J Bone Joint Surg Am
· 2026 Jun · PMID 42308325
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BACKGROUND: New drugs, devices, and other tools are essential to improving children's orthopaedic care. An often underappreciated aspect of new products is the amount of time and money needed to bring them to the bedside...BACKGROUND: New drugs, devices, and other tools are essential to improving children's orthopaedic care. An often underappreciated aspect of new products is the amount of time and money needed to bring them to the bedside. While grants and other seed money have a role very early in the development of technology by start-ups, the bulk of the expense of such development is borne by private investors. METHODS: We examined a quarter century of early-stage investments in pediatric orthopaedic start-ups and compared them with similar investments in adult-focused orthopaedic companies. RESULTS: Investor backing of pediatric enterprises was much less common, representing only 10% of investments in the field of orthopaedics. Yet, when pediatric companies were supported, the rate at which they acquired subsequent capital and the total amount of capital they raised were comparable with those of adult-focused companies. CONCLUSIONS: Investments in new pediatric orthopaedic innovations from 2000 to 2024 were far less common than adult orthopaedic investments. Our data underscore the unmet challenges of backing start-ups in the field and provide benchmark data against which founders and investors can judge their financial performance. CLINICAL RELEVANCE: The availability of new orthopaedic tools is tied to capital investment in the field's youngest companies. A more complete understanding of long-term trends in the private financing of pediatric orthopaedic start-ups is essential for founders, investors, and policymakers.
Soule S, Smith A, Staten T
… +6 more, Kirkham M, Zhang C, Presson A, Joyce CD, Tashjian RZ, Chalmers PN
J Bone Joint Surg Am
· 2026 Jun · PMID 42302114
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BACKGROUND: Loss to follow-up is among the most important sources of bias in clinical research. Thus, the purpose of this study was to identify factors associated with a failure to complete a 2-year follow-up after shoul...BACKGROUND: Loss to follow-up is among the most important sources of bias in clinical research. Thus, the purpose of this study was to identify factors associated with a failure to complete a 2-year follow-up after shoulder surgery. We hypothesized that older patients would demonstrate higher follow-up rates and that patients who underwent instability surgery would have lower follow-up rates. METHODS: A retrospective chart review was conducted on 1,028 consecutive patients who underwent shoulder surgery performed by a single surgeon between 2017 and 2022. All patients were contacted by the surgeon via telephone, text message, and email at 2 years postoperatively. Variables analyzed included demographic characteristics, insurance status, surgical procedure type, Social Deprivation Index (SDI), and distance from the surgical site to home. Multivariable logistic regression analysis was performed to determine which factors were associated with 2-year follow-up. RESULTS: Of the 1,028 patients, 507 (49%) completed a 2-year follow-up. The mean patient age was 51 years, 585 patients (57%) were male, and 443 patients (43%) were female. Ninety-four percent of patients were White. Patients who completed follow-up were older (mean age, 53 compared with 49 years; p < 0.001), more likely to have undergone an arthroplasty, and more often insured by Medicare. Loss to follow-up was associated with instability surgery, Medicaid or Workers' Compensation insurance, and missing preoperative visual analog scale (VAS) pain scores. SDI scores and distance from the surgical site were not significant predictors. Age was a covariate of both surgery type and insurance status. In the multivariable model, younger age (odds ratio [OR], 0.99; p < 0.001) and missing VAS scores (OR, 1.51; p = 0.001) independently predicted loss to follow-up, whereas current alcohol use (OR, 0.74; p = 0.024) was associated with lower odds of loss to follow-up. CONCLUSIONS: Older age emerged as the most significant predictor of follow-up adherence. Older patients, often undergoing arthroplasty and covered by Medicare, were more likely to complete follow-up. These findings highlight the need for targeted strategies to improve follow-up rates among younger patients, particularly those undergoing instability surgeries, as well as patients with Medicaid and Workers' Compensation insurance. LEVEL OF EVIDENCE: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
