Kim K, Kim SY, Kim SS
… +3 more, Kim JH, Ro DH, Choi BS
J Bone Joint Surg Am
· 2026 Jun · PMID 42234729
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BACKGROUND: Early diagnosis of knee osteoarthritis (KOA) is often delayed due to reliance on subjective interpretation of radiographs. Recent advances in artificial intelligence (AI)-based automated Kellgren-Lawrence (KL...BACKGROUND: Early diagnosis of knee osteoarthritis (KOA) is often delayed due to reliance on subjective interpretation of radiographs. Recent advances in artificial intelligence (AI)-based automated Kellgren-Lawrence (KL) grading offer the potential to improve diagnostic accuracy and enable earlier nonoperative treatment. However, the cost-effectiveness of such AI tools has not been comprehensively evaluated. This study aimed to assess the economic value of AI-assisted KL grading in comparison with conventional radiographic assessment by health-care professionals. METHODS: We developed a model-based cost-effectiveness analysis comparing AI-assisted KL grading versus conventional human-reader assessment. A hybrid decision tree and Markov model simulated disease progression and treatment pathways in a hypothetical cohort of South Korean adults aged ≥50 years. Outcomes included lifetime costs, quality-adjusted life years (QALYs), and incremental cost-effectiveness ratios (ICERs). Analyses were performed from a health-care system perspective. Deterministic and probabilistic sensitivity analyses (DSAs and PSAs) were conducted to evaluate the effects of uncertainty. RESULTS: The AI-assisted strategy yielded a total cost of $137,710 and 22.721 QALYs, compared with $140,834 and 22.461 QALYs for usual care. This resulted in cost savings of $3,125 and a QALY gain of 0.260, leading to an ICER of -$12,031 per QALY gained. One-way sensitivity analysis showed that the model was most sensitive to AI-related costs and the effectiveness of nonoperative treatment. PSA demonstrated a 55.1% probability of the AI-assisted strategy being cost-effective at a willingness-to-pay threshold of $34,642. CONCLUSIONS: AI-assisted radiographic grading of KOA demonstrated potential cost savings and a favorable cost-effectiveness profile compared with usual care. However, given the uncertainty reflected in the PSA, its integration into routine imaging workflows should be approached cautiously and supported by further validation in real-world clinical settings. LEVEL OF EVIDENCE: Economic and Decision Analysis Level II. See Instructions for Authors for a complete description of levels of evidence.
Liu J, Schmitt P, Caus S
… +5 more, Gilreath N, Okewunmi J, Antoci V, Testa EJ, Cohen E
J Bone Joint Surg Am
· 2026 Jun · PMID 42228770
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➢ Over the past 4 decades, total joint arthroplasty (TJA) has transitioned from primarily an inpatient procedure to a procedure increasingly performed in outpatient settings, driven by advancements in perioperative care...➢ Over the past 4 decades, total joint arthroplasty (TJA) has transitioned from primarily an inpatient procedure to a procedure increasingly performed in outpatient settings, driven by advancements in perioperative care protocols, regional anesthesia, reimbursement models, and a shift in cultural expectations.➢ Studies have shown that outpatient TJA can be performed with similar surgical outcomes compared with inpatient TJA, provided that there is appropriate patient selection and optimization of perioperative management. Patient selection for outpatient TJA relies on risk assessment, utilizing scoring systems and consideration of social factors and support systems for the patients. Key aspects of perioperative management include patient education, rehabilitation, and optimized pain control strategies, which are essential for the success of same-day discharge and the minimization of complications.➢ The transition to outpatient TJA aligns with the increasing demand for TJA and rising health-care costs, representing a shift toward value-based care and a change in clinical practice. Outpatient TJA has been shown to have optimal patient outcomes and cost-efficiency, contributing to the overall sustainability of health-care practices.
J Bone Joint Surg Am
· 2026 Jun · PMID 42228769
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Total joint arthroplasty (TJA) is increasingly performed in a global patient population that includes individuals observing prolonged daily fasting during Ramadan, a lunar calendar-based observance occurring over 29 to 3...Total joint arthroplasty (TJA) is increasingly performed in a global patient population that includes individuals observing prolonged daily fasting during Ramadan, a lunar calendar-based observance occurring over 29 to 30 consecutive days. Daily fasting may exceed 14 to 18 hours depending on geography and season, producing measurable alterations in hydration, glycemic variability, circadian rhythm, and sleep architecture that intersect with perioperative safety in TJA. This article synthesizes the physiologic and perioperative considerations, examines the implications for patients and surgeons, and proposes a framework for risk stratification, shared decision-making, and perioperative management. Elective TJA during Ramadan is not inherently contraindicated but requires structured assessment, perioperative planning, and patient counseling.
