The Journal Of The American Academy Of Orthopaedic Surgeons[JOURNAL]
Sun
200 papers
Normal or Not? Acetabular Morphology Is Not a Binary Classification.
Green CJ, Hoare S, Podeszwa D … +1 more , Nowlan NC
J Am Acad Orthop Surg · 2026 Jun · PMID 41812255 · Publisher ↗
Orthopaedic surgical decision making is a combination of clinical intuition, radiological measurements, and referenced standards. As clinicians and researchers, we consider hip pathology as a mechanical problem described...
Orthopaedic surgical decision making is a combination of clinical intuition, radiological measurements, and referenced standards. As clinicians and researchers, we consider hip pathology as a mechanical problem described in geometric and statistical language. For a clinical measurement to be useful, it must be easy to perform, reproducible, and demonstrably associated with the risk of the condition it seeks to diagnose or prevent. Using acetabular dysplasia as an analytic lens, this review discusses what our radiographs actually tell us about hip morphology risk, by separating population reference ("normative") intervals from outcome-anchored decision limits and by tracing the evidentiary lineage of the field's workhorse measurements. We revisit the origins, current use, and statistical power of the lateral center-edge angle, acetabular index/Tönnis angle, femoral head extrusion index, and Graf ultrasonography classification and synthesize what is known about their reproducibility and what clinical decisions can appropriately be made. We examine how nomenclature drift fuels routine miscommunication and show that superficially similar measurements are often tied to reference datasets they were neither derived from nor validated against. The current, normal or not, phenotypic model of risk allocation is considered, and the alternative of a continuous, dose-response relationship is proposed. The aim of this narrative review is to prompt clinicians and researchers to consider has our use of legacy morphological risk models actually curtailed osteoarthritis progression in conditions such as hip dysplasia and can we continue to depend on them? Or do models grounded more in lineage than validation now warrant a fundamental reconstruction.
Delays in Pediatric Supracondylar Humerus Fracture Management: A Comparison of Pre- and Postpandemic Trends.
Myers AY, Colello MJ, Wren TAL … +1 more , Goldstein RY
J Am Acad Orthop Surg · 2026 Apr · PMID 41812254 · Publisher ↗
BACKGROUND: The purpose of this study is to compare patient presentation characteristics and timeliness of pediatric supracondylar humerus fracture management from before and after the COVID-19 pandemic. These comparison...
BACKGROUND: The purpose of this study is to compare patient presentation characteristics and timeliness of pediatric supracondylar humerus fracture management from before and after the COVID-19 pandemic. These comparisons may lead to the identification of changes in emergency department (ED) flow or operating room availability since the pandemic. METHODS: A retrospective review was done of patients seen for an isolated supracondylar humerus fracture at a single tertiary care pediatric hospital. The prepandemic group presented from January 1, 2018 to June 30, 2019, and the postpandemic group presented from March 1, 2022 to August 31, 2023. The two groups were directly compared. RESULTS: Three hundred eighty-eight patients were included in the prepandemic group, and 413 patients in the postpandemic group with a median age of 5.3 years. Of the patients who presented directly to our ED and were admitted, there was markedly longer time to admission (5.7 vs. 4.0 hours; P < 0.0001), time to surgical intervention (14.0 vs. 9.2 hours; P < 0.0001), and total length of stay (22.9 vs. 20.0 hours; P = 0.0004) in the postpandemic group. Similarly, of the patients who were transferred to our institution and were admitted, there was markedly longer time to surgical intervention (7.4 vs. 5.8 hours; P = 0.0029) and total length of stay (20.0 vs. 17.1 hours; P = 0.0002) in the postpandemic group. In the postpandemic group, patients who presented directly to our ED and did not require surgery had a markedly longer total length of stay (5.0 vs. 3.9 hours; P < 0.0001). Patients transferred to our ED in the postpandemic group were more likely to require nonsurgical care, although this did not reach significance (12% vs. 6%; P = 0.084). CONCLUSION: Since the pandemic, there have been notable delays in care for pediatric supracondylar humerus fractures. Identification of these delays provides support for the restructuring of hospital resources to help improve the patient experience and physician morale and decrease hospital costs. LEVEL OF EVIDENCE: III.
Impact of GLP-1 Receptor Agonist Use on Total Knee Arthroplasty Outcomes in Metformin-Treated Diabetic Patients With and Without Comorbid Obesity: A Propensity-Matched Analysis.
Lee S, Sellig MT, Kim MT … +3 more , Jayne C, Seo HH, Goh GS
J Am Acad Orthop Surg · 2026 Mar · PMID 41805656 · Publisher ↗
INTRODUCTION: Glucagon-like peptide-1 receptor agonists (GLP-1RAs) have been linked to improved outcomes following total knee arthroplasty (TKA). However, it remains unclear whether the observed benefits are attributable...