Yu X, Yuan Y, Zhao S
… +9 more, Sun Z, Han F, Wang S, Zhang Z, Sun K, Duan F, Jia Y, Ma Y, Li T
J Bone Joint Surg Am
· 2026 Jun · PMID 42302095
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BACKGROUND: Hip fracture volumes are rising with population aging, and inadequate analgesia following hip fracture surgery has been shown to impede early mobilization and recovery. Liposomal bupivacaine (LB) may extend a...BACKGROUND: Hip fracture volumes are rising with population aging, and inadequate analgesia following hip fracture surgery has been shown to impede early mobilization and recovery. Liposomal bupivacaine (LB) may extend analgesia, but previous orthopaedic trials have yielded mixed results. We therefore tested whether adding local incisional infiltration of LB to multimodal analgesia confers clinically relevant advantages in geriatric hip fracture surgery. METHODS: This study was a single-center, prospective, randomized, participant and assessor-blinded, parallel-group exploratory trial in older adults undergoing hemiarthroplasty or total hip arthroplasty for a hip fracture. The intervention was local LB infiltration; the control was no local infiltration. The primary end point was resting pain measured on a visual analog scale (VAS, 0 to 10) at 48 hours postoperatively. Prespecified key secondary end points included early pain with activity, morphine milligram equivalents (MME) of the patient-controlled analgesia (PCA) infusion volume and of the total perioperative oral and intramuscular rescue counts, sleep quality measured on a numerical rating scale (NRS, 0 to 10), total sleep time, and nocturnal awakenings. RESULTS: A total of 76 patients (median age, 77 years; 49 female) were included in the analysis. The primary end point did not differ between the groups (median 0 for both; p = 0.143; point estimate of between-group difference: Cohen d = -0.506, 95% confidence interval: -0.962, -0.048), whereas several secondary outcomes significantly favored LB, including resting pain at 24 hours; activity pain at 8, 24, and 48 hours; and oral rescue administrations (median and interquartile range: 25 [0, 50] versus 50 [25, 100] MME). The LB group had a higher NRS sleep quality score after surgery, with a longer total sleep duration on the operative night, than the control group; the number of awakenings was similar between the groups. Ambulation at 48 and 72 hours and the number of postoperative days to discharge did not differ between the groups. CONCLUSIONS: In the context of a standardized multimodal analgesic pathway, local incisional infiltration of LB did not improve the prespecified primary end point of resting pain at 48 hours after geriatric hip fracture surgery. Overall, the current evidence does not support routine clinical use, and further investigation is warranted. LEVEL OF EVIDENCE: Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.
J Bone Joint Surg Am
· 2026 Jun · PMID 42301246
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BACKGROUND: Total ankle arthroplasty (TAA) is increasingly performed worldwide for the treatment of end-stage tibiotalar osteoarthritis. There are limited data in the literature regarding the long-term survival of third-...BACKGROUND: Total ankle arthroplasty (TAA) is increasingly performed worldwide for the treatment of end-stage tibiotalar osteoarthritis. There are limited data in the literature regarding the long-term survival of third-generation implants. The primary aim of this study was to characterize the long-term survival of the SALTO TALARIS TAA implant. METHODS: This was a multisurgeon, single-center, retrospective study of 164 consecutive ankles (155 patients) that underwent surgery between 2009 and 2013. The mean age at surgery was 64.4 years, and 60% of patients were women. The mean follow-up was 12 years (range, 10 to 15 years). Implant survival was estimated using the Kaplan-Meier method. Data collected included implant survival, clinical range of motion, American Orthopaedic Foot & Ankle Society (AOFAS) score, and the number of patients with a "forgotten" joint. The same surgical technique and identical pre- and postoperative radiographic assessments were used for all patients. RESULTS: One hundred and fifty-five patients with 164 TAAs were initially included; 17 patients (17 TAAs) died, and 3 patients (3 TAAs, 1.8%) were lost to follow-up before 10 years. Survival free from any surgery involving the tibiotalar joint was 