Pub Date : 2024-04-17DOI: 10.5435/JAAOS-D-24-00153
Joseph W Galvin, Brendan M Patterson, Maria F. Bozoghlian, James V Nepola, Zachary T Colburn
A biorepository, also referred to as a "biobank," is a collection of biologic samples that are stored for laboratory research. With the emergence of precision medicine, the importance of leveraging individual patient biomolecular signatures to improve diagnosis, prognosis, and treatment is becoming increasingly recognized. Successful development and sustainment of a biorepository provides the potential for transformative preclinical research. Establishing a biobank requires a team approach with involvement of the institutions' research laboratory team and regulatory body. Execution of research activities requires a coordinated team approach for case identification, consent process, data and specimen collection, specimen processing, and storage and archiving. The advancing fields of precision medicine and orthobiologics provide incredible opportunities for institutions to generate novel lines of inquiry in musculoskeletal diseases through a multiomics approach (genomic, transcriptomic, proteomic, microbiomic). In addition, a biobank is an important component of post-market surveillance for the rapidly emerging field of orthobiologics.
{"title":"Musculoskeletal Biorepository: Establishment, Sustainment, and Tips for Success.","authors":"Joseph W Galvin, Brendan M Patterson, Maria F. Bozoghlian, James V Nepola, Zachary T Colburn","doi":"10.5435/JAAOS-D-24-00153","DOIUrl":"https://doi.org/10.5435/JAAOS-D-24-00153","url":null,"abstract":"A biorepository, also referred to as a \"biobank,\" is a collection of biologic samples that are stored for laboratory research. With the emergence of precision medicine, the importance of leveraging individual patient biomolecular signatures to improve diagnosis, prognosis, and treatment is becoming increasingly recognized. Successful development and sustainment of a biorepository provides the potential for transformative preclinical research. Establishing a biobank requires a team approach with involvement of the institutions' research laboratory team and regulatory body. Execution of research activities requires a coordinated team approach for case identification, consent process, data and specimen collection, specimen processing, and storage and archiving. The advancing fields of precision medicine and orthobiologics provide incredible opportunities for institutions to generate novel lines of inquiry in musculoskeletal diseases through a multiomics approach (genomic, transcriptomic, proteomic, microbiomic). In addition, a biobank is an important component of post-market surveillance for the rapidly emerging field of orthobiologics.","PeriodicalId":110802,"journal":{"name":"The Journal of the American Academy of Orthopaedic Surgeons","volume":"148 2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140693683","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-17DOI: 10.5435/JAAOS-D-23-00857
Ben D. Pesante, Maryam Salimi, Whitney L Miller, Heather L Young, Timothy C Jenkins, Joshua A Parry
INTRODUCTION Distinguishing between septic arthritis and crystal arthropathy flares can be challenging. The purpose of this study was to determine how the presence of synovial crystals affects the diagnostic criteria of septic arthritis. METHODS A retrospective review identified patients undergoing joint aspirations to rule out native septic arthritis. Differences between septic arthritis presenting with and without synovial crystals were analyzed. A receiver-operating characteristic curve was plotted for laboratory markers to determine the area under the curve, or diagnostic accuracy, for septic arthritis and to evaluate thresholds that maximized sensitivity and specificity. RESULTS There were 302 joint aspirations in 267 patients. Septic arthritis was diagnosed in 17.9% (54/302). Patients with synovial crystals were less likely to have septic arthritis (4.2% [5/119] vs. 26.8% [49/183], P < 0.0001). Septic arthritis in patients with no synovial crystals was associated with fever and a higher synovial white blood cell (WBC) count, synovial polymorphonuclear cell percentage (PMN%), serum WBC, and C-reactive protein (CRP) (P < 0.05). Septic arthritis in patients with synovial crystals was only associated with inability to bear weight and a higher synovial WBC and CRP (P < 0.05). Synovial PMN% was considered nondiagnostic of septic arthritis (area under the curve 0.56) in patients with crystals while synovial WBC and CRP had acceptable (0.76) and excellent (0.83) diagnostic utility, respectively. The WBC and CRP value thresholds that maximized sensitivity and specificity for septic arthritis were greater in patients with crystals (21,600 vs. 17,954 cells/μL and 125 vs. 69 mg/L, respectively). DISCUSSION The presence of synovial crystals reduced the likelihood of septic arthritis and altered the laboratory diagnostic criteria. PMN% was nondiagnostic in the setting of synovial crystals.
