Pub Date : 2025-02-06DOI: 10.1097/CORR.0000000000003400
T Derek V Cooke
{"title":"Letter to the Editor: How Can the Environmental Impact of Orthopaedic Surgery Be Measured and Reduced? Using Anterior Cruciate Ligament Reconstruction as a Test Case.","authors":"T Derek V Cooke","doi":"10.1097/CORR.0000000000003400","DOIUrl":"https://doi.org/10.1097/CORR.0000000000003400","url":null,"abstract":"","PeriodicalId":10404,"journal":{"name":"Clinical Orthopaedics and Related Research®","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143467218","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 : 2025-02-06DOI: 10.1097/CORR.0000000000003409
Brian Prigmore, Sarah E Lindsay, Anna Agloro, Yee-Cheen Doung, Kenneth R Gundle, James B Hayden, Duncan C Ramsey
<p><strong>Background: </strong>Sarcoma and its treatment has the potential to limit adult height attainment in skeletally immature patients. However, evidence on the extent of this limitation in sarcoma specifically is mixed, and existing height prediction tools such as the Paley multiplier method have proven unreliable in this setting. As such, orthopaedic surgeons are left with the challenge of counseling patients and their families on expected height deficits without an adequate understanding of the extent of these deficits. Equally important, these surgeons must also understand the amount of skeletal growth remaining during the presurgical planning process for limb reconstruction to adequately grasp a patient's risk of subsequent limb length discrepancy.</p><p><strong>Questions/purposes: </strong>(1) To what extent does pediatric sarcoma and its treatment limit adult height attainment? (2) Using retrospective data on pediatric patients with sarcoma, can we create a height prediction model that yields more accurate estimates of expected adult height than the Paley multiplier method?</p><p><strong>Methods: </strong>For this retrospective pilot study, 223 pediatric patients with sarcoma from a single pediatric sarcoma center between 1976 and June 2022 were identified using diagnostic codes. Inclusion criteria were completion of chemotherapy before skeletal maturity, survival to maturity, and complete height data (that is, height at diagnosis and at skeletal maturity). Of the 223 patients identified as potentially eligible, 56 met inclusion criteria. The remaining 167 patients were excluded on the basis of not receiving chemotherapy (9% [15 of 167]), receiving chemotherapy after skeletal maturity was reached (20% [33 of 167]), not surviving to skeletal maturity (19% [31 of 167]), not reaching skeletal maturity at the time of chart review (43% [72 of 167]), having insufficient treatment data available for analysis (7% [11 of 167]), or being lost to follow-up (that is, no further clinic visits where height at skeletal maturity was recorded) (3% [5 of 167]). Data collection encompassed cancer type; age, height, and weight at diagnosis and maturity; and treatment characteristics. A total of 43% (24 of 56) were female and 57% (32 of 56) were male. Among included patients, 70% (39 of 56) had primary bone tumors, of which 64% (25 of 39) involved lower extremity. Diagnoses of osteosarcoma (41% [23 of 56]) and Ewing sarcoma (36% [20 of 56]) predominated. Doxorubicin (82% [46 of 56]) and cyclophosphamide (61% [34 of 56]) were the most common chemotherapeutics; the mean ± SD treatment duration was 76 ± 88 weeks. Female patients were diagnosed at a mean age of 11 ± 4 years, reaching skeletal maturity at 16 ± 1 years. Male patients were diagnosed at a mean age of 14 ± 3 years, reaching skeletal maturity at 17 ± 1 years. We compared CDC z-scores, which quantify patient height relative to the population mean using SD and percentiles, at diagnosis and maturity
{"title":"Can We Accurately Predict Adult Height in Pediatric Patients Who Undergo Treatment for Sarcoma?","authors":"Brian Prigmore, Sarah E Lindsay, Anna Agloro, Yee-Cheen Doung, Kenneth R Gundle, James B Hayden, Duncan C Ramsey","doi":"10.1097/CORR.0000000000003409","DOIUrl":"https://doi.org/10.1097/CORR.0000000000003409","url":null,"abstract":"<p><strong>Background: </strong>Sarcoma and its treatment has the potential to limit adult height attainment in skeletally immature patients. However, evidence on the extent of this limitation in sarcoma specifically is mixed, and existing height prediction tools such as the Paley multiplier method have proven unreliable in this setting. As such, orthopaedic surgeons are left with the challenge of counseling patients and their families on expected height deficits without an adequate understanding of the extent of these deficits. Equally important, these surgeons must also understand the amount of skeletal growth remaining during the presurgical planning process for limb reconstruction to adequately grasp a patient's risk of subsequent limb length discrepancy.</p><p><strong>Questions/purposes: </strong>(1) To what extent does pediatric sarcoma and its treatment limit adult height attainment? (2) Using retrospective data on pediatric patients with sarcoma, can we create a height prediction model that yields more accurate estimates of expected adult height than the Paley multiplier method?