic and practice data were extracted, including birthplace, medical school, residency and attending practice as of January 1, 2023. Locations were stratified by state and census division. RESULTS: The cohort represented 94.84% of orthopaedic surgeons trained nationally during the study period. Attendings returning to their state of birth, medical school, or residency to practice were 21.7%, 31.8%, and 33.9%, respectively, with pronounced state-level variability (birthplace: 2.50% to 47.95%; medical school: 3.94% to 61.8%; residency: 11.71% to 63.95%). Indiana (pop:6,880,131) trained the fewest residents per capita (1:1.15 million), whereas neighboring Ohio (pop:11,824,034) ranked fifth nationally (1:191,000). Univariate logistic regression revealed notable associations ( P < 0.01) between practice location by census division at all career stages. Attending distribution per capita showed strong correlations by state (R 2 = 0.98) and census division (R 2 = 0.99), whereas birthplace (R 2 = 0.71), medical school (R 2 = 0.53), and residency (R 2 = 0.63) showed moderate association. DISCUSSION: This study demonstrates that birthplace and training location are strongly associated with practice location for US orthopaedic surgeons. Despite variation in trainee numbers by state, the distribution of practicing surgeons normalizes relative to state population, likely driven by economic incentives, local workforce demands, and market conditions. Given the strong statistical association for surgeons to practice near their training location, aligning local programs with underserved or high-need areas may offer a potential solution to reduce regional disparities and improve access to orthopaedic care.
Critical Analysis of Pediatric Orthopaedic Surgery Medical Malpractice Litigation: A Nationwide Retrospective Review.
Arif HA, Devkumar D, Pyle A … +5 more , Moore ST, Williams KA, Conklin MJ, Ghomrawi HK, Gilbert SR
J Am Acad Orthop Surg · 2026 Apr · PMID 41860575 · Publisher ↗
PURPOSE: The primary aim of this study was to identify and characterize medical malpractice lawsuits pertaining to pediatric orthopaedic surgery. METHODS: The Westlaw research database was queried for all jury verdicts a...
PURPOSE: The primary aim of this study was to identify and characterize medical malpractice lawsuits pertaining to pediatric orthopaedic surgery. METHODS: The Westlaw research database was queried for all jury verdicts and settlements pertaining to pediatric orthopaedic medical malpractice from 1980 to 2024. Cases were only included if the primary basis of litigation rested on a malpractice claim related to pediatric orthopaedic surgery and were levied against an orthopaedic surgeon. Data collected included date and state of case filing, patient (plaintiff) and surgeon (defendant) demographics, jury verdict, monetary awards, alleged negligence, and patient complications. RESULTS: Of 5,031 cases screened for inclusion, a total of 100 cases met the inclusion and exclusion criteria and were subsequently included in the final analysis. Plaintiff favorable outcomes were more commonly seen than a defendant verdict (56% vs. 44%). Patients most commonly presented for fracture management (62%), and most commonly underwent casting (30%). Alleged failure to diagnose was the most frequent basis of litigation (30%) and was predictive of a plaintiff outcome. The most frequent complication was the presence of permanent deformity (22%). A pediatric orthopaedic surgeon was the primary defendant in 59% of cases and was more commonly named following closed reduction and percutaneous pinning. Adult orthopaedic surgeons (41%) were more commonly named following fracture casting. CONCLUSION: The majority of medical malpractice cases in pediatric orthopaedic surgery result in plaintiff-favorable outcomes. Pediatric orthopaedic medical malpractice cases most often arise in the setting of fracture care and allegations of missed diagnoses. Patients pursuing litigation most frequently sustain permanent deformity as a result of the alleged negligence. Both pediatric and adult orthopaedic surgeons primarily face litigation following call-related fracture cases.
Improvement in Antimicrobial Stewardship for Orthopaedics Procedures: A NSQIP Quality-Improvement Project.
Nash A, Mason M, Kiesel K … +7 more , Vodzak J, McCann A, Kestecher B, Atanda AW, Berman L, Shah SA, Franzone JM
J Am Acad Orthop Surg · 2026 Apr · PMID 41860574 · Publisher ↗
INTRODUCTION: Antimicrobial resistance is a notable threat to global health. In an institution-specific report generated through National Surgical Quality-Improvement Pediatric Program (NSQIP-P) for our institution, our...