{"title":"The Effect of Crystal Arthropathy on the Diagnostic Criteria of Native Septic Arthritis.","authors":"Ben D. Pesante, Maryam Salimi, Whitney L Miller, Heather L Young, Timothy C Jenkins, Joshua A Parry","doi":"10.5435/JAAOS-D-23-00857","DOIUrl":"https://doi.org/10.5435/JAAOS-D-23-00857","url":null,"abstract":"INTRODUCTION\u0000Distinguishing between septic arthritis and crystal arthropathy flares can be challenging. The purpose of this study was to determine how the presence of synovial crystals affects the diagnostic criteria of septic arthritis.\u0000\u0000\u0000METHODS\u0000A retrospective review identified patients undergoing joint aspirations to rule out native septic arthritis. Differences between septic arthritis presenting with and without synovial crystals were analyzed. A receiver-operating characteristic curve was plotted for laboratory markers to determine the area under the curve, or diagnostic accuracy, for septic arthritis and to evaluate thresholds that maximized sensitivity and specificity.\u0000\u0000\u0000RESULTS\u0000There were 302 joint aspirations in 267 patients. Septic arthritis was diagnosed in 17.9% (54/302). Patients with synovial crystals were less likely to have septic arthritis (4.2% [5/119] vs. 26.8% [49/183], P < 0.0001). Septic arthritis in patients with no synovial crystals was associated with fever and a higher synovial white blood cell (WBC) count, synovial polymorphonuclear cell percentage (PMN%), serum WBC, and C-reactive protein (CRP) (P < 0.05). Septic arthritis in patients with synovial crystals was only associated with inability to bear weight and a higher synovial WBC and CRP (P < 0.05). Synovial PMN% was considered nondiagnostic of septic arthritis (area under the curve 0.56) in patients with crystals while synovial WBC and CRP had acceptable (0.76) and excellent (0.83) diagnostic utility, respectively. The WBC and CRP value thresholds that maximized sensitivity and specificity for septic arthritis were greater in patients with crystals (21,600 vs. 17,954 cells/μL and 125 vs. 69 mg/L, respectively).\u0000\u0000\u0000DISCUSSION\u0000The presence of synovial crystals reduced the likelihood of septic arthritis and altered the laboratory diagnostic criteria. PMN% was nondiagnostic in the setting of synovial crystals.","PeriodicalId":110802,"journal":{"name":"The Journal of the American Academy of Orthopaedic Surgeons","volume":"78 2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140694675","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-17DOI: 10.5435/JAAOS-D-23-00831
Anthony Bozzo, James M G Tsui, Sahir Bhatnagar, Jonathan Forsberg
This review article focuses on the applications of deep learning with neural networks and multimodal neural networks in the orthopaedic domain. By providing practical examples of how artificial intelligence (AI) is being applied successfully in orthopaedic surgery, particularly in the realm of imaging data sets and the integration of clinical data, this study aims to provide orthopaedic surgeons with the necessary tools to not only evaluate existing literature but also to consider AI's potential in their own clinical or research pursuits. We first review standard deep neural networks which can analyze numerical clinical variables, then describe convolutional neural networks which can analyze image data, and then introduce multimodal AI models which analyze various types of different data. Then, we contrast these deep learning techniques with related but more limited techniques such as radiomics, describe how to interpret deep learning studies, and how to initiate such studies at your institution. Ultimately, by empowering orthopaedic surgeons with the knowledge and know-how of deep learning, this review aspires to facilitate the translation of research into clinical practice, thereby enhancing the efficacy and precision of real-world orthopaedic care for patients.
{"title":"Deep Learning and Multimodal Artificial Intelligence in Orthopaedic Surgery.","authors":"Anthony Bozzo, James M G Tsui, Sahir Bhatnagar, Jonathan Forsberg","doi":"10.5435/JAAOS-D-23-00831","DOIUrl":"https://doi.org/10.5435/JAAOS-D-23-00831","url":null,"abstract":"This review article focuses on the applications of deep learning with neural networks and multimodal neural networks in the orthopaedic domain. By providing practical examples of how artificial intelligence (AI) is being applied successfully in orthopaedic surgery, particularly in the realm of imaging data sets and the integration of clinical data, this study aims to provide orthopaedic surgeons with the necessary tools to not only evaluate existing literature but also to consider AI's potential in their own clinical or research pursuits. We first review standard deep neural networks which can analyze numerical clinical variables, then describe convolutional neural networks which can analyze image data, and then introduce multimodal AI models which analyze various types of different data. Then, we contrast these deep learning techniques with related but more limited techniques such as radiomics, describe how to interpret deep learning studies, and how to initiate such studies at your institution. Ultimately, by empowering orthopaedic surgeons with the knowledge and know-how of deep learning, this review aspires to facilitate the translation of research into clinical practice, thereby enhancing the efficacy and precision of real-world orthopaedic care for patients.","PeriodicalId":110802,"journal":{"name":"The Journal of the American Academy of Orthopaedic Surgeons","volume":"83 5","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140694647","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-17DOI: 10.5435/JAAOS-D-23-00954
Robert Lee Satcher, Benjamin Fiedler, Abdullah Ghali, D. Dirschl
With National Aeronautics and Space Administration's plans for longer distance, longer duration spaceflights such as missions to Mars and the surge in popularity of space tourism, the need to better understand the effects of spaceflight on the musculoskeletal system has never been more present. However, there is a paucity of information on how spaceflight affects orthopaedic health. This review surveys existing literature and discusses the effect of spaceflight on each aspect of the musculoskeletal system. Spaceflight reduces bone mineral density at rapid rates because of multiple mechanisms. While this seems to be recoverable upon re-exposure to gravity, concern for fracture in spaceflight remains as microgravity impairs bone strength and fracture healing. Muscles, tendons, and entheses similarly undergo microgravity adaptation. These changes result in decreased muscle mass, increased tendon laxity, and decreased enthesis stiffness, thus decreasing the strength of the muscle-tendon-enthesis unit with variable recovery upon gravity re-exposure. Spaceflight also affects joint health; unloading of the joints facilitates changes that thin and atrophy cartilage similar to arthritic phenotypes. These changes are likely recoverable upon return to gravity with exercise. Multiple questions remain regarding effects of longer duration flights on health and implications of these findings on terrestrial medicine, which should be the target of future research.
