The Journal Of The American Academy Of Orthopaedic Surgeons[JOURNAL]
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200 papers
A Comprehensive Analysis of the Preoperative and Postoperative Psychological Health Status of Patients With Achilles Tendon Rupture: Clinical Observation and Efficacy Evaluation.
Gao S, Cao S, Hu D … +3 more , Lu J, Li Y, Xu J
J Am Acad Orthop Surg · 2026 Jul · PMID 41712888 · Publisher ↗
PURPOSE: This study aims to assess the psychological health status of patients with Achilles tendon rupture (ATR) and explore the potential effect of preoperative psychological health on the prognosis of ATR surgical out...
PURPOSE: This study aims to assess the psychological health status of patients with Achilles tendon rupture (ATR) and explore the potential effect of preoperative psychological health on the prognosis of ATR surgical outcomes. By thoroughly analyzing the role of psychological factors in surgical recovery, this study seeks to provide a more comprehensive reference for clinical treatment. METHODS: This study included 71 patients with ATR who underwent open surgical treatment at the Department of Foot and Ankle Surgery at Xi'an Honghui Hospital from March 2018 to February 2022. Based on the presence of anxiety/depressive symptoms before surgery, patients were divided into two groups: group A, comprising patients with anxiety/depressive symptoms before surgery, and group B, comprising patients without anxiety/depressive symptoms before surgery. Preoperative and final follow-up evaluations were conducted using the Hospital Anxiety and Depression Scale, the Visual Analog Scale (0-100 mm), the American Orthopaedic Foot and Ankle Society Ankle-Hindfoot Scale, and the Achilles Tendon Rupture Score. A comparative analysis of the clinical functional outcomes of the two groups was done, and changes in pain symptoms before and after surgery were compared between the two groups. RESULTS: A total of 71 patients with ATR were included in the study, with 34 patients (47.9%) exhibiting anxiety/depressive symptoms before surgery. After undergoing open surgical repair, both groups showed significant improvements in all evaluation indicators ( P < 0.05). Preoperatively, patients with anxiety/depressive symptoms reported significantly more severe pain compared with those without such symptoms ( P < 0.05); at the final follow-up, no significant differences were observed between the two groups in pain and depressive symptoms ( P > 0.05). However, patients with preoperative anxiety/depressive symptoms demonstrated significantly worse outcomes in anxiety symptoms and functional activities compared with those without such symptoms ( P < 0.05). No significant intergroup differences were detected in pain symptom progression from baseline to final follow-up ( P > 0.05). However, although postoperative pain changes did not differ markedly, patients with preoperative anxiety or depression demonstrated greater recovery challenges, especially in functional outcomes. CONCLUSIONS: Open surgical repair of ATR markedly improved patients' foot function. However, patients with preoperative anxiety/depressive symptoms experienced more severe pain and a slower functional recovery postoperatively. Although no notable differences were observed in the changes in pain symptoms before and after surgery between the two groups, preoperative psychological health status markedly influenced postoperative functional recovery. Future research should further investigate the use of psychological interventions to enhance postoperative recovery, particularly for patients with anxiety or depressive symptoms before surgery.
Spontaneous Closed Extensor Tendon Ruptures in the Nonrheumatoid Hand and Wrist.
Bekisz JM, Mudgal CS
J Am Acad Orthop Surg · 2026 Feb · PMID 41707134 · Publisher ↗
Extensor tendon disruptions are frequently seen in emergency rooms and hand surgery offices. Traumatic open injuries are more familiar, but spontaneous closed extensor tendon ruptures represent an important clinical enti...
Extensor tendon disruptions are frequently seen in emergency rooms and hand surgery offices. Traumatic open injuries are more familiar, but spontaneous closed extensor tendon ruptures represent an important clinical entity. Often occurring without any prodromal warning, they can surprise patients and their providers alike. Spontaneous extensor tendon ruptures often occur in the setting of systemic medical conditions or hand and wrist pathology, with the mechanisms that lead to rupture often dependent upon the underlying comorbidities. Remaining knowledge of the factors that place patients at risk of developing these problems is vital to maintain the necessary suspicion to ensure prompt diagnosis and facilitate proper treatment.
Common Injuries and Their Management Among Youth to Elite Artistic Male and Female Gymnasts.
