Pub Date : 2025-02-01Epub Date: 2024-10-25DOI: 10.1097/CORR.0000000000003269
Michelle Ghert
{"title":"CORR Insights®: Is Information About Musculoskeletal Malignancies From Large Language Models or Web Resources at a Suitable Reading Level for Patients?","authors":"Michelle Ghert","doi":"10.1097/CORR.0000000000003269","DOIUrl":"10.1097/CORR.0000000000003269","url":null,"abstract":"","PeriodicalId":10404,"journal":{"name":"Clinical Orthopaedics and Related Research®","volume":" ","pages":"316-317"},"PeriodicalIF":4.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11753729/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142521199","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01Epub Date: 2024-08-19DOI: 10.1097/CORR.0000000000003205
Anas Nooh, Ahmed Aoude, Adam Hart, Michael Tanzer, Robert E Turcotte
<p><strong>Background: </strong>Advancements in musculoskeletal oncologic treatment have allowed for longer survival of patients with malignant bone tumors and the associated longer use of tumor endoprostheses in those who have had such reconstructions. Several studies have reported on increased serum metal ions with the use of such implants. Modularity in these implants introduces the risk of taper junction corrosion and subsidence resulting in metal wear particle release that may cause an adverse local tissue reaction or systemic toxicity. Additionally, these implants contain a large surface area of cobalt and chromium. It is unclear whether the source of the increased serum ion levels was due to the taper junction corrosion or the implant itself. To our knowledge, no prior study has reported on taper junction subsidence.</p><p><strong>Questions/purposes: </strong>In this study we sought (1) to determine survivorship free from radiographic taper junction subsidence in a femoral modular tumor endoprosthesis, and (2) to identify the implant characteristics in the endoprostheses associated with taper subsidence.</p><p><strong>Methods: </strong>Between January 1996 and February 2020, the senior author performed 150 proximal or distal femur replacements following resections of soft tissue or bone tumors of the thigh and femur. Of those, 6% (9 of 150) of patients were lost to follow-up before 2 years, 25% (37 of 150) could not be analyzed due to absence of plain radiographs during follow-up, and 13% (20 of 150) died before 2 years follow-up, leaving 56% (84 of 150) for analysis in this retrospective study, with a median time for analysis of 14 years (range 2 to 31 years) after the index resection and endoprosthetic reconstruction for patients with distal femur replacements and 5 years (range 2 to 19 years) for patients with proximal femur replacement. Radiographs involving the entire implant were evaluated for the presence or absence of subsidence of the taper junction that was evident and clear to see if present. The association between the number of taper junctions, the length of resection, the number of collapsed junctions, and the time to collapse from the initial surgery were examined using regression analysis.</p><p><strong>Results: </strong>Overall, 14% (12 of 84) patients with a distal femur replacement had radiographic collapse of at least one of the modular tapers. Survivorship free from taper subsidence was 91% (95% CI 86% to 96%) at 10 years and 84% (95% CI 78% to 90%) at 20 years. All patients were in the distal femur replacement group. The median follow-up of patients with subsidence was 15 years (range 5 to 26). Fifty-eight percent (7 of 12) of patients had two junctions involved, 25% (3 of 12) had three junctions, and 17% (2 of 12) had one junction involved. All but one patient had subsidence in a single junction. The median time to subsidence was 15 years (range 4.5 to 24.0 years). The subsidence was progressive in all patients who d
{"title":"Taper Junction Subsidence Occurs in Modular Tumor Endoprostheses: How Concerned Should We Be?","authors":"Anas Nooh, Ahmed Aoude, Adam Hart, Michael Tanzer, Robert E Turcotte","doi":"10.1097/CORR.0000000000003205","DOIUrl":"10.1097/CORR.0000000000003205","url":null,"abstract":"<p><strong>Background: </strong>Advancements in musculoskeletal oncologic treatment have allowed for longer survival of patients with malignant bone tumors and the associated longer use of tumor endoprostheses in those who have had such reconstructions. Several studies have reported on increased serum metal ions with the use of such implants. Modularity in these implants introduces the risk of taper junction corrosion and subsidence resulting in metal wear particle release that may cause an adverse local tissue reaction or systemic toxicity. Additionally, these implants contain a large surface area of cobalt and chromium. It is unclear whether the source of the increased serum ion levels was due to the taper junction corrosion or the implant itself. To our knowledge, no prior study has reported on taper junction subsidence.