随着美国国家航空航天局（National Aeronautics and Space Administration）计划进行更长距离、更长时间的太空飞行（如火星任务）以及太空旅游的兴起，现在比以往任何时候都更需要更好地了解太空飞行对肌肉骨骼系统的影响。然而，有关太空飞行如何影响骨科健康的信息却很少。本综述对现有文献进行了调查，并讨论了太空飞行对肌肉骨骼系统各方面的影响。由于多种机制，太空飞行会快速降低骨矿物质密度。虽然在重新暴露于重力环境后似乎可以恢复，但由于微重力会损害骨强度和骨折愈合，人们仍然担心在太空飞行中会发生骨折。肌肉、肌腱和粘膜同样会发生微重力适应性变化。这些变化会导致肌肉质量下降、肌腱松弛度增加和粘膜硬度下降，从而降低肌肉-肌腱-粘膜单元的强度，并在重力重新暴露后出现不同程度的恢复。太空飞行也会影响关节健康；关节卸载会导致软骨变薄和萎缩，类似于关节炎表型。这些变化很可能在通过运动恢复重力后得到恢复。关于更长时间的飞行对健康的影响以及这些发现对地面医学的影响，仍然存在许多问题，这应该是未来研究的目标。
{"title":"Effect of Spaceflight and Microgravity on the Musculoskeletal System: A Review.","authors":"Robert Lee Satcher, Benjamin Fiedler, Abdullah Ghali, D. Dirschl","doi":"10.5435/JAAOS-D-23-00954","DOIUrl":"https://doi.org/10.5435/JAAOS-D-23-00954","url":null,"abstract":"With National Aeronautics and Space Administration's plans for longer distance, longer duration spaceflights such as missions to Mars and the surge in popularity of space tourism, the need to better understand the effects of spaceflight on the musculoskeletal system has never been more present. However, there is a paucity of information on how spaceflight affects orthopaedic health. This review surveys existing literature and discusses the effect of spaceflight on each aspect of the musculoskeletal system. Spaceflight reduces bone mineral density at rapid rates because of multiple mechanisms. While this seems to be recoverable upon re-exposure to gravity, concern for fracture in spaceflight remains as microgravity impairs bone strength and fracture healing. Muscles, tendons, and entheses similarly undergo microgravity adaptation. These changes result in decreased muscle mass, increased tendon laxity, and decreased enthesis stiffness, thus decreasing the strength of the muscle-tendon-enthesis unit with variable recovery upon gravity re-exposure. Spaceflight also affects joint health; unloading of the joints facilitates changes that thin and atrophy cartilage similar to arthritic phenotypes. These changes are likely recoverable upon return to gravity with exercise. Multiple questions remain regarding effects of longer duration flights on health and implications of these findings on terrestrial medicine, which should be the target of future research.","PeriodicalId":110802,"journal":{"name":"The Journal of the American Academy of Orthopaedic Surgeons","volume":" 34","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140692190","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-10DOI: 10.5435/JAAOS-D-23-01213
Kevin C. Liu, Neelesh Bagrodia, Mary K. Richardson, Amit S. Piple, Nicholas Kusnezov, Jennifer C. Wang, J. R. Lieberman, N. Heckmann
INTRODUCTION Venous thromboembolism (VTE) remains a dangerous complication after total hip arthroplasty (THA), despite advances in chemoprophylactic measures. This study aimed to identify risk factors of developing pulmonary embolism (PE) and deep vein thrombosis (DVT) after THA using a modern cohort of patients reflecting contemporary practices. METHODS The Premier Healthcare Database was queried for primary, elective THAs from January 1st, 2015, to December 31st, 2021. Patients who developed PE or DVT within 90 days of THA were compared with patients who did not develop any postoperative VTE. Differences in patient demographics, comorbidities, hospital factors, perioperative medications, chemoprophylactic agents, and allogeneic blood transfusion were compared between cohorts. Multivariable logistic regression models were used to identify independent risk factors of PE and DVT. In total, 544,298 THAs were identified, of which 1,129 (0.21%) developed a PE and 1,799 (0.33%) developed a DVT. RESULTS Patients diagnosed with a PE had significantly higher rates of in-hospital death (2.6% vs 0.1%, P < 0.001) compared with those without a PE. Age (adjusted odds ratio: 1.02 per year, 95% confidence interval [CI]: 1.01 to 1.03) and Black race (aOR: 1.52, 95% CI: 1.24 to 1.87) were associated with an increased risk of PE. Comorbidities associated with increased risk of PE included chronic pulmonary disease (aOR: 1.58, 95% CI: 1.36 to 1.84), pulmonary hypertension (aOR: 2.06, 95% CI: 1.39 to 3.04), and history of VTE (aOR: 2.38, 95% CI: 1.98 to 2.86). Allogeneic blood transfusion (aOR: 2.40, 95% CI: 1.88 to 3.06) was also associated with an increased risk of PE while dexamethasone utilization was associated with a reduced risk (aOR: 0.83, 95% CI: 0.73 to 0.95). DISCUSSION Increasing age; Black race; allogeneic blood transfusion; and comorbidities, including chronic pulmonary disease, pulmonary hypertension, and history of VTE, were independent risk factors of PE after THA. Given the increased mortality associated with PE, patients should be carefully evaluated for these factors and managed with an appropriate chemoprophylactic regimen.
