Pekas DR, Adrados M, Lee MM
… +5 more, Lee Y, Burks WG, Martino JM, Coobs BR, Moskal JT
J Bone Joint Surg Am
· 2026 Apr · PMID 42013190
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BACKGROUND: Effective pain management following total knee arthroplasty (TKA) is crucial to optimizing patient outcomes and experiences. Multimodal pain management protocols vary between institutions, with some recently...BACKGROUND: Effective pain management following total knee arthroplasty (TKA) is crucial to optimizing patient outcomes and experiences. Multimodal pain management protocols vary between institutions, with some recently proposing the addition of an intraosseous (IO) injection of morphine intraoperatively. The purpose of this study was to investigate whether the addition of an intraoperative, IO injection of morphine during elective primary TKA would lead to improved pain control and decreased narcotic consumption during the postoperative period. METHODS: In this double-blinded, randomized controlled trial, 100 patients undergoing elective primary TKA were prospectively enrolled. All patients received spinal anesthesia and intravenous sedation combined with an intraoperative, surgeon-administered adductor canal block. The experimental group received an intraoperative, IO injection containing 10 mg of morphine and 500 mg of vancomycin in 110 mL of normal saline solution. The control group received the same injection but without morphine. All patients received 6 daily text-message surveys (3 in the morning and 3 in the evening) for 14 days postoperatively to collect pain scores, morphine milligram equivalent (MME) consumption, and nausea and vomiting events. Data on demographics, operative factors, post-anesthesia care unit (PACU) pain scores, PACU MME consumption, and patient-reported outcomes were also collected. Linear mixed-effects (LME) models were utilized. RESULTS: A total of 88 patients (52.3% [n = 46] female; mean age, 69.1 ± 9.0 years [range, 46 to 89 years]; 89.8% [n = 79] White) were included in the analysis. The LME model demonstrated no differences between the groups with respect to daily pain scores at any time point within 14 days postoperatively (p = 0.969). There were no differences between the groups with respect to daily MME consumption at any time point within 14 days postoperatively (p = 0.377). There were also no differences in total MME consumption or weekly MME consumption postoperatively (p ≥ 0.878). CONCLUSIONS: IO morphine did not significantly improve postoperative pain control or decrease narcotic consumption up to 2 weeks postoperatively among patients undergoing elective primary TKA. LEVEL OF EVIDENCE: Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.
Iyer A, Telang SS, Culler MC
… +4 more, Yun AG, Oakes DA, Lieberman JR, Heckmann ND
J Bone Joint Surg Am
· 2026 Apr · PMID 42008602
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BACKGROUND: Lower surgeon case-volume has been associated with a greater risk of postoperative complications such as dislocation following total hip arthroplasty (THA). However, robotic assistance and computer navigation...BACKGROUND: Lower surgeon case-volume has been associated with a greater risk of postoperative complications such as dislocation following total hip arthroplasty (THA). However, robotic assistance and computer navigation may mitigate the volume-dependent risk of instability. This study sought to compare dislocation rates between lower-volume surgeons performing technology-assisted (TA) THAs and higher-volume surgeons utilizing conventional instrumentation (CI). METHODS: The Premier Healthcare Database was queried to identify adult patients who underwent primary elective THA from 2016 to 2023. Surgeons with <10% technology use formed the CI group, and surgeons with ≥90% technology use formed the TA group. These groups were further subdivided into higher-volume (HV) and lower-volume (LV) on the basis of surgeon annual case-volume, using a previously validated threshold of 109 cases/year. Mixed-effects modeling was used to compare the 90-day risk of dislocation between patients treated by low-volume surgeons using TA (LV-TA group) and high-volume surgeons using CI (HV-CI group). RESULTS: A total of 669,098 patients undergoing THA were identified. Of these, 5,447 patients were treated by LV-TA surgeons and 190,550, by HV-CI surgeons. Notably, LV-TA surgeons achieved a similar rate of dislocation compared with HV-CI surgeons (0.48% versus 0.42%, p = 0.510). After controlling for confounding factors, the risk of dislocation remained comparable between LV-TA and HV-CI surgeons (adjusted odds ratio: 1.062, 95% confidence interval: 0.677 to 1.668, p = 0.793). CONCLUSIONS: Surgeons with a lower case-volume who used technology assistance achieved a rate of dislocation similar to that of surgeons with a higher case-volume who used conventional instrumentation. These findings demonstrate that technology assistance, including computer navigation and robotic assistance, may attenuate the association between surgeon case-volume and dislocation risk following primary THA. 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 41990135
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Knee pain resulting from acute trauma and overuse injury is common among athletes and represents a major cause of reduced performance, time loss from sport, and long-term sequelae including osteoarthritis. Injectable the...Knee pain resulting from acute trauma and overuse injury is common among athletes and represents a major cause of reduced performance, time loss from sport, and long-term sequelae including osteoarthritis. Injectable therapies are frequently used as a nonoperative treatment modality to alleviate symptoms and facilitate early return to sport. This review evaluates the current evidence on commonly used knee injectables in the younger athletic population with pre-arthritic knee pain, including corticosteroids, hyaluronic acid, platelet-rich plasma (PRP), and other biologics. Relevant literature was identified without restriction on study design and with a focus on athlete-specific outcomes and clinical applicability. Overall, the available evidence on knee injectables for athletes remains limited, heterogeneous, and largely extrapolated from older, nonathletic cohorts. In the absence of available athlete-specific guidelines, most injectables carry weak and/or conditional recommendations, highlighting the need for individualized treatment and shared decision-making. High-quality, sport-specific clinical trials are required to establish clear guidelines and optimize outcomes in this population.