</p><p><strong>Methods: </strong>For this retrospective pilot study, 223 pediatric patients with sarcoma from a single pediatric sarcoma center between 1976 and June 2022 were identified using diagnostic codes. Inclusion criteria were completion of chemotherapy before skeletal maturity, survival to maturity, and complete height data (that is, height at diagnosis and at skeletal maturity). Of the 223 patients identified as potentially eligible, 56 met inclusion criteria. The remaining 167 patients were excluded on the basis of not receiving chemotherapy (9% [15 of 167]), receiving chemotherapy after skeletal maturity was reached (20% [33 of 167]), not surviving to skeletal maturity (19% [31 of 167]), not reaching skeletal maturity at the time of chart review (43% [72 of 167]), having insufficient treatment data available for analysis (7% [11 of 167]), or being lost to follow-up (that is, no further clinic visits where height at skeletal maturity was recorded) (3% [5 of 167]). Data collection encompassed cancer type; age, height, and weight at diagnosis and maturity; and treatment characteristics. A total of 43% (24 of 56) were female and 57% (32 of 56) were male. Among included patients, 70% (39 of 56) had primary bone tumors, of which 64% (25 of 39) involved lower extremity. Diagnoses of osteosarcoma (41% [23 of 56]) and Ewing sarcoma (36% [20 of 56]) predominated. Doxorubicin (82% [46 of 56]) and cyclophosphamide (61% [34 of 56]) were the most common chemotherapeutics; the mean ± SD treatment duration was 76 ± 88 weeks. Female patients were diagnosed at a mean age of 11 ± 4 years, reaching skeletal maturity at 16 ± 1 years. Male patients were diagnosed at a mean age of 14 ± 3 years, reaching skeletal maturity at 17 ± 1 years. We compared CDC z-scores, which quantify patient height relative to the population mean using SD and percentiles, at diagnosis and maturity ","PeriodicalId":10404,"journal":{"name":"Clinical Orthopaedics and Related Research®","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143363974","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 : 2025-02-06DOI: 10.1097/CORR.0000000000003408
Richard M Schwend
{"title":"CORR Insights®: How Do Patients Perceive Success and Satisfaction After Vertebral Body Tethering and Fusion for Adolescent Idiopathic Scoliosis? A Qualitative Study.","authors":"Richard M Schwend","doi":"10.1097/CORR.0000000000003408","DOIUrl":"https://doi.org/10.1097/CORR.0000000000003408","url":null,"abstract":"","PeriodicalId":10404,"journal":{"name":"Clinical Orthopaedics and Related Research®","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143363841","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>A better understanding of the correlation between social health and mindsets, comfort, and capability could aid the design of individualized care models. However, currently available social health checklists are relatively lengthy, burdensome, and designed for descriptive screening purposes rather than quantitative assessment for clinical research, patient monitoring, or quality improvement. Alternatives such as area deprivation index are prone to overgeneralization, lack depth in regard to personal circumstances, and evolve rapidly with gentrification. To fill this void, we aimed to identify the underlying themes of social health and develop a new, personalized and quantitative social health measure.</p><p><strong>Questions/purposes: </strong>(1) What underlying themes of social health (factors) among a subset of items derived from available legacy checklists and questionnaires can be identified and quantified using a brief social health measure? (2) How much of the variation in levels of discomfort, capability, general health, feelings of distress, and unhelpful thoughts regarding symptoms is accounted for by quantified social health?</p><p><strong>Methods: </strong>In this two-stage, cross-sectional study among people seeking musculoskeletal specialty care in an urban area in the United States, all English and Spanish literate adults (ages 18 to 89 years) were invited to participate in two separate cohorts to help develop a provisional new measure of quantified social health. In a first stage (December 2021 to August 2022), 291 patients rated a subset of items derived from commonly used social health checklists and questionnaires (Tool for Health and Resilience in Vulnerable Environments [THRIVE]; Protocol for Responding to and Assessing Patient Assets, Risks and Experiences [PRAPARE]; and Accountable Health Communities Health-Related Social Needs Screening Tool [HRSN]), of whom 95% (275 of 291; 57% women; mean ± SD age 49 ± 16 years; 51% White, 33% Hispanic; 21% Spanish speaking; 38% completed high school or less) completed all items required to perform factor analysis and were included. Given that so few patients decline participation (estimated at < 