INTRODUCTION: Antimicrobial resistance is a notable threat to global health. In an institution-specific report generated through National Surgical Quality-Improvement Pediatric Program (NSQIP-P) for our institution, our orthopaedic surgery department was a high outlier for postoperative antibiotic prophylaxis duration of >24 hours. We describe an initiative to reduce the incidence of postoperative duration of antibiotics of >24 hours for pediatric patients undergoing orthopaedic surgery. METHODS: An interdisciplinary team was formed to identify and monitor interventions for improvement. Patients undergoing orthopaedic surgeries and receiving postoperative intravenous antibiotics were included. First-stage interventions included verbal education for front-line staff to ensure that postoperative antibiotic prescribing did not exceed two doses. Second-stage interventions included a modification that changed the default postoperative antibiotic dose from three to two doses for the three most used orthopaedic admission order sets in the electronic medical record. Patient-level, electronic health record data elements were extracted and presented through a created electronic dashboard to track near-real-time metrics. Surgical site infections were tracked through NSQIP-P database as a balancing measure. RESULTS: A total of 2,546 surgical cases met study criteria: 1,680 and 866 cases in the pre- and post-intervention cohorts, respectively. Cefazolin was the primary postoperative antibiotic prescribed in 95.4% of cases. In the preintervention cohort, <24 hours of postoperative antibiotics was 36.7% compared with 84.7% (48.0% improvement) in the post-second stage intervention cohort. A sampling of postintervention cases demonstrated no notable increase in surgical site infection events compared with matched period sampling of preintervention cases. CONCLUSION: NSQIP-P can be leveraged to improve antibiotic stewardship in pediatric orthopaedic surgical cases. Multidisciplinary collaboration, front-line staff education coupled with electronic medical record order set modification, and near-real-time data tracking for provider feedback resulted in a 48.0% improvement of patients receiving <24 hours of perioperative antibiotics. LEVEL OF EVIDENCE: III.
Femoral Distraction Osteogenesis in Fibular Hemimelia: Risks and Advantages Using Magnetically Driven Antegrade Intramedullary Lengthening Nails.
Frommer A, Porokhovnikov I, Gosheger G … +5 more , Vogt B, Laufer A, Tretow H, Roedl R, Toporowski G
J Am Acad Orthop Surg · 2026 Apr · PMID 41860573 · Publisher ↗
BACKGROUND: Fibular hemimelia (FH) is a rare congenital condition characterized by longitudinal lower limb deficiency with fibular hypoplasia or aplasia commonly associated with femoral and tibial shortening resulting in...
BACKGROUND: Fibular hemimelia (FH) is a rare congenital condition characterized by longitudinal lower limb deficiency with fibular hypoplasia or aplasia commonly associated with femoral and tibial shortening resulting in leg length discrepancy (LLD). Femoral distraction osteogenesis represents a well-established reconstructive approach in patients with LLD exceeding 2 cm. METHODS: Twenty-three patients with FH were treated with antegrade femoral distraction osteogenesis between 2018 and 2021 using magnetically controlled motorized intramedullary lengthening nails (Precice P2 or Stryde, NuVasive/Globus Medical). The primary end points included accuracy, precision, reliability, distraction and consolidation index, and the complication profile. Radiographic and clinical outcomes were assessed over a median follow-up period of 39 (interquartile range [IQR], 26 to 52) months. RESULTS: The median preoperative LLD of 45 (IQR, 39 to 53) mm was reduced to 9 (IQR, 4 to 13) mm (P < 0.001) following a median distraction length of 40 (IQR, 34 to 44) mm. Planned lengthening was achieved with an accuracy of 91% ± 8% and a precision of 91%. The mean distraction index was 0.8 ± 0.2 mm/d, and a consolidation index of 36 ± 15 d/cm. At least one complication was observed in 70% of cases, including transient or persistent knee stiffness (39%) and pain (39%). Unplanned additional surgery related to complications was conducted in 17% of patients and all complications were successfully treated without permanent sequelae. The reliability of the treatment was 96%. No significant correlation was observed between distraction length and complications or revision surgery. CONCLUSION: Femoral distraction osteogenesis using magnetically driven intramedullary lengthening nails represents a precise and reliable treatment for LLD in FH. Despite favorable radiographic outcomes and high distraction accuracy, the notable complication rate underscores the necessity of rigorous patient selection and structured postoperative management.
