Schafer KA, Day J, Motsay M
… +3 more, Zhang H, Zhang Z, Schon LC
J Bone Joint Surg Am
· 2026 Jun · PMID 42359899
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BACKGROUND: Total ankle arthroplasty (TAA), traditionally performed through an anterior approach, has generally been reserved for older patients. A lateral transfibular approach requires minimal osseous resection and per...BACKGROUND: Total ankle arthroplasty (TAA), traditionally performed through an anterior approach, has generally been reserved for older patients. A lateral transfibular approach requires minimal osseous resection and permits implantation into denser bone, which may make it a durable option for younger candidates. This study compared midterm implant survivorship and clinical and radiographic outcomes following primary transfibular TAA in patients younger and older than 55 years. METHODS: Patients who underwent primary transfibular TAA and had a minimum follow-up of 5 years were included. Patient-reported outcome measures (PROMs) included the 12-Item Short-Form Health Survey (SF-12), Ankle Osteoarthritis Scale (AOS), and visual analog scale (VAS) for pain. Radiographic alignment, range of motion, and periprosthetic cysts (radiolucency of >2 mm) were assessed. Adverse events and reoperations were reported. Outcomes in younger (<55 years old) and older (≥55 years old) patients were compared using multivariable linear regression and linear mixed models. RESULTS: Two hundred and fifty-one ankles (in 236 patients; 86% White) were included. The younger group included 72 ankles (in 70 patients, mean age of 45.4 years [95% confidence interval (CI), 43.7 to 47.1] years) with a mean of 6.9 (6.2 to 7.5) years of follow-up; the older group included 179 ankles (in 166 patients, mean age of 65.7 years [64.7 to 66.7] years) with a mean of 7.0 (6.7 to 7.3) years of follow-up. The younger group more commonly had a primary diagnosis of posttraumatic arthritis (83% versus 61%) and a history of ankle fracture fixation (84% versus 68%) (both p < 0.05). There were no significant differences between the younger and older groups in the rate of adverse events (40.3% versus 33.0%), time to reoperation (21.7 versus 27.4 months), implant revision (1.4% versus 0%), or periprosthetic cysts (5.6% versus 2.8%). In analyses controlling for confounding variables, age did not demonstrate significant associations with pre- or postoperative PROMs, alignment, or range of motion (all p > 0.05). CONCLUSIONS: Although this study was not designed to determine equivalence between the age groups, favorable midterm outcomes were observed in both younger and older patients. These results suggest that transfibular TAA may be a viable treatment option for end-stage ankle arthritis across a wide age range, but longer-term follow-up is needed. LEVEL OF EVIDENCE: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
Kumaran P, Telang SS, Culler M
… +7 more, Palmer RC, Longjohn DB, Oakes DA, Anderson LA, Fillingham YA, Wolfstadt JI, Heckmann ND
J Bone Joint Surg Am
· 2026 Jun · PMID 42340321
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BACKGROUND: Stacked metaphyseal cone constructs can be used to address extensive metaphyseal and metadiaphyseal bone loss encountered during complex primary or revision total knee arthroplasty (TKA). Our study reports th...BACKGROUND: Stacked metaphyseal cone constructs can be used to address extensive metaphyseal and metadiaphyseal bone loss encountered during complex primary or revision total knee arthroplasty (TKA). Our study reports the 5-year outcomes of a multicenter cohort of stacked-cone constructs used to manage extensive bone loss encountered during primary or revision TKA. METHODS: A retrospective review was conducted to identify patients who underwent primary or revision TKA with tibial and/or femoral stacked-cone constructs between July 2016 and September 2025 at 4 tertiary academic institutions. Demographic, operative, clinical, and radiographic data were obtained and analyzed. Five-year implant survivorship free from all-cause reoperation, all-cause revision, and stacked-cone construct revision for aseptic loosening was analyzed using Kaplan-Meier estimation. RESULTS: Eighty-four cases with a mean patient age of 67.3 years and a mean follow-up of 20.85 months were identified. Five-year survivorship was 56.5% (95% confidence interval [CI], 22.7% to 78.3%) free from all-cause reoperation, 65.2% (95% CI, 25.8% to 87.1%) free from all-cause revision, and 91.7% (95% CI, 52.5% to 99.8%) free from stacked-cone construct revision for aseptic loosening. Stacked-cone revision due to aseptic loosening was performed on the tibial side in 1 case (1.2%) at 3.6 years following the index surgery. Five other stacked cones were revised for periprosthetic joint infection (4 all femoral stacked-cone cases) and tibial implant fracture (1 tibial stacked-cone case). CONCLUSIONS: Stacked-cone constructs demonstrated excellent 5-year survivorship free from aseptic loosening. However, all-cause reoperations and revisions were common in this cohort, reflecting the complex nature of this patient population. LEVEL OF EVIDENCE: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
