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Computer-Assisted Virtual Preoperative Planning for the Treatment of Pilon Fractures: A Retrospective Propensity Score-Matched Cohort Study.
IF 4.4 1区 医学 Q1 ORTHOPEDICS Pub Date : 2025-02-28 DOI: 10.2106/JBJS.24.00473
Xiaoyang Jia, Kun Zhang, Minfei Qiang, Gengxin Jia, Tianhao Shi, Qinghui Han, Ying Wu, Yanxi Chen

Background: Preoperative planning is critical for the operative management of any fracture. Unfortunately, conventional planning methods for pilon fractures have not yielded satisfactory results. Therefore, the purpose of this study was to evaluate whether the outcomes of surgically treated pilon fractures could be improved with computer-assisted preoperative planning.

Methods: Between January 2010 and December 2019, 611 East Asian patients (≥18 years old) with a pilon fracture were identified. After 107 patients were excluded, the final cohort comprised 504 patients: 294 received conventional planning and 210 received computer-assisted preoperative planning. The primary outcome measure was the Olerud-Molander Ankle Score (OMAS) at 12 months. The secondary outcomes were lower-limb function, pain, quality of life, quality of fracture reduction, and complications related to soft-tissue and bone healing. Propensity score matching for 20 baseline characteristics yielded 204 patient pairs.

Results: In the entire cohort of 504 patients, the median age was 41 years (interquartile range, 37 to 46 years) and 375 patients (74.4%) were male. After matching (408 patients; 204 patients in each cohort), patients who received computer-assisted preoperative planning had a better mean OMAS value at 12 months (80.3 points [95% CI, 79.5 to 81.1]) than patients for whom the conventional planning method was used (73.2 points [95% CI, 72.5 to 74.0]; mean difference, -7.1 points [95% CI, -8.2 to -6.0]; p < 0.001). Similarly, better outcomes were observed for lower-limb function, pain, quality of life, and reduction quality in the computer-assisted planning group. Patients who received computer-assisted planning had a lower rate of soft-tissue complications (9.3% [19 of 204 patients]) than patients who received conventional planning (18.6% [38 of 204 patients]; absolute rate difference, -9.3% [95% CI, -16.1% to -2.6%]; relative risk, 0.45 [95% CI, 0.25 to 0.81]; p = 0.008), but a significant difference was not found with respect to bone-healing complications.

Conclusions: In patients with a pilon fracture, the use of computer-assisted preoperative planning yielded better functional and radiographic outcomes and a lower rate of soft-tissue complications compared with the use of conventional planning methods.

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

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引用次数: 0
Economic Incentives in Orthopaedic Surgery: A Primer.
IF 4.4 1区 医学 Q1 ORTHOPEDICS Pub Date : 2025-02-28 DOI: 10.2106/JBJS.24.00050
Matthew L Magruder, Mitchell K Ng, Michael A Mont, Andrea Coppolecchia, David J Jacofsky

➢ Orthopaedic surgeon pay structures are diverse, but most commonly are productivity-based.➢ Physician ownership of ambulatory surgery centers is a growing phenomenon and may have effects on clinical decision-making.➢ Hospital systems are paid by multiple mechanisms, including case-based reimbursement (based on Diagnosis-Related Groups). Incentives are substantially different between the types of payers (Medicare and Medicaid compared with private insurance).➢ Payer revenues stem from risk-adjusted premiums and investments in income-generating assets; a growing focus on cost-effective care and outcome-focused data by payers has led to changes in pay structures.

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引用次数: 0
The PENG Block in Elective Primary Anterior Total Hip Arthroplasty Is Associated with Reduced Length of Stay: A Multidisciplinary Prospective Randomized Double-Blinded Controlled Trial.
IF 4.4 1区 医学 Q1 ORTHOPEDICS Pub Date : 2025-02-28 DOI: 10.2106/JBJS.24.00825
Matthieu Hanauer, Alexander F Heimann, Pavel Kricka, Stefan Blümel, Darius Marti, Angela M Moosmann, Vlad Popa, Corinne A Zurmühle, Joseph M Schwab, Moritz Tannast

Background: The pericapsular nerve group (PENG) block has been shown to reduce pain and opioid consumption in posterior total hip arthroplasty (THA). The present study assessed the effects of the PENG block versus a placebo on postoperative (1) pain, (2) morphine consumption, and (3) length of stay in patients undergoing primary anterior THA.