Gender Differences in Academic Productivity Among Pediatric Orthopaedic Surgeons.
Mayer MA, Viggiano MK, Pema PM … +3 more , Reiss SL, Bernstein JM, Joffe AL
J Am Acad Orthop Surg · 2026 Apr · PMID 41860572 · Publisher ↗
INTRODUCTION: Existing literature lacks clarity on how geography may affect gender disparities among pediatric orthopaedic surgeons. This study compares the academic productivity of pediatric orthopaedic attendings based...
INTRODUCTION: Existing literature lacks clarity on how geography may affect gender disparities among pediatric orthopaedic surgeons. This study compares the academic productivity of pediatric orthopaedic attendings based on their sex and region. METHODS: Faculty lists from the 45 Pediatric Orthopaedic Society of North America fellowship programs were accessed in February 2024. Data on sex, training history, fellowship director status, institution, publication counts, and H-indices were collected from program websites and Scopus. The attending publication rate was calculated by dividing the total number of publications completed as an attending by the number of years in practice. Results were displayed using (mean ± SD). Categorical variables were analyzed using Pearson chi square. Mann-Whitney U and one-way analysis of variance were used for nonparametric and parametric data, respectively. Analyses were done using GraphPad Prism 10, with significance set at P < 0.05. RESULTS: Four hundred one pediatric orthopaedic surgeons (302 male, 99 female) from 45 fellowship programs were analyzed. Female surgeons had fewer publications, lower H-indices, and lower publication rates than male surgeons. In the Northeast, male attendings had higher publication counts, rates, and H-indices. Men also had higher H-indices than women in the Midwest and Southwest. Among male pediatric orthopaedic attendings, those in the Northeast exhibited the highest publication counts, rates, and H-indices. However, no regional differences were observed among female pediatric orthopaedic surgeons. CONCLUSION: Notable gender disparities persist among pediatric orthopaedic surgeons in the United States, reflecting systemic barriers that limit women's research opportunities. Male faculty outnumber female faculty across fellowship programs and have higher publication counts, rates, and H-indices. Regional differences were most notable in the Northeast, where male attendings had markedly higher publication counts, rates, and H-indices. H-index disparities were also present in the Midwest and Southwest. Targeted strategies are needed to improve research access and support for women trainees and faculty.
Hip Spine Syndrome: Management of Patients With Concurrent Hip and Spine Degenerative Pathologies: Erratum.
Le HV, Shahzad H, Klineberg E … +2 more , Heckmann N, Lum ZC
J Am Acad Orthop Surg · 2026 Apr · PMID 41860571 · Publisher ↗
Abstract loading — click title to view on PubMed.
Isolating the Effect of Surgeon Experience on Spine Surgery Outcomes: A Retrospective Cohort Study Stratified by Procedure Type.
Movva AK, Bennett CF, Hurka KL … +3 more , Joaquin TA, Patel AA, Divi SN
J Am Acad Orthop Surg · 2026 Mar · PMID 41848016 · Publisher ↗
INTRODUCTION: Outcomes research for spinal surgery has typically focused on patient, diagnosis, or procedure as a predictor of surgical results; the impact of surgeon experience remains uncertain. Although experience imp...