Bouché PA, Lübbeke A, Brand C
… +3 more, Gonzalez AI, Beck M, Hannouche D
J Bone Joint Surg Am
· 2026 Feb · PMID 41985069
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BACKGROUND: Periprosthetic femoral fractures (PFFs) are an increasingly common indication for revision total hip arthroplasty (THA). While patient-related risk factors are well documented, the influence of femoral stem d...BACKGROUND: Periprosthetic femoral fractures (PFFs) are an increasingly common indication for revision total hip arthroplasty (THA). While patient-related risk factors are well documented, the influence of femoral stem design on PFF risk remains poorly characterized. In this study using nationwide data, we assessed the association between stem design and PFF risk. METHODS: We analyzed 182,118 primary THAs (performed from 2015 to 2023) from the Swiss National Joint Registry (SIRIS). Cementless stems were categorized according to the Kheir classification, and cemented stems were categorized as double-tapered polished, triple-tapered polished, composite-beam, or custom. A multivariable Cox regression model, including variables such as age, sex, American Society of Anesthesiologists (ASA) class, body mass index (BMI), surgical indication, prior ipsilateral hip surgery, stem design, collar, dual-mobility cup, bearing, and head size, was analyzed. Hazard ratios (HRs) with 95% confidence intervals (CIs) are reported. RESULTS: Among 182,118 THAs (mean patient age, 68.9 ± 11.5 years; female sex in 53.1% of cases), 1,226 (0.7%) were complicated by PFF. The cumulative incidence of PFF reached 0.7% at 5 years and 1.3% at 10 years. Higher PFF risk was associated with an age of 75 to 84 years (HR = 1.68 [95% CI = 1.44 to 1.96]) and ≥85 years (HR = 1.86 [95% CI = 1.47 to 2.35]), ASA class of 3 to 5 (females, HR = 1.70; males, HR = 1.73), BMI of <18.5 kg/m2 (HR = 1.61) or ≥40 kg/m2 (HR = 1.64), prior ipsilateral hip surgery (HR = 1.32), and use of a dual-mobility cup (HR = 1.56). Elective procedures (HR = 0.36) and collared stems (HR = 0.26) were associated with a lower risk. Compared with cementless type-3 stems, cementless type-7 (anatomic) stems showed a higher risk of PFF (HR = 1.88), whereas cementless type-1B (HR = 0.62) and composite-beam cemented stems (HR = 0.45) were protective. CONCLUSIONS: In this large nationwide registry study, femoral stem design independently influenced PFF risk after primary THA. Cementless anatomic stems increased the risk, whereas composite-beam cemented stems and the presence of a collar conferred a protective effect. These findings support personalized implant selection, particularly for older patients or those with frailty. LEVEL OF EVIDENCE: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
Super JT, Chahla J, Geeslin AG
… +2 more, Moatshe G, LaPrade RF
J Bone Joint Surg Am
· 2026 Jun · PMID 41984925
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➢ Multiligament knee injuries (MLKIs) encompass a heterogeneous spectrum of severe knee trauma, presenting ongoing challenges in their diagnosis, classification, management, and postoperative rehabilitation. This review...➢ Multiligament knee injuries (MLKIs) encompass a heterogeneous spectrum of severe knee trauma, presenting ongoing challenges in their diagnosis, classification, management, and postoperative rehabilitation. This review synthesizes the current evidence with expert clinical perspectives to summarize key principles in evaluation and management. ➢ Thorough clinical examination, stress radiography, and magnetic resonance imaging can improve injury characterization and objective quantification of pathologic laxity to guide surgical planning. ➢ Contemporary reconstruction strategies emphasize the detection of posteromedial corner, posterolateral corner, and meniscal pathologies, while recognizing that appropriate management of these associated injuries protects cruciate reconstruction grafts. ➢ Treatment timing remains controversial, with increasing evidence and consensus for early, comprehensive single-stage surgery when feasible in selected patients. ➢ Modern approaches to MLKI management should prioritize restoration of anatomy, biomechanical stability, meticulous planning to avoid tunnel convergence, and rehabilitation strategies.