94.1% (95% confidence interval [CI]: 90.5% to 97.9%) at 10 years. Implant survival with the end point of revision of at least 1 metallic component was 96.2% (95% CI: 93.4% to 99.2%) at 10 years. Implant survival with the end point of removal and conversion to arthrodesis was 99% (95% CI: 98% to 100%) at 10 years. At the latest follow-up, the mean dorsiflexion (and standard deviation) was 12° ± 5°, the mean plantar flexion was 23° ± 7°, and the median AOFAS score was 98. Patients considered 62 (43%) of the ankles "forgotten" joints. CONCLUSIONS: The SALTO TALARIS TAA is a reliable implant with a low reoperation rate and excellent long-term survival. These findings provide long-term reference survival data for a third-generation fixed-bearing TAA system. LEVEL OF EVIDENCE: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
Lex JR, Ekhtiari S, Entezari B
… +4 more, Koucheki R, McLawhorn AS, Pincus D, Ravi B
J Bone Joint Surg Am
· 2026 Jun · PMID 42300223
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BACKGROUND: Obesity is an independent risk factor for complications following total hip arthroplasty (THA). Preoperative bariatric surgery to facilitate weight loss has been used to reduce complication risk, but its effe...BACKGROUND: Obesity is an independent risk factor for complications following total hip arthroplasty (THA). Preoperative bariatric surgery to facilitate weight loss has been used to reduce complication risk, but its effectiveness remains unclear. The purpose of this study was to evaluate the impact of bariatric surgery on the risk of surgical complications in patients with morbid obesity undergoing THA. METHODS: A population-based, retrospective cohort study was conducted using administrative data from Ontario, Canada. All adults undergoing primary elective THA from 2002 to 2023 were subclassified according to the presence of morbid obesity (body mass index [BMI], ≥40 kg/m2) and whether they had undergone prior bariatric surgery. The primary outcome was a composite of major surgical complications within 1 year, including revision arthroplasty, periprosthetic fracture, periprosthetic joint infection (PJI), and dislocation. Secondary outcomes were 30-day hospital readmission and length of stay. Multivariable logistic regression adjusted for demographic, medical, and surgical factors was used. RESULTS: A total of 148,977 patients who underwent THA were identified, including 10,287 patients (6.9%) with morbid obesity and 637 patients (0.4%) who had undergone prior bariatric surgery. Patients who had undergone bariatric surgery had the highest risk of major surgical complications, particularly PJI. Even among patients who achieved a BMI of <40 kg/m2 following bariatric surgery, there was a higher risk of major complications (odds ratio [OR], 1.84 [95% confidence interval (CI), 1.16 to 2.94]) and PJI (OR, 3.36 [95% CI, 1.48 to 7.63]) compared with patients with a similar BMI who had not undergone prior bariatric surgery. Prior bariatric surgery did not reduce revision risk, including in patients achieving a BMI of <40 kg/m2 (p = 0.077). All bariatric and morbidly obese cohorts demonstrated higher 30-day readmission rates. CONCLUSIONS: Prior bariatric surgery did not significantly reduce major surgical complications or infection risk following THA. Our findings suggest that THA should not be routinely delayed for bariatric surgery to reduce postoperative complications. Alternative strategies for obesity management and perioperative risk mitigation warrant further investigation. LEVEL OF EVIDENCE: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
J Bone Joint Surg Am
· 2026 Jun · PMID 42284371
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➢ Romanian orthopaedic practice has demonstrated a growing uptake of digital infrastructure, including the implementation of robotic-assisted surgical workflows and emerging applications of artificial intelligence.➢ Roma...➢ Romanian orthopaedic practice has demonstrated a growing uptake of digital infrastructure, including the implementation of robotic-assisted surgical workflows and emerging applications of artificial intelligence.➢ Romania ranks among the European countries with the highest hospital bed capacity per capita, supporting the provision of sustained care for elderly patients, including those with fragility fractures and oncologic orthopaedic conditions and those undergoing complex revision surgeries.➢ The Romanian Arthroplasty Register was modernized and relaunched in 2025 as an initiative to align with other long-standing national European counterparts.