Methods: This was an institutional review board-approved, single-center, parallel-group, prospective, randomized, double-blinded, controlled trial of patients undergoing primary anterior THA between June 2022 and April 2023. Both groups underwent ultrasound-guided injection of a 20-mL solution (0.5% ropivacaine in the PENG group, 0.9% NaCl in the placebo group), according to the PENG block procedure. Sixty patients were included (32 in the PENG group, 28 in the placebo group). We assessed (1) postoperative pain at 1, 6, 12, and 24 hours with use of the visual analogue scale; (2) total morphine consumption as the morphine-equivalent dose (MED) during the first 24 hours postoperatively; and (3) the length of stay in days.

Results: For the primary outcome, the median visual analogue scale pain score was 3.5 (range, 0 to 10) in the PENG group versus 4 (range, 0 to 10) in the placebo group at 1 hour postoperatively (p = 0.335); 1 (range, 0 to 7) versus 2 (range, 0 to 6) at 6 hours postoperatively (p = 0.306); 1 (range, 0 to 8) versus 1 (range, 0 to 6) at 12 hours postoperatively (p = 0.895); and 1.5 (range, 0 to 6) versus 1.5 (range, 0 to 6) at 24 hours postoperatively (p = 0.914). For secondary outcomes, the mean ± standard deviation 24-hour morphine consumption was 24 ± 17 MED in the PENG group versus 35 ± 29 MED in the placebo group (p = 0.110). The median length of stay was 2 days (range, 2 to 5 days) in the PENG group versus 4 days (range, 2 to 7 days) in the placebo group (p = 0.003).

Conclusions: In this trial, the PENG block showed a significant decrease in hospital length of stay; however, no significant difference was found for visual analogue scale pain scores or morphine consumption following primary anterior THA compared with a placebo.

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

背景:在后全髋关节置换术(THA)中,囊周神经组(PENG)阻滞可减轻疼痛和阿片类药物的消耗。本研究评估了 PENG 阻滞与安慰剂相比对初次前路全髋关节置换术患者术后(1)疼痛、(2)吗啡消耗量和(3)住院时间的影响:这是一项经机构审查委员会批准的、单中心、平行组、前瞻性、随机、双盲、对照试验,对象是2022年6月至2023年4月间接受初次前路THA手术的患者。两组患者均在超声引导下按照PENG阻滞程序注射20毫升溶液(PENG组为0.5%罗哌卡因,安慰剂组为0.9%氯化钠)。共纳入 60 例患者(PENG 组 32 例,安慰剂组 28 例)。我们使用视觉模拟量表评估了(1)术后1、6、12和24小时的疼痛情况;(2)术后24小时内吗啡总用量,即吗啡当量剂量(MED);以及(3)住院天数:就主要结果而言,术后 1 小时时,PENG 组的视觉模拟量表疼痛评分中位数为 3.5(范围为 0 至 10),而安慰剂组为 4(范围为 0 至 10)(P = 0.335);PENG 组的视觉模拟量表疼痛评分中位数为 1(范围为 0 至 10),而安慰剂组为 4(范围为 0 至 10)(P = 0.335)。335);术后 6 小时时,1 例(范围 0 至 7)对 2 例(范围 0 至 6)(p = 0.306);术后 12 小时时,1 例(范围 0 至 8)对 1 例(范围 0 至 6)(p = 0.895);术后 24 小时时,1.5 例(范围 0 至 6)对 1.5 例(范围 0 至 6)(p = 0.914)。在次要结果方面,PENG 组 24 小时吗啡消耗量的平均值(标准差)为 24 ± 17 MED,而安慰剂组为 35 ± 29 MED(P = 0.110)。PENG组的中位住院时间为2天(范围为2至5天),而安慰剂组为4天(范围为2至7天)(P = 0.003):结论:在这项试验中,PENG阻滞显著缩短了住院时间;然而,与安慰剂相比,初级前路THA术后视觉模拟量表疼痛评分或吗啡用量没有发现显著差异:有关证据等级的完整描述,请参阅 "作者须知"。
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引用次数: 0
Rate of Osteonecrosis After Femoral Lengthening with Intramedullary Lengthening Nails.
IF 4.4 1区 医学 Q1 ORTHOPEDICS Pub Date : 2025-02-28 DOI: 10.2106/JBJS.24.00564
Jeremy A Dubin, Gabrielle N Swartz, Sandeep S Bains, Caleb Gottlich, John E Herzenberg, Philip K McClure

Background: There has been historical concern that the use of intramedullary nails could present undue risk of osteonecrosis of the femoral head due to compromise of the femoral blood supply. Intramedullary lengthening nails are rapidly becoming commonplace in lengthening procedures. As such, the primary objective of this study was to analyze the rates of osteonecrosis following femoral lengthening. The secondary objective was to characterize general trends in femoral lengthening.