INTRODUCTION: Outcomes research for spinal surgery has typically focused on patient, diagnosis, or procedure as a predictor of surgical results; the impact of surgeon experience remains uncertain. Although experience improves scoliosis correction and total disk arthroplasty outcomes, its effects on common procedures, including lumbar fusions, anterior cervical diskectomy and fusion (ACDF), and posterior cervical decompression and fusion (PCDF), remain understudied. This study evaluates the impact of surgeon experience on outcomes in a large, multisurgeon, multisite academic center, examining prospectively collected data. METHODS: We analyzed 1,567 ACDF, 248 PCDF, and 1,834 lumbar fusion cases (2003 to 2023) from a multisite academic center. Data were captured prospectively but reviewed retrospectively. Cohorts were stratified by levels of fusion and procedure type. Outcomes assessed included readmissions, sepsis, surgical site infection (SSI), wound dehiscence, and long-term complications. Multivariate logistic regression was done, adjusting for age, body-mass index, sex, race, diagnoses, primary surgeon, and Elixhauser comorbidities. RESULTS: Increased surgeon experience markedly reduces long-term complications in lumbar fusion (odds ratio [OR]: 0.83, confidence interval [CI], 0.79 to 0.88, P < 0.001) and PCDF (OR: 0.71, CI, 0.60 to 0.85, P < 0.001), along with decreasing SSI rates in lumbar fusion (OR: 0.84, CI, 0.75 to 0.94, P = 0.002). Similar effects were observed in lumbar fusion subgroups, stratified by level (single- or multilevel) and procedure (anterior lumbar interbody fusion or posterior lumbar fusion/transforaminal lumbar interbody fusion). No notable associations with experience were observed for ACDF, including long-term complications (OR: 0.93, CI, 0.76 to 1.13, P = 0.440). Notably, a notable increase in sepsis risk correlated with increased experience in lumbar fusion (OR: 1.32, CI, 1.04 to 1.68, P = 0.024). LEVEL OF EVIDENCE: Level III. CONCLUSION: Surgeon experience markedly reduces complications and improves lumbar fusion and PCDF outcomes, emphasizing its value in optimizing care while challenging the notion that surgeons are interchangeable.
High Depressive Burden as a Predictor of Worse Patient-Reported Outcome Measures and Increased Revision Rates After Lumbar Fusion.
Dalton J, Herczeg C, Giakas A … +21 more , Oris RJ, Baidya J, Huang R, Olson J, Eichbaum YK, Baek G, Green WA, Mathew J, Lee Y, Hitchner M, Mastrokostas P, Ng MK, Narayanan R, Kaye ID, Kurd MF, Canseco JA, Hilibrand AS, Vaccaro AR, Kepler CK, Schroeder GD, Mangan JJ
J Am Acad Orthop Surg · 2026 Mar · PMID 41848008 · Publisher ↗
OBJECTIVE: The aim of this study was to investigate the effect of high "depressive burden" on patient-reported outcome measures (PROMs) after lumbar fusion surgery. METHODS: Adult patients who underwent elective 1-3 leve...
OBJECTIVE: The aim of this study was to investigate the effect of high "depressive burden" on patient-reported outcome measures (PROMs) after lumbar fusion surgery. METHODS: Adult patients who underwent elective 1-3 level lumbar fusion at a single institution (2017 to 2023) were identified. PROMs included Oswestry Disability Index (ODI), Visual Analogue Scale (VAS) Back and Leg, Mental Component Summary (MCS), and Physical Component Summary (PCS). High depressive burden was defined as an average preoperative and 3-month postoperative MCS score below 45, a threshold used in the psychiatry literature to indicate depression requiring intervention. PROMs and minimal clinically important difference (MCID) were compared between patients with and without high depressive burden. RESULTS: A total of 418 patients were included (127 [30.4%] had high depressive burden). Patients with high depressive burden were younger (60.6 vs. 63.9 years; P = 0.004) and more commonly Black (13.7% vs. 5.94%; P = 0.031) compared with patients without high depressive burden-otherwise, the two groups were demographically similar. Patients with high depressive burden had longer cut-to-close times (240 vs. 215 minutes; P = 0.031) but otherwise were surgically similar. High depressive burden was associated with a higher 2-year revision surgery rate (13.4% vs. 5.15%; P = 0.007). High depressive burden was associated with worse scores for all PROMs at 6 months and 1 year postoperatively. Multivariable regression identified depressive burden as independently predictive of a decreased likelihood of achieving MCID for 1-year ODI (odds ratio [OR]: 0.19; P < 0.001) and PCS (OR: 0.35; P = 0.002) and of requiring revision surgery within 2 years (OR: 2.98; P = 0.006). CONCLUSIONS: High depressive burden provides a more robust measurement of mental health in the preoperative and early postoperative period. High depressive burden was associated with a higher 2-year revision surgery rate and worse performance on all PROMs at 6 months and 1 year. High depressive burden was also independently predictive of decreased likelihood of achieving MCID for ODI and PCS at 1 year and of requiring revision surgery within 2 years.