5%), we did not track them. We then randomly parsed participants into (1) a learning cohort (69% [189 of 275]) used to identify underlying themes of social health and develop a new measure of quantified social health using exploratory and confirmatory factor analysis (CFA), and (2) a validation cohort (31% [86 of 275]) used to test and internally validate the findings on data not used in its development. During the validation process, we found inconsistencies in the correlations of quantified social health with levels of discomfort and capability between the learning and validation cohort that could not be resolved or explained despite various sensitivity analyses. We therefore identified an additional cohort of 356 eligible patients (February 2023 to June 2023) t
{"title":"A New Measure of Quantified Social Health Is Associated With Levels of Discomfort, Capability, and Mental and General Health Among Patients Seeking Musculoskeletal Specialty Care.","authors":"Niels Brinkman, Melle Broekman, Teun Teunis, Seung Choi, David Ring, Prakash Jayakumar","doi":"10.1097/CORR.0000000000003394","DOIUrl":"https://doi.org/10.1097/CORR.0000000000003394","url":null,"abstract":"<p><strong>Background: </strong>A better understanding of the correlation between social health and mindsets, comfort, and capability could aid the design of individualized care models. However, currently available social health checklists are relatively lengthy, burdensome, and designed for descriptive screening purposes rather than quantitative assessment for clinical research, patient monitoring, or quality improvement. Alternatives such as area deprivation index are prone to overgeneralization, lack depth in regard to personal circumstances, and evolve rapidly with gentrification. To fill this void, we aimed to identify the underlying themes of social health and develop a new, personalized and quantitative social health measure.</p><p><strong>Questions/purposes: </strong>(1) What underlying themes of social health (factors) among a subset of items derived from available legacy checklists and questionnaires can be identified and quantified using a brief social health measure? (2) How much of the variation in levels of discomfort, capability, general health, feelings of distress, and unhelpful thoughts regarding symptoms is accounted for by quantified social health?</p><p><strong>Methods: </strong>In this two-stage, cross-sectional study among people seeking musculoskeletal specialty care in an urban area in the United States, all English and Spanish literate adults (ages 18 to 89 years) were invited to participate in two separate cohorts to help develop a provisional new measure of quantified social health. In a first stage (December 2021 to August 2022), 291 patients rated a subset of items derived from commonly used social health checklists and questionnaires (Tool for Health and Resilience in Vulnerable Environments [THRIVE]; Protocol for Responding to and Assessing Patient Assets, Risks and Experiences [PRAPARE]; and Accountable Health Communities Health-Related Social Needs Screening Tool [HRSN]), of whom 95% (275 of 291; 57% women; mean ± SD age 49 ± 16 years; 51% White, 33% Hispanic; 21% Spanish speaking; 38% completed high school or less) completed all items required to perform factor analysis and were included. Given that so few patients decline participation (estimated at < 5%), we did not track them. We then randomly parsed participants into (1) a learning cohort (69% [189 of 275]) used to identify underlying themes of social health and develop a new measure of quantified social health using exploratory and confirmatory factor analysis (CFA), and (2) a validation cohort (31% [86 of 275]) used to test and internally validate the findings on data not used in its development. During the validation process, we found inconsistencies in the correlations of quantified social health with levels of discomfort and capability between the learning and validation cohort that could not be resolved or explained despite various sensitivity analyses. We therefore identified an additional cohort of 356 eligible patients (February 2023 to June 2023) t","PeriodicalId":10404,"journal":{"name":"Clinical Orthopaedics and Related Research®","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143363970","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 : 2025-02-05DOI: 10.1097/CORR.0000000000003390
Paul J Dougherty
{"title":"CORR Insights®: Do Fellowship-educated Military Orthopaedic Oncologists Who Practice in Military Settings Treat a Sufficient Volume of Patients to Maintain Their Oncologic Expertise?","authors":"Paul J Dougherty","doi":"10.1097/CORR.0000000000003390","DOIUrl":"https://doi.org/10.1097/CORR.0000000000003390","url":null,"abstract":"","PeriodicalId":10404,"journal":{"name":"Clinical Orthopaedics and Related Research®","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143363761","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 : 2025-02-05DOI: 10.1097/CORR.0000000000003382
