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Common Comorbidities and a Comparison of 4 Comorbidity Indices in Patients Undergoing Orthopaedic Oncology Surgery.
IF 4.4 1区 医学 Q1 ORTHOPEDICS Pub Date : 2025-03-05 Epub Date: 2025-01-22 DOI: 10.2106/JBJS.22.01273
Shalin S Patel, Theresa Nalty, Douglas H Fletcher, Timothy S Ballard, Spencer J Frink, Justin E Bird, Valerae O Lewis
<p><strong>Background: </strong>Comorbidity indices are used to help to estimate patients' length of hospital stay, care costs, outcomes, and mortality. Increasingly, they are considered in reimbursement models. The applicability of comorbidity indices to patients undergoing orthopaedic oncology surgery has not been studied. The purpose of this study was to determine the predominant comorbidities in patients undergoing orthopaedic oncology surgery and to evaluate the predictive value of these indices.</p><p><strong>Methods: </strong>Patient demographic characteristics, diagnoses, and preoperative comorbidities were collected retrospectively on 300 patients undergoing orthopaedic oncology surgery between January 2014 and March 2023. In this study, 3 subsets of 100 patients each with malignant primary bone tumors, malignant primary soft-tissue tumors, or osseous metastatic disease were randomly selected. Comorbidities were tabulated and weighted according to the guidelines of the Charlson Comorbidity Index (CCI), the National Institute on Aging/National Cancer Institute (NIA/NCI) index, the van Walraven Index, and the Agency for Healthcare Research and Quality (AHRQ) Index. Two-tailed bivariate Pearson correlations were performed to assess the relationship between the indices and between each index and patient outcomes. Comorbidities in our patient population were compared with those published in other studies.</p><p><strong>Results: </strong>The predominant comorbidities in patients undergoing orthopaedic oncology surgery were hypertension, deficiency anemias, metastatic disease, recent unintended weight loss or being underweight, and fluid or electrolyte disorders. The percentage of patients with certain comorbidities exceeded those reported in other cancer, orthopaedic, and inpatient populations. The 4 comorbidity indices had variable correlation when assessing our patient population. The number of comorbidities and the weighted scores from all indices demonstrated little to no correlation with length of stay and survival in our patient sample.</p><p><strong>Conclusions: </strong>The prevalence of many comorbidities in patients undergoing orthopaedic oncology surgery is greater than those reported in other patient populations. Commonly utilized indices demonstrate variable correlation with one another. With these tools, there was little to no correlation between comorbidities and patient outcomes in our patient population. The comorbidities deemed protective in these tools may underestimate the true assessment of the comorbidities in patients undergoing orthopaedic oncology surgery. This highlights the importance of developing tools to properly assess the comorbidities in defined patient populations, especially as these models are used to set benchmarks for measuring patient outcomes; assessing quality, efficiency, and safety; and determining reimbursement criteria.</p><p><strong>Level of evidence: </strong>Prognostic Level III . See Instruction
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引用次数: 0
TXA Use in Adolescent Patients Undergoing Sarcoma Surgery: Commentary on an article by Ahmed Mohamed El Ghoneimy, MD, et al.: "Intraoperative Tranexamic Acid Infusion Reduces Perioperative Blood Loss in Pediatric Limb-Salvage Surgeries. A Double-Blinded Randomized Placebo-Controlled Trial".
IF 4.4 1区 医学 Q1 ORTHOPEDICS Pub Date : 2025-03-05 DOI: 10.2106/JBJS.24.01157
Yi Guo
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引用次数: 0
Multidimensional Approach for Predicting 30-Day Mortality in Patients with a Hip Fracture: Development and External Validation of the Rotterdam Hip Fracture Mortality Prediction-30 Days (RHMP-30). 预测髋部骨折患者30天死亡率的多维方法:鹿特丹髋部骨折30天死亡率预测(rmp -30)的开发和外部验证。
IF 4.4 1区 医学 Q1 ORTHOPEDICS Pub Date : 2025-03-05 Epub Date: 2025-01-21 DOI: 10.2106/JBJS.23.01397
Louis de Jong, Eveline de Haan, Veronique A J I M van Rijckevorsel, T Martijn Kuijper, Gert R Roukema

Background: The aim of this study was to develop an accurate and clinically relevant prediction model for 30-day mortality following hip fracture surgery.