Methods: This retrospective cohort study evaluated patients who had undergone femoral lengthening at a single institution from 2012 to 2021. Retrospective chart review and radiographic evaluation of osteonecrosis were conducted. The primary end point was radiographic evidence of osteonecrosis. The secondary variables were the starting point of the femoral nail, the total amount of lengthening, and the time to consolidation.

Results: Two hundred and forty-seven patients were included in the analysis, including 111 males and 136 females, with a mean age of 17 years. No patient had radiographic evidence of osteonecrosis (0%) or coxa valga (0%). The average amount of lengthening was 4.88 cm (range, 1.5 to 8.5 cm). No patient had any extensive complications, such as alterations in the proximal femoral anatomy.

Conclusions: This largest study to date investigating complications following femoral lengthening using intramedullary lengthening nails revealed that femoral lengthening is a well-tolerated procedure, and osteonecrosis is an infrequent complication.

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

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引用次数: 0
Evaluating the Performance of Artificial Intelligence for Improving Readability of Online English- and Spanish-Language Orthopaedic Patient Educational Material: Challenges in Bridging the Digital Divide.
IF 4.4 1区 医学 Q1 ORTHOPEDICS Pub Date : 2025-02-28 DOI: 10.2106/JBJS.24.01078
Carrie N Reaver, Daniel E Pereira, Elisa V Carrillo, Carolena Rojas Marcos, Charles A Goldfarb

Background: The readability of most online patient educational materials (OPEMs) in orthopaedic surgery is above the American Medical Association/National Institutes of Health recommended reading level of sixth grade for both English- and Spanish-language content. The current project evaluates ChatGPT's performance across English- and Spanish-language orthopaedic OPEMs when prompted to rewrite the material at a sixth-grade reading level.

Methods: We performed a cross-sectional study evaluating the readability of 57 English- and 56 Spanish-language publicly available OPEMs found by querying online in both English and Spanish for 6 common orthopaedic procedures. Five distinct, validated readability tests were used to score the OPEMs before and after ChatGPT 4.0 was prompted to rewrite the OPEMs at a sixth-grade reading level. We compared the averages of each readability test, the cumulative average reading grade level, average total word count, average number of complex words (defined as ≥3 syllables), and average number of long sentences (defined as >22 words) between original content and ChatGPT-rewritten content for both languages using paired t tests.

Results: The cumulative average reading grade level of original English- and Spanish-language OPEMs was 9.6 ± 2.6 and 9.5 ± 1.5, respectively. ChatGPT significantly lowered the reading grade level (improved comprehension) to 7.7 ± 1.9 (95% CI of difference, 1.68 to 2.15; p < 0.05) for English-language content and 8.3 ± 1.3 (95% CI, 1.17 to 1.45; p < 0.05) for Spanish-language content. English-language OPEMs saw a reduction of 2.0 ± 1.8 grade levels, whereas Spanish-language OPEMs saw a reduction of 1.5 ± 1.2 grade levels. Word count, use of complex words, and long sentences were also reduced significantly in both languages while still maintaining high accuracy and similarity compared with original content.

Conclusions: Our study supports the potential of artificial intelligence as a low-cost, accessible tool to assist health professionals in improving the readability of orthopaedic OPEMs in both English and Spanish.

Clinical relevance: TK.