INTRODUCTION: Glucagon-like peptide-1 receptor agonists (GLP-1RAs) have been linked to improved outcomes following total knee arthroplasty (TKA). However, it remains unclear whether the observed benefits are attributable to weight loss, glycemic control, or first-line type 2 diabetes mellitus (T2DM) medications such as metformin. This study aimed to evaluate the impact of perioperative GLP-1RA use on TKA outcomes in T2DM patients stratified by obesity status. METHODS: The TriNetX Global Collaborative Network was queried using relevant Current Procedural Terminology and ICD-10 codes for metformin-treated T2DM patients aged 18 years or older undergoing primary TKA. Patients were divided into two groups based on obesity status and further stratified based on GLP-1RA use within three months of surgery. The groups were propensity matched (1:1) based on age, sex, body mass index (BMI), HbA1c, and comorbidities. Surgical outcomes, medical complications, and resource utilization were assessed at 90 days and 1 year. Surgical outcomes and revision rates were also assessed at two years. RESULTS: In obese patients (n = 8,170), GLP-1RA use was associated with notable reductions in postoperative anemia (odds ratio [OR] 0.714; P = 0.001), acute kidney injury (OR 0.755; P = 0.021), 90-day readmission (OR 0.776; P = 0.001), emergency department (ED) visits (OR 0.836; P = 0.008), and aseptic loosening at two years (OR 0.498; P = 0.037). These patients also demonstrated greater postoperative reductions in BMI and HbA1c. In nonobese patients (n = 1,328), GLP-1RA use was similarly associated with lower rates of 90-day readmission (OR 0.514; P = 0.004) and ED visits (OR 0.649; P = 0.024), although no notable differences in other outcomes were observed. CONCLUSION: Among metformin-treated T2DM patients undergoing TKA, GLP-1RA use was associated with reduced resource utilization irrespective of obesity. However, additional reductions in medical complications and aseptic loosening were observed in the obese group, suggesting a potential synergistic effect between weight loss and glycemic control. These findings highlight the effectiveness of GLP-1RAs in optimizing high-risk candidates undergoing TKA.
Pulling the Trigger Sooner: Patients Pursue Subsequent Contralateral Total Joint Arthroplasty With Lower Preoperative Pain.
Singh M, Nassar JE, Liu J … +5 more , McAnena AP, Toavs TL, Harary J, Schilling PL, Moschetti WE
J Am Acad Orthop Surg · 2026 Mar · PMID 41802212 · Publisher ↗
BACKGROUND: Severe osteoarthritis is commonly managed with total hip/knee arthroplasty (THA/TKA). A subset of patients present with bilateral osteoarthritis and undergo staged total joint arthroplasty (TJA). Among those...
BACKGROUND: Severe osteoarthritis is commonly managed with total hip/knee arthroplasty (THA/TKA). A subset of patients present with bilateral osteoarthritis and undergo staged total joint arthroplasty (TJA). Among those who ultimately proceed with both stages, we hypothesize that the decision to proceed with the second surgery is likely influenced by their initial TJA. METHODS: Adults who underwent staged bilateral THA or TKA between 2018 and 2023 were included. Daily Visual Analog Scale (VAS) pain scores (0 to 10) were tracked from 30 days preoperatively to 90 days postoperatively for all patients. Mean preoperative and postoperative pain score plateaus were described and compared after the first and second operations. Hospital-related and patient-reported outcomes were also collected and compared. Finally, optimal intervals between surgeries that maximized pain improvement were also identified. RESULTS: A total of 193 staged bilateral THA (64 years, 54% female) and 280 staged bilateral TKA (70 years, 55% female) patients were included. Patients had higher preoperative pain scores (THA: first = 6.7 vs. second = 5.4, TKA: 5.7 vs. 4.7) and larger absolute reductions in pain scores (THA: -5.3 vs. -4.0, TKA: -3.8 vs. -2.2) after their first TJA (P < 0.05). In addition, they had higher procedural satisfaction scores (THA: 4.8/5.0 vs. 4.7/5.0, TKA: 4.7/5.0 vs. 4.6/5.0) and higher rates of emergency department (THA: 11% vs. 6%, TKA: difference not significant) or urgent care (THA: difference not significant, TKA: 5% vs. 1%) visits after their first procedure (P < 0.05). Furthermore, they had worse preoperative patient-reported outcome measures and larger preoperative to postoperative improvements after their initial operation (P < 0.05). VAS pain improvement was greatest in those waiting 6 to 12 months between THAs and TKAs (P < 0.05). CONCLUSION: Patients undergoing their second contralateral TJA had lower preoperative pain scores and similar postoperative pain levels compared with their first procedure, resulting in smaller absolute pain reductions. Greater pain improvement was observed when the second operation was done >6 months after first TJA.
Alcohol Misuse, Posttraumatic Stress Symptoms, and Recovery After Musculoskeletal Injury: Implications for Effective Orthopaedic Care.
