Journal of Bone and Joint Surgery, American Volume最新文献

Background: This study evaluated the progression of humeral head medialization in patients who underwent pyrocarbon hemiarthroplasty (PyC-HA). The authors hypothesized that glenoid erosion would not dramatically progress between the short-term and final imaging evaluations, and that there would be excellent clinical outcomes at ≥5-year follow-up.

Methods: Patients who underwent PyC-HA with ≥60 months of follow-up were included in this prospective study. Relevant data included preoperative demographic characteristics, Walch glenoid classification, changes in clinical outcomes, and revision-free and failure-free survival rates. An investigator, who was blinded to patient outcomes, assessed the glenoid morphology, changes in medialization, joint space, acromiohumeral distance (AHD), critical shoulder and β angles, and posterior subluxation in decentered glenoids at the 2-year and final follow-up visits.

Results: Forty-five patients with a mean age of 52 years and a mean follow-up of 73 months met the inclusion criteria. Significant improvements were observed across all outcome measures. The 7-year revision-free survival rate was 95.7%. Posterior subluxation in decentered shoulders decreased from 27.1% preoperatively to 19.8% postoperatively (p = 0.008). The mean medialization of the humeral head was 2.9 ± 2.8 mm at the 2-year follow-up and increased to 4.0 ± 3.3 mm at the time of the final follow-up (p = 0.096). A >2-mm decrease in AHD from early postoperative to final imaging was observed in 82.2% of patients (p < 0.001). All other radiographic changes were not significant.

Conclusions: PyC-HA is a reliable procedure for treating glenohumeral joint disease, demonstrating excellent clinical outcomes and stabilized glenoid morphology in the majority of patients between the 2-year and intermediate-term follow-up.

Level of evidence: Therapeutic Level II . See Instructions for Authors for a complete description of levels of evidence.

Background: Novel osteoconductive and osteoinductive therapies for posterior-based lumbar interbody fusion surgery are needed. Bezeotermin alfa (recombinant human bone morphogenetic protein [rhBMP]-6, previously referred to as AGA111) is a potential potent stimulator of bone regeneration. This prospective, multicenter, randomized, double-blinded, placebo-controlled Phase-2 trial evaluated the safety and preliminary efficacy of bezeotermin carried by autologous blood coagulum (ABC) in patients undergoing lumbar interbody fusion surgery between L3 and S1 for degenerative disc disease.

Methods: Adult patients scheduled for single-level elective lumbar interbody fusion surgery across 6 clinical trial sites in the People's Republic of China were randomized 1:1:1 to placebo, 0.25 mg bezeotermin, or 0.5 mg bezeotermin and followed for 12 months. The primary end point was the incidence of adverse events (AEs). Secondary end points included anti-rhBMP-6 antibodies, the success rate of radiographic fusion, changes in the Oswestry Disability Index (ODI) score, changes in the pain score on a visual analogue scale (VAS), and serum drug concentrations.

Results: Sixty-three patients with a mean age of 59.2 years (52% female, 98.4% Han) were enrolled in the study. Twenty-one, 20, and 22 of the patients were randomized to placebo, 0.25 mg bezeotermin, and 0.5 mg bezeotermin, respectively. All patients reported at least 1 AE during the study, but most AEs were mild to moderate in severity. No drug-related serious AEs were reported in the bezeotermin groups. There was a trend toward a higher rate of successful radiographic fusion and greater improvement of the ODI and VAS scores in the bezeotermin groups than in the placebo group from month 3 to month 12.

Conclusions: This prospective, randomized, double-blinded, placebo-controlled trial demonstrated that bezeotermin/ABC was safe and well tolerated during posterior-based single-level lumbar interbody fusion. The preliminary efficacy of bezeotermin in accelerating spinal fusion and improving clinical outcomes supports its further clinical development.

Level of evidence: Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.

➢ Medical malpractice litigation in orthopaedic surgery remains a major challenge, as the field consistently ranks among the most frequently litigated specialties. Malpractice claims in orthopaedics often involve surgical errors, misdiagnoses, delayed treatment, and inadequate postoperative care, with substantial financial and emotional consequences for health-care providers.➢ Malpractice risk varies by orthopaedic subspecialty, with adult reconstruction and spine surgeons facing the highest litigation rates, often due to nerve injuries, delayed or missed diagnoses, or postoperative complications. Although defense verdicts are the most common outcome, substantial settlements and plaintiff verdicts occur in cases involving irreversible damages, inadequate informed consent, or technical errors.➢ Proactive risk management and legal preparedness can help to mitigate liability and protect physicians. Preventative strategies include clear, supportive communication to build patient trust, comprehensive documentation ensuring adherence to evidence-based guidelines, and diagnostic accuracy through use of objective tools.