背景:大多数骨科手术在线患者教育材料(OPEM)的可读性都高于美国医学会/美国国立卫生研究院推荐的六年级阅读水平(英语和西班牙语)。本项目评估了 ChatGPT 在被要求以六年级阅读水平重写材料时,在英语和西班牙语骨科 OPEM 中的表现:我们进行了一项横向研究,评估了通过在线查询发现的 57 份英语和 56 份西班牙语公开 OPEM 的可读性,其中包括英语和西班牙语的 6 种常见骨科手术。在 ChatGPT 4.0 按六年级阅读水平重写 OPEM 之前和之后,我们使用了五种不同的、经过验证的可读性测试对 OPEM 进行评分。我们使用配对 t 检验比较了两种语言的原始内容和 ChatGPT 重写后内容的每个可读性测试的平均值、累计平均阅读年级、平均总字数、复杂单词平均数量(定义为≥3 个音节)和长句平均数量(定义为大于 22 个单词):英语和西班牙语原始 OPEM 的累计平均阅读水平分别为 9.6 ± 2.6 和 9.5 ± 1.5。对于英语内容,ChatGPT 大幅降低了阅读等级(提高了理解能力),达到 7.7 ± 1.9(95% CI 差异,1.68 至 2.15;p < 0.05);对于西班牙语内容,达到 8.3 ± 1.3(95% CI,1.17 至 1.45;p < 0.05)。英语 OPEM 降低了 2.0 ± 1.8 个年级,而西班牙语 OPEM 降低了 1.5 ± 1.2 个年级。两种语言的字数、复杂词语的使用和长句也都显著减少,但与原始内容相比仍保持了较高的准确性和相似性:我们的研究证实了人工智能作为一种低成本、易获得的工具,在帮助医疗专业人员提高英语和西班牙语骨科 OPEMs 的可读性方面所具有的潜力:临床相关性:TK.
{"title":"Evaluating the Performance of Artificial Intelligence for Improving Readability of Online English- and Spanish-Language Orthopaedic Patient Educational Material: Challenges in Bridging the Digital Divide.","authors":"Carrie N Reaver, Daniel E Pereira, Elisa V Carrillo, Carolena Rojas Marcos, Charles A Goldfarb","doi":"10.2106/JBJS.24.01078","DOIUrl":"https://doi.org/10.2106/JBJS.24.01078","url":null,"abstract":"<p><strong>Background: </strong>The readability of most online patient educational materials (OPEMs) in orthopaedic surgery is above the American Medical Association/National Institutes of Health recommended reading level of sixth grade for both English- and Spanish-language content. The current project evaluates ChatGPT's performance across English- and Spanish-language orthopaedic OPEMs when prompted to rewrite the material at a sixth-grade reading level.</p><p><strong>Methods: </strong>We performed a cross-sectional study evaluating the readability of 57 English- and 56 Spanish-language publicly available OPEMs found by querying online in both English and Spanish for 6 common orthopaedic procedures. Five distinct, validated readability tests were used to score the OPEMs before and after ChatGPT 4.0 was prompted to rewrite the OPEMs at a sixth-grade reading level. We compared the averages of each readability test, the cumulative average reading grade level, average total word count, average number of complex words (defined as ≥3 syllables), and average number of long sentences (defined as >22 words) between original content and ChatGPT-rewritten content for both languages using paired t tests.</p><p><strong>Results: </strong>The cumulative average reading grade level of original English- and Spanish-language OPEMs was 9.6 ± 2.6 and 9.5 ± 1.5, respectively. ChatGPT significantly lowered the reading grade level (improved comprehension) to 7.7 ± 1.9 (95% CI of difference, 1.68 to 2.15; p < 0.05) for English-language content and 8.3 ± 1.3 (95% CI, 1.17 to 1.45; p < 0.05) for Spanish-language content. English-language OPEMs saw a reduction of 2.0 ± 1.8 grade levels, whereas Spanish-language OPEMs saw a reduction of 1.5 ± 1.2 grade levels. Word count, use of complex words, and long sentences were also reduced significantly in both languages while still maintaining high accuracy and similarity compared with original content.</p><p><strong>Conclusions: </strong>Our study supports the potential of artificial intelligence as a low-cost, accessible tool to assist health professionals in improving the readability of orthopaedic OPEMs in both English and Spanish.</p><p><strong>Clinical relevance: </strong>TK.</p>","PeriodicalId":15273,"journal":{"name":"Journal of Bone and Joint Surgery, American Volume","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143527794","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
Patient-Reported Outcomes of Pain and Related Quality of Life 1 Year After Bone-Anchored Limb Implantation in Patients with Lower-Limb Amputation.
IF 4.4 1区 医学 Q1 ORTHOPEDICS Pub Date : 2025-02-27 DOI: 10.2106/JBJS.24.00148
Kylie G Shaw, Mohamed E Awad, Danielle Melton, Brecca M M Gaffney, Cory L Christiansen, Jason W Stoneback

Background: Patients with lower-extremity amputations experience various pain types. Osseointegration allows for prosthesis wear through a bone-anchored implant. Patient-reported outcome measures following osseointegration have not been well studied. Our aim was to evaluate differences in pain and quality of life at 1 year after osseointegration of a bone-anchored limb.