简介尽管化学预防措施取得了进步，但静脉血栓栓塞症（VTE）仍然是全髋关节置换术（THA）后的一种危险并发症。本研究旨在通过一个反映当代实践的现代患者队列，确定全髋关节置换术后发生肺栓塞（PE）和深静脉血栓形成（DVT）的风险因素。方法查询 Premier Healthcare 数据库，了解 2015 年 1 月 1 日至 2021 年 12 月 31 日期间的初级、择期全髋关节置换术。将 THA 术后 90 天内发生 PE 或 DVT 的患者与术后未发生任何 VTE 的患者进行比较。比较了两组患者在人口统计学、合并症、医院因素、围手术期用药、化学预防药物和异体输血方面的差异。采用多变量逻辑回归模型确定了发生 PE 和深静脉血栓的独立风险因素。结果与未发生 PE 的患者相比，确诊发生 PE 的患者的院内死亡率明显更高（2.6% vs 0.1%，P < 0.001）。年龄（调整后的几率比：每年1.02，95%置信区间[CI]：1.01至1.03年龄（调整赔率比：每年 1.02，95% 置信区间 [CI]：1.01 至 1.03）和黑人种族（aOR：1.52，95% CI：1.24 至 1.87）与 PE 风险增加有关。与 PE 风险增加相关的合并症包括慢性肺部疾病（aOR：1.58，95% CI：1.36 至 1.84）、肺动脉高压（aOR：2.06，95% CI：1.39 至 3.04）和 VTE 病史（aOR：2.38，95% CI：1.98 至 2.86）。讨论年龄增加、黑人种族、异体输血和合并症（包括慢性肺部疾病、肺动脉高压和 VTE 病史）是 THA 后 PE 的独立危险因素。鉴于与 PE 相关的死亡率增加，应仔细评估患者的这些因素，并采用适当的化学预防方案进行管理。
{"title":"Risk Factors Associated with Thromboembolic Complications After total Hip Arthroplasty: An Analysis of 1,129 Pulmonary Emboli.","authors":"Kevin C. Liu, Neelesh Bagrodia, Mary K. Richardson, Amit S. Piple, Nicholas Kusnezov, Jennifer C. Wang, J. R. Lieberman, N. Heckmann","doi":"10.5435/JAAOS-D-23-01213","DOIUrl":"https://doi.org/10.5435/JAAOS-D-23-01213","url":null,"abstract":"INTRODUCTION\u0000Venous thromboembolism (VTE) remains a dangerous complication after total hip arthroplasty (THA), despite advances in chemoprophylactic measures. This study aimed to identify risk factors of developing pulmonary embolism (PE) and deep vein thrombosis (DVT) after THA using a modern cohort of patients reflecting contemporary practices.\u0000\u0000\u0000METHODS\u0000The Premier Healthcare Database was queried for primary, elective THAs from January 1st, 2015, to December 31st, 2021. Patients who developed PE or DVT within 90 days of THA were compared with patients who did not develop any postoperative VTE. Differences in patient demographics, comorbidities, hospital factors, perioperative medications, chemoprophylactic agents, and allogeneic blood transfusion were compared between cohorts. Multivariable logistic regression models were used to identify independent risk factors of PE and DVT. In total, 544,298 THAs were identified, of which 1,129 (0.21%) developed a PE and 1,799 (0.33%) developed a DVT.\u0000\u0000\u0000RESULTS\u0000Patients diagnosed with a PE had significantly higher rates of in-hospital death (2.6% vs 0.1%, P < 0.001) compared with those without a PE. Age (adjusted odds ratio: 1.02 per year, 95% confidence interval [CI]: 1.01 to 1.03) and Black race (aOR: 1.52, 95% CI: 1.24 to 1.87) were associated with an increased risk of PE. Comorbidities associated with increased risk of PE included chronic pulmonary disease (aOR: 1.58, 95% CI: 1.36 to 1.84), pulmonary hypertension (aOR: 2.06, 95% CI: 1.39 to 3.04), and history of VTE (aOR: 2.38, 95% CI: 1.98 to 2.86). Allogeneic blood transfusion (aOR: 2.40, 95% CI: 1.88 to 3.06) was also associated with an increased risk of PE while dexamethasone utilization was associated with a reduced risk (aOR: 0.83, 95% CI: 0.73 to 0.95).\u0000\u0000\u0000DISCUSSION\u0000Increasing age; Black race; allogeneic blood transfusion; and comorbidities, including chronic pulmonary disease, pulmonary hypertension, and history of VTE, were independent risk factors of PE after THA. Given the increased mortality associated with PE, patients should be carefully evaluated for these factors and managed with an appropriate chemoprophylactic regimen.","PeriodicalId":110802,"journal":{"name":"The Journal of the American Academy of Orthopaedic Surgeons","volume":"28 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140716804","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-10DOI: 10.5435/JAAOS-D-23-00958
Amir H Karimi, Robert J. Burkhart, Monish S. Lavu, Aakash K Shah, R. J. Mistovich
INTRODUCTION Despite recent efforts to increase the participation of women in orthopaedic surgery, there remains a gender gap, particularly when compared with other medical specialties. Acting as a principal investigator (PI) in a clinical trial can give physicians notable exposure and national recognition, which can improve their chances of promotion and tenure. This study aims to assess the proportion of women serving as PIs in pediatric orthopaedic clinical trials, examine associated trial characteristics, and explore geographic distribution. METHODS A cross-sectional analysis of clinical trials was conducted using data from the ClinicalTrials.gov registry. Specific search terms were used to identify pediatric orthopaedic trials. Data on trial characteristics, including phase, status, funding source, and intervention type, were collected. PI sex was determined using Genderize.io, an application program interface that predicts the sex of