Bakhshaie J, Zvolensky MJ, Vujanovic AA … +2 more , Ditre JW, Ring D
J Am Acad Orthop Surg · 2026 May · PMID 41802211 · Publisher ↗
Musculoskeletal injuries severe enough to warrant hospitalization commonly co-occur with alcohol misuse and posttraumatic stress disorder (PTSD) symptoms, complicating recovery (return of comfort and capability). Nearly...
Musculoskeletal injuries severe enough to warrant hospitalization commonly co-occur with alcohol misuse and posttraumatic stress disorder (PTSD) symptoms, complicating recovery (return of comfort and capability). Nearly half of trauma patients have detectable alcohol at injury, and over one in five exhibit symptoms of PTSD during recovery. These co-occurring conditions are associated with greater levels of pain intensity and incapability, limited participation in exercises, and adverse events and hospital readmissions. Routine screening and brief interventions such as Screening, Brief Intervention, and Referral to Treatment for alcohol misuse and standardized self-report screening tools such as the Primary Care PTSD Screen for DSM-5 (PC-PTSD-5) have established clinical utility; however, implementation within orthopaedic practice remains inconsistent because of resource limitations, clinician uncertainty, and fragmented care coordination. Integrated, technology-enhanced interventions incorporate psychoeducation, coping-skills training, motivational interviewing, and personalized feedback to concurrently address alcohol misuse, PTSD symptoms, and pain. Digital health platforms-including telehealth and mobile applications-may help overcome barriers to implementing integrated interventions in orthopaedic trauma settings, thereby supporting widespread use and long-term sustainability. Adopting multidisciplinary care pathways tailored to individual risk profiles may facilitate implementation of these interventions, enhancing clinical efficiency, patient adherence, and orthopaedic recovery outcomes.
Tandem Spinal Stenosis: A Proposed Therapeutic Algorithm Based on a Systematic Review and Meta-Analysis.
Kotheeranurak V, Sarasombath P, Chancharoenchai T … +3 more , Liu Y, Singhatanadgige W, Limthongkul W
J Am Acad Orthop Surg · 2026 May · PMID 41802210 · Publisher ↗
BACKGROUND: Tandem spinal stenosis (TSS) is characterized by stenosis in two or more noncontiguous spinal regions. Surgical management may involve simultaneous decompression or staged procedures; however, no universally...
BACKGROUND: Tandem spinal stenosis (TSS) is characterized by stenosis in two or more noncontiguous spinal regions. Surgical management may involve simultaneous decompression or staged procedures; however, no universally accepted decision-making algorithm exists. METHODS: A systematic review and meta-analysis were conducted in accordance with PRISMA guidelines. PubMed, Scopus, and EMBASE databases were searched for studies reporting outcomes of simultaneous and/or staged surgery for TSS. Fifteen studies were included in the qualitative review, and 12 were eligible for meta-analysis. Surgical strategies were compared based on postoperative functional outcomes. RESULTS: A total of 1,006 interventions (604 staged and 402 simultaneous) were analyzed. Overall, significant postoperative improvement in Japanese Orthopaedic Association scores was observed (pooled SMD, 2.87; 95% CI, 1.88 to 3.86). Subgroup analysis demonstrated the greatest improvement with staged surgery using a cervical-first approach (SMD, 4.31; 95% CI, 3.87 to 4.76; I 2 = 0%), followed by simultaneous surgery (SMD, 2.65; 95% CI, 1.76 to 3.53). Lumbar-first staged surgery showed smaller and statistically negligible improvement (SMD, 1.94; 95% CI, -1.69 to 5.56). Complication rates were higher in older patients and in those with longer operative times and greater estimated blood loss. CONCLUSIONS: Surgical strategy for TSS should be individualized. In the presence of myelopathy, staged surgery prioritizing cervical decompression is recommended. In the absence of myelopathy, simultaneous decompression may be considered in patients who can tolerate longer operative times. We propose a treatment algorithm to guide surgical decision-making based on symptom predominance, presence of myelopathy, and patient comorbidities.
Short-Term Comparison of Open Surgical Approaches to Minimally Invasive Techniques for the Treatment of Metastatic Periacetabular Bone Disease.
Dowd JR, Neilson JC, Wooldridge AN … +5 more , Hackbarth DA, Tutton SM, Scheidt MJ, Key BM, King DM
J Am Acad Orthop Surg · 2026 Jul · PMID 41802193 · Publisher ↗
BACKGROUND: Periacetabular metastatic disease can cause notable morbidity, prompting potential surgical intervention. Open approaches, including the Harrington type reconstructive with a total hip replacement and cemente...