Li Y, Wang F, Li Y
… +4 more, Mu W, Ji B, Zhang X, Cao L
J Bone Joint Surg Am
· 2026 Jun · PMID 42275484
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BACKGROUND: Although cellularity is traditionally evaluated morphologically, an emerging transcriptome-sequencing-based algorithm enables simultaneous inference of cellular information. We studied whether cellularity pro...BACKGROUND: Although cellularity is traditionally evaluated morphologically, an emerging transcriptome-sequencing-based algorithm enables simultaneous inference of cellular information. We studied whether cellularity profiles predicted using CIBERSORTx would (1) depict immune cell-type abundances in periprosthetic tissues across arthroplasty failure etiologies, and (2) provide prognostic value for identifying cases of periprosthetic joint infection (PJI). METHODS: CIBERSORTx-derived cellularity profiles were evaluated in 185 periprosthetic tissue samples, including 135 from patients with PJI (64 males; median age, 66 years) and 50 from those with aseptic failure (AF) (36 males; median age, 62.5 years), that had been subjected to bulk RNA sequencing. Kaplan-Meier survival analysis was performed to assess prognostic outcomes in PJI. RESULTS: Of the 22 evaluated cell types, 5 were significantly elevated in PJI cases: plasma cells, resting memory CD4+ T cells, CD8+ T cells, activated mast cells, and M1 macrophages (all p < 0.05 after Benjamini-Hochberg [BH] correction). Conversely, 3 cell types were significantly elevated in AF cases: gamma delta T cells, M0 macrophages, and M2 macrophages (all p < 0.05 after BH correction). Of the combined immune cell populations, total B cells, total T cells, and natural killer cells were significantly elevated in PJI cases, while total macrophages/monocytes were significantly elevated in AF cases (all p < 0.05 after BH correction). Patients with PJI who had a CD8+/regulatory T cell (Treg) ratio above the median had a significantly lower rate of infection recurrence than those below the median (log-rank p = 0.0252). CONCLUSIONS: CIBERSORTx analysis of samples from periprosthetic tissues predicted distinct immune cell profiles that differed between PJI and aseptic arthroplasty failure modes, and also identified a high CD8+/Treg ratio as a potential prognostic marker. This transcriptomic approach provides a novel, single-assay strategy for evaluating local immune cell responses across arthroplasty failure etiologies. CLINICAL RELEVANCE: The comparative analysis of immune cell-type abundances in periprosthetic tissues across arthroplasty failure etiologies revealed distinct immune microenvironment signatures that differentiate PJI from AF. Additionally, the finding that a higher CD8+/Treg cell ratio is associated with a lower rate of infection recurrence offers a potential prognostic marker to help identify patients with PJI who are at a lower risk for treatment failure.
Klaassen AD, Willigenburg NW, Musters JWQ
… +3 more, Jager J, Poolman RW,
the Santeon Hip Osteoarthritis Group
J Bone Joint Surg Am
· 2026 Jul · PMID 42274751
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BACKGROUND: Hip dislocation is the most common reason for early revision after total hip arthroplasty (THA). To prevent dislocation, patients are often prescribed movement restrictions following THA; however, these restr...BACKGROUND: Hip dislocation is the most common reason for early revision after total hip arthroplasty (THA). To prevent dislocation, patients are often prescribed movement restrictions following THA; however, these restrictions can be uncomfortable and limiting for patients and may delay a return to daily activities. The present study aimed to investigate whether a protocol with reduced movement restrictions following THA would lead to an increased incidence of early hip dislocations. METHODS: In this uncontrolled, multicenter, before-and-after study, 2 groups were retrospectively compared. Patients who underwent a THA between January 1, 2015, and March 31, 2020, were included. Patients in the first group (n = 7,666) were prescribed strict movement restrictions following THA, and patients in the second group (n = 2,691) were prescribed minimal movement restrictions. Patient and prosthesis characteristics were collected, as well as data regarding hip dislocations within 90 days postoperatively as the primary outcome. RESULTS: The incidence of early hip dislocations was not significantly different between movement groups, with 112 (1.46%) of 7,661 hips in the restricted group and 52 (1.93%) of 2,691 hips in the minimally restricted group experiencing a dislocation (p = 0.093). CONCLUSIONS: The use of a protocol with minimal movement restrictions following THA did not increase the incidence of early hip dislocations. LEVEL OF EVIDENCE: Therapeutic Level III . See Instructions for Authors for a complete description of levels of evidence.