</p><p><strong>Questions/purposes: </strong>In this study we sought (1) to determine survivorship free from radiographic taper junction subsidence in a femoral modular tumor endoprosthesis, and (2) to identify the implant characteristics in the endoprostheses associated with taper subsidence.</p><p><strong>Methods: </strong>Between January 1996 and February 2020, the senior author performed 150 proximal or distal femur replacements following resections of soft tissue or bone tumors of the thigh and femur. Of those, 6% (9 of 150) of patients were lost to follow-up before 2 years, 25% (37 of 150) could not be analyzed due to absence of plain radiographs during follow-up, and 13% (20 of 150) died before 2 years follow-up, leaving 56% (84 of 150) for analysis in this retrospective study, with a median time for analysis of 14 years (range 2 to 31 years) after the index resection and endoprosthetic reconstruction for patients with distal femur replacements and 5 years (range 2 to 19 years) for patients with proximal femur replacement. Radiographs involving the entire implant were evaluated for the presence or absence of subsidence of the taper junction that was evident and clear to see if present. The association between the number of taper junctions, the length of resection, the number of collapsed junctions, and the time to collapse from the initial surgery were examined using regression analysis.</p><p><strong>Results: </strong>Overall, 14% (12 of 84) patients with a distal femur replacement had radiographic collapse of at least one of the modular tapers. Survivorship free from taper subsidence was 91% (95% CI 86% to 96%) at 10 years and 84% (95% CI 78% to 90%) at 20 years. All patients were in the distal femur replacement group. The median follow-up of patients with subsidence was 15 years (range 5 to 26). Fifty-eight percent (7 of 12) of patients had two junctions involved, 25% (3 of 12) had three junctions, and 17% (2 of 12) had one junction involved. All but one patient had subsidence in a single junction. The median time to subsidence was 15 years (range 4.5 to 24.0 years). The subsidence was progressive in all patients who d","PeriodicalId":10404,"journal":{"name":"Clinical Orthopaedics and Related Research®","volume":" ","pages":"289-302"},"PeriodicalIF":4.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11753736/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142145314","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-31DOI: 10.1097/CORR.0000000000003267
Benjamin K Potter, Julio A Rivera, Ashley B Anderson, Jason M Souza, Jonathan A Forsberg
<p><strong>Background: </strong>Individuals who have undergone transfemoral amputation often have difficulty donning and utilizing a conventional socket prosthesis. Osseointegrated prostheses may alleviate certain issues, potentially resulting in better outcomes, but few prospective studies have either evaluated these outcomes or quantified the purported benefits.</p><p><strong>Questions/purposes: </strong>(1) Did patient-reported outcome measures improve between baseline and 2-year follow-up among those who underwent osseointegration surgery after transfemoral amputation? (2) What was the frequency and severity of early complications related to the osseointegration procedures? (3) What was the minimum clinically important difference (MCID) in a global patient-reported outcome measure in this patient population?</p><p><strong>Methods: </strong>Between October 2017 and October 2023, we recruited 41 participants to undergo transfemoral osseointegration surgery treated with the Osseointegrated Prostheses for the Rehabilitation of Amputees implant system for patients who had trouble utilizing traditional, socket-based prostheses. Of those, 5% (2 of 41) did not undergo surgery, 2% (1 of 41) were lost to follow-up, and 2% (1 of 41) died before the final 2-year follow-up, leaving 90% (37 of 41) for analysis in this prospective, observational trial. Participants were asked to complete the validated Questionnaire for Persons with a Transfemoral Amputation (Q-TFA) and the Patient-Reported Outcomes Measurement