Gender Disparities in the Spine Surgeon Workforce Performing Cervical Spine Surgery in the Medicare Population.
Gammel J, Rivas GA, Ferdon RJ … +3 more , Banagan KE, Ravinsky RA, Silvestre J
J Am Acad Orthop Surg · 2026 Mar · PMID 41848006 · Publisher ↗
INTRODUCTION: Gender disparities persist across surgical specialties including orthopaedic surgery and neurosurgery, which may limit workforce diversity and potentially influence care delivery. Understanding representati...
INTRODUCTION: Gender disparities persist across surgical specialties including orthopaedic surgery and neurosurgery, which may limit workforce diversity and potentially influence care delivery. Understanding representation among spine surgeons performing common procedures such as anterior cervical diskectomy and fusion (ACDF) may identify opportunities to enhance equity. METHODS: This was a retrospective cross-sectional study of spine surgeons performing ACDF using Medicare Provider Utilization and Payment Data from 2013 to 2021. The total representation of female spine surgeons performing ACDF, including their case volumes, practice characteristics, and payments, was compared with that of male spine surgeons. RESULTS: A total of 2,492 spine surgeons who performed 139,456 ACDF cases were included in the sample. Of these, 58 female spine surgeons (2.3%) performed 2,733 cases (2.0%). The percentage of female surgeons increased from 0% (0/1,124) in 2013 to 1.8% (12/651) in 2021 (β = 0.163, R2 = 0.263, P < 0.001). The average annual volume of ACDF procedures was similar between female and male surgeons (16.8 ± 3.6 vs. 17.2 ± 7.6, P = 0.712). No difference was observed in academic teaching hospital affiliation between female and male surgeons (13.9% vs. 11.8%, P = 0.697). No difference was found in mean standardized Medicare reimbursement for ACDF procedures over the study period (P = 0.145). In 2021, female surgeons treated a higher proportion of female patients (56.8% vs 55.0%, P = 0.043). CONCLUSIONS: Although representation of female spine surgeons increased modestly, gender disparities remain pronounced within the Medicare workforce. Strategies are needed to increase the number of female trainees interested in a career in spine surgery.
A Novel Technique for Diagnosing Posterior Implant-Implant Impingement After Total Hip Arthroplasty.
Kovacs A, Listopadzki T, Boyle KK … +1 more , Nodzo SR
J Am Acad Orthop Surg · 2026 Mar · PMID 41848002 · Publisher ↗
INTRODUCTION: Implant-implant impingement in total hip arthroplasty remains a primarily clinical diagnosis, with little technology available to demonstrate impingement radiographically. The purpose of this study was to d...
INTRODUCTION: Implant-implant impingement in total hip arthroplasty remains a primarily clinical diagnosis, with little technology available to demonstrate impingement radiographically. The purpose of this study was to determine the effectiveness of external rotation stress CT scans in evaluating for posterior impingement in patients with painful total hip prostheses. METHODS: Sixty-seven patients presenting with CT IMA (implant movement analysis) scans previously used for evaluation of potential aseptic loosening were identified between May 2021 and May 2024. Plain radiographs were evaluated to assess for acetabular cup abduction. CT IMA scans in external rotation IMA protocol position were evaluated to measure acetabular implant version and the distance between the femoral and acetabular components. Patients were separated into impingement and nonimpingement groups based on whether a clinical or intraoperative diagnosis of impingement had been made. Cup version, abduction, and implant-implant distances on the external rotation CT were compared between the groups. A receiver operating characteristic curve was created, and the area under the curve was calculated to determine an optimal implant-implant distance for diagnosing impingement. RESULTS: Overall, 29 patients were diagnosed with impingement and 38 patients were diagnosed with other sources of hip pain. Linear regression showed a notable negative correlation (P = 0.004) of measured cup version versus implant-implant distance. Implant-implant distance was markedly smaller in the impingement group versus the non-impingement group (P < 0.0001). The receiver operating characteristic curve demonstrated 100% sensitivity and 89% specificity impingement when the implant-implant distance was <5 mm, with an area under the curve of 0.98 ± 0.02. CONCLUSION: External rotation stress CT scans used by the IMA protocol were 100% sensitive and 89% specific in identifying patients with posterior impingement when an implant-implant distance of <5 mm was considered. This technology may help clinicians objectively define a diagnosis of impingement in total hip prostheses in the absence of other clinically identifiable sources of pain.