BACKGROUND: Periacetabular metastatic disease can cause notable morbidity, prompting potential surgical intervention. Open approaches, including the Harrington type reconstructive with a total hip replacement and cemented gap cup, have been the standard approach; however, these surgeries are invasive. Minimally invasive techniques, including screw fixation with cementation and potential ablation, aim to reduce morbidity. This study compares surgical and short-term postoperative outcomes between open reconstructive techniques and minimally invasive treatments in patients with periacetabular metastatic disease. METHODS: Prospectively maintained institutional medical records were used to retrospectively identify patients who had undergone an open approach, who would be minimally invasive candidates, and patients who have undergone the minimally invasive procedure. Demographic, surgical data, and postoperative outcomes of patients with minimum 3-month follow-up were collected. Wilcoxon rank-sum test, chi-squared, and minimal clinically important difference (MCID) tests were used to determine statistical and clinical differences. RESULTS: Seventeen open and 48 minimally invasive patients were identified. Minimally invasive patients had statistically significant lower rate of surgical blood loss, transfusion rates, surgical time, and length of stay ( P < 0.05). Fourteen open and 32 minimally invasive patients had minimum 3-month follow-up. No notable difference was found in the need for secondary procedures, complications, death within 90 days, or Pain and Ambulatory Function Scores ( P > 0.05). 57.1% of the open cohort and 43.8% of the minimally invasive cohort met the MCID threshold. Minimally invasive patients had statistically significant quicker return to adjuvant therapies ( P < 0.05). DISCUSSION: Our cohort study demonstrated that minimally invasive techniques reduced surgical morbidity while achieving similar short-term (3 month) postoperative outcomes and a faster return to potentially life-prolonging therapies. Larger patient sample will help determine patients at risk for failure of both approaches and the need for secondary procedures to further define patients who might benefit from the different techniques.
The Value of an MBA in Orthopaedic Surgery: Applying Business Concepts to Clinical Practice.
Ohanisian LL, Sanders RW
J Am Acad Orthop Surg · 2026 Jun · PMID 41802181 · Publisher ↗
In the evolving healthcare landscape, orthopaedic surgeons are increasingly required to demonstrate not only clinical excellence but also strategic thinking, leadership, and financial literacy. This review explores the i...
In the evolving healthcare landscape, orthopaedic surgeons are increasingly required to demonstrate not only clinical excellence but also strategic thinking, leadership, and financial literacy. This review explores the intersection of business principles and surgical practice, highlighting foundational concepts frequently taught in MBA programs: project management, value proposition, the time value of money, cost accounting, and operations management. This article presents an evidence-based discussion on how these principles can enhance surgical efficiency, as well as long-term financial and career planning.
A Brief, Single-Session Mindfulness Intervention Decreased Surgical Patients' Preoperative Pain, Pain Medication Desire, and Anxiety: Results From a Randomized Controlled Trial.
Hanley AW, Coleman C, Davis A … +3 more , Sorkpor S, Gililland J, Zgierska AE
J Am Acad Orthop Surg · 2026 Mar · PMID 41793773 · Publisher ↗
OBJECTIVE: This study examined the effects of a 20-minute mindfulness-based intervention (MBI) on preoperative pain, desire for pain medication, and anxiety among adults scheduled for knee or hip arthroplasty, compared w...
OBJECTIVE: This study examined the effects of a 20-minute mindfulness-based intervention (MBI) on preoperative pain, desire for pain medication, and anxiety among adults scheduled for knee or hip arthroplasty, compared with a pain psychoeducation intervention (control condition). DESIGN: A single-site, two-arm, parallel-group, randomized, controlled trial. METHODS: Participants attending a preoperative education program were randomized to either a MBI or pain psychoeducation intervention, which were matched in format (group), duration (20 minutes), and frequency (once). Pain intensity, pain unpleasantness, desire for pain medication, and anxiety symptoms were assessed using 0 to 10 numeric rating scales immediately before and after the intervention. T-tests evaluated within-group change. Intention-to-treat generalized linear mixed modeling evaluated between-group pre-post changes in outcomes. FINDINGS: Among 170 enrolled participants (86 MBI; 84 control), 160 (94%) completed all study procedures. Both MBI and control participants markedly reduced their pain-related and anxiety symptoms postintervention; however, only the MBI group reduced their pain medication desire. Generalized linear mixed modeling revealed that the MBI group, compared with the control group, markedly decreased their pain intensity (P < 0.001; d = 0.85), pain unpleasantness (P < 0.001; d = 0.64), desire for pain medication (P = 0.008; d = 0.41), and anxiety symptoms (P < 0.001; d = 0.55). On average, the MBI decreased pain intensity by over two points, and a higher percentage of participants in the MBI condition reported clinically meaningful reductions in pain intensity (ie, by at least 30%) compared with the control participants (60% versus 26%, respectively, P < 0.001). CONCLUSIONS: These findings suggest the effectiveness of a brief MBI in reducing preoperative pain and anxiety among adults preparing for knee or hip arthroplasty, underscoring the potential of MBIs to safely address pain and anxiety in surgical settings.