Information System (PROMIS) questionnaire before surgery as well as 3, 6, 12, and 24 months after the two-stage procedure. Thirty-seven participants (three women and 34 men; mean ± SD age 38 ± 10 years) reached the 24-month follow-up visit, and four patients were withdrawn. We tabulated the frequency and types of surgical complications that patients experienced and calculated the anchored-based MCID for the Q-TFA global score (0 to 100 maximum). The Q-TFA's global score is generated based on answers to three questions: "How would you summarize your level of function with your current prosthesis?", "How would you summarize the problems you experience with your current prosthesis?", and "How would you summarize your overall situation as an amputee?" Using the sum of the numerical scores for the three questions, we found the difference between the baseline and the final follow-up for the participants. Then, we took the first quartile of the difference to represent the median change in the lower 25% of the data and used this value as our MCID.</p><p><strong>Results: </strong>Scores in the study group improved in nearly all domains of the Q-TFA and PROMIS, including those related to prosthetic use, prosthetic mobility, and physical function (all p < 0.05). Patients developed superficial infections in 29% (15 of 51) of implanted limbs, all of which were treated successfully with antibiotics alone; 7 patients developed deep infections, only 1 of which involv
{"title":"What Functional Outcomes Can Be Expected With Osseointegrated Prostheses in Transfemoral Amputations?","authors":"Benjamin K Potter, Julio A Rivera, Ashley B Anderson, Jason M Souza, Jonathan A Forsberg","doi":"10.1097/CORR.0000000000003267","DOIUrl":"https://doi.org/10.1097/CORR.0000000000003267","url":null,"abstract":"<p><strong>Background: </strong>Individuals who have undergone transfemoral amputation often have difficulty donning and utilizing a conventional socket prosthesis. Osseointegrated prostheses may alleviate certain issues, potentially resulting in better outcomes, but few prospective studies have either evaluated these outcomes or quantified the purported benefits.</p><p><strong>Questions/purposes: </strong>(1) Did patient-reported outcome measures improve between baseline and 2-year follow-up among those who underwent osseointegration surgery after transfemoral amputation? (2) What was the frequency and severity of early complications related to the osseointegration procedures? (3) What was the minimum clinically important difference (MCID) in a global patient-reported outcome measure in this patient population?</p><p><strong>Methods: </strong>Between October 2017 and October 2023, we recruited 41 participants to undergo transfemoral osseointegration surgery treated with the Osseointegrated Prostheses for the Rehabilitation of Amputees implant system for patients who had trouble utilizing traditional, socket-based prostheses. Of those, 5% (2 of 41) did not undergo surgery, 2% (1 of 41) were lost to follow-up, and 2% (1 of 41) died before the final 2-year follow-up, leaving 90% (37 of 41) for analysis in this prospective, observational trial. Participants were asked to complete the validated Questionnaire for Persons with a Transfemoral Amputation (Q-TFA) and the Patient-Reported Outcomes Measurement Information System (PROMIS) questionnaire before surgery as well as 3, 6, 12, and 24 months after the two-stage procedure. Thirty-seven participants (three women and 34 men; mean ± SD age 38 ± 10 years) reached the 24-month follow-up visit, and four patients were withdrawn. We tabulated the frequency and types of surgical complications that patients experienced and calculated the anchored-based MCID for the Q-TFA global score (0 to 100 maximum). The Q-TFA's global score is generated based on answers to three questions: \"How would you summarize your level of function with your current prosthesis?\", \"How would you summarize the problems you experience with your current prosthesis?\", and \"How would you summarize your overall situation as an amputee?\" Using the sum of the numerical scores for the three questions, we found the difference between the baseline and the final follow-up for the participants. Then, we took the first quartile of the difference to represent the median change in the lower 25% of the data and used this value as our MCID.</p><p><strong>Results: </strong>Scores in the study group improved in nearly all domains of the Q-TFA and PROMIS, including those related to prosthetic use, prosthetic mobility, and physical function (all p < 0.05). Patients developed superficial infections in 29% (15 of 51) of implanted limbs, all of which were treated successfully with antibiotics alone; 7 patients developed deep infections, only 1 of which involv","PeriodicalId":10404,"journal":{"name":"Clinical Orthopaedics and Related Research®","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143078721","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-31DOI: 10.1097/CORR.0000000000003391