Hadley M, Popper HR, Ty J … +1 more , Su AW
J Am Acad Orthop Surg · 2026 Jun · PMID 41707121 · Publisher ↗
Artistic gymnastics is a complex and challenging sport. The specific demands of gymnastics place athletes at unique risk of injuries to the spine, as well as upper and lower extremities. Changes to the rules and scoring...
Artistic gymnastics is a complex and challenging sport. The specific demands of gymnastics place athletes at unique risk of injuries to the spine, as well as upper and lower extremities. Changes to the rules and scoring system since the 2004 Olympics have encouraged athletes to perform more challenging skills, adding to the risk of injury. Single-sport specialization occurs at a young age among competitive gymnasts, introducing an increased risk of overuse injuries. Common injuries include spondylolysis, medial-sided elbow injuries, gymnast's wrist, ligamentous injuries of the knee, and Achilles tendon ruptures. It is important to understand these injury patterns to properly prevent, treat, and safely return these athletes to play.
Reply to Letter to the Editor: Perioperative Pain Management in Patients Being Treated for Opioid Use Disorder: The Orthopaedic Surgeon's Role and Strategies for Comprehensive Care.
Benson E, Khan T, Rolfs H … +1 more , Ahankoob N
J Am Acad Orthop Surg · 2026 Apr · PMID 41707055 · Publisher ↗
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Rotator Cuff Repair Augmentation.
Huff SW, Haislup BD, Murthi AM
J Am Acad Orthop Surg · 2026 May · PMID 41698211 · Publisher ↗
Rotator cuff repair (RCR) failure and retear remain a persistent problem and concern in shoulder surgery. Successful healing is paramount for long-term functional results. Failure of rotator cuff healing can be broadly s...
Rotator cuff repair (RCR) failure and retear remain a persistent problem and concern in shoulder surgery. Successful healing is paramount for long-term functional results. Failure of rotator cuff healing can be broadly separated into biologic and structural complications. Biologic issues include poor host variables such as healing ability and blood flow. Structural problems include tendon thinning and loss as well as poor time-zero fixation. Recently, commercial grafts or "patches" designed for rotator cuff augmentation have increased dramatically. Various grafts aim to enhance biology, provide structure, or both. In addition, grafts are designed to be placed either on-lay, over an RCR, or interpositional, at the bone-tendon interface. Graft may be allograft, xenograft, or fully synthetic. This article discusses the current RCR augmentation graft types and representative products currently available.
Trends in Cervical Disk Arthroplasty Utilization in the Medicare Population: Projections Through 2040.
Mastrokostas PG, Mastrokostas LE, Razi A … +4 more , Inzerillo S, Bou Monsef J, Razi AE, Ng MK
J Am Acad Orthop Surg · 2026 Feb · PMID 41649844 · Publisher ↗
INTRODUCTION: Cervical disk arthroplasty (CDA) has emerged as a motion-preserving alternative to anterior cervical diskectomy and fusion, offering the potential to reduce adjacent segment degeneration while maintaining c...
INTRODUCTION: Cervical disk arthroplasty (CDA) has emerged as a motion-preserving alternative to anterior cervical diskectomy and fusion, offering the potential to reduce adjacent segment degeneration while maintaining cervical spine mobility. Although previous studies have highlighted the increasing adoption of CDA, trends within the broader Medicare population, including those enrolled in Medicare Advantage (MA), remain less defined. This study retrospectively analyzed Medicare Part B National Summary data from 2009 to 2022 to assess historical utilization patterns of single-level and multilevel CDA and applied statistical modeling to project future procedure volumes through 2040. METHODS: Medicare Part B National Summary data from 2009 to 2022 were analyzed to quantify single-level and multilevel CDA procedure volumes. Data adjustments accounted for MA enrollment using established correction factors. Forecasting models-including log-linear, Poisson, negative binomial regression, and autoregressive integrated moving average-were applied to project utilization trends. Model performance was assessed using mean absolute error and root mean square error. The Poisson regression model was selected for final projections due to its optimal balance of predictive accuracy and stability. RESULTS: From 2009 to 2022, single-level CDA volume increased by 1,454% (108 to 1,679 cases), while multilevel CDA volume grew by 609.5% from 2015 to 2022 (147 to 1,042 cases). Forecasting projected a 23.5% annual growth rate for single-level CDA and 24.4% for multilevel CDA through 2040. By 2040, single-level CDA is expected to reach 96,430 procedures annually (95% confidence interval, 95,822 to 97,039), while multilevel CDA will reach 63,362 procedures (95% confidence interval, 62,869 to 63,856). CONCLUSION: CDA utilization among all Medicare beneficiaries, including those enrolled in MA, has grown substantially and is projected to continue increasing through 2040. These trends reflect rising demand for motion-preserving cervical spine procedures and highlight the importance of healthcare planning, surgeon training, and equitable reimbursement policies to accommodate future growth.