Anant Tewari, Stephen D Lockey
{"title":"CORR Synthesis: What Is the Impact of Frailty on Postoperative Complications After Spinal Surgery?","authors":"Anant Tewari, Stephen D Lockey","doi":"10.1097/CORR.0000000000003382","DOIUrl":"https://doi.org/10.1097/CORR.0000000000003382","url":null,"abstract":"","PeriodicalId":10404,"journal":{"name":"Clinical Orthopaedics and Related Research®","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143363891","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 : 2025-02-05DOI: 10.1097/CORR.0000000000003386
Kevin D Plancher, Carlo Mannina, Elias Schwartz, Karen K Briggs, Stephanie C Petterson
<p><strong>Background: </strong>The incidence of revision TKA is escalating. The safety and efficacy of performing revision TKA in an outpatient setting is important given this increased demand.</p><p><strong>Questions/purposes: </strong>(1) Are patients who undergo revision TKA in an outpatient setting more likely to undergo a repeat revision within 1 year compared with patients undergoing revision TKA in an inpatient setting? (2) Are patients who undergo outpatient revision TKA more likely to have increased hospital readmissions, manipulation under anesthesia (MUA), and medical complications compared with patients undergoing revision TKA in an inpatient setting?</p><p><strong>Methods: </strong>Patients who underwent single-component revision TKA in either an outpatient or inpatient setting were identified in the PearlDiver Mariner database using Current Procedural Terminology codes or ICD-9 and ICD-10 diagnosis codes. The PearlDiver database is a for-fee insurance patient records database that contains > 165 million individual patient records from 2010 to 2022 and allows patients to be tracked over time. Groups were propensity score-matched to minimize the risk of selection bias that patients with greater comorbidities would be treated in an inpatient setting. Propensity matching was performed using a 1:4 ratio by age, gender, and Elixhauser Comorbidity Index (ECI). After propensity matching, a total of 30,924 patients who underwent single-component revision TKA were included in the inpatient group and 7731 patients were included in the outpatient group. Outcome measures included rates of repeat revision at 1 year, hospital readmission at 90 days, and complications including deep vein thrombosis, pulmonary embolus, blood transfusion, wound complications, periprosthetic joint infection, and MUA at 90 days. Chi-square analyses were used to compare categorical variables, and independent samples t-tests were used to compare continuous variables. Because any observed differences favoring outpatient revision TKA were likely due to selection bias with no biologically plausible explanation for outpatient surgery resulting in fewer medical or surgical complications, the findings were interpreted as a noninferiority analysis, indicating that outpatient revision TKA is not inferior to inpatient revision TKA even if the data indicated a potential advantage for outpatient revision TKA over inpatient revision TKA.</p><p><strong>Results: </strong>The 1-year incidence of repeat revision was no higher in the outpatient group than the inpatient group (5% [359 of 7731] versus 5% [1606 of 30,924]; p = 0.05). The incidence of 90-day hospital readmission was no higher in the outpatient revision TKA group compared with the inpatient revision TKA group (8% [643 of 7731] versus 15% [4561 of 30,924]; p < 0.001). The incidence of all medical and surgical complications investigated was no higher in the outpatient revision TKA group compared with the inpatient revision TKA
{"title":"Outpatient Revision TKA Does Not Increase Incidence of Repeat Revision or Medical and Surgical Complications Compared With Inpatient Revision TKA.","authors":"Kevin D Plancher, Carlo Mannina, Elias Schwartz, Karen K Briggs, Stephanie C Petterson","doi":"10.1097/CORR.0000000000003386","DOIUrl":"https://doi.org/10.1097/CORR.0000000000003386","url":null,"abstract":"<p><strong>Background: </strong>The incidence of revision TKA is escalating. The safety and efficacy of performing revision TKA in an outpatient setting is important given this increased demand.</p><p><strong>Questions/purposes: </strong>(1) Are patients who undergo revision TKA in an outpatient setting more likely to undergo a repeat revision within 1 year compared with patients undergoing revision TKA in an inpatient setting? (2) Are patients who undergo outpatient revision TKA more likely to have increased hospital readmissions, manipulation under anesthesia (MUA), and medical complications compared with patients undergoing revision TKA in an inpatient setting?