Hassan Ghomrawi
{"title":"CORR Insights®: How Does Shame Relate to Clinical and Psychosocial Outcomes in Knee Osteoarthritis?","authors":"Hassan Ghomrawi","doi":"10.1097/CORR.0000000000003391","DOIUrl":"https://doi.org/10.1097/CORR.0000000000003391","url":null,"abstract":"","PeriodicalId":10404,"journal":{"name":"Clinical Orthopaedics and Related Research®","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143363876","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-28DOI: 10.1097/CORR.0000000000003387
Peter J Stasikelis
{"title":"CORR Insights®: Asymmetry in the Onset of Paraspinal Muscles Activity Differs in Adolescents With Idiopathic Scoliosis Compared With Those With a Symmetrical Spine.","authors":"Peter J Stasikelis","doi":"10.1097/CORR.0000000000003387","DOIUrl":"https://doi.org/10.1097/CORR.0000000000003387","url":null,"abstract":"","PeriodicalId":10404,"journal":{"name":"Clinical Orthopaedics and Related Research®","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143058244","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
<p><strong>Background: </strong>Manipulation under anesthesia is a widely used treatment for frozen shoulder, but the factors that influence patient outcomes after manipulation remain unclear. The degree of shoulder stiffness, a critical feature of frozen shoulder, likely reflects the severity of the condition but currently lacks standardized, objective assessment methods.</p><p><strong>Questions/purposes: </strong>(1) What are the releasing forces in patients with frozen shoulder, and do the forces vary across different stages of frozen shoulder? (2) Are there differences in postoperative outcomes of manipulation under anesthesia among patients with frozen shoulder at different stages of the condition? (3) Is a higher releasing force associated with poorer outcomes of manipulation, and what threshold of releasing force is optimal for better outcomes? (4) What clinical factors influence the magnitude of releasing forces?</p><p><strong>Methods: </strong>This prospective cohort study included patients with primary unilateral frozen shoulder who underwent manipulation under anesthesia after at least 3 months of unsuccessful nonsurgical treatment, which was defined as progressive worsening ROM, failure to make progress, or residual functional impairment after 3 months of treatment. Between December 1, 2022, and December 31, 2023, we treated 280 patients with unilateral frozen shoulder, all of whom were considered potentially eligible for this study. The inclusion criteria were: a reduction of passive external rotation in the affected shoulder to less than 50% compared with the contralateral side, at least 3 months of unsuccessful nonsurgical treatment, absence of shoulder trauma, radiographs and MRI showing no other pathologic lesions in the shoulder, and no prior medical history in the contralateral shoulder. The exclusion criteria were patients who had previously undergone shoulder surgery, those who had bilateral frozen shoulder, patients with anesthesia intolerance, and those with incomplete preoperative assessments. One hundred fifty-six patients were enrolled in follow-up assessments at 1, 3, and 6 months after manipulation. The mean ± SD age for enrolled patients was 54 ± 8 years, 35% (55 of 156) of all participants were male, and the mean BMI was 23 ± 3 kg/m2. Two percent (3 of 156) withdrew consent, and 4% (7 of 156) were lost to follow-up, leaving 94% (146 of 156) for analysis. The contralateral unaffected shoulder was used as a self-control. During the manipulation process, the force-time curves for the affected and unaffected shoulders were sequentially recorded using a handheld dynamometer, following the order of forward flexion, external rotation, and internal rotation. Two key force values, an initial tear value and a peak value, were extracted from the curve for the affected shoulder, while only the peak value was recorded for the unaffected shoulder. Passive ROM, the Oxford shoulder score (OSS), and the VAS were evaluated at the base