Methods: We analyzed the severity and types of pain as measured by validated patient-reported outcome measures. Data were compared between the initial visit and the 1-year postoperative visit.

Results: Fifty-four patients were included in this study and demonstrated improvement in pain intensity as measured by the Numeric Rating Scale (p < 0.001) and Patient-Reported Outcomes Measurement Information System Global Health (PROMIS-GH) (p < 0.001), as well as residual limb pain when walking (p < 0.001), at 1 year postoperatively. The self-reported impact of pain on quality of life improved in both transfemoral and transtibial amputees (p < 0.001).

Conclusions: The osseointegration of a bone-anchored limb improved patient-reported pain and quality of life in lower-extremity amputees.

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

{"title":"Patient-Reported Outcomes of Pain and Related Quality of Life 1 Year After Bone-Anchored Limb Implantation in Patients with Lower-Limb Amputation.","authors":"Kylie G Shaw, Mohamed E Awad, Danielle Melton, Brecca M M Gaffney, Cory L Christiansen, Jason W Stoneback","doi":"10.2106/JBJS.24.00148","DOIUrl":"https://doi.org/10.2106/JBJS.24.00148","url":null,"abstract":"<p><strong>Background: </strong>Patients with lower-extremity amputations experience various pain types. Osseointegration allows for prosthesis wear through a bone-anchored implant. Patient-reported outcome measures following osseointegration have not been well studied. Our aim was to evaluate differences in pain and quality of life at 1 year after osseointegration of a bone-anchored limb.</p><p><strong>Methods: </strong>We analyzed the severity and types of pain as measured by validated patient-reported outcome measures. Data were compared between the initial visit and the 1-year postoperative visit.</p><p><strong>Results: </strong>Fifty-four patients were included in this study and demonstrated improvement in pain intensity as measured by the Numeric Rating Scale (p < 0.001) and Patient-Reported Outcomes Measurement Information System Global Health (PROMIS-GH) (p < 0.001), as well as residual limb pain when walking (p < 0.001), at 1 year postoperatively. The self-reported impact of pain on quality of life improved in both transfemoral and transtibial amputees (p < 0.001).</p><p><strong>Conclusions: </strong>The osseointegration of a bone-anchored limb improved patient-reported pain and quality of life in lower-extremity amputees.</p><p><strong>Level of evidence: </strong>Therapeutic Level IV. 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":""},"PeriodicalIF":4.4,"publicationDate":"2025-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143523108","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
Accuracy and Precision of Anatomical Medial Patellofemoral Ligament Identification Using the CLASS MRI Method: A Cadaveric Study. 使用 CLASS MRI 方法识别髌股内侧韧带解剖结构的准确性和精确性:一项尸体研究
IF 4.4 1区 医学 Q1 ORTHOPEDICS Pub Date : 2025-02-27 DOI: 10.2106/JBJS.24.00747
Grégoire Thürig, Marc Barrera Usó, Raul Panadero-Morales, Elisabeth Alonso Domenech, Joseph M Schwab, Moritz Tannast, Daniel Petek
<p><strong>Background: </strong>The medial patellofemoral ligament (MPFL) serves as the primary stabilizer of the patellofemoral joint, and surgical reconstruction aims to replicate its biomechanical properties. However, misplacement of the femoral tunnel remains a major problem that leads to revision after surgery for patellar instability. The C-arm technique for identifying the femoral origin of the MPFL (fMPFL) during surgery may not account for individual variability. Magnetic resonance imaging (MRI) allows for personalized fMPFL identification. The CLASS (Compressed Lateral and Anteroposterior Anatomical Systematic Sequences) method compresses MRI data into a lateral view, similar to intraoperative C-arm imaging. Recent research has shown that C-arm positioning directly affects fMPFL localization. The aim of this study was to investigate how accurate the identification of the femoral MPFL footprint is with the CLASS method and on which side the C-arm must be positioned.