Saline Hydrodissection Does Not Markedly Alter Local Temperatures in Percutaneous Transpedicular Cryoablation.
Walker KE, Gutierrez E, Jesse MK … +2 more , Baldini T, Lindeque BP
J Am Acad Orthop Surg · 2026 Feb · PMID 41649843 · Publisher ↗
INTRODUCTION: Cryoablation can be used to palliatively and/or definitively treat bone tumors. In transpedicular cryoablation of spine tumors, hydrodissection is frequently used in attempts to protect local anatomy, like...
INTRODUCTION: Cryoablation can be used to palliatively and/or definitively treat bone tumors. In transpedicular cryoablation of spine tumors, hydrodissection is frequently used in attempts to protect local anatomy, like nerves. No studies have investigated the direct clinical benefits of hydrodissection in spinal tumor cryoablation. METHODS: To assess for any meaningful rise in temperature around the pedicle when using hydrodissection, cryoprobes were placed through the pedicles bilaterally at six vertebral levels, and a 10-minute freeze cycle was initiated. At each level, one pedicle served as a control and the other received hydrodissection. Temperature measurements were taken every minute at the inferior pedicular cortex, medial pedicular cortex, and at midline of the spinal canal. Distance measurements between the thermometers and cryoprobe were obtained with the aid of three-dimensional reconstruction software. RESULTS: In a time-temperature regression model, the distance from the cryoprobe demonstrated a polynomial relationship with an overtly positive effect on temperature. Time, predictably, resulted in more negative temperatures. The positive polynomial relationship was maintained when looking at the final time point in isolation. Interestingly, no statistically significant change in temperature was demonstrated with use of hydrodissection. Analysis revealed an average temperature difference of 1.89°C (95% confidence interval, -2.26 to 6.05°C) throughout a 10-minute freeze cycle and -1.40°C (95% confidence interval, -8.03°C to 5.24°C) at the final. CONCLUSION: These results suggest that hydrodissection with saline during transpedicular cryoablation may not result in clinically relevant increases in local temperatures. As such, the time devoted to hydrodissection may be better devoted to attaining a well-placed cryoprobe.
Evidence for Systemic Perioperative Antibiotic Prophylaxis for Prevention of Fracture-related Infections Following Open Fractures: Systematic Review and Meta-Analysis of Randomized, Controlled, Clinical Trials.
Klifto KM, Klifto CS, Mithani SK … +3 more , Mundy LR, Gage MJ, Della Rocca GJ
J Am Acad Orthop Surg · 2026 Feb · PMID 41649842 · Publisher ↗
INTRODUCTION: Clinical guidelines rely heavily on expert opinions and institution protocols to provide recommendations for administration of systemic antibiotic prophylaxis for open extremity fractures to prevent fractur...
INTRODUCTION: Clinical guidelines rely heavily on expert opinions and institution protocols to provide recommendations for administration of systemic antibiotic prophylaxis for open extremity fractures to prevent fracture-related infections. The purpose of this study was to determine evidence-based (1) durations; (2) types; (3) dosing regimens of systemic perioperative antibiotic prophylaxis following Gustilo-Anderson types I, I/II, II, III, and I/II/III, for upper and lower extremity open fractures, isolated upper extremity open fractures, and isolated lower extremity open fractures to prevent fracture-related infections. METHODS: Guidelines from Preferred Reporting Items for Systematic Reviews and Meta-Analysis, Cochrane, and the GRADE approach were implemented to structure and synthesize this study. Five databases (PubMed, Cochrane Library, Web of Science, Scopus, CINAHL) were systematically and independently searched for randomized controlled trials (RCTs) meeting eligibility criteria. Included patients had open extremity fractures and were treated with prophylactic systemic antibiotics administered perioperatively (preoperative, intraoperative, postoperative). Meta-analyses were done of the data. RESULTS: Twenty-one (n = 21) RCTs met eligibility criteria (Gustilo-Anderson type I = 6, Gustilo-Anderson type II = 4, Gustilo-Anderson type I/II = 12, Gustilo-Anderson type III = 4, Gustilo-Anderson type I/II/III = 21). Summary tables were generated to provide evidence-based durations and types of systemic antibiotic prophylaxis after Gustilo-Anderson types I, I/II, II, III, and I/II/III, for upper and lower extremity open fractures, isolated upper extremity (hand) open fractures, and isolated lower extremity open fractures. DISCUSSION: Although data were derived primarily from older studies, we summarized the strongest available evidence from RCTs for antibiotic prophylaxis following Gustilo-Anderson types I, I/II, II, III, and I/II/III, for upper and lower extremity open fractures, isolated upper extremity open fractures, and isolated lower extremity open fractures.