Methods: A previous study protocol was utilized as a guideline for data collection and as the standard for the hip fracture treatment. Two prospective, detailed hip fracture databases of 2 different hospitals (hospital A, training cohort; hospital B, testing cohort) were utilized to obtain data. On the basis of the literature, the results of a univariable analysis, and expert opinion, 26 candidate predictors of 30-day mortality were selected. Subsequently, the training of the model, including variable selection, was performed on the training cohort (hospital A) with use of adaptive least absolute shrinkage and selection operator (LASSO) logistic regression. External validation was performed on the testing cohort (hospital B).

Results: A total of 3,523 patients were analyzed, of whom 302 (8.6%) died within 30 days after surgery. After the LASSO analysis, 7 of the 26 variables were included in the prediction model: age, gender, an American Society of Anesthesiologists score of 4, dementia, albumin level, Katz Index of Independence in Activities of Daily Living total score, and residence in a nursing home. The area under the receiver operating characteristic curve of the prediction model was 0.789 in the training cohort and 0.775 in the testing cohort. The calibration curve showed good consistency between observed and predicted 30-day mortality.

Conclusions: The Rotterdam Hip Fracture Mortality Prediction-30 Days (RHMP-30) was developed and externally validated, and showed adequate performance in predicting 30-day mortality following hip fracture surgery. The RHMP-30 will be helpful for shared decision-making with patients regarding hip fracture treatment.

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

背景:本研究的目的是建立一个准确和临床相关的髋部骨折术后30天死亡率预测模型。方法:采用先前的研究方案作为数据收集的指南和髋部骨折治疗的标准。来自2家不同医院的两个前瞻性、详细的髋部骨折数据库(A医院,培训队列;B医院,测试队列)获得数据。在文献、单变量分析结果和专家意见的基础上,选择了26个候选的30天死亡率预测因子。随后,使用自适应最小绝对收缩和选择算子(LASSO)逻辑回归对培训队列(A医院)进行模型训练,包括变量选择。结果:共分析3,523例患者,其中302例(8.6%)在手术后30天内死亡。LASSO分析后,将26个变量中的7个纳入预测模型:年龄、性别、美国麻醉医师学会评分4分、痴呆、白蛋白水平、日常生活活动独立性Katz指数总分、养老院居住情况。训练组受试者工作特征曲线下面积为0.789,测试组受试者工作特征曲线下面积为0.775。校正曲线显示观察到的30天死亡率与预测的30天死亡率具有良好的一致性。结论:鹿特丹髋部骨折死亡率预测-30天(rmp -30)已开发并经过外部验证,在预测髋部骨折手术后30天死亡率方面表现良好。RHMP-30将有助于与髋部骨折患者共同决策治疗。证据等级:预后II级。有关证据水平的完整描述,请参见作者说明。
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引用次数: 0
Spine-Abductor Syndrome: Novel Associations Between Lumbar Spine Disease and Hip Gluteal Muscle Pathology. 脊柱-外展肌综合征:腰椎疾病与臀臀肌病理之间的新联系。
IF 4.4 1区 医学 Q1 ORTHOPEDICS Pub Date : 2025-03-05 Epub Date: 2024-11-21 DOI: 10.2106/JBJS.24.00012
Monish S Lavu, Christian J Hecht, David C Kaelber, George Grammatopoulos, Yasuhiro Homma, Atul F Kamath

Background: Risk factors for gluteal tears include age-related deterioration, female sex, and increased body mass index. As the literature that supports the sagittal relationship between the lumbar spine and the hip is increasing, there may be a parallel relationship between the perturbations in spinopelvic alignment caused by lumbar spine disease and gluteal muscle tears. Because no prior studies other than single-institution series have reported on this phenomenon, we investigated spine-abductor syndrome at the population level.

Methods: This study utilized TriNetX, a federated research network that continuously aggregates deidentified electronic health record data from >92 million patients across the United States. The relative risks of gluteal tear encounter diagnoses and procedures were calculated for patients with and without the following characteristics: age ≥45 years, female sex, obesity, lumbar spine diagnoses, lumbar spine injections, and lumbar spine surgery. Utilizing the Cox proportional hazard model, we also analyzed gluteal tear-free survival over a period of ≥10 years in subgroups of patients who had been diagnosed with lumbar pathology, had been administered a lumbar injection, or had received lumbar surgery.