</p><p><strong>Methods: </strong>Patients who underwent single-component revision TKA in either an outpatient or inpatient setting were identified in the PearlDiver Mariner database using Current Procedural Terminology codes or ICD-9 and ICD-10 diagnosis codes. The PearlDiver database is a for-fee insurance patient records database that contains > 165 million individual patient records from 2010 to 2022 and allows patients to be tracked over time. Groups were propensity score-matched to minimize the risk of selection bias that patients with greater comorbidities would be treated in an inpatient setting. Propensity matching was performed using a 1:4 ratio by age, gender, and Elixhauser Comorbidity Index (ECI). After propensity matching, a total of 30,924 patients who underwent single-component revision TKA were included in the inpatient group and 7731 patients were included in the outpatient group. Outcome measures included rates of repeat revision at 1 year, hospital readmission at 90 days, and complications including deep vein thrombosis, pulmonary embolus, blood transfusion, wound complications, periprosthetic joint infection, and MUA at 90 days. Chi-square analyses were used to compare categorical variables, and independent samples t-tests were used to compare continuous variables. Because any observed differences favoring outpatient revision TKA were likely due to selection bias with no biologically plausible explanation for outpatient surgery resulting in fewer medical or surgical complications, the findings were interpreted as a noninferiority analysis, indicating that outpatient revision TKA is not inferior to inpatient revision TKA even if the data indicated a potential advantage for outpatient revision TKA over inpatient revision TKA.</p><p><strong>Results: </strong>The 1-year incidence of repeat revision was no higher in the outpatient group than the inpatient group (5% [359 of 7731] versus 5% [1606 of 30,924]; p = 0.05). The incidence of 90-day hospital readmission was no higher in the outpatient revision TKA group compared with the inpatient revision TKA group (8% [643 of 7731] versus 15% [4561 of 30,924]; p < 0.001). The incidence of all medical and surgical complications investigated was no higher in the outpatient revision TKA group compared with the inpatient revision TKA","PeriodicalId":10404,"journal":{"name":"Clinical Orthopaedics and Related Research®","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143363935","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 : 2025-02-05DOI: 10.1097/CORR.0000000000003385
Foster Chen, Richard N Chang, Heather A Prentice, Brian H Fasig, Elizabeth W Paxton, Kevin T Hug, Matthew P Kelly
<p><strong>Background: </strong>Use of cementless TKA has grown after encouraging data from contemporary implants. Yet registry studies have shown inferior survivorship of cementless fixation when treated as a monolithic class aggregating contemporary and historic designs. Two contemporary cementless TKA designs with distantly different fixation strategies have emerged in the last 2 decades, mostly focused on tibial fixation: porous tantalum and twin-peg tibia and, more recently, porous titanium and a spikes-and-keel tibia. However, their survivorship in comparison with cemented options and between each other remains to be thoroughly delineated.</p><p><strong>Questions/purposes: </strong>(1) Is there a difference in aseptic survivorship between cementless twin-peg TKA constructs compared with cemented options? (2) Is there a difference in aseptic survivorship between cementless spikes-and-keel TKA constructs compared with cemented options? (3) Is there a difference in aseptic survivorship between cementless twin-peg TKA constructs compared with cementless spikes-and-keel TKA constructs?</p><p><strong>Methods: </strong>We conducted a cohort study using data from the Kaiser Permanente Total Joint Replacement Registry (TJRR). The TJRR prospectively collects patient, perioperative, and implant details on all patients who undergo TKA in a multiregional organization with 12 million members; patients included in the TJRR are longitudinally monitored for outcomes after TKA, and identified outcomes are manually validated through chart review. Patients who underwent primary TKA for osteoarthritis from 2009 to 2023 with a fully cementless construct of either twin-peg or spikes-and-keel, and their fully cemented options, were included (n = 136,443). TKA with hybrid or unknown fixation (2.6% [3571]), rotating or unknown mobility (0.8% [1081]), or fully constrained or unknown stability (1.1% [1549]) were excluded. The final study sample included 130,242 primary TKAs performed by 388 surgeons at 60 hospitals. Of the 125,414 patients receiving twin-peg TKAs, 9.2% who received cemented and 12.3% who received cementless were lost to follow-up. Of the 4828 patients receiving spikes-and-keel TKAs, 11.3% who received cemented versus 11.2% who received cementless were lost to follow-up. Those who terminated membership during the study period tended to be younger than those who did not (65 versus 68 years for both groups). A comparison between cementless (575 twin-peg and 1574 spikes-and-keel) versus cemented (124,839 twin-peg and 3254 spikes-and-keel) fixation was performed for each pair of analogous implants. For the twin-peg comparison, when comparing the cementless group to the cemented group, the cementless group was younger (61 versus 68 years), included more male patients (77% versus 39%), and more patients who self-reported White race (76% versus 66%). For the spikes-and-keel comparison, when comparing the cementless group to the cemented group, the cementless