Kadiyala S, Powis E, Mirahmadi A
… +13 more, Mercado C, Yu S, Velichala SR, Colannino A, Hung I, Bikoroti JB, Kubwimana O, Dusingizimana LR, Alayande BT, Ingabire JCA, Byiringiro JC, Rodriguez EK, Agarwal-Harding KJ
J Bone Joint Surg Am
· 2026 Jun · PMID 41973832
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➢ Open fractures are a critical global health challenge that disproportionately affect individuals in low- and middle-income countries (LMICs), primarily due to road traffic collisions. Surgical management of open fractu...➢ Open fractures are a critical global health challenge that disproportionately affect individuals in low- and middle-income countries (LMICs), primarily due to road traffic collisions. Surgical management of open fractures is 1 of the 3 essential bellwether procedures identified by The Lancet Commission on Global Surgery. ➢ We developed and evaluated a novel hybrid course on open fracture management for surgical trainees and practicing surgeons in Rwanda, combining a self-directed, virtual, pre-course curriculum with a live, in-person workshop in Kigali in June 2025 that was simultaneously live-streamed for virtual attendees. Prerecorded multilingual lectures (English and French) and curated peer-reviewed articles provided foundational knowledge in advance and prepared learners for in-person didactics, case discussions, and skills training. ➢ The in-person workshop included didactic sessions and discussions of local clinical cases from Rwanda related to open fracture management and other orthopaedic emergencies, along with hands-on practice in fracture external fixation and negative pressure wound therapy using affordable devices designed for resource-constrained practice. ➢ The workshop engaged 160 active learners (37 in-person, 123 virtual) and demonstrated high overall satisfaction among 84 survey respondents, with an average rating of 4.6 out of 5. ➢ Self-reported confidence in managing open fractures increased substantially following the course, from a mean rating of 3.83 to 4.69 on a 5-point scale (p < 0.001). Most survey respondents reported that the course moderately or significantly improved their knowledge (96.4%) and would change their clinical practice (96.5%). ➢ Participant feedback highlighted opportunities for improvement, including extending the workshop duration to increase hands-on time, expanding the content on complex soft-tissue management, and improving the engagement of remote learners through mechanisms such as the provision of low-cost external fixation models for at-home practice. ➢ Future directions include integrating the course into medical student and general practitioner education in Rwanda, adapting it for major surgical conferences regionally and internationally, and continuing to prioritize hands-on training modules. Iterative refinement of the course is planned on the basis of participant feedback.
J Bone Joint Surg Am
· 2026 Apr · PMID 41973830
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Short-term surgical missions have expanded access to total joint arthroplasty (TJA) in regions where degenerative joint disease remains undertreated. Reports from these initiatives frequently highlight procedural volume...Short-term surgical missions have expanded access to total joint arthroplasty (TJA) in regions where degenerative joint disease remains undertreated. Reports from these initiatives frequently highlight procedural volume and low early complication rates, reinforcing the perception of success. However, these metrics capture only the earliest phase of outcome assessment following TJA. Durable arthroplasty quality is defined by implant survivorship, complication surveillance, revision capacity, and longitudinal follow-up. In many short-term mission models, long-term tracking, implant traceability, and local capacity for complication management are described incompletely. Without standardized benchmarks, the orthopaedic community risks equating surgical throughput with sustained impact. This article examines the limitations of the current reporting practices in mission-based arthroplasty and proposes an accountability framework that is centered on safety surveillance, follow-up infrastructure, implant traceability, revision capability, capacity development, and financial transparency. As global TJA efforts expand, defining meaningful quality metrics is essential to ensure that episodic interventions translate into durable patient benefit and resilient local systems.
Nepple JJ, Hood H, Kim YJ
… +7 more, Beaulé P, Sierra R, Millis M, Robben Z, Drain C, Clohisy JC, ANCHOR Study Group
J Bone Joint Surg Am
· 2026 Jun · PMID 41973826
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BACKGROUND: Long-term outcomes of femoroacetabular impingement (FAI) surgery, particularly survivorship, are critical to guide treatment decision-making and patient counseling, yet only a limited number of studies have r...BACKGROUND: Long-term outcomes of femoroacetabular impingement (FAI) surgery, particularly survivorship, are critical to guide treatment decision-making and patient counseling, yet only a limited number of studies have reported mid- to long-term survivorship. The purpose of this study was to report survivorship rates at a mean 10-year follow-up in a large, multicenter FAI surgery cohort and to identify clinical predictors of survivorship. METHODS: A prospective, multicenter cohort study assessed patients treated for FAI with hip arthroscopy or surgical dislocation from 2008 to 2012. At a minimum of 8 years, 362 hips (80.1%) had follow-up that permitted assessment of total hip arthroplasty (THA)-free survivorship. A Cox proportional-hazards model was developed to identify risk factors for THA. RESULTS: tThe cohort included 362 hips with a mean patient age of 32.1 years; 53% were in females, and 95.6% were in Caucasian patients. The THA-free survivorship of the cohort was 90.6% at a mean of 10.4 ± 1.6 years postoperatively. Risk factors for THA were older age at surgery (p = 0.01), male sex (p = 0.02), body mass index of ≥30 kg/m 2 (p = 0.009), and femoral head chondromalacia (p < 0.001). CONCLUSIONS: This study demonstrates that FAI surgery yielded durable 10-year THA-free survivorship of 90.6%. Older age at surgery, obesity, male sex, and femoral head chondromalacia were key predictors of conversion to THA. LEVEL OF EVIDENCE: Therapeutic Level II . See Instructions for Authors for a complete description of levels of evidence.