Jung SH, Kim SH, Yeo I
… +3 more, Han SH, Suk KS, Park SY
J Bone Joint Surg Am
· 2026 Jun · PMID 42335210
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➢ This review commemorates the centennial of orthopaedic practice at Severance Hospital and Yonsei University College of Medicine by tracing its historical evolution and milestones in modern orthopaedic surgery in South...➢ This review commemorates the centennial of orthopaedic practice at Severance Hospital and Yonsei University College of Medicine by tracing its historical evolution and milestones in modern orthopaedic surgery in South Korea.➢ Chejungwon, the predecessor of Severance Hospital and Yonsei University College of Medicine, was founded in 1885 as Korea's first Western-style hospital and played a pivotal role in the introduction and institutionalization of modern medicine in Korea. This development was made possible through the efforts of American missionaries, who contributed to the early establishment of Western medical education and clinical practice.➢ Modern orthopaedic practice at Severance began in 1926 with the return of Yong-Seol Lee, the first Korean physician to receive structured orthopaedic training in the United States, marking the emergence of orthopaedics as a distinct specialty in Korea.➢ The establishment of an independent Department of Orthopaedic Surgery at Severance Hospital in 1953 further strengthened its academic and clinical foundations during a period characterized by war-related trauma, infectious diseases, and national reconstruction.➢ Over subsequent decades, the department has contributed to the development of orthopaedic subspecialties, clinical excellence, and academic research, while playing a central role in founding and leading the Korean Orthopaedic Association.
He M, Ferrini A, Chisari E
… +3 more, Kolhoff F, Sehgal P, Parvizi J
J Bone Joint Surg Am
· 2026 Jun · PMID 42308500
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➢ The relationship between the gastrointestinal tract and joint diseases has garnered increased attention over recent decades, leading to the introduction of the gut-joint axis concept.➢ Infections at sites such as joint...➢ The relationship between the gastrointestinal tract and joint diseases has garnered increased attention over recent decades, leading to the introduction of the gut-joint axis concept.➢ Infections at sites such as joints and the spine may originate endogenously from the gut microbiome.➢ The idea of microbial translocation through a compromised epithelial barrier, resulting in the circulation of pathogens or their byproducts, and the idea of immune cell-mediated transport of pathogens to various sites are gaining further attention.➢ By understanding the interaction between the immune system and gut microbiota, potential therapeutic strategies, such as the use of organoids, can be developed to restore the gut barrier integrity, to replenish gut microbiota, and to provide biodiversity.➢ To better understand the mechanisms linking gut health and joint diseases, future basic-science research and well-designed clinical trials, exploiting advanced next-generation sequencing techniques, are needed.
Acuña AJ, Forlenza EM, Jones CM
… +3 more, DeBenedetti A, Terhune EB, Della Valle CJ
J Bone Joint Surg Am
· 2026 Jun · PMID 42308497
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BACKGROUND: The purpose of this study was to compare the outcomes of patients who underwent a total hip arthroplasty (THA) and sustained a postoperative periprosthetic femoral fracture either within the early postoperati...BACKGROUND: The purpose of this study was to compare the outcomes of patients who underwent a total hip arthroplasty (THA) and sustained a postoperative periprosthetic femoral fracture either within the early postoperative period, within 30 days, or at later time points. METHODS: A large, all-payer national database was queried to identify patients who underwent a primary THA between 2010 and 2022. Patients who underwent a primary THA and sustained a periprosthetic femoral fracture within 30 days postoperatively were propensity-score matched on the basis of age, sex, and comorbidity burden to 3 separate cohorts based on timing: fracture between 31 and 90 days postoperatively (n = 1,725), fracture between 91 days and 1 year (n = 1,887), and no fracture within 1 year (n = 4,465). The 30-day fracture group had a mean age of 66.63 ± 10.15 years, and 75% of patients in this group were female. Regression analyses were utilized to evaluate outcomes at 90 days and 2 years. Survivorship analyses utilizing death as a competing end-point were conducted for rates of infection, refracture, and reoperation at up to 2 years. RESULTS: Patients who sustained a periprosthetic femoral fracture within 30 days after primary THA demonstrated significantly greater rates of complications within 90 