{"title":"Releasing Forces in Adhesive Capsulitis Are Imporant Indicators of Shoulder Stiffness and Postoperative Function.","authors":"Hengzhi Liu, Honglu Cai, Jungang Xu, Yuquan Jiang, Canlong Wang, Zheyu Huang, Hongwei Ouyang, Jinzhong Zhao, Weiliang Shen","doi":"10.1097/CORR.0000000000003365","DOIUrl":"https://doi.org/10.1097/CORR.0000000000003365","url":null,"abstract":"<p><strong>Background: </strong>Manipulation under anesthesia is a widely used treatment for frozen shoulder, but the factors that influence patient outcomes after manipulation remain unclear. The degree of shoulder stiffness, a critical feature of frozen shoulder, likely reflects the severity of the condition but currently lacks standardized, objective assessment methods.</p><p><strong>Questions/purposes: </strong>(1) What are the releasing forces in patients with frozen shoulder, and do the forces vary across different stages of frozen shoulder? (2) Are there differences in postoperative outcomes of manipulation under anesthesia among patients with frozen shoulder at different stages of the condition? (3) Is a higher releasing force associated with poorer outcomes of manipulation, and what threshold of releasing force is optimal for better outcomes? (4) What clinical factors influence the magnitude of releasing forces?</p><p><strong>Methods: </strong>This prospective cohort study included patients with primary unilateral frozen shoulder who underwent manipulation under anesthesia after at least 3 months of unsuccessful nonsurgical treatment, which was defined as progressive worsening ROM, failure to make progress, or residual functional impairment after 3 months of treatment. Between December 1, 2022, and December 31, 2023, we treated 280 patients with unilateral frozen shoulder, all of whom were considered potentially eligible for this study. The inclusion criteria were: a reduction of passive external rotation in the affected shoulder to less than 50% compared with the contralateral side, at least 3 months of unsuccessful nonsurgical treatment, absence of shoulder trauma, radiographs and MRI showing no other pathologic lesions in the shoulder, and no prior medical history in the contralateral shoulder. The exclusion criteria were patients who had previously undergone shoulder surgery, those who had bilateral frozen shoulder, patients with anesthesia intolerance, and those with incomplete preoperative assessments. One hundred fifty-six patients were enrolled in follow-up assessments at 1, 3, and 6 months after manipulation. The mean ± SD age for enrolled patients was 54 ± 8 years, 35% (55 of 156) of all participants were male, and the mean BMI was 23 ± 3 kg/m2. Two percent (3 of 156) withdrew consent, and 4% (7 of 156) were lost to follow-up, leaving 94% (146 of 156) for analysis. The contralateral unaffected shoulder was used as a self-control. During the manipulation process, the force-time curves for the affected and unaffected shoulders were sequentially recorded using a handheld dynamometer, following the order of forward flexion, external rotation, and internal rotation. Two key force values, an initial tear value and a peak value, were extracted from the curve for the affected shoulder, while only the peak value was recorded for the unaffected shoulder. Passive ROM, the Oxford shoulder score (OSS), and the VAS were evaluated at the base","PeriodicalId":10404,"journal":{"name":"Clinical Orthopaedics and Related Research®","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143064131","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-28DOI: 10.1097/corr.0000000000003381
James Rickert
{"title":"On Patient Safety: It Is Time to Rethink Gabapentin.","authors":"James Rickert","doi":"10.1097/corr.0000000000003381","DOIUrl":"https://doi.org/10.1097/corr.0000000000003381","url":null,"abstract":"","PeriodicalId":10404,"journal":{"name":"Clinical Orthopaedics and Related Research®","volume":"20 1","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143057042","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-24DOI: 10.1097/CORR.0000000000003369
Charlotte van Vliet-Bockting, Robin Atallah, Jan Paul M Frölke, Ruud A Leijendekkers