Efficacy of Ultrasonic Scalpel in Orthopaedic Oncology Surgery: An Initial Patient Cohort Study Based on Propensity Score Matching Analysis.
Hu J, Zhu J, Huang Z … +4 more , Zhu K, Ma X, Gao T, Zhang C
J Am Acad Orthop Surg · 2026 Jul · PMID 41841506 · Publisher ↗
BACKGROUND: Ultrasonic scalpels (USs) have been widely used in various cancer surgeries due to their advantages of minimal thermal damage, effective vascular/lymphatic sealing, and reduced complications. However, robust...
BACKGROUND: Ultrasonic scalpels (USs) have been widely used in various cancer surgeries due to their advantages of minimal thermal damage, effective vascular/lymphatic sealing, and reduced complications. However, robust evidence supporting their efficacy in soft-tissue sarcoma (STS) surgery remains limited, especially for large-size thigh STS (≥8 cm)-a subgroup characterized by high intraoperative bleeding risk and frequent wound healing issues. This study aimed to comprehensively evaluate the efficacy of USs in the surgical management of large thigh STS (≥8 cm). PATIENTS AND METHODS: We conducted a retrospective study of patients who underwent surgical resection of large thigh STS (≥8 cm) between January 2019 and December 2024. Patients' clinical characteristics and treatment details were meticulously collected, and key metrics analyzed included intraoperative blood loss, hospital stays, and wound complications. To reduce selection biases, propensity score matching was applied. We defined the matched cases wherein US was used as the "using group" and the other matched cases as the "non-using group." Outcomes were compared between the groups. RESULTS: After propensity score matching, 36 patients were included in each group. The ultrasonic using group showed markedly reduced estimated intraoperative blood loss (204.2 vs. 505.6 mL; P = 0.041) and shorter hospital stay (6.9 vs. 11.4 days; P = 0.002). In addition, the incidence of major wound complications (Clavien-Dindo grade III or higher) was markedly lower (13.9% vs. 38.9%; P = 0.031). Multivariate logistic regression analysis confirmed that US use was independently associated with fewer major wound complications (odds ratio, 0.118; 95% confidence interval, 0.026 to 0.531; P = 0.005). CONCLUSIONS: The application of USs in the surgical resection of large thigh STS (≥8 cm) is associated with reduced intraoperative blood loss, shorter hospital stay, and lower rates of major postoperative wound complications. These findings support the potential value of US as a technical adjunct in complex STS surgery and warrant further validation in prospective randomized controlled trials.
Radiographic Risk Factors for Scapular Stress Fractures After Reverse Total Shoulder Arthroplasty: A Case-Control Study.
Bengart JJ, Kohut KT, Haider MN … +2 more , Feng L, Duquin TR
J Am Acad Orthop Surg · 2026 Mar · PMID 41823169 · Publisher ↗
BACKGROUND: Acromial and scapular spine fractures following reverse total shoulder arthroplasty (rTSA) occur with prevalence rates ranging from 0.8% to 7.2%.1-5 This study aimed to identify radiographic risk factors for...