Osteochondritis Dissecans of the Elbow: Current Diagnosis and Management.
Haislup BD, Huff SD, Johnston PS … +2 more , Ho JC, Murthi AM
J Am Acad Orthop Surg · 2026 Feb · PMID 41649841 · Publisher ↗
Osteochondritis dissecans (OCD) of the elbow occurs mainly in adolescents and young adults. It can be debilitating and difficult to manage. It occurs frequently in the capitellum of athletes who experience repetitive str...
Osteochondritis dissecans (OCD) of the elbow occurs mainly in adolescents and young adults. It can be debilitating and difficult to manage. It occurs frequently in the capitellum of athletes who experience repetitive stress on the elbow, such as gymnasts and overhead throwers. OCD of the elbow produces insidious pain that can be deep and difficult to localize. Patients with free floating cartilage experience catching or locking sensation in the elbow throughout range of motion. Lesions can be characterized as stable, partially detached, or completely detached (fragmentation with free bodies in the elbow). Evaluation of these OCD lesions includes radiography, ultrasonography, CT, and magnetic resonance imaging. Nonsurgical treatment of OCD lesions is commonly used for stable lesions, with protective weight bearing or complete immobilization for at least 4 weeks and progression to full activity over 6 months. Recently, casting with immobilization has shown to be effective in the management of stable lesions. Surgical management is indicated for lesions that are unstable, produce mechanical symptoms, or have failed nonsurgical treatment. Surgery includes arthroscopic and open procedures such as microfracture, fragment removal, autologous chondrocyte implantation, osteochondral autograft transplantation (OAT), wedge osteotomy, osteochondral allograft, and ultrapurified alginate gel with grafting.
The Evidence Basis and Regulatory Framework for Biologic Augmentation of Foot and Ankle Surgeries.
Haupt ET, Shi GG, Shapiro SA
J Am Acad Orthop Surg · 2026 Jul · PMID 41592273 · Publisher ↗
Biologic augmentation, using substances like bone marrow aspirate concentrate (BMAC) and platelet-rich plasma (PRP), shows promise for improving outcomes in foot and ankle surgery, particularly in high-risk patients. His...
Biologic augmentation, using substances like bone marrow aspirate concentrate (BMAC) and platelet-rich plasma (PRP), shows promise for improving outcomes in foot and ankle surgery, particularly in high-risk patients. Historically, autologous bone graft is the benchmark due to its trifecta of osteogenic, osteoinductive, and osteoconductive properties, despite its associated donor site morbidity. Current evidence supporting orthobiologics remains fragmented and inconclusive, with a lack of high-level randomized controlled trials (RCTs). BMAC shows fusion rates comparable to autograft in some foot and ankle applications, but PRP evidence is often conflicting due to a lack of preparation standardization. The regulatory environment is complex. The Food and Drug Administration (FDA) oversees human cells and tissues (HCT/Ps) through a tiered system: high-risk §351 products (eg, cultured stem cells) require rigorous premarket approval, whereas §361 products (eg, allograft bone) have minimal oversight. BMAC and PRP often bypass this through the Same Surgical Procedure Exemption or are regulated through their processing devices, meaning the biologics themselves are not FDA-approved therapeutics. This regulatory gap and direct-to-consumer marketing necessitate meticulous informed consent, transparently discussing the lack of specific FDA approval, limited evidence, and high out-of-pocket costs. Future success depends on standardized, prospective RCTs and a collaborative "middle-ground pathway" for regulatory approval.
Effect of Postoperative Medication on Range of Motion After Total Knee Arthroplasty: An Evaluation of Venous Thromboembolism Chemoprophylaxis.