Investigating the Potential Causal Relationship Between Thyroid Function and Carpal Tunnel Syndrome: A Two-Sample Mendelian Randomization Study.
Yu H, Wang T
J Am Acad Orthop Surg · 2026 Mar · PMID 41793772 · Publisher ↗
OBJECTIVES: There is a burgeoning body of research suggesting a possible relationship between thyroid function and carpal tunnel syndrome (CTS). This study aimed to investigate the potential causal relationship between v...
OBJECTIVES: There is a burgeoning body of research suggesting a possible relationship between thyroid function and carpal tunnel syndrome (CTS). This study aimed to investigate the potential causal relationship between various aspects of thyroid function and CTS using a two-sample mendelian randomization (MR) approach. However, their causal relationship has yet to be conclusively determined. METHODS: Using summary data from extensive genome-wide association studies, we conducted a two-sample MR analysis to investigate the potential genetic causal relationship between thyroid function-encompassing hyperthyroidism, hypothyroidism, thyroid-stimulating hormone, free thyroxine (FT4), free triiodothyronine, total triiodothyronine, and their ratios (free triiodothyronine/FT4 and total triiodothyronine/FT4)-and CTS. Our analytical strategy included the inverse-variance weighted (IVW) method, supplemented by MR-Egger regression, weighted median, and weighted mode analyses, with the IVW method regarded the primary analytical approach. Sensitivity analyses were done using Cochran Q test, the MR pleiotropy residual sum and outlier test, MR-Egger regression, and the leave-one-out method. RESULTS: Robust sets of genetic instrumental variables were identified for different aspects of thyroid function using stringent selection criteria (including F-statistics >10). The IVW method, relying on genome-wide association studies summary data for thyroid function, did not provide evidence a supporting causal effect of genetically predicted thyroid function on CTS (all P > 0.05). Despite observed heterogeneity and pleiotropy in some relationships, the overall findings were consistent and robust across all sensitivity analyses. CONCLUSION: Our two-sample MR analysis did not establish a potential causal relationship between thyroid function and CTS, highlighting the necessity for further studies to clarify the complex interplay between these two entities.
Contemporary Management of Standard Chordoma Arising in the Mobile Spine and Sacrum.
Mascarenhas L, Balzer B, Nguyen AT … +1 more , Schwab JH
J Am Acad Orthop Surg · 2026 Mar · PMID 41793771 · Publisher ↗
Chordomas are rare, slow-growing tumors originating from the notochord, commonly occurring in the sacrum and mobile spine. These tumors have a high rate of local recurrence and potential for metastasis. Local management...
Chordomas are rare, slow-growing tumors originating from the notochord, commonly occurring in the sacrum and mobile spine. These tumors have a high rate of local recurrence and potential for metastasis. Local management continues to evolve. The primary treatment approach involves en bloc resection aiming for negative margins, but even with this aggressive strategy, late recurrences occur in up to 50% of cases within 10 to 15 years. Advanced radiation therapy techniques, such as stereotactic body radiation therapy, proton therapy, and carbon ion therapy, play an ever-increasing role as adjuvants to surgery, particularly when negative margins are not achieved, and, in select cases, as standalone treatment. Despite these advancements, chordomas remain challenging to treat due to their tendency for late recurrences and metastases. Emerging therapies such as immunotherapy provide hope for improved treatment with less morbidity. The management of chordoma requires a multidisciplinary approach integrating surgery, radiation therapy, and systemic therapies to optimize local control and long-term survival outcomes. Continued research and clinical trials are essential for improving treatment efficacy and developing novel therapeutic strategies for this locally aggressive tumor type.
Modern Approaches and Time-Tested Methods in Managing Congenital Scoliosis in Children.
Brooks JT, Shalabi M, Johnston C
J Am Acad Orthop Surg · 2026 Mar · PMID 41793770 · Publisher ↗
Congenital scoliosis encompasses a highly variable, heterogenous group of vertebral anomalies, the mere presence of which is not an indication for intervention; documentation of curve progression is a prerequisite for tr...
Congenital scoliosis encompasses a highly variable, heterogenous group of vertebral anomalies, the mere presence of which is not an indication for intervention; documentation of curve progression is a prerequisite for treatment. Initial evaluation should include investigations to diagnose concomitant genitourinary and cardiac anomalies primarily, and the morphology of the vertebral anomaly should be classified for prognostic purposes. Although sometimes considered only a delaying tactic, bracing treatment and casting can have definite value in controlling flexible congenital curves. Surgical options include prophylactic in situ fusion for the child with mixed vertebral anomalies involving ≤5 segments and a small curve. For young patients without coronal imbalance and ≤5 anomalous segments, a convex growth arrest/hemiepiphysiodesis can be effective for growth modulation, and it can be augmented with a concave growing rod, either traditional or magnetically controlled to improve balance and correction. Although traditional growing rod methods have been used for congenital scoliosis, crankshafting and adding-on may occur due to lack of apical fixation. Thus, apical control techniques have been recently added to traditional growing rod to minimize this cause of curve progression. Finally, an isolated hemivertebra excision with short segment fusion is a mainstay of treatment for progressive curves <50° in young children. In the more mature patient, generally at least 8 to 10 years old, a single definitive correction and fusion gives the most reliable outcomes.