Results: Of the 8,475,800 patients who had received lumbar spine diagnoses, undergone lumbar injections, and/or undergone lumbar surgeries, 458,311 patients (5.4%) had gluteal tears, representing a relative risk of 13.6 (95% confidence interval [CI]:13.6 to 13.6). After controlling for age, sex, and obesity, survival analysis showed markedly increased hazard ratios (HRs) for patients having a gluteal tear encounter diagnosis in the intervening 13 years (2010 to 2023) if they had had a previous lumbar spine pathology encounter diagnosis (HR: 4.8, 95% CI: 4.5 to 5.1), had undergone lumbar spine injections (HR: 7.7, 95% CI: 6.2 to 9.5), or had undergone lumbar spine surgery (HR: 6.6, 95% CI: 5.3 to 8.1) in 2010.

Conclusions: These findings suggest a strong association between lumbar spine pathology and abductor tears. Further biomechanical and neuroanatomic studies may elucidate the effects of lumbar spine disease in relation to gluteal tears. Additionally, there may be a need to optimize diagnostic protocols for lateral hip pain in patients with a history of lumbar spine disease.

Level of evidence: Prognostic Level III . See Instructions for Authors for a complete description of levels of evidence.

背景:臀肌撕裂的危险因素包括年龄相关性恶化、女性和体重指数增加。随着支持腰椎与髋关节矢状位关系的文献越来越多,腰椎疾病引起的脊柱骨盆位线紊乱与臀肌撕裂之间可能存在平行关系。由于除了单一机构的系列研究外,没有其他先前的研究报道过这种现象,因此我们在人群水平上调查了脊柱外展综合征。方法:本研究利用TriNetX,这是一个联邦研究网络,持续收集来自美国9200万患者的未识别电子健康记录数据。计算有或没有以下特征的患者发生臀撕裂的相对风险:年龄≥45岁、女性、肥胖、腰椎诊断、腰椎注射和腰椎手术。利用Cox比例风险模型,我们还分析了被诊断为腰椎病理、接受腰椎注射或接受腰椎手术的患者亚组中≥10年的臀肌无撕裂生存率。结果:在接受腰椎诊断、腰椎注射和/或腰椎手术的8,475,800例患者中,458,311例(5.4%)患者发生臀肌撕裂,相对风险为13.6(95%置信区间[CI]:13.6至13.6)。在控制了年龄、性别和肥胖因素后,生存分析显示,在13年(2010年至2023年)期间诊断为臀撕裂的患者,如果他们在2010年有过腰椎病理诊断(HR: 4.8, 95% CI: 4.5至5.1),接受过腰椎注射(HR: 7.7, 95% CI: 6.2至9.5),或接受过腰椎手术(HR: 6.6, 95% CI: 5.3至8.1),那么他们的风险比(HR)显著增加。结论:这些发现表明腰椎病理与外展肌撕裂之间有很强的联系。进一步的生物力学和神经解剖学研究可以阐明腰椎疾病对臀肌撕裂的影响。此外,对于有腰椎病史的患者,可能需要优化髋外侧疼痛的诊断方案。证据等级:预后III级。有关证据水平的完整描述,请参见作者说明。
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引用次数: 0
Surgery for Olecranon Fractures in the Elderly (SOFIE): Results of the SOFIE Randomized Controlled Trial. 手术治疗老年人鹰嘴骨折(SOFIE): SOFIE随机对照试验的结果。
IF 4.4 1区 医学 Q1 ORTHOPEDICS Pub Date : 2025-03-05 Epub Date: 2025-01-09 DOI: 10.2106/JBJS.24.00655
Mithun A Joshi, Michael Le, Ryan Campbell, Brahman Sivakumar, John Limbers, Ian A Harris, Michael Symes

Background: The financial and resource burden of management of olecranon fractures in the elderly is likely to increase with an aging population. There is limited evidence guiding treatment choice in this cohort. This study aimed to determine whether operative treatment of displaced olecranon fractures in elderly patients provides superior 12-month functional outcomes compared to nonoperative treatment.