Kirwood KL, Dornan GJ, Dietrich AN … +4 more , Hatzinger BM, Hartman Budnik JV, Kuppersmith DA, Kim RH
J Am Acad Orthop Surg · 2026 Jan · PMID 41592270 · Publisher ↗
INTRODUCTION: Postoperative stiffness is a common complication after total knee arthroplasty (TKA), leading to limited range of motion (ROM), pain, and reduced function. Direct oral anticoagulants (DOACs), such as factor...
INTRODUCTION: Postoperative stiffness is a common complication after total knee arthroplasty (TKA), leading to limited range of motion (ROM), pain, and reduced function. Direct oral anticoagulants (DOACs), such as factor Xa inhibitors, are commonly prescribed for venous thromboembolism (VTE) prophylaxis but may increase the risk of postoperative stiffness due to postoperative bleeding within the knee. This study seeks to evaluate the effect of postoperative VTE prophylaxis (factor Xa inhibitors vs. aspirin) on ROM outcomes in patients undergoing TKA. METHODS: A total of 1,054 patients who underwent primary TKA by the senior author between November 2021 and May 2023 were retrospectively identified from an institutional database. Records were examined at preoperative, 2-week, 6-week, <1-year, and >1-year postoperative visits. Logistic regression models analyzed ROM outcomes, defining success as 90° flexion and 0° extension at 2 weeks and 125° flexion and 0° extension at 6 weeks. Manipulation under anesthesia (MUA) was recorded as a secondary end point. RESULTS: Factor Xa inhibitors (apixaban or rivaroxaban) did not significantly affect ROM success at 2 weeks (OR = 0.956, 95% confidence interval [CI, 0.866 to 1.054], P = 0.364) or 6 weeks (OR = 0.986, 95% CI [0.892 to 1.089], P = 0.778) postoperatively, compared with aspirin. VTE prophylaxis type was not found to be significantly associated with MUA likelihood. DISCUSSION: No association was found between postoperative ROM and VTE prophylaxis medication. Previous studies used lower ROM thresholds or focused solely on MUAs. Understanding the effects of DOACs on postoperative stiffness can help guide chemoprophylaxis decisions after TKA.
Transplant Medications and Their Effects on Wound Healing in Orthopaedic Surgery.
Ubong SE, Lozano-Calderon SA
J Am Acad Orthop Surg · 2026 May · PMID 41592263 · Publisher ↗
Transplant medications are an indispensable component of treatment for patients with autoimmune diseases, malignancy, or solid organ transplants. These immunosuppressive agents, although life preserving, create unique ch...
Transplant medications are an indispensable component of treatment for patients with autoimmune diseases, malignancy, or solid organ transplants. These immunosuppressive agents, although life preserving, create unique challenges when patients require orthopaedic surgery. With increased survival rates, immunosuppressed transplant patients frequently require orthopaedic intervention, with approximately 5% developing osteonecrosis, 15% to 20% experiencing osteoporotic fractures, and many developing degenerative joint disease necessitating arthroplasty or reconstructive procedures. By inhibiting inflammatory responses, decreasing collagen synthesis, reducing angiogenesis, and impairing cellular proliferation, transplant medications compromise normal immune function and wound healing processes. This physiological interference leads to elevated risks of surgical site infections, wound dehiscence, delayed union, and implant failure-complications resulting in prolonged hospitalization and poorer functional outcomes. Perioperative management becomes even more complex because of the two to fourfold higher incidence of malignancy in long-term immunosuppressed patients, with orthopaedic surgeons frequently treating individuals on both immunosuppressive and antineoplastic therapies. Despite the growing prevalence of orthopaedic procedures in this population, comprehensive guidance on perioperative wound healing management remains fragmented across the literature. This review systematically examines how transplant medications interfere with tissue repair mechanisms and provides evidence-based recommendations for perioperative medication adjustment to optimize surgical outcomes in this high-risk patient group.
Ondansetron Oral Soluble Pellicles Effectively Reduce the Incidence of Postoperative Nausea and Vomiting Following Primary Total Joint Arthroplasty: A Randomized Controlled Trial.
Wang Y, Zhong S, Zhao L … +2 more , Zhou Z, Wang H
J Am Acad Orthop Surg · 2026 Jan · PMID 41570178 · Publisher ↗
BACKGROUND: Ondansetron is a cornerstone medication for preventing postoperative nausea and vomiting (PONV) in numerous international guidelines. Ondansetron oral soluble pellicles (OSP) represent a needle-free PONV prop...