Management of Anterior Glenohumeral Dislocations in Elderly Patients.
Sheth M, Griffin D, Wiesel B … +1 more , Nagda S
J Am Acad Orthop Surg · 2026 Mar · PMID 41791030 · Publisher ↗
The pathoanatomy of anterior glenohumeral dislocations in elderly patients is different from those in younger patients in that rotator cuff tears, large glenoid fractures, and peripheral nerve injury are more common. In...
The pathoanatomy of anterior glenohumeral dislocations in elderly patients is different from those in younger patients in that rotator cuff tears, large glenoid fractures, and peripheral nerve injury are more common. In addition, decision making is made more complex by the wide spectrum of preexisting degenerative pathology, functional demands, and social considerations, such as arthritis, chronic rotator cuff tears, and upper extremity demand for ambulation. Many patients with a first-time dislocation can be treated conservatively with a brief period of immobilization followed by physical rehabilitation. Rotator cuff repair is advisable for most active patients with symptomatic, acute tears. Capsulolabral repairs can be considered for similarly active patients with recurrent instability. Fixation of large glenoid fractures should be considered for patients with displaced fragments >25% of the glenoid width and/or demonstrating humeral subluxation through the fragment if there is adequate bone quality and healing potential. Reverse shoulder arthroplasty plays a large role in managing recurrent instability in patients with limited potential for soft-tissue or bone healing, inability to comply with soft-tissue repair postoperative protocols, and preexisting degenerative changes.
Long-Term Functional Outcomes and Survival Following Intramedullary Nailing of Pathological Diaphyseal Tibial Fractures.
Sood H, Gonzalez MR, Ubong SE … +1 more , Lozano-Calderon SA
J Am Acad Orthop Surg · 2026 Jul · PMID 41791026 · Publisher ↗
BACKGROUND: Pathologic fractures of the tibia represent only 3% to 7% of all pathologic long bone fractures, with reported 12-month survival rates below 30%. Although intramedullary nailing (IMN) has become the preferred...
BACKGROUND: Pathologic fractures of the tibia represent only 3% to 7% of all pathologic long bone fractures, with reported 12-month survival rates below 30%. Although intramedullary nailing (IMN) has become the preferred fixation strategy for pathologic fractures, data specific to tibial lesions remain limited, with existing studies including fewer than 10 patients and focusing primarily on survival or implant failure rather than functional outcomes. METHODS: We conducted a retrospective review of 30 patients who underwent IMN for pathologic tibial fractures at two tertiary care academic medical centers between January 2000 and December 2024. Primary outcomes included overall survival, revision surgery rates, pain scores (visual analogue scale), weight-bearing status, Eastern Cooperative Oncology Group scores, and Combined Pain and Ambulatory Function scale measurements assessed longitudinally through 2-year follow-up. RESULTS: Overall survival was 48.7% at 1 year and 38.3% at 2 years, with a median survival of 8.9 months. Three patients (10%) required revision surgery at a median of 13 months, with two patients (7%) ultimately requiring implant revision. Median pain visual analogue scale scores decreased markedly from 38 preoperatively to six at 1 month ( P = 0.005), with sustained improvement at all subsequent time points ( P < 0.01). The proportion of patients achieving full weight-bearing increased from 29% preoperatively to 73% at 3 months, whereas patients with good functional status (Eastern Cooperative Oncology Group 0 to 1) increased from 40% preoperatively to 75% at 6 months and 100% at 2 years. CONCLUSION: IMN for pathologic tibial fractures provides durable pain relief, low complication rates, and meaningful functional recovery. These results support IMN as an effective palliative intervention that can markedly enhance the quality of life in this population. LEVEL OF EVIDENCE: III.
Optimal Duration of Antibiotic Holiday Before Reimplantation in Two-Stage Exchange Arthroplasty for Periprosthetic Joint Infection: Systematic Review and Meta-analysis.
Carlino EK, Cichos KH, Hart C … +7 more , Hohmann A, Leary E, Higuera C, Fillingham Y, Pupaibool J, Nana A, Ghanem ES
J Am Acad Orthop Surg · 2026 Feb · PMID 41759059 · Publisher ↗
INTRODUCTION: Two-stage exchange arthroplasty is commonly used for the management of chronic periprosthetic joint infection (PJI). Along with many other aspects of this technique, the optimal duration of antibiotic holid...