Methods: A multicenter pragmatic randomized controlled trial was conducted across 24 hospitals in Australia and New Zealand. Patients aged ≥75 years presenting with an acute (within 14 days), displaced, closed, isolated olecranon fracture were included. Operative treatment involved reduction and stabilization using tension band wiring or plate fixation. Nonoperative treatment consisted of a sling for comfort and early movement as tolerated. The primary outcome was the Disabilities of the Arm, Shoulder and Hand (DASH) score at 12 months. Secondary outcomes were the DASH score at 3 months and pain, quality of life, Mayo Elbow Performance Score (MEPS), active elbow range of motion, and complication rate at 3 and 12 months. Data were analyzed based on an intention-to-treat principle, with sensitivity analyses using as-treated groups.

Results: Sixty participants were randomized, 27 to the operative group (mean age and standard deviation [SD], 83 ± 5.8 years; 22 [81%] females) and 33 to the nonoperative group (mean age, 82 ± 4.5 years; 23 [70%] females), with no significant difference in baseline characteristics. There was no significant difference (mean difference, -6.6; 95% confidence interval [CI] = -14.9 to 1.8; p = 0.12) in the mean DASH scores at 12 months (the primary outcome) between the operative (12.3 ± 14) and nonoperative (18.9 ± 18) groups. Although active elbow extension was significantly superior in the operative group at 12 months, no other secondary outcome differed significantly between groups at 12 months.

Conclusions: The study found no significant difference in DASH scores at 12 months between the operative and nonoperative groups. This supports nonoperative treatment as a reasonable option for displaced stable olecranon fractures in elderly patients.

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

背景:随着人口的老龄化,老年人鹰嘴骨折治疗的财政和资源负担可能会增加。在该队列中,指导治疗选择的证据有限。本研究旨在确定与非手术治疗相比,手术治疗老年鹰嘴移位骨折患者是否能提供更好的12个月功能预后。方法:在澳大利亚和新西兰的24家医院进行了一项多中心实用随机对照试验。患者年龄≥75岁,表现为急性(14天内),移位,封闭,孤立的鹰嘴骨折。手术治疗包括使用张力带钢丝或钢板固定复位和稳定。非手术治疗包括吊带舒适和早期活动的容忍。主要终点是12个月时手臂、肩膀和手的残疾(DASH)评分。次要结果是3个月时的DASH评分和疼痛、生活质量、Mayo肘关节功能评分(MEPS)、肘关节活动范围和3个月和12个月时的并发症发生率。根据意向治疗原则对数据进行分析,并使用治疗组进行敏感性分析。结果:60例患者随机分组,其中手术组27例(平均年龄和标准差[SD]: 83±5.8岁;女性22例(81%),非手术组33例(平均年龄82±4.5岁;23[70%]女性),基线特征无显著差异。差异无统计学意义(平均差异-6.6;95%置信区间[CI] = -14.9 ~ 1.8;p = 0.12),手术组(12.3±14)和非手术组(18.9±18)12个月平均DASH评分(主要终点)差异显著。虽然在12个月时,手术组的主动肘关节伸展明显优于手术组,但在12个月时,两组之间的其他次要结果没有显著差异。结论:研究发现手术组与非手术组12个月时DASH评分无显著差异。这支持非手术治疗作为老年患者移位型稳定鹰嘴骨折的合理选择。证据水平:治疗性i级。参见《作者说明》获得证据水平的完整描述。
{"title":"Surgery for Olecranon Fractures in the Elderly (SOFIE): Results of the SOFIE Randomized Controlled Trial.","authors":"Mithun A Joshi, Michael Le, Ryan Campbell, Brahman Sivakumar, John Limbers, Ian A Harris, Michael Symes","doi":"10.2106/JBJS.24.00655","DOIUrl":"10.2106/JBJS.24.00655","url":null,"abstract":"<p><strong>Background: </strong>The financial and resource burden of management of olecranon fractures in the elderly is likely to increase with an aging population. There is limited evidence guiding treatment choice in this cohort. This study aimed to determine whether operative treatment of displaced olecranon fractures in elderly patients provides superior 12-month functional outcomes compared to nonoperative treatment.</p><p><strong>Methods: </strong>A multicenter pragmatic randomized controlled trial was conducted across 24 hospitals in Australia and New Zealand. Patients aged ≥75 years presenting with an acute (within 14 days), displaced, closed, isolated olecranon fracture were included. Operative treatment involved reduction and stabilization using tension band wiring or plate fixation. Nonoperative treatment consisted of a sling for comfort and early movement as tolerated. The primary outcome was the Disabilities of the Arm, Shoulder and Hand (DASH) score at 12 months. Secondary outcomes were the DASH score at 3 months and pain, quality of life, Mayo Elbow Performance Score (MEPS), active elbow range of motion, and complication rate at 3 and 12 months. Data were analyzed based on an intention-to-treat principle, with sensitivity analyses using as-treated groups.</p><p><strong>Results: </strong>Sixty participants were randomized, 27 to the operative group (mean age and standard deviation [SD], 83 ± 5.8 years; 22 [81%] females) and 33 to the nonoperative group (mean age, 82 ± 4.5 years; 23 [70%] females), with no significant difference in baseline characteristics. There was no significant difference (mean difference, -6.6; 95% confidence interval [CI] = -14.9 to 1.8; p = 0.12) in the mean DASH scores at 12 months (the primary outcome) between the operative (12.3 ± 14) and nonoperative (18.9 ± 18) groups. Although active elbow extension was significantly superior in the operative group at 12 months, no other secondary outcome differed significantly between groups at 12 months.</p><p><strong>Conclusions: </strong>The study found no significant difference in DASH scores at 12 months between the operative and nonoperative groups. This supports nonoperative treatment as a reasonable option for displaced stable olecranon fractures in elderly patients.</p><p><strong>Level of evidence: </strong>Therapeutic Level I . See Instructions for Authors for a complete description of levels of evidence.</p>","PeriodicalId":15273,"journal":{"name":"Journal of Bone and Joint Surgery, American Volume","volume":" ","pages":"452-458"},"PeriodicalIF":4.4,"publicationDate":"2025-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142949602","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Two Decades Since the Unequal Treatment Report: The State of Racial, Ethnic, and Socioeconomic Disparities in Elective Total Hip and Knee Replacement Use. 不平等待遇报告二十年后:选择性全髋关节和膝关节置换术中种族、民族和社会经济差异的状况。
IF 4.4 1区 医学 Q1 ORTHOPEDICS Pub Date : 2025-03-05 Epub Date: 2024-11-20 DOI: 10.2106/JBJS.24.00347
Caroline P Thirukumaran, Jordan J Cruse, Patricia D Franklin, Benjamin F Ricciardi, Linda I Suleiman, Said A Ibrahim