Background: Alcohol negatively affects bone health and fracture repair, yet its effects on implant osseointegration remain poorly understood. This in vivo study utilized a previously developed murine model to evaluate implant osseointegration before and after continuous ethanol consumption.

Methods: Adult mice were given regular drinking water (control group) or 10% to 15% ethanol in their drinking water for 3 months before undergoing surgical implantation of a load-bearing, porous titanium implant in the proximal tibia. Ethanol consumption was continued until euthanasia at 4 weeks post-implantation (ethanol group) or stopped immediately post-implantation (abstinence group) to mimic postoperative ethanol cessation. Osseointegration was assessed using micro-computed tomography (micro-CT), biomechanical pullout testing, and histological analysis.

Results: Mice with continuous ethanol consumption exhibited significantly reduced peri-implant bone formation, as measured with histology and micro-CT, compared with controls. Biomechanical testing demonstrated a weaker bone-implant interface in the ethanol group compared with controls. In contrast, postoperative abstinence restored the peri-implant bone formation and bone-implant interface strength to levels similar to those in the control group.

Conclusions: Ethanol consumption compromised implant osseointegration in mice, while postoperative abstinence promoted the recovery of peri-implant bone formation and interface strength.

Clinical relevance: Future clinical studies are needed to assess the impact of preoperative and postoperative abstinence of ethanol on osseointegration of orthopaedic implants.

Background: Financial conflicts of interest (COIs) are arguably a powerful form of COI in scientific journal publishing. The purposes of this paper were to explore the financial COIs of the 6 most highly ranked U.S.-based orthopaedic surgery journals, to more thoroughly examine financial COIs in the journal with the highest industry payments, and to discuss possible approaches to mitigating the potential negative impact of financial COIs.

Methods: Two publicly available sources of data were used to characterize editor industry funding: the websites or mastheads of high-impact U.S.-based journals and the Open Payments database from the Centers for Medicare & Medicaid Services.

Results: From 2021 to 2023, the median General and Research Payments per editor varied substantially, from a low of $0 to Clinical Orthopaedics and Related Research editors to $2,735,566 to The Journal of Arthroplasty editors.

Conclusions: Financial COIs existed for some editors at each of the 6 most highly ranked U.S.-based orthopaedic surgery journals. For The Journal of Arthroplasty, the sixth-highest-ranking journal, the majority of the editors and editorial board members had financial COIs. Adverse journal consequences related to financial COIs could be mitigated by enhancing the transparency of disclosures and prominently displaying journal policies for handling COIs on journal websites.

Background: The primary purpose of this randomized controlled trial was to evaluate serum metal levels in patients after total hip arthroplasty (THA) with a conventional compared with a modular dual-mobility bearing. The secondary aim was to compare patient-reported outcome measure (PROM) scores between the 2 cohorts.

Methods: Patients undergoing primary THA for osteoarthritis were randomized to receive either a modular dual-mobility or conventional polyethylene bearing. All patients received the same titanium acetabular and femoral components and a ceramic femoral head. Serum cobalt and chromium levels were measured preoperatively and annually at 1 through 5 years postoperatively. A total of 53 patients were enrolled. The 2 cohorts did not differ significantly in terms of demographics. In the conventional-bearing cohort, 76% of the patients were White and 24% were Black, African American; 48% of the patients were male and 52% were female. In the dual-mobility cohort, 86% of the patients were White and 14% were Black, African American; 79% of the patients were male and 21% were female.

Results: Forty-one patients who were randomized to a modular dual-mobility (n = 24) or conventional (n = 17) bearing and had a minimum follow-up of 2 years underwent serum metal analysis. No differences in serum cobalt levels (mean, 0.14 ng/mL [range, 0.075 to 0.29 ng/mL] versus 0.21 ng/mL [range, 0.075 to 0.57 ng/mL]; p = 0.22) or chromium levels (mean, 0.14 ng/mL [range, 0.05 to 0.50 ng/mL] versus 0.12 ng/mL [range, 0.05 to 0.35 ng/mL]; p = 0.65) were identified between the modular dual-mobility and conventional cohorts, respectively, at the 2-year postoperative time point.

Conclusions: There were no significant differences in serum cobalt or chromium levels at 1 and 2 years postoperatively in patients who received a ceramic femoral head and this specific dual-mobility bearing compared with a ceramic head and a conventional acetabular component. While modest expected elevations in postoperative relative to preoperative serum cobalt and chromium levels were observed in the dual-mobility group, in no case did the cobalt level exceed the laboratory reference range or the threshold of 1 ng/mL that has been associated with adverse local tissue reactions due to mechanically assisted crevice corrosion.

Level of evidence: Therapeutic Level I . See Instructions for Authors for a complete description of levels of evidence.