Khan AA, Paris E, Sbampato V
… +6 more, De Marco G, Tabard-Fougère A, Vazquez O, Steiger C, Dayer R, Ceroni D
J Bone Joint Surg Am
· 2026 May · PMID 42085536
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BACKGROUND: This observational study systematically used magnetic resonance imaging (MRI) to determine the prevalence of concomitant osteomyelitis and its influence on clinical outcomes in cases of pediatric septic arthr...BACKGROUND: This observational study systematically used magnetic resonance imaging (MRI) to determine the prevalence of concomitant osteomyelitis and its influence on clinical outcomes in cases of pediatric septic arthritis (SA) of the hip. METHODS: We retrospectively analyzed the demographic, clinical, microbiological, and radiographic data of 58 children treated for SA of the hip who underwent systematic MRI between 2000 and 2025. Patients were categorized into 2 groups: isolated septic arthritis and septic arthritis with concomitant osteomyelitis. The clinical and laboratory parameters, causative pathogens, and treatments were compared between the groups. RESULTS: Concomitant osteomyelitis was identified with MRI in 43% (25) of the 58 patients, while radiographs detected it in only 16%. Demographic, clinical, and inflammatory parameters were statistically similar between the groups. Kingella kingae was the most commonly identified pathogen (37.9%), and Staphylococcus aureus and Streptococcus spp. were more frequently associated with repeat surgery. No significant differences in complication rates, treatment duration, or outcomes were found between the groups. CONCLUSIONS: The systematic use of MRI revealed concomitant osteomyelitis in >40% of cases of pediatric SA. However, the presence of osteomyelitis was not associated with worse outcomes, suggesting that factors related to the microorganism profile or virulence must contribute substantially to disease severity. Nonetheless, MRI should be considered early in any diagnostic work-up of pediatric SA of the hip. LEVEL OF EVIDENCE: Diagnostic Level III. See Instructions for Authors for a complete description of levels of evidence.
Mun JS, Dean MC, Gillinov SM
… +7 more, Poutre RL, Chenna SS, Allen BJ, Beck da Silva Etges AP, Treloar JA, Satalich JR, Martin SD
J Bone Joint Surg Am
· 2026 Jun · PMID 42024715
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BACKGROUND: Understanding drivers of supply and labor cost variation in orthopaedic surgery is crucial to provide value-based care. Time-driven activity-based costing (TDABC) is a more accurate methodology for capturing...BACKGROUND: Understanding drivers of supply and labor cost variation in orthopaedic surgery is crucial to provide value-based care. Time-driven activity-based costing (TDABC) is a more accurate methodology for capturing costs of care than traditional methods. Anterior cruciate ligament reconstruction (ACLR) is one of the most performed outpatient procedures within orthopaedic surgery. The purpose of this study was to characterize the cost composition of ACLR and identify factors that drive cost variation. METHODS: Cost data for supplies and time-based personnel usage were extracted from electronic health records and were used to calculate costs using TDABC. TDABC methodology was applied to calculate the cost of personnel usage by multiplying the duration and associated cost per minute. Descriptive statistics and mixed-effects modeling were used to determine cost drivers. RESULTS: This study included 861 patients who underwent ACLR at 8 hospitals. The mean patient age (and standard deviation) was 31.1 ± 11.6 years. Of the 861 patients, 350 were male and 511 were female; 85.6% of patients were White, 8.1% were Asian, and 3.4% were Black. There was 3.2-fold variation in supply costs ($2,950) and 1.6-fold variation in labor costs ($940) between the 10th and 90th percentiles. Overall, supply costs accounted for 58.2% of total costs, whereas labor costs comprised the remaining 41.8%. The intraoperative phase was the greatest generator of total cost (89.7%). After adjusting for surgeon and hospital variability, variation in total cost was most effectively explained by graft type, primary surgery status, and meniscal repair (conditional R 2 = 0.84; marginal R 2 = 0.27). On subanalysis, patients undergoing allograft ACLR had significantly higher total costs, implant costs, and age compared with those undergoing ACLR with any autograft type (all p < 0.01). CONCLUSIONS: The most notable drivers of labor and supply cost variation were graft type, surgeon, surgery center, primary surgery status, and concomitant meniscal repair. Understanding modifiable cost drivers may aid health systems in designing value-based pathways, implant formularies, and surgeon education programs. Future studies may integrate cost with outcome measures for a more holistic view of value. LEVEL OF EVIDENCE: Economic and Decision Analysis Level III . See Instructions for Authors for a complete description of levels of evidence.