Abstract: Published in 2003 by the Institute of Medicine, Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care placed an unprecedented spotlight on disparities in the U.S. health-care system. In the 2 decades since the publication of that landmark report, disparities continue to be prevalent and remain an important significant national concern. This article synthesizes the evolution, current state, and future of racial and ethnic disparities in the use of elective total joint replacement surgeries. We contextualize our impressions with respect to the recommendations of the Unequal Treatment Report.

摘要:美国医学研究所(Institute of Medicine) 2003年发表的《不平等待遇:直面医疗保健中的种族和民族差异》(equal Treatment: facing Racial and Ethnic disparity in Health Care)一文,将美国医疗保健体系中的不平等问题置于前所未有的聚光灯下。在那份具有里程碑意义的报告发表以来的20年里,差距仍然普遍存在,仍然是一个重要的国家关切问题。本文综合了选择性全关节置换手术中种族和民族差异的演变、现状和未来。我们把我们对《不平等待遇报告》各项建议的印象放在背景中考虑。
{"title":"Two Decades Since the Unequal Treatment Report: The State of Racial, Ethnic, and Socioeconomic Disparities in Elective Total Hip and Knee Replacement Use.","authors":"Caroline P Thirukumaran, Jordan J Cruse, Patricia D Franklin, Benjamin F Ricciardi, Linda I Suleiman, Said A Ibrahim","doi":"10.2106/JBJS.24.00347","DOIUrl":"10.2106/JBJS.24.00347","url":null,"abstract":"<p><strong>Abstract: </strong>Published in 2003 by the Institute of Medicine, Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care placed an unprecedented spotlight on disparities in the U.S. health-care system. In the 2 decades since the publication of that landmark report, disparities continue to be prevalent and remain an important significant national concern. This article synthesizes the evolution, current state, and future of racial and ethnic disparities in the use of elective total joint replacement surgeries. We contextualize our impressions with respect to the recommendations of the Unequal Treatment Report.</p>","PeriodicalId":15273,"journal":{"name":"Journal of Bone and Joint Surgery, American Volume","volume":" ","pages":"523-538"},"PeriodicalIF":4.4,"publicationDate":"2025-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143005953","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Intraoperative Tranexamic Acid Infusion Reduces Perioperative Blood Loss in Pediatric Limb-Salvage Surgeries: A Double-Blinded Randomized Placebo-Controlled Trial.
IF 4.4 1区 医学 Q1 ORTHOPEDICS Pub Date : 2025-03-05 Epub Date: 2025-01-22 DOI: 10.2106/JBJS.24.00261
Ahmed Mohamed El Ghoneimy, Tamer Ahmed Mahmoud Kotb, Ismail Rashad, Dina Elgalaly, Kareem AlFarsi, Mohamed Ahmed Khalil