BACKGROUND: Acromial and scapular spine fractures following reverse total shoulder arthroplasty (rTSA) occur with prevalence rates ranging from 0.8% to 7.2%.1-5 This study aimed to identify radiographic risk factors for the development of scapular stress fractures following primary rTSA and to provide quantifiable recommendations for surgeons to decrease risk for stress fracture. METHODS: This was an institutional review board‑approved retrospective case-control study. Electronic medical records were screened for patients who underwent a rTSA from 2010 to 2021. Patients with stress fractures were then matched in a 3:1 ratio for a comparison control group. Radiographs were analyzed and compared at multiple time points. RESULTS: Patients developed a fracture at a median of 3.4 months postoperatively (n = 14, mean age = 76 years, 79% female) and were compared with matched controls who did not (n = 42, mean age = 76 years, 79% female). Minimal radiographical differences were seen except in those who developed a fracture of lower Hamada classification (1 to 3 vs. 4 to 5) preoperatively (P = 0.005) and wider acromion to lateral humerus distance postoperatively (P = 0.034). Regarding pre- to postoperative change, the fracture group had an increase in acromion to lateral humerus distance by 2.3 mm, whereas the control group had a reduction by 3 mm (P = 0.024). These two variables alone were 80.4% accurate in predicting fractures on logistic regression. For the acromion to lateral humerus distance, receiver operator characteristic analysis identified 9.78 mm as the most discriminant cutoff (area under curve = 0.690). CONCLUSION: In our study, the distance from the lateral edge of the acromion to the lateral humerus was a useful tool for identifying risk of acromial fracture. Based on these findings, our current practice is to avoid lateralizing beyond an acromion to lateral humerus distance of 10 mm and to use unicortical screw fixation in the superior half of the glenoid to avoid creation of a stress riser in the scapular spine. LEVEL OF EVIDENCE: III.
Surgical Reconstruction of Irreparable Hip Abductors With the Use of Allograft: A Systematic Review and Meta-analysis of Clinical Outcomes.
Clark SC, Lee S, Thomas TL … +3 more , Hevesi M, Sierra RJ, Goh GS
J Am Acad Orthop Surg · 2026 Mar · PMID 41823157 · Publisher ↗
BACKGROUND: Chronic hip abductor insufficiency remains a challenging problem to treat and can result in notable disability in some patients. The use of allograft has become an increasingly common option for surgical reco...
BACKGROUND: Chronic hip abductor insufficiency remains a challenging problem to treat and can result in notable disability in some patients. The use of allograft has become an increasingly common option for surgical reconstruction. The purpose of this systematic review was to analyze the clinical outcomes, complications, and revisions rates of patients who underwent allograft reconstruction for irreparable hip abductor tears. METHODS: PubMed (MEDLINE), Scopus (EMBASE, MEDLINE, COMPENDEX), and Cochrane databases were used to conduct a systematic review. A total of five studies were included, comprising three that used a dermal allograft, one that used an Achilles tendon allograft with a calcaneal bone block, and one that used an extensor mechanism of the knee allograft. Demographics, hip setting (native hip, primary total hip arthroplasty [THA], revision THA), patient-reported outcome measures, presence of Trendelenburg sign, use of walking aids, abduction strength, complication rates, and revision rates were analyzed. RESULTS: A total of 76 patients (76 hips) underwent hip abductor reconstruction with allograft. The mean age was 63.2 years with 84.2% being female. The mean follow-up was 23.6 months. Four studies reported changes in preoperative to postoperative patient-reported outcome measures, all of which demonstrated an improvement in outcomes. The mean preoperative reported abduction strength was 2.7/5, which improved to 3.9/5 postoperatively (P < 0.001). Two studies demonstrated a persistent postoperative Trendeleburg sign in more than one third of patients. The complication and revision rates were 5.3% (4/76) and 1.3% (1/76), respectively. CONCLUSION: Allograft reconstruction is a salvage procedure for a challenging problem that provides satisfactory clinical outcomes in patients with chronic hip abductor insufficiency not amendable to primary repair. Complication and revision rates were notably low. Future research should compare the clinical outcomes of allograft reconstruction with other muscle transfer techniques to determine the optimal surgical treatment for chronic hip abductor deficiency.
Comparison of Radial Styloid Fracture Fixation Using a Radial Plate Versus a Cannulated Screw.
Abdel Fattah HAH, Yusuf Nor Gedi I
J Am Acad Orthop Surg · 2026 Mar · PMID 41812265 · Publisher ↗
PURPOSE: Radial styloid fractures may occur in isolation or as part of complex intra-articular distal radius injuries. Fixation can be achieved using either a cannulated screw or a radial plate. This study aimed to compa...