Jiang W, Gan D, Tommasini S
… +3 more, Latich IY, Lindskog D, Lee FY
J Bone Joint Surg Am
· 2026 Apr · PMID 42018647
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BACKGROUND: For patients with periacetabular metastases, protrusio acetabuli is a severely painful and mobility-impairing complication that requires subsequent open joint surgery. We aimed to identify specific structural...BACKGROUND: For patients with periacetabular metastases, protrusio acetabuli is a severely painful and mobility-impairing complication that requires subsequent open joint surgery. We aimed to identify specific structural changes that are associated with progression to protrusio acetabuli and to create a scoring system to guide risk stratification. METHODS: In this single-institution cohort study, we identified all patients who underwent primary surgical stabilization for periacetabular metastases with osteolytic or mixed osteolytic-osteoblastic characteristics from October 2017 through January 2025. Cases of protrusio acetabuli prior to surgical intervention were identified. Pain and ambulatory functional scores and treatment history were recorded. Locations of bone destruction were evaluated using coronal-cut computed tomography (CT) scans obtained within 3 months before clinical presentation (and earlier, as available). Trabecular and subchondral cortical bone mass of the periacetabular weight-bearing portions were indirectly assessed via Hounsfield unit ratio comparisons across scans. Univariable analysis of each feature was performed. The highest-scoring features were used to create a scoring system and analyzed using a receiver operating characteristic (ROC) curve. Finite element analysis was performed for biomechanical validation. RESULTS: Eighty-seven patients (67 non-protrusio [mean age of 65.5 ± 13.0 years; 37 female]; 20 protrusio [mean age of 72.9 ± 10.1 years; 11 female]) were included. Locationally, bone defects, thinning, or linear fractures in the middle-third (apex) alongside contiguous involvement of either the medial- or lateral-third of the weight-bearing dome were highly predictive of protrusio. A >50% cortical bone-mass decrease of the acetabular weight-bearing dome was associated with protrusio (p < 0.05). A radiographic risk scoring system was then constructed using a grading system from low- to high-risk features. ROC analysis showed a score of ≥3.0 as 95.0% sensitive and 91.0% specific for progression to protrusio. Finite element analysis further showed that cortical bone loss of the middle-third (apex) of the weight-bearing dome was critical. CONCLUSIONS: We propose the use of clinical and radiographic risk predictors to stratify patients with periacetabular metastases on the basis of the risk of protrusio. Anatomically, surgical stabilization of the middle-third (apex) of the weight-bearing dome is critical to preventing or delaying progression to protrusio. LEVEL OF EVIDENCE: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
Lum ZC, Cohen-Rosenblum A, Yao JJ
… +3 more, Chen AF, Landy DC, Parvizi J
J Bone Joint Surg Am
· 2026 Apr · PMID 42018608
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Infection remains one of the most catastrophic complications following orthopaedic surgery. Despite substantial advances in molecular diagnostics, biomarker assays, and consensus definitions, accurately diagnosing orthop...Infection remains one of the most catastrophic complications following orthopaedic surgery. Despite substantial advances in molecular diagnostics, biomarker assays, and consensus definitions, accurately diagnosing orthopaedic infection continues to challenge even the most experienced clinicians. There are differences in the diagnosis and treatment of infections that are related to different anatomic regions. The difficulty arises from the inherent biological diversity of infecting organisms and surgical locations, variable host responses, and the absence of a true diagnostic "gold standard." This article summarizes the current diagnostic challenges and emerging solutions, drawing on recent high-impact evidence and consensus frameworks.
Zhang Y, Wang S, Bai Z
… +6 more, Zhang Y, Niu X, Liu S, Han Y, Zhuang Q, Zhang J
J Bone Joint Surg Am
· 2026 Apr · PMID 42013198
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BACKGROUND: Pedicle subtraction osteotomy (PSO) and vertebral column resection (VCR) are powerful techniques for correcting severe spinal deformities. Although PSO has been proposed as a viable alternative to VCR, their...BACKGROUND: Pedicle subtraction osteotomy (PSO) and vertebral column resection (VCR) are powerful techniques for correcting severe spinal deformities. Although PSO has been proposed as a viable alternative to VCR, their comparative efficacies and safety profiles require further elucidation. METHODS: This single-center retrospective study analyzed 169 patients (mean age, 22 years; 84 male; 169 ethnic Chinese) with severe kyphoscoliosis who underwent primary corrective surgery via PSO (n = 85) or VCR (n = 84). Radiographic parameters, surgical data, intraoperative neuromonitoring (IOM) changes, Scoliosis Research Society (SRS)-22 scores, and complications were compared between groups. RESULTS: Both techniques significantly improved all radiographic parameters and SRS-22 scores (p < 0.001). The VCR group demonstrated superior correction of the major curve (65.5% versus 56.9%, p = 0.003), segmental kyphosis (68.1% versus 61.5%, p = 0.03), and apical vertebral rotation (48.5% versus 34.4%, p = 0.001). At the critical osteotomy stage, 105 (62.1%) of 169 patients experienced IOM signal decline. The neurological complications rate was significantly higher in the VCR group (13 of 84 versus 7 of 85, p = 0.038), as was the overall complication rate (43 of 84 versus 29 of 85, p = 0.008). Each 1° increase in correction achieved with VCR was associated with a 1.6% higher risk of complications (OR = 1.016, p = 0.045). CONCLUSIONS: Although both PSO and VCR were highly effective for major deformity correction, VCR provided a greater magnitude of correction in the coronal, sagittal, and axial planes. However, this advantage was counterbalanced by a significantly higher risk of complications, including neurological deficits. Despite the frequent reversibility of IOM signal declines, VCR retained a higher risk profile due to its higher overall complication rate. LEVEL OF EVIDENCE: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
Morgan JT, Nishioka T, Casanova F
… +3 more, Moatshe G, LaPrade RF, Chahla J
J Bone Joint Surg Am
· 2026 Jun · PMID 42013196
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➢ Meniscal preservation has become the central management principle of meniscal tears. Biomechanical evidence has demonstrated that meniscal resection increases joint contact stress, accelerates osteoarthritis progressio...➢ Meniscal preservation has become the central management principle of meniscal tears. Biomechanical evidence has demonstrated that meniscal resection increases joint contact stress, accelerates osteoarthritis progression, and worsens long-term outcomes compared with repair and nonoperative management. ➢ Treatment decisions should be individualized based on tear morphology, tissue quality, and patient-specific factors. ➢ Repair technique selection (all-inside, inside-out, or outside-in) should be dictated by the tear location and pattern. ➢ Adjunct treatment strategies, such as biologic augmentation, may be used selectively to increase the potential for meniscal healing, although these strategies have inconsistent outcomes.