Background: Limb-salvage surgery for malignant bone tumors can be associated with considerable perioperative blood loss. The aim of this randomized controlled trial was to assess the safety and efficacy of the intraoperative infusion of tranexamic acid (TXA) in children and adolescents undergoing limb-salvage surgery.

Methods: All participants were <18 years of age at the time of surgery and diagnosed with a malignant bone tumor of the femur that was treated with resection and reconstruction with a megaprosthesis. Exclusion criteria included anatomic locations other than the femur, reconstruction with a vascularized fibular graft, and a previous history of deep venous thrombosis, coagulopathy, or renal dysfunction. Participants were randomly allocated to either the TXA group (a preoperative loading dose infusion of 10 mg/kg of TXA followed by a continuous infusion of 5 mg/kg/hr until the end of surgery) or the placebo group (the same dosage but with TXA substituted with an infusion of normal saline solution). Intraoperative and perioperative blood loss were calculated with use of the hemoglobin balance method. Perioperative blood loss at postoperative day 1 and at discharge from the hospital were calculated. The total volumes of blood transfused intraoperatively and postoperatively were recorded. A statistical comparison between the groups was performed for blood loss and blood transfusion as well as for possible independent variables other than TXA, including age, body mass index, histopathologic diagnosis, tumor volume, preoperative hemoglobin level, type of resection, and the duration of surgery.

Results: A total of 48 participants, with a mean age of 12.5 ± 3.44 years (range, 5 to 18 years) and a male-to-female ratio of 1.18, were included. All participants were Egyptians by race and ethnicity. There were no minor or major drug-related adverse events. There was no significant difference between the groups with respect to intraoperative blood loss (p = 0.0616) or transfusion requirements (p = 0.812), but there was a significant difference in perioperative blood loss at postoperative day 1 (p = 0.0144) and at discharge from the hospital (p = 0.0106) and in perioperative blood transfusion (p = 0.023).

Conclusions: TXA can be safely infused intraoperatively in children and adolescents undergoing limb-salvage surgery, and it contributes significantly to the reduction of perioperative blood loss and transfusion requirements.