INTRODUCTION: Two-stage exchange arthroplasty is commonly used for the management of chronic periprosthetic joint infection (PJI). Along with many other aspects of this technique, the optimal duration of antibiotic holiday during the interstage period remains contentious. We aimed to answer this question through a systematic review and meta-analysis by synthesizing evidence from the current literature. METHODS: Systematic review was conducted for studies reporting on two-stage exchange arthroplasty for the management PJI in total hip or total knee arthroplasty (TKA) published between January 1, 2013 and May 1, 2024. The meta-analysis included 14 studies reporting outcomes of two-stage exchange arthroplasty with antibiotic holidays for the treatment of chronic PJI following primary total hip arthroplasty or TKA, and the proportion of failed cases were analyzed using prediction models. RESULTS: The pooled proportion of failed cases across studies of any length for antibiotic holiday was 18% (95% confidence interval [CI], 0.16 to 0.20). The proportion of failed cases in studies using an extended duration antibiotic holiday was 18% (95% CI, 0.16 to 0.20) versus 18% (95% CI, 0.15 to 0.23) for studies using a short duration. CONCLUSION: With the number available, the findings identified no notable difference in treatment failure rates with short (<2 weeks) or extended (≥2 weeks) antibiotic holiday duration between the two stages. However, the evidence is limited by substantial heterogeneity among studies, and further studies are necessary to appropriately address this topic.
The Effectiveness of Interventions in Orthopaedic Surgeons' Clinical Practice: A Systematic Review.
Banfield NF, Kleinsmith RM, Puckett HD … +2 more , Cunningham BP, Swiontkowski M
J Am Acad Orthop Surg · 2026 Jul · PMID 41759039 · Publisher ↗
BACKGROUND: Orthopaedic surgeons face increasing pressure to align clinical decision making with evidence-based practices. However, the adoption of such practices can be inconsistent because of variability in surgical te...
BACKGROUND: Orthopaedic surgeons face increasing pressure to align clinical decision making with evidence-based practices. However, the adoption of such practices can be inconsistent because of variability in surgical techniques, patient factors, and entrenched habits. This systematic review evaluates interventions designed to change orthopaedic surgeons' clinical decision making across cost optimization, diagnostic ordering, and prescribing behaviors. METHODS: A Preferred Reporting Items for Systematic Reviews and Meta-Analyses and MECIR-adherent search was conducted across seven databases (MEDLINE, PsycINFO, EMBASE, Cochrane Library, Business Source Premier, SPORTDiscus, and Scopus) to identify studies from the United States and Canada reporting interventions aimed at modifying orthopaedic surgeons' clinical decision making. Studies were included if they evaluated changes in practice patterns in at least one of the three domains: procedure costs, orders (tests/procedures), or medication prescribing. Two independent reviewers conducted screening, data extraction, and quality assessment using the Effective Public Health Practice Project tool. RESULTS: Of 9,065 records identified, 28 studies met inclusion criteria: education (n = 24), physician reminders (n = 3), and incentive systems (n = 1). Most used before-and-after designs (n = 23) and were of moderate quality (n = 21). Three of five studies (60%) on procedure costs demonstrated statistical significance in cost reduction after intervention ( P ≤ 0.05), with the largest from a surgeon "scorecard" initiative ($694 per total knee arthroplasty case, P < 0.001). Four of 14 studies (29%) on diagnostic/procedural ordering demonstrated statistical significance in clinical decision-making change. All nine studies on prescribing behaviors, predominantly opioid stewardship, showed statistically significant clinical decision-making change, including reductions in morphine milligram equivalents and improved guideline compliance. CONCLUSIONS: Evidence-based interventions, particularly education combined with audit and feedback, can meaningfully shift orthopaedic surgeons' clinical decision making. Sustained change is less well studied, highlighting the need for prospective trials with long-term follow-up. This synthesis provides a framework for designing future interventions that improve adherence to best practices. LEVEL OF EVIDENCE: Level III.
"After Surgery, I Filed for Bankruptcy."The Financial Ramifications of Unexpected Surgery for Upper Extremity Trauma.
Pereira DE, DeMartini SJ, Dy CJ
J Am Acad Orthop Surg · 2026 Feb · PMID 41734368 · Publisher ↗
BACKGROUND: Traumatic injuries of the upper extremity and hand (UE) can result in notable financial ramifications particularly if they involve surgical intervention. Although most studies in orthopaedics address direct c...