BACKGROUND: Ondansetron is a cornerstone medication for preventing postoperative nausea and vomiting (PONV) in numerous international guidelines. Ondansetron oral soluble pellicles (OSP) represent a needle-free PONV prophylaxis administration regimen with favorable practicality. We conducted this study to investigate the optimal dosing regimen by comparing the efficacy and safety of different doses of ondansetron OSP for preventing PONV following total joint arthroplasty (TJA). METHODS: This is a randomized, controlled, and double-masked clinical trial. A total of 198 patients were randomized into three groups: the control group receiving two placebo pellicles orally 1 hour before anesthesia induction; the preoperation (Preop) 8-mg group receiving one ondansetron OSP (8 mg) plus one placebo pellicles; and the Preop 16-mg group receiving two ondansetron OSP (16 mg total). The primary outcome was the incidence and severity (measured by visual analog scale scores) of PONV within 48 hours after TJA. The secondary outcome included the frequency of tramadol and metoclopramide and the occurrence of ondansetron adverse drug reactions. RESULTS: Both 8 and 16 mg ondansetron OSP markedly reduced PONV incidence. Compared with the Preop 8-mg group, the Preop 16-mg group demonstrated markedly lower PONV incidence and reduced nausea severity at all postoperative time points relative to the control group, with a greater absolute risk reduction, indicating superior prophylactic efficacy. Adverse drug reactions rates did not differ markedly between the groups. CONCLUSIONS: Compared with placebo, ondansetron OSP effectively reduces the incidence of PONV following TJA and demonstrates a favorable safety profile. The findings suggest a trend toward better efficacy with a preoperative oral dose of 16 mg compared with 8 mg. TRIAL REGISTRATION: Chinese Clinical Trial Registry, ChiCTR2500097588. Registered on 21 February 2025.
Dexmedetomidine Combined With Propofol in Hip Fracture Surgery and Its Effect on Postoperative Pain and Hemodynamics.
Shi L, Ye P, Peng W … +6 more , Yin Y, Xing Y, Pan C, Zhang B, Zhang Y, Zhang D
J Am Acad Orthop Surg · 2026 Feb · PMID 41570176 · Publisher ↗
OBJECTIVE: This study aims to examine the use of dexmedetomidine (DEX) combined with propofol in hip fracture surgery and its effect on postoperative pain and hemodynamics. METHODS: One hundred forty patients undergoing...
OBJECTIVE: This study aims to examine the use of dexmedetomidine (DEX) combined with propofol in hip fracture surgery and its effect on postoperative pain and hemodynamics. METHODS: One hundred forty patients undergoing hip fracture surgery were divided into a treatment group (receiving DEX combined with propofol anesthesia) and a control group (receiving propofol anesthesia). The Ramsay Sedation Scale was used to evaluate the sedative effect 24 hours postoperatively, while the Visual Analog Scale was used to assess the analgesic effect 24 hours after surgery. The Montreal Cognitive Assessment (MoCA) scale was used to evaluate cognitive function before and 24 hours after surgery. Heart rate (HR) and mean arterial pressure (MAP) were recorded at different stages of anesthesia, and the incidence of postoperative adverse reactions was also recorded. RESULTS: Compared with the control group, at 24 hours postoperatively, patients in the treatment group had higher Ramsay sedation scores and lower Visual Analog Scale scores ( P < 0.05). Before surgery, the MoCA scores of both groups showed no significant difference ( P > 0.05), but the treatment group had higher MoCA scores 24 hours after surgery compared with the control group ( P < 0.05). No difference was observed in HR and MAP levels before anesthesia between the two groups ( P > 0.05), while the treatment group performed lower MAP and HR levels than the control group at skin incision and at the end of surgery ( P < 0.05). In addition, the incidence of postoperative adverse reactions was lower in the treatment group than in the control group ( P < 0.05). CONCLUSION: DEX combined with propofol for composite anesthesia in hip fracture surgery effectively meets the requirements for surgical anesthesia, maintains hemodynamic stability, and exhibits good postoperative analgesic and sedative effects.
Tuberosity Management in Reverse Shoulder Arthroplasty for Proximal Humerus Fractures.