days relative to each comparison cohort. The 2-year survivorships free of refracture and reoperation were significantly lower (p < 0.05) for the early fracture cohort relative to matched patients who sustained a fracture at other time points. Additionally, 2-year survivorships were poorer in the ≤30-day cohort than in the comparison cohort who had not sustained a fracture within 1 year postoperatively: survivorships free of infection (87.8% [95% confidence interval (CI), 86.8% to 88.8%] compared with 97.7% [95% CI, 97.3% to 98.1%]), refracture (57.4% [95% CI, 56.0% to 58.9%] compared with 99.5% [95% CI, 99.3% to 99.7%]), and reoperation (48.5% [95% CI, 47.1% to 50.0%] compared with 97.6% [95% CI, 97.2% to 98.1%]) were all significantly lower (p < 0.05). CONCLUSIONS: Patients who sustained an early periprosthetic femoral fracture within 30 days following primary THA were at significantly greater risk for complications than patients who sustained a periprosthetic femoral fracture at later time points. The exceedingly high rates of complications compared with patients without a periprosthetic femoral fracture stresses the importance of not only prevention but potential interventions both perioperatively and postoperatively in an attempt to mitigate the risk of complications for these at-risk patients. LEVEL OF EVIDENCE: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
Valsamis EM, Dufresne M, Chambers K
… +3 more, Lapner P, Beaulé P, Grammatopoulos G
J Bone Joint Surg Am
· 2026 Jun · PMID 42308495
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BACKGROUND: The mandatory collection of patient-reported outcome measures and the implementation of thresholds for hip and knee replacement surgery represent a growing international trend in value-based health-care polic...BACKGROUND: The mandatory collection of patient-reported outcome measures and the implementation of thresholds for hip and knee replacement surgery represent a growing international trend in value-based health-care policy. Our aim was to investigate whether the Oxford Hip Score (OHS) and Oxford Knee Score (OKS) can be used to accurately predict patient satisfaction, and to estimate thresholds to guide value-based health-care policy. METHODS: All primary total hip replacements (THRs) and total knee replacements (TKRs) for osteoarthritis undertaken at a tertiary academic institution over a 6-year period were identified. Logistic regression models were used to evaluate preoperative and postoperative values for the OHS and OKS, and the change between them, as predictors of patient satisfaction. Optimal thresholds for both the minimal clinically important difference (MCID) and the substantial clinical benefit (SCB) were identified. RESULTS: A total of 1,429 THRs (mean patient age, 66.1 years, standard deviation [SD], 11.1 years; 819 [57.3%] female) and 1,079 TKRs (mean patient age, 68.3 years, SD, 8.4 years; 635 [58.9%] female) were included. For the postoperative OHS, thresholds of 35.5 (95% confidence interval [CI], 29.1 to 41.9) for the MCID and 36.5 (95% CI, 33.0 to 40.0) for the SCB were identified. For the postoperative OKS, thresholds of 30.5 (95% CI, 24.2 to 36.8) for the MCID and 38.5 (95% CI, 36.7 to 40.3) for the SCB were identified. For the change in OHS, thresholds of 19.5 (95% CI, 13.4 to 25.6) for the MCID and 20.5 (95% CI, 16.0 to 25.0) for the SCB were identified. For the change in OKS, thresholds of 13.5 (95% CI, 8.3 to 18.7) for the MCID and 14.5 (95% CI, 11.7 to 17.3) for the SCB were identified. Patients with worse preoperative function had higher thresholds. Preoperative Oxford scores were poor predictors of patient satisfaction. CONCLUSIONS: The thresholds for the postoperative Oxford scores and change scores may guide value-based health-care decision-making using the OHS and OKS. LEVEL OF EVIDENCE: Prognostic Level II . See Instructions for Authors for a complete description of levels of evidence.
J Bone Joint Surg Am
· 2026 Jun · PMID 42308468
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An important and often overlooked legacy and orthopaedic innovation of Dr. David G. Murray is the Variable Axis knee prosthesis. Conceptualized by Dr. Murray in 1972 and engineered over the ensuing 2 years, the unique "b...An important and often overlooked legacy and orthopaedic innovation of Dr. David G. Murray is the Variable Axis knee prosthesis. Conceptualized by Dr. Murray in 1972 and engineered over the ensuing 2 years, the unique "ball-in-socket" design of the prosthesis represented the first unconstrained cruciate-substituting knee prosthesis. Its metal-backed tibial component with modular polyethylene inserts of varying thicknesses and angular designs was also an innovative first and is a design feature that was incorporated into virtually all subsequent prosthetic knees. Released for clinical application in 1974, the Variable Axis knee prosthesis enjoyed over a decade of successful clinical use but was ultimately supplanted by the more anatomically configured Total Condylar-type designs.