BACKGROUND: Traumatic injuries of the upper extremity and hand (UE) can result in notable financial ramifications particularly if they involve surgical intervention. Although most studies in orthopaedics address direct costs, little is known about the personal experience with financial distress following UE trauma surgery. METHODS: Fourteen patients, identified as having markedly high financial distress using self-reported validated surveys, who received UE trauma surgery were interviewed. Semistructured interviews were conducted until thematic saturation was achieved after sequential thematic analysis by two independent researchers. Interviews were recorded, transcribed, and qualitative methodology was used to create a final conceptual model. RESULTS: Most patients (57%) were female, uninsured (36%) with an average age of 37.7 years. Distal radius fractures (29%) were the most common injuries, and most injuries received open reduction and internal fixation (71%). A total of 14 unique, overarching subthemes emerged, which were collated to create a conceptual model comprising (1) community and personal impact; (2) insurance challenges and legal struggles; and (3) consequences of debt and catastrophic loss. Methods for improving support for future patients also emerged during the interview process. CONCLUSION: The costs related to upper extremity trauma surgery affects patients' families and communities and may result in unexpectedly large material loss and distress beyond the known direct physical impact of injury, such as the loss of access to care, inadequate insurance coverage, and inability to self-actualize. Understanding these reverberating effects is critical, as surgeons seek to holistically understand, care for, and study the patient experience after surgery while also effectively advocating for targeted interventions in policy. LEVEL OF EVIDENCE: Prognostic Level II.
Contemporary Tumor Histology Grouping for Survival Prediction of Patients With Metastatic Long-bone Disease Undergoing Surgery.
de Groot TM, Groot OQ, Kuijten RH … +7 more , Shimizu MR, Raskin KA, Newman ET, Doornberg JN, Jutte PC, Lozano-Calderón SA, Schwab JH
J Am Acad Orthop Surg · 2026 Apr · PMID 41718588 · Publisher ↗
BACKGROUND: The prevalence of metastatic bone disease continues to rise with advances in cancer diagnostics and systemic therapy. Accurate survival prediction remains essential for surgical decision-making near the end o...
BACKGROUND: The prevalence of metastatic bone disease continues to rise with advances in cancer diagnostics and systemic therapy. Accurate survival prediction remains essential for surgical decision-making near the end of life. The Katagiri score is a widely used tool incorporating primary tumor histology grouped by expected growth rate. However, it was developed using 2005-2008 data from mainly non-surgical, spinal metastasis patients. As oncologic treatments evolve, tumor histology groupings require reassessment. This study investigated the impact of primary tumor histology on postoperative survival in patients with metastatic long-bone disease. METHODS: We retrospectively included 460 patients who underwent surgery for long-bone metastases at two affiliated tertiary institutions between 2016 and 2021. The primary outcome was postoperative survival. Tumor types were classified into three survival groups-better, intermediate, and worse-by setting thresholds at the 33rd and 66th percentiles of coefficients derived from multivariable Cox proportional hazards regression. RESULTS: Median survival was 16.5 months (interquartile ranges [IQR], 4.7 to 37.9) for better-survival tumors, 9.2 months (IQR, 2.6 to 20.6) for intermediate, and 3.9 months (IQR, 1.6 to 11.6) for worse. Survival improved significantly in tumors responsive to modern systemic therapies, particularly immunotherapy, including renal cell carcinoma, melanoma, hepatocellular carcinoma, and colorectal carcinoma. Gynecological malignancies demonstrated the poorest outcomes. DISCUSSION: This contemporary, histology-based classification reflects modern oncologic outcomes and provides a practical prognostic tool for clinicians treating patients with extremity metastases. Incorporating this updated grouping into prediction models may enhance accuracy and clinical utility. These findings emphasize the importance of regularly auditing prognostic models to remain aligned with evolving cancer therapies and survival trends.
Gathering Orthobiologic Real-word Evidence Using Registries and Biorepositories: Proceedings of the American Academy of Orthopaedic Surgeons-Biologic Association Symposium November, 2022.
Shapiro SA, Çiçek MS, Saris DBF … +2 more , Bayer R, Dragoo JL
J Am Acad Orthop Surg · 2026 Apr · PMID 41712938 · Publisher ↗
Orthobiologics represents a growing field of potential orthopaedic therapy. However, the current level of evidence supporting or refuting the use of many biologic agents in clinical practice is sparse and of low quality....
Orthobiologics represents a growing field of potential orthopaedic therapy. However, the current level of evidence supporting or refuting the use of many biologic agents in clinical practice is sparse and of low quality. The American Academy of Orthopaedic Surgeons and members of the Biologic Association recently convened a symposium dedicated to outlining processes with the goal of accumulating real-world evidence in support of the scientific validity and efficacy of orthobiologic agents. The results of this meeting as well as subsequent ongoing work comprise the American Academy of Orthopaedic Surgeons recommendations for the establishment of registries and biorepositories to assess the value of these treatments moving forward.
Letter to the Editor: Opioid Use Disorder and Perioperative Pain Management-The Practice of Discontinuing Buprenorphine Perioperatively Does Not Align With Expert Consensus.
Hartmann K, Robbins J, Hayes-Lattin M … +2 more , O'Glasser A, Skogrand E
J Am Acad Orthop Surg · 2026 Apr · PMID 41712889 · Publisher ↗
Abstract loading — click title to view on PubMed.
About
- Frequency
- Sun
- Papers found
- 200
- RSS feed
- Subscribe