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

{"title":"Intraoperative Tranexamic Acid Infusion Reduces Perioperative Blood Loss in Pediatric Limb-Salvage Surgeries: A Double-Blinded Randomized Placebo-Controlled Trial.","authors":"Ahmed Mohamed El Ghoneimy, Tamer Ahmed Mahmoud Kotb, Ismail Rashad, Dina Elgalaly, Kareem AlFarsi, Mohamed Ahmed Khalil","doi":"10.2106/JBJS.24.00261","DOIUrl":"10.2106/JBJS.24.00261","url":null,"abstract":"<p><strong>Background: </strong>Limb-salvage surgery for malignant bone tumors can be associated with considerable perioperative blood loss. The aim of this randomized controlled trial was to assess the safety and efficacy of the intraoperative infusion of tranexamic acid (TXA) in children and adolescents undergoing limb-salvage surgery.</p><p><strong>Methods: </strong>All participants were <18 years of age at the time of surgery and diagnosed with a malignant bone tumor of the femur that was treated with resection and reconstruction with a megaprosthesis. Exclusion criteria included anatomic locations other than the femur, reconstruction with a vascularized fibular graft, and a previous history of deep venous thrombosis, coagulopathy, or renal dysfunction. Participants were randomly allocated to either the TXA group (a preoperative loading dose infusion of 10 mg/kg of TXA followed by a continuous infusion of 5 mg/kg/hr until the end of surgery) or the placebo group (the same dosage but with TXA substituted with an infusion of normal saline solution). Intraoperative and perioperative blood loss were calculated with use of the hemoglobin balance method. Perioperative blood loss at postoperative day 1 and at discharge from the hospital were calculated. The total volumes of blood transfused intraoperatively and postoperatively were recorded. A statistical comparison between the groups was performed for blood loss and blood transfusion as well as for possible independent variables other than TXA, including age, body mass index, histopathologic diagnosis, tumor volume, preoperative hemoglobin level, type of resection, and the duration of surgery.</p><p><strong>Results: </strong>A total of 48 participants, with a mean age of 12.5 ± 3.44 years (range, 5 to 18 years) and a male-to-female ratio of 1.18, were included. All participants were Egyptians by race and ethnicity. There were no minor or major drug-related adverse events. There was no significant difference between the groups with respect to intraoperative blood loss (p = 0.0616) or transfusion requirements (p = 0.812), but there was a significant difference in perioperative blood loss at postoperative day 1 (p = 0.0144) and at discharge from the hospital (p = 0.0106) and in perioperative blood transfusion (p = 0.023).</p><p><strong>Conclusions: </strong>TXA can be safely infused intraoperatively in children and adolescents undergoing limb-salvage surgery, and it contributes significantly to the reduction of perioperative blood loss and transfusion requirements.</p><p><strong>Level of evidence: </strong>Therapeutic Level I . See Instructions for Authors for a complete description of levels of evidence.</p>","PeriodicalId":15273,"journal":{"name":"Journal of Bone and Joint Surgery, American Volume","volume":" ","pages":"437-443"},"PeriodicalIF":4.4,"publicationDate":"2025-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143023545","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Efficacy of Platelet-Rich Plasma Versus Placebo for the Treatment of Greater Trochanteric Pain Syndrome: A Double-Blinded Randomized Controlled Trial. 富血小板血浆与安慰剂治疗大转子疼痛综合征的疗效:一项双盲随机对照试验
IF 4.4 1区 医学 Q1 ORTHOPEDICS Pub Date : 2025-03-05 Epub Date: 2025-01-13 DOI: 10.2106/JBJS.24.00763
Ismael Atchia, Mohammed Ali, Eshan Oderuth, Richard Holleyman, Ajay Malviya

Background: Greater trochanteric pain syndrome (GTPS) is a painful condition that can impair a patient's quality of life. If nonoperative measures fail, progressively more invasive treatment options may be required. This clinical trial aimed to evaluate the effectiveness of ultrasound-guided leukocyte-rich platelet-rich plasma (LR-PRP) injections in the treatment of refractory GTPS caused by bursitis and/or gluteal tendinopathy.

Methods: An ethically approved, adequately powered, double-blinded randomized controlled trial (RCT) was conducted to evaluate the clinical outcomes in randomized LR-PRP and placebo groups using the International Hip Outcome Tool-12 (iHOT-12), a visual analogue scale (VAS) for pain, the modified Harris hip score (mHHS), the EuroQol 5-Dimensions (EQ-5D) questionnaire, and the presence or absence of complications. All injections were performed under ultrasound guidance into the trochanteric bursa and gluteus medius tendon.

Results: The final analysis included 79 patients (39 in the LR-PRP and 40 in the placebo group; 73 female and 6 male; all Caucasian). Both the LR-PRP and the placebo group generally had improvement from baseline that was maintained to 12 months. The only deterioration in scores compared to baseline was seen in the LR-PRP group for the iHOT-12 at 12 months, the EQ-5D index at 3 and 6 months, and the EQ-5D VAS at all follow-up time points. However, there was no significant difference between the 2 groups at any follow-up point (p > 0.05). A multivariable linear regression model, with adjustment for age, sex, body mass index, and preoperative baseline score, did not reveal any significant associations between iHOT-12 and EQ-5D score gains at 12 months and treatment.