PURPOSE: Radial styloid fractures may occur in isolation or as part of complex intra-articular distal radius injuries. Fixation can be achieved using either a cannulated screw or a radial plate. This study aimed to compare these two fixation techniques with respect to surgical time, fracture union, and postoperative complications in patients with isolated radial styloid fractures, thereby eliminating confounding factors related to associated injuries. METHODS: Between 2024 and 2025, a retrospective study was conducted involving 20 patients (mean age, 37.6 ± 6.9 years) with isolated radial styloid fractures. Patients were assigned to undergo open reduction and internal fixation using either a cannulated screw (group A, n = 10) or a radial plate (group B, n = 10). All patients were followed for 6 months. The primary outcomes included surgical time, fracture union, and postoperative complications. RESULTS: Group A demonstrated a markedly shorter surgical time than group B (34.4 ± 2.4 minutes vs 50.6 ± 3.9 minutes; P < 0.05) and achieved faster fracture union (6.7 ± 0.7 weeks vs 7.6 ± 1.0 weeks; P < 0.05). Temporary extensor tendinitis and implant irritation occurred slightly more frequently in group B (10% vs 0%), although this difference was not statistically significant. The incidence of transient superficial radial neuritis was similar between the groups (10%). CONCLUSION: Cannulated screw fixation for isolated radial styloid fractures is a reliable and efficient alternative to radial plate fixation. It provides shorter surgical time, earlier fracture union, and comparable complication rates while minimizing soft-tissue dissection.
Anatomic Total Shoulder Arthroplasty: Long-Term Clinical, Radiographic, and Patient-Reported Outcomes.
Patel AV, White CA, Schroen CA … +7 more , Cirino CM, Ranson WA, Shukla DR, Galatz LM, Parsons BO, Flatow EL, Cagle PJ
J Am Acad Orthop Surg · 2026 Mar · PMID 41812257 · Publisher ↗
BACKGROUND: Short- to midterm outcomes following anatomic total shoulder arthroplasty (aTSA) are well documented. However, few studies to date have reported on long-term outcomes following aTSA. The purpose of this study...
BACKGROUND: Short- to midterm outcomes following anatomic total shoulder arthroplasty (aTSA) are well documented. However, few studies to date have reported on long-term outcomes following aTSA. The purpose of this study was to investigate and report the long-term clinical, functional, and radiographic outcomes of patients who underwent anatomic aTSA at our institution. METHODS: Patients who underwent aTSA with a minimum of 10.0 years of follow-up were included. Range of motion (ROM; forward elevation, external rotation, internal rotation), patient-reported outcomes (American Shoulder and Elbow Surgeons score, simple shoulder test, and visual analog scale scores), and radiographic variables (glenoid morphology, lateral humeral offset, acromiohumeral interval, and humeral lucency) were recorded. Implant failure-free survival was defined as shoulders requiring no revision surgeries following primary aTSA. RESULTS: Seventy-eight patients (78 shoulders) were included with an average age at surgery of 63.2 ± 8.4 years and a mean follow-up of 15.0 ± 4.5 years. All measurements of ROM saw notable preoperative to postoperative improvements. Overall, forward elevation improved from 118.8° ± 23.9° preoperatively to 147.6° ± 22.6° postoperatively (P < 0.01). External rotation improved from 22.3° ± 25.8° to 54.7° ± 18.6° (P < 0.01); internal rotation improved from L4 to T12 (P < 0.01). American Shoulder and Elbow Surgeons scores improved from 34.8 ± 21.6 preoperatively to 72.6 ± 23.0 postoperatively (P < 0.01). Simple shoulder test scores improved from 3.5 ± 2.6 preoperatively to 8.1 ± 3.4 postoperatively (P < 0.01). Visual analog scale pain scores improved from a mean preoperative score of 6.4 ± 2.7 to a mean postoperative score of 2.3 ± 2.8 (P < 0.01). Implant survivorship was 97% at 10 years and 72% at 20 years. CONCLUSION: aTSA provides long-term improvements in pain scores, ROM, and shoulder function. Implant survivorship was excellent and demonstrated aTSA results to be durable at 20 years postoperatively. LEVEL OF EVIDENCE: IV.
About
- Frequency
- Sun
- Papers found
- 200
- RSS feed
- Subscribe