{"title":"What Is the Survivorship of TKA With a Twin-peg or Spikes-and-keel Cementless Implant Compared With Cemented? A Registry-based Cohort Study.","authors":"Foster Chen, Richard N Chang, Heather A Prentice, Brian H Fasig, Elizabeth W Paxton, Kevin T Hug, Matthew P Kelly","doi":"10.1097/CORR.0000000000003385","DOIUrl":"https://doi.org/10.1097/CORR.0000000000003385","url":null,"abstract":"<p><strong>Background: </strong>Use of cementless TKA has grown after encouraging data from contemporary implants. Yet registry studies have shown inferior survivorship of cementless fixation when treated as a monolithic class aggregating contemporary and historic designs. Two contemporary cementless TKA designs with distantly different fixation strategies have emerged in the last 2 decades, mostly focused on tibial fixation: porous tantalum and twin-peg tibia and, more recently, porous titanium and a spikes-and-keel tibia. However, their survivorship in comparison with cemented options and between each other remains to be thoroughly delineated.</p><p><strong>Questions/purposes: </strong>(1) Is there a difference in aseptic survivorship between cementless twin-peg TKA constructs compared with cemented options? (2) Is there a difference in aseptic survivorship between cementless spikes-and-keel TKA constructs compared with cemented options? (3) Is there a difference in aseptic survivorship between cementless twin-peg TKA constructs compared with cementless spikes-and-keel TKA constructs?</p><p><strong>Methods: </strong>We conducted a cohort study using data from the Kaiser Permanente Total Joint Replacement Registry (TJRR). The TJRR prospectively collects patient, perioperative, and implant details on all patients who undergo TKA in a multiregional organization with 12 million members; patients included in the TJRR are longitudinally monitored for outcomes after TKA, and identified outcomes are manually validated through chart review. Patients who underwent primary TKA for osteoarthritis from 2009 to 2023 with a fully cementless construct of either twin-peg or spikes-and-keel, and their fully cemented options, were included (n = 136,443). TKA with hybrid or unknown fixation (2.6% [3571]), rotating or unknown mobility (0.8% [1081]), or fully constrained or unknown stability (1.1% [1549]) were excluded. The final study sample included 130,242 primary TKAs performed by 388 surgeons at 60 hospitals. Of the 125,414 patients receiving twin-peg TKAs, 9.2% who received cemented and 12.3% who received cementless were lost to follow-up. Of the 4828 patients receiving spikes-and-keel TKAs, 11.3% who received cemented versus 11.2% who received cementless were lost to follow-up. Those who terminated membership during the study period tended to be younger than those who did not (65 versus 68 years for both groups). A comparison between cementless (575 twin-peg and 1574 spikes-and-keel) versus cemented (124,839 twin-peg and 3254 spikes-and-keel) fixation was performed for each pair of analogous implants. For the twin-peg comparison, when comparing the cementless group to the cemented group, the cementless group was younger (61 versus 68 years), included more male patients (77% versus 39%), and more patients who self-reported White race (76% versus 66%). For the spikes-and-keel comparison, when comparing the cementless group to the cemented group, the cementless ","PeriodicalId":10404,"journal":{"name":"Clinical Orthopaedics and Related Research®","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143363937","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 : 2025-02-05DOI: 10.1097/CORR.0000000000003396
Michael D Ries
{"title":"CORR Insights®: Kinematic Alignment Does Not Result in Clinically Important Improvements After TKA Compared With Mechanical Alignment: A Meta-analysis of Randomized Trials.","authors":"Michael D Ries","doi":"10.1097/CORR.0000000000003396","DOIUrl":"https://doi.org/10.1097/CORR.0000000000003396","url":null,"abstract":"","PeriodicalId":10404,"journal":{"name":"Clinical Orthopaedics and Related Research®","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143363884","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 : 2025-02-05DOI: 10.1097/CORR.0000000000003412
Wakenda K Tyler
{"title":"CORR Insights®: Does Merit-based Incentive Payment System Performance Differ Based on Orthopaedic Surgeon Gender?","authors":"Wakenda K Tyler","doi":"10.1097/CORR.0000000000003412","DOIUrl":"https://doi.org/10.1097/CORR.0000000000003412","url":null,"abstract":"","PeriodicalId":10404,"journal":{"name":"Clinical Orthopaedics and Related Research®","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143363764","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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