Hachadorian M, Cutuk A, Hebert-Davies J … +1 more , Kent WT
J Am Acad Orthop Surg · 2026 Feb · PMID 41549864 · Publisher ↗
The predictability of outcomes with reverse shoulder arthroplasty (RSA), compared with hemiarthroplasty or open reduction and internal fixation, has led to its increased use in treating displaced three- and four-part pro...
The predictability of outcomes with reverse shoulder arthroplasty (RSA), compared with hemiarthroplasty or open reduction and internal fixation, has led to its increased use in treating displaced three- and four-part proximal humerus fractures (PHFs) in patients older than 65 years. Although RSA was initially designed to restore humeral elevation in the absence of a functional rotator cuff, studies have shown improved patient-reported outcomes and range of motion in patients who achieve tuberosity union following surgery. Despite numerous advancements in implant design over the past decade, optimal strategies to maximize outcomes in PHFs remain debated. This article reviews indications, intraoperative decision making, implant selection, and surgical techniques to optimize outcomes for patients undergoing RSA for PHFs.
Targeted Muscle Reinnervation and Regenerative Peripheral Nerve Interface: The Evolving Landscape in the Treatment of Postamputation Pain and Prosthetics.
Roubaud MJ, Babu A, Moon BS … +1 more , Lewis VO
J Am Acad Orthop Surg · 2026 Feb · PMID 41549863 · Publisher ↗
Targeted muscle reinnervation (TMR) and regenerative peripheral nerve interface (RPNI) are two novel microsurgical techniques that can improve prosthetic control and prevent and treat chronic limb pain following amputati...
Targeted muscle reinnervation (TMR) and regenerative peripheral nerve interface (RPNI) are two novel microsurgical techniques that can improve prosthetic control and prevent and treat chronic limb pain following amputation. Both techniques use nerve transfer to reroute the neural input from a transected nerve to new muscle targets, thereby preventing neuroma formation and creating a new functional pathway between peripheral nerves and the brain. These techniques were originally developed to improve myoelectronic bioprosthetic control, but both TMR and RPNI have expanded in their indications to the prevention and treatment of symptomatic neuromas, thus improving quality of life and decreasing the narcotic burden in this vulnerable population. This review describes the principles of TMR and RPNI, their indications, the perioperative technique, and the postoperative management of patients undergoing these procedures.
Hip Spine Syndrome: Management of Patients With Concurrent Hip and Spine Degenerative Pathologies.
Le HV, Shahzad H, Klineberg E … +2 more , Heckmann N, Lum ZC
J Am Acad Orthop Surg · 2026 Feb · PMID 41549862 · Publisher ↗
Hip-spine syndrome (HSS) is characterized by the presence of concurrent hip and spine degenerative conditions. It can be further classified as simple, secondary, complex, or misdiagnosis. Patients may present with a myri...
Hip-spine syndrome (HSS) is characterized by the presence of concurrent hip and spine degenerative conditions. It can be further classified as simple, secondary, complex, or misdiagnosis. Patients may present with a myriad of symptoms, including low back pain, groin pain, radicular leg pain, and neurogenic claudication, with or without neurological deficits. Treatment of HSS is complex and involves a multidisciplinary team of spine surgeons, hip surgeons, pain physiatrists, and physical therapists. In treating HSS, it is imperative to first identify the primary pain generator through a thorough hip and spine examination and diagnostic and therapeutic injections. The decision whether to operate on the hip or spine first is multifaceted and depends on clinical, radiographic, and surgical considerations. In this article, we review the most recent literature on the management of patients with HSS, with an emphasis on surgical treatment.
Clinical and Radiologic Outcomes After Periacetabular Osteotomy for Dysplastic Hips of Adolescents With Hypermobility Spectrum Disorder.
Sullivan C, Zhao L, Uchtman M … +2 more , McCarthy JJ, Whitlock PW
J Am Acad Orthop Surg · 2026 Apr · PMID 41533890 · Publisher ↗
BACKGROUND: Periacetabular osteotomy (PAO) is a common procedure for the treatment of symptomatic acetabular dysplasia in adolescent patients. Despite concerns regarding surgical outcomes and complications in patients wi...