individuals based on their name, and the geographic distribution of women PIs was examined. RESULTS From 2007 to 2022, women PIs increased from zero to 26.86%. The United States saw no significant increase (β = 1.553; P = 0.125), but international trials did (β = 2.845; P = 0.008). Women PIs led more active/completed trials and trials with behavioral/other interventions. Geographic analysis showed higher representation in North America (38.47%), especially the Northeast (28.17%) and West (25.35%). The United States had 28.74% women PIs, with California (15.49%) leading. CONCLUSION Progress toward gender parity in pediatric orthopaedic research is evident; however, disparities still exist. Efforts to provide additional research opportunities for women in orthopaedics may be crucial in attracting and retaining diverse talent in the field. Targeted initiatives may have potential in achieving equal representation in orthopaedics.
引言尽管最近在努力提高女性参与骨科手术的比例，但性别差距依然存在，尤其是与其他医学专业相比。在临床试验中担任主要研究者（PI）可以为医生带来显著的曝光度和国家认可度，从而提高他们晋升和终身任职的机会。本研究旨在评估在小儿骨科临床试验中担任首席研究员的女性比例，研究相关试验的特点，并探讨地理分布情况。方法利用ClinicalTrials.gov注册中心的数据对临床试验进行了横断面分析。使用特定的检索词来识别儿科矫形试验。收集了有关试验特征的数据，包括阶段、状态、资金来源和干预类型。使用Genderize.io（一种根据姓名预测性别的应用程序界面）确定了PI的性别，并研究了女性PI的地理分布。结果从2007年到2022年，女性PI从0增加到26.86%。美国没有明显增加（β = 1.553; P = 0.125），但国际试验有明显增加（β = 2.845; P = 0.008）。女性首席研究员领导了更多积极/已完成的试验以及有行为/其他干预措施的试验。地域分析表明，北美洲（38.47%），尤其是东北部（28.17%）和西部（25.35%）的女性首席科学家比例较高。美国的女性首席研究员占 28.74%，其中加利福尼亚州（15.49%）居首位。努力为骨科领域的女性提供更多的研究机会，对于吸引和留住该领域的多元化人才至关重要。有针对性的举措有可能实现骨科领域的平等代表性。
{"title":"Women's Representation as Principal Investigators Among Pediatric Orthopaedic Clinical Trials: An Analysis of ClinicalTrials.Gov.","authors":"Amir H Karimi, Robert J. Burkhart, Monish S. Lavu, Aakash K Shah, R. J. Mistovich","doi":"10.5435/JAAOS-D-23-00958","DOIUrl":"https://doi.org/10.5435/JAAOS-D-23-00958","url":null,"abstract":"INTRODUCTION\u0000Despite recent efforts to increase the participation of women in orthopaedic surgery, there remains a gender gap, particularly when compared with other medical specialties. Acting as a principal investigator (PI) in a clinical trial can give physicians notable exposure and national recognition, which can improve their chances of promotion and tenure. This study aims to assess the proportion of women serving as PIs in pediatric orthopaedic clinical trials, examine associated trial characteristics, and explore geographic distribution.\u0000\u0000\u0000METHODS\u0000A cross-sectional analysis of clinical trials was conducted using data from the ClinicalTrials.gov registry. Specific search terms were used to identify pediatric orthopaedic trials. Data on trial characteristics, including phase, status, funding source, and intervention type, were collected. PI sex was determined using Genderize.io, an application program interface that predicts the sex of individuals based on their name, and the geographic distribution of women PIs was examined.\u0000\u0000\u0000RESULTS\u0000From 2007 to 2022, women PIs increased from zero to 26.86%. The United States saw no significant increase (β = 1.553; P = 0.125), but international trials did (β = 2.845; P = 0.008). Women PIs led more active/completed trials and trials with behavioral/other interventions. Geographic analysis showed higher representation in North America (38.47%), especially the Northeast (28.17%) and West (25.35%). The United States had 28.74% women PIs, with California (15.49%) leading.\u0000\u0000\u0000CONCLUSION\u0000Progress toward gender parity in pediatric orthopaedic research is evident; however, disparities still exist. Efforts to provide additional research opportunities for women in orthopaedics may be crucial in attracting and retaining diverse talent in the field. Targeted initiatives may have potential in achieving equal representation in orthopaedics.","PeriodicalId":110802,"journal":{"name":"The Journal of the American Academy of Orthopaedic Surgeons","volume":"5 7","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140716332","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-10DOI: 10.5435/JAAOS-D-23-00669
Melissa A Wright, Matthew J Smith, Christopher J Roach