J Bone Joint Surg Am
· 2026 Jun · PMID 42228767
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The extended trochanteric osteotomy (ETO) has been a standard technique in complex revision hip arthroplasty. Despite the satisfactory healing rates with ETO, nonunion may occur, and failure of fixation and displacement...The extended trochanteric osteotomy (ETO) has been a standard technique in complex revision hip arthroplasty. Despite the satisfactory healing rates with ETO, nonunion may occur, and failure of fixation and displacement of the trochanter may compromise abductor strength. The extended lesser trochanteric osteotomy (ELTO) is an alternative to the ETO in select patients that allows medial access to 3 sides of the femoral stem and incorporates the lesser trochanter along with a variable length of the medial femoral cortex, to which the iliopsoas tendon and adductors remain attached. The ELTO might be easier, faster, and shorter compared with the ETO while offering unobstructed exposure of 3 sides of the femoral stem. The most substantial advantage is the ability to spare the abductor attachment, eliminating the need for postoperative protected weight-bearing and abduction braces.
J Bone Joint Surg Am
· 2026 May · PMID 42213819
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BACKGROUND: The utilization of artificial intelligence (AI), such as machine learning, in health care has risen exponentially, underscoring the necessity of transparency and traceability in the reporting of AI in randomi...BACKGROUND: The utilization of artificial intelligence (AI), such as machine learning, in health care has risen exponentially, underscoring the necessity of transparency and traceability in the reporting of AI in randomized controlled trials (RCTs) that involve AI. In 2020, a CONSORT (Consolidated Standards of Reporting Trials) AI extension was published that included 14 additional items that should be reported when AI is used in RCTs. This study aimed to evaluate compliance with these additional guidelines. METHODS: A systematic approach was used to identify all RCTs in orthopaedics that involved AI since the extension was published. Three databases were searched (PubMed, Embase, Cochrane) using the search terms ([orthopaedic] OR [orthopedic]) AND ([artificial intelligence] OR [AI] OR [machine learning] OR [deep learning]). RESULTS: One hundred and seventy-four articles were identified, and 11 articles satisfied the inclusion and exclusion criteria and were assessed for compliance. The average number of CONSORT AI-extension items met per study was 11.4 ± 1.6 (81.2% ± 12.1%). Eight items (1a [i], 1b [ii], 2a [i], 4a [i], 5 [ii], 5 [v], 5 [vi], 19) that were related to standard reporting of AI utilization were reported in all articles. The items with the lowest reporting rates were related to data transparency and included 4a (ii), 5 (iii), and 25, with only 9.1%, 36.4%, and 45.5% of all studies complying, respectively. CONCLUSIONS: Orthopaedic RCTs involving AI showed high compliance with respect to standard trial reporting and broad AI descriptors but low compliance with respect to detailed data transparency, data-quality handling, and code accessibility. Addressing these weaker areas is essential to improve reproducibility, reduce bias, and strengthen trust in AI-driven clinical research. CLINICAL RELEVANCE: Improved compliance with CONSORT-AI reporting standards may help orthopaedic clinicians to critically evaluate AI-based randomized trials, reproduce findings, and determine whether AI interventions are reliable and safe for clinical use.
Kamio S, Ikegami M, Kitada R
… +7 more, Miwa S, Ogura K, Iwata S, Kawai A, Kobayashi E, Suehara Y, Kohsaka S
J Bone Joint Surg Am
· 2026 May · PMID 42202043
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BACKGROUND: Accurate identification of gene fusions is critical for precision oncological approaches to sarcomas, where specific fusion genes are actionable targets of tyrosine kinase (TK) inhibitors. This study provides...BACKGROUND: Accurate identification of gene fusions is critical for precision oncological approaches to sarcomas, where specific fusion genes are actionable targets of tyrosine kinase (TK) inhibitors. This study provides a descriptive overview of the real-world use, under a universal health insurance program, of 3 different comprehensive genomic profiling (CGP) panels within the Japanese national CGP system: GenMineTOP, which integrates DNA and RNA sequencing, and 2 DNA-based panels, FoundationOne CDx and the OncoGuide NCC Oncopanel System. METHODS: We examined 2,633 sarcoma cases from the Center for Cancer Genomics and Advanced Therapeutics (C-CAT) database to identify potentially actionable alterations classified by the Cancer Knowledge Database (CKDB). The mean patient age was 51.1 years, and 45% were female. Detection rates of TK fusions (FGFR1-4, NTRK1-3, ALK, RET, ROS1, and BRAF) were compared descriptively. Additionally, 3 sarcoma cases with an NTRK fusion detected by GenMineTOP were functionally validated. RESULTS: Potentially actionable alterations (CKDB Levels A, B, and C) were identified in 566 patients (21.5%). Actionable TK fusions were detected in 3.1% (8 of 254) with GenMineTOP, 1.4% (31 of 2,211) with FoundationOne CDx, and 0.6% (1 of 168) with NCC Oncopanel. GenMineTOP identified rare NTRK fusions, including RBPMS::NTRK2, HTT::NTRK2, and EML4::NTRK3. Functional assays suggested their oncogenic potential and demonstrated responsiveness to the TK inhibitors larotrectinib and entrectinib. CONCLUSIONS: In this cohort, the DNA+RNA-based panel showed a higher detection rate for TK fusions, although the panels were applied to different patient groups and the sensitivity and specificity could not be determined. Future studies evaluating different test types on the same tumor specimens are warranted to clarify whether the dual-sequencing approaches can improve the identification of actionable genetic events. LEVEL OF EVIDENCE: Diagnostic Level IV. See Instructions for Authors for a complete description of levels of evidence.