BACKGROUND: Periacetabular osteotomy (PAO) is a common procedure for the treatment of symptomatic acetabular dysplasia in adolescent patients. Despite concerns regarding surgical outcomes and complications in patients with hypermobility spectrum disorders (HSD), the outcomes of PAO in such patients are not well documented. METHODS: We conducted a retrospective cohort review of patients who underwent PAO for the treatment of symptomatic acetabular dysplasia. Radiographic parameters including the lateral center edge angle of Wiberg (LCEA), medial center edge angle (MCEA), anterior wall index (AWI), posterior wall index (PWI), and Tönnis angle were measured. Patient-reported outcomes (PROs) were also collected. RESULTS: The mean duration of follow-up of non-HSD and HSD patients was 2.86 ± 0.73 years and 3.00 ± 1.11 years, respectively. No significant differences were found in mean age ( P = 0.289), sex, body mass index ( P = 0.125), laterality ( P = 0.192), or the duration of follow-up ( P = 0.636). Postoperatively, LCEA and AWI in patients with HSD were higher than those in non-HSD patients ( P = 0.002, P = 0.007, respectively). No notable differences were observed in Modified Harris Hip Score, Nonarthritic Hip Score, International Hip Outcome Tool, Hip Dysfunction and Osteoarthritis Outcome Score, or mean changes in PROs between the non-HSD and HSD groups at preoperative, 1-year postoperative, and most recent follow-up timepoints. However, patient-reported satisfaction with surgery in the HSD group (9.39 ± 1.04) was significantly higher than the non-HSD group (8.35 ± 1.95; P = 0.047). CONCLUSION: Patients with HSD exhibited similar outcomes to patients without HSD after PAO for symptomatic acetabular dysplasia. Postoperative AWI and LCEA were markedly greater in patients with HSD consistent with our technical bias toward increased correction in such hips, suggesting greater anterolateral coverage of the femoral head after PAO may be a promising strategy to achieve improved outcomes in patients with HSD.
Management of Chest Wall Injuries: An Updated Review.
Dehghan N, Nauth A, McKee M
J Am Acad Orthop Surg · 2026 May · PMID 41525674 · Publisher ↗
Injuries to the chest wall are common after blunt thoracic trauma, which can cause injury to the ribcage and intrathoracic structures. Such trauma can result in a spectrum of injuries, ranging from minor injuries such as...
Injuries to the chest wall are common after blunt thoracic trauma, which can cause injury to the ribcage and intrathoracic structures. Such trauma can result in a spectrum of injuries, ranging from minor injuries such as an isolated rib fracture to extensive injuries such as multiple rib fractures/flail segments with underlying lung or intrathoracic injury. The primary focus of this article will be on the assessment and treatment of injuries of the bony chest wall, with an emphasis on flail chest and multiple rib fractures. Patient evaluation, treatment, and outcomes differ depending on the severity of injury. The use of CT scans has become routine in the diagnosis and evaluation of injury severity. Treatment options include both nonsurgical care (analgesia, regional anesthetic techniques, and mechanical ventilation) and surgical fixation of the chest wall. While there has been notable interest in surgical fixation of flail chest injuries over the past two decades, there remains controversy regarding the potential benefits of surgery and the indications for surgical management. However, it is clear that patients with flail chest injuries are best managed by a multidisciplinary team, including collaboration between orthopaedic and trauma surgery.
Acute Total Hip Arthroplasty for Acetabular Fractures.
Pumilia CA, Cunningham DJ, Murr K … +1 more , Jones T
J Am Acad Orthop Surg · 2026 May · PMID 41512262 · Publisher ↗
Acetabular fractures are becoming more common, especially in the elderly population. Standard goals of management include restoring stability and articular congruity to the hip joint in an effort to minimize the risk of...
Acetabular fractures are becoming more common, especially in the elderly population. Standard goals of management include restoring stability and articular congruity to the hip joint in an effort to minimize the risk of posttraumatic arthritis. This is most commonly achieved through open reduction and internal fixation, from which outcomes are generally positive. However, several preoperative risk factors have been identified that correlate with poor outcomes, such as severe acetabular impaction, femoral-sided lesions, and older age. Furthermore, goals of management in the increasingly encountered elderly acetabular fracture may predominantly consist of postoperative mobilization and minimizing revision surgery. In the select patient with identifiable risk factors, acute total hip arthroplasty with or without concurrent fracture fixation may be able to improve outcomes. Specifically, acute total hip arthroplasty appears to reduce the risk of revision surgery in comparison to fracture fixation alone and may improve complication profiles in comparison to conversion arthroplasty after failed fixation, albeit at the expense of an increased surgical insult at the initial surgery. However, given the heterogeneity and short-term nature of the available data, more robust and long-term data will be required before definitive conclusions can be drawn.
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