The American Academy of Orthopaedic Surgeons has developed an Appropriate Use Criteria (AUC) for Treatment of Shoulder Osteoarthritis with Intact Rotator Cuff and Severe Glenoid Retroversion. Evidence-based information, in conjunction with the clinical expertise of physicians, was used to develop the criteria to determine the appropriateness of various treatments of shoulder osteoarthritis with intact rotator cuff and severe glenoid retroversion. The AUC for Treatment of Shoulder Osteoarthritis with Intact Rotator Cuff and Severe Glenoid Retroversion were derived by identifying scenarios evident during the clinical decision-making process on this topic. These scenarios relied on definitions and general assumptions, mutually agreed upon by the writing panel during scenario development. These definitions and assumptions were necessary to provide consistency in the interpretation of the clinical scenarios among experts rating the scenarios and readers using the final criteria. Writing panel members of this AUC developed patient scenarios using these guiding principles: comprehensive (covers a wide range of patients), mutually exclusive (no overlap between patient scenarios/indications), homogeneous (final ratings should result in equal application in each of the patient scenarios), and manageable (number of total rating items [ie, number of patient scenarios × number of treatments] should be practical for the rating panel). The target number of total rating items was <1,500. This means that not all patient indications and treatments can be assessed using AUC. A total of 240 patient scenarios and five treatments were developed by the writing panel, a group of clinicians who are specialists in this AUC topic. Next, a separate, multidisciplinary, rating panel (made up of specialists and non-specialists) rated the appropriateness of treatment of each patient scenario using a nine-point scale to designate a treatment as "appropriate" (median rating, 7 to 9), "may be appropriate" (median rating, 4 to 6), or "rarely appropriate" (median rating, 1 to 3).
{"title":"Treatment of Shoulder Osteoarthritis With Intact Rotator Cuff and Severe Glenoid Retroversion.","authors":"Melissa A Wright, Matthew J Smith, Christopher J Roach","doi":"10.5435/JAAOS-D-23-00669","DOIUrl":"https://doi.org/10.5435/JAAOS-D-23-00669","url":null,"abstract":"The American Academy of Orthopaedic Surgeons has developed an Appropriate Use Criteria (AUC) for Treatment of Shoulder Osteoarthritis with Intact Rotator Cuff and Severe Glenoid Retroversion. Evidence-based information, in conjunction with the clinical expertise of physicians, was used to develop the criteria to determine the appropriateness of various treatments of shoulder osteoarthritis with intact rotator cuff and severe glenoid retroversion. The AUC for Treatment of Shoulder Osteoarthritis with Intact Rotator Cuff and Severe Glenoid Retroversion were derived by identifying scenarios evident during the clinical decision-making process on this topic. These scenarios relied on definitions and general assumptions, mutually agreed upon by the writing panel during scenario development. These definitions and assumptions were necessary to provide consistency in the interpretation of the clinical scenarios among experts rating the scenarios and readers using the final criteria. Writing panel members of this AUC developed patient scenarios using these guiding principles: comprehensive (covers a wide range of patients), mutually exclusive (no overlap between patient scenarios/indications), homogeneous (final ratings should result in equal application in each of the patient scenarios), and manageable (number of total rating items [ie, number of patient scenarios × number of treatments] should be practical for the rating panel). The target number of total rating items was <1,500. This means that not all patient indications and treatments can be assessed using AUC. A total of 240 patient scenarios and five treatments were developed by the writing panel, a group of clinicians who are specialists in this AUC topic. Next, a separate, multidisciplinary, rating panel (made up of specialists and non-specialists) rated the appropriateness of treatment of each patient scenario using a nine-point scale to designate a treatment as \"appropriate\" (median rating, 7 to 9), \"may be appropriate\" (median rating, 4 to 6), or \"rarely appropriate\" (median rating, 1 to 3).","PeriodicalId":110802,"journal":{"name":"The Journal of the American Academy of Orthopaedic Surgeons","volume":"22 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140717973","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-10DOI: 10.5435/JAAOS-D-23-00914
Vishal Hegde, Andrew B Harris, Bryan D Springer, H. Khanuja