<p><strong>Background: </strong>Many patients with a lower limb socket-suspended prothesis experience socket-related problems, such as pain, chronic skin conditions, and mechanical problems, and as a result, health-related quality of life (HRQoL) is often negatively affected. A bone-anchored prosthesis can overcome these problems and improve HRQoL, but these prostheses have potential downsides as well. A valid and reliable tool to assess potential candidates for surgery concerning a favorable risk-benefit ratio between potential complications related to bone-anchored prostheses and improvements in HRQoL is not available yet. Having this information may inform treating physicians and patients when deciding whether to pursue bone-anchored prostheses.</p><p><strong>Questions/purpose: </strong>In this study, we asked: (1) What is the difference in HRQoL at 6, 12, and 24 months among patients who underwent lower limb bone-anchored prosthesis treatment after using a socket-suspended prosthesis preoperatively? (2) What factors are associated with change in HRQoL 24 months after lower limb bone-anchored prosthesis treatment? (3) Which complications occurred within 24 months after lower limb bone-anchored prosthesis treatment? (4) What factors are associated with minor to severe complications within 24 months after lower limb bone-anchored prosthesis treatment?</p><p><strong>Methods: </strong>A total of 206 patients who underwent lower limb bone-anchored prosthesis treatment (femoral or tibial) at the Radboud University Medical Center between May 2014 and September 2020 were included in this study. Of those, 8% (17 of 206) were lost to follow-up at 24 months without meeting a study endpoint (not attending the clinic unrelated to the bone-anchored prosthesis, re-amputation), and another < 1% (1 of 206) died prior to 24 months, leaving 92% (189 of 206) of the original group who had a follow-up time of at least 24 months. The mean ± SD age was 54.3 ± 12.7 years, and 72% were men. Amputation levels included 64% (139 of 218) transfemoral amputation, 3% (7 of 218) knee exarticulation, 32% (70 of 218) transtibial amputation, 0.5% (1 of 218) foot amputation, and 0.5% (1 of 218) osseointegration implant after primary amputation. Causes of amputation included 52% (108 of 206) trauma, 8% (17 of 206) oncology, 19% (38 of 206) dysvascular, 12% (25 of 206) infection, 1% (2 of 206) congenital, and 8% (16 of 206) other. Primary outcomes were generic HRQoL (Short-Form 36 health survey mental component summary [MCS] and physical component summary [PCS] scores), disease-specific HRQoL (Questionnaire for Persons with a Transfemoral Amputation global score), and complication occurrence (infection, implant complications such as loosening or breakage, stoma-related problems, periprosthetic fracture, and death). Multivariable multiple regression was used to develop association models. These models demonstrated which group of characteristics were associated with change in HRQoL a
{"title":"How To Improve Patient Selection in Individuals With Lower Extremity Amputation Using a Bone-anchored Prosthesis.","authors":"Charlotte van Vliet-Bockting, Robin Atallah, Jan Paul M Frölke, Ruud A Leijendekkers","doi":"10.1097/CORR.0000000000003369","DOIUrl":"https://doi.org/10.1097/CORR.0000000000003369","url":null,"abstract":"<p><strong>Background: </strong>Many patients with a lower limb socket-suspended prothesis experience socket-related problems, such as pain, chronic skin conditions, and mechanical problems, and as a result, health-related quality of life (HRQoL) is often negatively affected. A bone-anchored prosthesis can overcome these problems and improve HRQoL, but these prostheses have potential downsides as well. A valid and reliable tool to assess potential candidates for surgery concerning a favorable risk-benefit ratio between potential complications related to bone-anchored prostheses and improvements in HRQoL is not available yet. Having this information may inform treating physicians and patients when deciding whether to pursue bone-anchored prostheses.</p><p><strong>Questions/purpose: </strong>In this study, we asked: (1) What is the difference in HRQoL at 6, 12, and 24 months among patients who underwent lower limb bone-anchored prosthesis treatment after using a socket-suspended prosthesis preoperatively? (2) What factors are associated with change in HRQoL 24 months after lower limb bone-anchored prosthesis treatment? (3) Which complications occurred within 24 months after lower limb bone-anchored prosthesis treatment? (4) What factors are associated with minor to severe complications within 24 months after lower limb bone-anchored prosthesis treatment?