Conclusions: This randomized trial found no significant difference in outcomes between LR-PRP and placebo for the treatment of greater trochanteric pain up to 6 months following the intervention. As a result, we do not support the routine use of PRP for the treatment of this condition.

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

背景:大转子疼痛综合征(GTPS)是一种会影响患者生活质量的疼痛症状。如果非手术治疗失败,可能需要逐步增加侵入性治疗。本临床试验旨在评估超声引导下富白细胞富血小板血浆(LR-PRP)注射治疗由滑囊炎和/或臀腱病引起的难治性GTPS的有效性。方法:采用国际髋关节结局工具-12 (iHOT-12)、疼痛视觉模拟量表(VAS)、改良Harris髋关节评分(mHHS)、EuroQol 5-Dimensions (EQ-5D)问卷以及是否存在并发症,进行一项经伦理批准、充分支持的双盲随机对照试验(RCT),评估随机LR-PRP组和安慰剂组的临床结果。所有注射均在超声引导下进行,注射部位为粗隆囊和臀中肌腱。结果:最终分析纳入79例患者(LR-PRP组39例,安慰剂组40例;女性73人,男性6人;所有的白人)。LR-PRP组和安慰剂组一般都有改善,从基线维持到12个月。与基线相比,LR-PRP组在12个月时的iHOT-12、3个月和6个月时的EQ-5D指数以及所有随访时间点的EQ-5D VAS评分均出现了唯一的恶化。然而,两组在任何随访点之间均无显著差异(p < 0.05)。对年龄、性别、体重指数和术前基线评分进行调整的多变量线性回归模型显示,iHOT-12和EQ-5D评分在12个月和治疗时的增加之间没有任何显著关联。结论:这项随机试验发现,干预后6个月,LR-PRP和安慰剂治疗大转子疼痛的结果无显著差异。因此,我们不支持常规使用PRP治疗这种情况。证据水平:治疗性i级。参见《作者说明》获得证据水平的完整描述。
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引用次数: 0
Treatment of Displaced Olecranon Fractures in the Elderly: Should the Pendulum Swing?: Commentary on an article by Mithun A. Joshi, MBBS(Hons), FRACS(Orth), FAOrthA, et al.: "Surgery for Olecranon Fractures in the Elderly (SOFIE). Results of the SOFIE Randomized Controlled Trial".
IF 4.4 1区 医学 Q1 ORTHOPEDICS Pub Date : 2025-03-05 DOI: 10.2106/JBJS.24.01097
Christopher O Bayne
{"title":"Treatment of Displaced Olecranon Fractures in the Elderly: Should the Pendulum Swing?: Commentary on an article by Mithun A. Joshi, MBBS(Hons), FRACS(Orth), FAOrthA, et al.: \"Surgery for Olecranon Fractures in the Elderly (SOFIE). Results of the SOFIE Randomized Controlled Trial\".","authors":"Christopher O Bayne","doi":"10.2106/JBJS.24.01097","DOIUrl":"https://doi.org/10.2106/JBJS.24.01097","url":null,"abstract":"","PeriodicalId":15273,"journal":{"name":"Journal of Bone and Joint Surgery, American Volume","volume":"107 5","pages":"e14"},"PeriodicalIF":4.4,"publicationDate":"2025-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143557097","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
What's Important: Let's Learn to Talk About Our Patients as if They Are Sitting Right in Front of Us. 重要的是什么?让我们学会像对待眼前的病人一样对待我们的病人。
IF 4.4 1区 医学 Q1 ORTHOPEDICS Pub Date : 2025-03-05 Epub Date: 2024-11-07 DOI: 10.2106/JBJS.24.00958
Ryan K Harrison
{"title":"What's Important: Let's Learn to Talk About Our Patients as if They Are Sitting Right in Front of Us.","authors":"Ryan K Harrison","doi":"10.2106/JBJS.24.00958","DOIUrl":"10.2106/JBJS.24.00958","url":null,"abstract":"","PeriodicalId":15273,"journal":{"name":"Journal of Bone and Joint Surgery, American Volume","volume":" ","pages":"518-519"},"PeriodicalIF":4.4,"publicationDate":"2025-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142604645","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
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Journal of Bone and Joint Surgery, American Volume
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