There is renewed interest in cemented femoral fixation in total hip arthroplasty in the United States, and to fully appreciate the evolution of cemented femoral stem designs, an understanding of their history and design rationale is essential. To adequately study the outcomes of modern-day designs, a comprehensive classification system is also necessary. The biomechanical principles, failure mechanisms, and clinical outcomes associated with various cemented femoral stems are described in this comprehensive review. In addition, an updated version of an existing classification system is described that incorporates the primary design characteristics which differentiate implants currently in use. In this classification, implants are categorized as taper-slip (Type I), which are subdivided by Anatomic (IA), Double-Taper (IB), and Triple-Taper (IC) with subclassification for Traditional and Line-to-Line implants. Composite beam (Type II) implants are similarly divided into Anatomic (IIA), Straight (IIB), and Wedge (IIC) with subclassification for Polished, Satin, or Roughened finish. This classification system provides a basis for comparing cemented femoral stems, thereby improving our understanding of the effect of design characteristics on survivorship to guide future advancements and improve clinical outcomes.
{"title":"Cemented Stem Design in Total Hip Arthroplasty: Fixation Philosophies, Biomechanics, and an Updated Classification System.","authors":"Vishal Hegde, Andrew B Harris, Bryan D Springer, H. Khanuja","doi":"10.5435/JAAOS-D-23-00914","DOIUrl":"https://doi.org/10.5435/JAAOS-D-23-00914","url":null,"abstract":"There is renewed interest in cemented femoral fixation in total hip arthroplasty in the United States, and to fully appreciate the evolution of cemented femoral stem designs, an understanding of their history and design rationale is essential. To adequately study the outcomes of modern-day designs, a comprehensive classification system is also necessary. The biomechanical principles, failure mechanisms, and clinical outcomes associated with various cemented femoral stems are described in this comprehensive review. In addition, an updated version of an existing classification system is described that incorporates the primary design characteristics which differentiate implants currently in use. In this classification, implants are categorized as taper-slip (Type I), which are subdivided by Anatomic (IA), Double-Taper (IB), and Triple-Taper (IC) with subclassification for Traditional and Line-to-Line implants. Composite beam (Type II) implants are similarly divided into Anatomic (IIA), Straight (IIB), and Wedge (IIC) with subclassification for Polished, Satin, or Roughened finish. This classification system provides a basis for comparing cemented femoral stems, thereby improving our understanding of the effect of design characteristics on survivorship to guide future advancements and improve clinical outcomes.","PeriodicalId":110802,"journal":{"name":"The Journal of the American Academy of Orthopaedic Surgeons","volume":"109 3","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140719815","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-10DOI: 10.5435/JAAOS-D-23-00080
Andrew G Kim, Adam A. Rizk, Jason G. Ina, Steven J Magister, Michael J Salata
INTRODUCTION Although hip arthroscopy continues to be one of the most used arthroscopic procedures, no focused, comprehensive evaluation of reimbursement trends has been conducted. The purpose of this study was to analyze the temporal Medicare reimbursement trends for hip arthroscopy procedures. METHODS From 2011 to 2021, the Medicare Physician Fee Schedule Look-Up Tool was queried for Current Procedural Terminology (CPT) codes related to hip arthroscopy (29860 to 29863, 29914 to 29916). All monetary data were adjusted to 2021 US dollars. The compound annual growth rate and total percentage change were calculated. Mann-Kendall trend tests were used to evaluate the reimbursement trends. RESULTS Based on the unadjusted values, a significant increase in physician fee was observed from 2011 to 2021 for CPT codes 29861 (removal of loose or foreign bodies; % change: 3.49, P = 0.03) and 29862 (chondroplasty, abrasion arthroplasty, labral resection; % change: 3.19, P = 0.03). The remaining CPT codes experienced no notable changes in reimbursement based on the unadjusted values. After adjusting for inflation, all seven of the hip arthroscopy CPT codes were observed to experience a notable decline in Medicare reimbursement. Hip arthroscopy with acetabuloplasty (CPT: 29915) and labral repair (CPT: 29916) exhibited the greatest reduction in reimbursement with a decrease in physician fee of 24.69% (P < 0.001) and 24.64% (P < 0.001), respectively, over the study period. DISCUSSION Medicare reimbursement for all seven of the commonly used hip arthroscopy services did not keep up with inflation, demonstrating marked reductions from 2011 to 2021. Specifically, the inflation-adjusted reimbursements decreased between 19.23% and 24.69% between 2011 and 2021.