</p><p><strong>Methods: </strong>A total of 206 patients who underwent lower limb bone-anchored prosthesis treatment (femoral or tibial) at the Radboud University Medical Center between May 2014 and September 2020 were included in this study. Of those, 8% (17 of 206) were lost to follow-up at 24 months without meeting a study endpoint (not attending the clinic unrelated to the bone-anchored prosthesis, re-amputation), and another < 1% (1 of 206) died prior to 24 months, leaving 92% (189 of 206) of the original group who had a follow-up time of at least 24 months. The mean ± SD age was 54.3 ± 12.7 years, and 72% were men. Amputation levels included 64% (139 of 218) transfemoral amputation, 3% (7 of 218) knee exarticulation, 32% (70 of 218) transtibial amputation, 0.5% (1 of 218) foot amputation, and 0.5% (1 of 218) osseointegration implant after primary amputation. Causes of amputation included 52% (108 of 206) trauma, 8% (17 of 206) oncology, 19% (38 of 206) dysvascular, 12% (25 of 206) infection, 1% (2 of 206) congenital, and 8% (16 of 206) other. Primary outcomes were generic HRQoL (Short-Form 36 health survey mental component summary [MCS] and physical component summary [PCS] scores), disease-specific HRQoL (Questionnaire for Persons with a Transfemoral Amputation global score), and complication occurrence (infection, implant complications such as loosening or breakage, stoma-related problems, periprosthetic fracture, and death). Multivariable multiple regression was used to develop association models. These models demonstrated which group of characteristics were associated with change in HRQoL a","PeriodicalId":10404,"journal":{"name":"Clinical Orthopaedics and Related Research®","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143032445","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-23DOI: 10.1097/CORR.0000000000003377
David N Kugelman, Justin Leal, Sharrieff Shah, Rebekah Wrenn, Amy Mackowiak, Sean P Ryan, William A Jiranek, Thorsten M Seyler, Jessica Seidelman
<p><strong>Background: </strong>Rifampin therapy is indicated for the treatment of staphylococcal periprosthetic joint infection (PJI) in patients who have undergone debridement, antibiotics, and implant retention (DAIR) or one-stage revision as per the Infectious Diseases Society of America (IDSA) guideline. Given the well-established effectiveness of rifampin as adjunctive therapy in staphylococcal PJI, it is crucial to evaluate its utilization in practice and identify factors that contribute to its underuse or incomplete administration, as these deviations may undermine treatment efficacy and patient outcomes.</p><p><strong>Questions/purposes: </strong>Among patients who met clear indications for rifampin use having undergone DAIR or one-stage revision for staphylococcal PJI, (1) what proportion of patients did not receive it? (2) What proportion of patients started it but did not complete the planned course? (3) Where documented in the medical record, what were the common reasons for not using it or prematurely discontinuing it, and in what percentage of the patients' charts was no reason given? (4) What proportion of patients were taking a medication that put them at risk for a drug-drug interaction (DDI)?</p><p><strong>Methods: </strong>Using an institutional database, patients who underwent DAIR or revision arthroplasty for PJI from January 2013 to April 2023 were identified (n = 935). We defined clear indications for rifampin use as a patient diagnosed with staphylococcal PJI treated via DAIR or one-stage revision, as set forth by the clinical practice guidelines of the IDSA. Based on those indications, we surveyed patients' electronic medical records (EMRs) and calculated the proportion of patients who did not receive the drug in situations where it would have seemed appropriate that they receive it. We then determined the planned length of antibiotic management and calculated the proportion of patients whose planned courses of rifampin were not completed based on what was documented in each patient's chart. Next, we performed a review of the EMR and recorded qualitatively the reasons why patients either did not receive rifampin or why the planned course was not completed, as well as the percentage of patients whose medical records did not indicate why the drug was not used or was discontinued before the planned course had been administered. Last, we retrospectively reviewed the medications that the patients were taking at the time of indicated adjunctive rifampin initiation and evaluated whether there were DDIs and the potential severity of those interactions.</p><p><strong>Results: </strong>A total of 9% (87 of 935) of patients who underwent DAIR or revision arthroplasty for PJI met IDSA criteria, suggesting that rifampin use would have been appropriate. Of those meeting IDSA criteria, 49% (43 of 87) started rifampin. Of those who started on rifampin for staphylococcal PJI, 19% (8 of 43) discontinued it before the planned 6-week course