{"title":"Declining Inflation-Adjusted Medicare Physician Fees: An Unsustainable Trend in Hip Arthroscopy.","authors":"Andrew G Kim, Adam A. Rizk, Jason G. Ina, Steven J Magister, Michael J Salata","doi":"10.5435/JAAOS-D-23-00080","DOIUrl":"https://doi.org/10.5435/JAAOS-D-23-00080","url":null,"abstract":"INTRODUCTION\u0000Although hip arthroscopy continues to be one of the most used arthroscopic procedures, no focused, comprehensive evaluation of reimbursement trends has been conducted. The purpose of this study was to analyze the temporal Medicare reimbursement trends for hip arthroscopy procedures.\u0000\u0000\u0000METHODS\u0000From 2011 to 2021, the Medicare Physician Fee Schedule Look-Up Tool was queried for Current Procedural Terminology (CPT) codes related to hip arthroscopy (29860 to 29863, 29914 to 29916). All monetary data were adjusted to 2021 US dollars. The compound annual growth rate and total percentage change were calculated. Mann-Kendall trend tests were used to evaluate the reimbursement trends.\u0000\u0000\u0000RESULTS\u0000Based on the unadjusted values, a significant increase in physician fee was observed from 2011 to 2021 for CPT codes 29861 (removal of loose or foreign bodies; % change: 3.49, P = 0.03) and 29862 (chondroplasty, abrasion arthroplasty, labral resection; % change: 3.19, P = 0.03). The remaining CPT codes experienced no notable changes in reimbursement based on the unadjusted values. After adjusting for inflation, all seven of the hip arthroscopy CPT codes were observed to experience a notable decline in Medicare reimbursement. Hip arthroscopy with acetabuloplasty (CPT: 29915) and labral repair (CPT: 29916) exhibited the greatest reduction in reimbursement with a decrease in physician fee of 24.69% (P < 0.001) and 24.64% (P < 0.001), respectively, over the study period.\u0000\u0000\u0000DISCUSSION\u0000Medicare reimbursement for all seven of the commonly used hip arthroscopy services did not keep up with inflation, demonstrating marked reductions from 2011 to 2021. Specifically, the inflation-adjusted reimbursements decreased between 19.23% and 24.69% between 2011 and 2021.","PeriodicalId":110802,"journal":{"name":"The Journal of the American Academy of Orthopaedic Surgeons","volume":"557 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140719277","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-10DOI: 10.5435/JAAOS-D-23-00839
Yasir AlShehri, Arashdeep Sidhu, L. Lakshmanan, K. Lefaivre
Natural language processing is an exciting and emerging field in health care that can transform the field of orthopaedics. It can aid in the process of automated clinical data analysis, changing the way we extract data for various purposes including research and registry formation, diagnosis, and medical billing. This scoping review will look at the various applications of NLP in orthopaedics. Specific examples of NLP applications include identification of essential data elements from surgical and imaging reports, patient feedback analysis, and use of AI conversational agents for patient engagement. We will demonstrate how NLP has proven itself to be a powerful and valuable tool. Despite these potential advantages, there are drawbacks we must consider. Concerns with data quality, bias, privacy, and accessibility may stand as barriers in the way of widespread implementation of NLP technology. As natural language processing technology continues to develop, it has the potential to revolutionize orthopaedic research and clinical practices and enhance patient outcomes.
{"title":"Applications of Natural Language Processing for Automated Clinical Data Analysis in Orthopaedics.","authors":"Yasir AlShehri, Arashdeep Sidhu, L. Lakshmanan, K. Lefaivre","doi":"10.5435/JAAOS-D-23-00839","DOIUrl":"https://doi.org/10.5435/JAAOS-D-23-00839","url":null,"abstract":"Natural language processing is an exciting and emerging field in health care that can transform the field of orthopaedics. It can aid in the process of automated clinical data analysis, changing the way we extract data for various purposes including research and registry formation, diagnosis, and medical billing. This scoping review will look at the various applications of NLP in orthopaedics. Specific examples of NLP applications include identification of essential data elements from surgical and imaging reports, patient feedback analysis, and use of AI conversational agents for patient engagement. We will demonstrate how NLP has proven itself to be a powerful and valuable tool. Despite these potential advantages, there are drawbacks we must consider. Concerns with data quality, bias, privacy, and accessibility may stand as barriers in the way of widespread implementation of NLP technology. As natural language processing technology continues to develop, it has the potential to revolutionize orthopaedic research and clinical practices and enhance patient outcomes.","PeriodicalId":110802,"journal":{"name":"The Journal of the American Academy of Orthopaedic Surgeons","volume":"546 3","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140719584","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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