{"title":"How Often Is Rifampin Therapy Initiated and Completed in Patients With Periprosthetic Joint Infections?","authors":"David N Kugelman, Justin Leal, Sharrieff Shah, Rebekah Wrenn, Amy Mackowiak, Sean P Ryan, William A Jiranek, Thorsten M Seyler, Jessica Seidelman","doi":"10.1097/CORR.0000000000003377","DOIUrl":"https://doi.org/10.1097/CORR.0000000000003377","url":null,"abstract":"<p><strong>Background: </strong>Rifampin therapy is indicated for the treatment of staphylococcal periprosthetic joint infection (PJI) in patients who have undergone debridement, antibiotics, and implant retention (DAIR) or one-stage revision as per the Infectious Diseases Society of America (IDSA) guideline. Given the well-established effectiveness of rifampin as adjunctive therapy in staphylococcal PJI, it is crucial to evaluate its utilization in practice and identify factors that contribute to its underuse or incomplete administration, as these deviations may undermine treatment efficacy and patient outcomes.</p><p><strong>Questions/purposes: </strong>Among patients who met clear indications for rifampin use having undergone DAIR or one-stage revision for staphylococcal PJI, (1) what proportion of patients did not receive it? (2) What proportion of patients started it but did not complete the planned course? (3) Where documented in the medical record, what were the common reasons for not using it or prematurely discontinuing it, and in what percentage of the patients' charts was no reason given? (4) What proportion of patients were taking a medication that put them at risk for a drug-drug interaction (DDI)?</p><p><strong>Methods: </strong>Using an institutional database, patients who underwent DAIR or revision arthroplasty for PJI from January 2013 to April 2023 were identified (n = 935). We defined clear indications for rifampin use as a patient diagnosed with staphylococcal PJI treated via DAIR or one-stage revision, as set forth by the clinical practice guidelines of the IDSA. Based on those indications, we surveyed patients' electronic medical records (EMRs) and calculated the proportion of patients who did not receive the drug in situations where it would have seemed appropriate that they receive it. We then determined the planned length of antibiotic management and calculated the proportion of patients whose planned courses of rifampin were not completed based on what was documented in each patient's chart. Next, we performed a review of the EMR and recorded qualitatively the reasons why patients either did not receive rifampin or why the planned course was not completed, as well as the percentage of patients whose medical records did not indicate why the drug was not used or was discontinued before the planned course had been administered. Last, we retrospectively reviewed the medications that the patients were taking at the time of indicated adjunctive rifampin initiation and evaluated whether there were DDIs and the potential severity of those interactions.</p><p><strong>Results: </strong>A total of 9% (87 of 935) of patients who underwent DAIR or revision arthroplasty for PJI met IDSA criteria, suggesting that rifampin use would have been appropriate. Of those meeting IDSA criteria, 49% (43 of 87) started rifampin. Of those who started on rifampin for staphylococcal PJI, 19% (8 of 43) discontinued it before the planned 6-week course","PeriodicalId":10404,"journal":{"name":"Clinical Orthopaedics and Related Research®","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143032340","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-23DOI: 10.1097/CORR.0000000000003371
Mihir Sheth
{"title":"CORR Insights®: Fracture of the Anteromedial Facet of the Coronoid Is More Common Than Previously Thought in Combined Fractures of the Coronoid and Radial Head.","authors":"Mihir Sheth","doi":"10.1097/CORR.0000000000003371","DOIUrl":"https://doi.org/10.1097/CORR.0000000000003371","url":null,"abstract":"","PeriodicalId":10404,"journal":{"name":"Clinical Orthopaedics and Related Research®","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143032333","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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