</p><p><strong>Methods: </strong>Ten Caucasian cadaveric knees were utilized in this study. MRIs of the native and dissected knee were obtained. The MRIs, with the fMPFL anatomy dissected and marked, were used to create the "anatomical CLASS" (aCLASS) data. Additionally, the "native MRI" was used to identify the fMPFL in order to simulate preoperative planning, generating the "planned CLASS" (pCLASS) data. True-lateral fluoroscopic images with the image receptor contralaterally or ipsilaterally positioned were obtained. Statistical tests included the Wilcoxon signed-rank test for positional comparisons across all groups. A 1-way analysis of variance (ANOVA) with the Bonferroni adjustment was conducted for clinically relevant groups. Significance was set at p < 0.05.</p><p><strong>Results: </strong>The pCLASS showed no significant differences compared with the aCLASS. The 1-way ANOVA showed significant differences between the ipsilateral group and the pCLASS and between the ipsilateral and contralateral groups only in the distal-proximal axis.</p><p><strong>Conclusions: </strong>This time-zero cadaveric study offers a novel method for determining the individual fMPFL. Various locations for femoral MFL attachment have been described in the literature, highlighting the need for individualized assessment methods. The CLASS method offered a reliable and reproducible approach for fMPFL identification. Also, proper intraoperative positioning of the C-arm, with the image receptor kept contralaterally, should be performed to increase the effectiveness of identifying the fMPFL using the CLASS method.</p><p><strong>Clinical relevance: </strong>The CLASS method offers a personalized approach for accurately identifying the fMPFL during surgery, which could potentially reduce tunnel misplacement and revision rates. Proper C-arm positioning with contralateral image receptor placement enhances the effectiveness of this technique, which has the potential to improve outcomes for patients underg
背景:髌股内侧韧带(MPFL)是髌股关节的主要稳定器,手术重建的目的是复制其生物力学特性。然而,股骨隧道的错位仍然是导致髌骨不稳手术后翻修的主要问题。在手术过程中,用于确定 MPFL 股骨起源(fMPFL)的 C 型臂技术可能无法考虑个体差异。磁共振成像(MRI)可实现个性化的股骨头内侧肌层(fMPFL)识别。CLASS(压缩侧向和前向解剖系统序列)方法将核磁共振成像数据压缩为侧向视图,类似于术中C臂成像。最近的研究表明,C 型臂的定位会直接影响 fMPFL 的定位。本研究的目的是调查 CLASS 方法对股骨 MPFL 基底面识别的准确性,以及 C 臂必须放置在哪一侧:方法:本研究使用了十个白种人尸体膝关节。方法:本研究使用了十个白种人的尸体膝关节,并获得了原生膝关节和解剖膝关节的核磁共振成像。剖开并标记了膝关节前缘肌肉束解剖结构的核磁共振成像被用于创建 "解剖CLASS"(aCLASS)数据。此外,"原生磁共振成像 "还被用来识别膝部软组织弹力纤维束,以模拟术前规划,生成 "规划CLASS"(pCLASS)数据。在图像受体对侧或同侧定位的情况下,获得真实的侧透视图像。统计检验包括 Wilcoxon 符号秩检验,用于所有组间的位置比较。对临床相关组进行单因素方差分析(ANOVA),并进行 Bonferroni 调整。显著性以 p < 0.05 为标准:结果:pCLASS 与 aCLASS 相比无明显差异。单因素方差分析显示,同侧组与 pCLASS 之间以及同侧组与对侧组之间仅在远近轴上存在显著差异:这项时间为零的尸体研究为确定个体股骨髓纤维膜提供了一种新方法。文献中描述了股骨MFL附着的不同位置,强调了个体化评估方法的必要性。CLASS方法提供了一种可靠且可重复的方法来识别股骨头内膜厚度。此外,术中应正确定位 C 臂,将图像接收器保持在对侧,以提高使用 CLASS 方法识别股骨髓纤维肌层的有效性:CLASS方法提供了一种个性化的方法,可在手术中准确识别fMPFL,从而降低隧道错置率和翻修率。正确的C臂定位和对侧图像受体的放置可提高该技术的有效性,从而有可能改善因髌骨不稳而接受MPFL重建术的患者的预后。
{"title":"Accuracy and Precision of Anatomical Medial Patellofemoral Ligament Identification Using the CLASS MRI Method: A Cadaveric Study.","authors":"Grégoire Thürig, Marc Barrera Usó, Raul Panadero-Morales, Elisabeth Alonso Domenech, Joseph M Schwab, Moritz Tannast, Daniel Petek","doi":"10.2106/JBJS.24.00747","DOIUrl":"https://doi.org/10.2106/JBJS.24.00747","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;The medial patellofemoral ligament (MPFL) serves as the primary stabilizer of the patellofemoral joint, and surgical reconstruction aims to replicate its biomechanical properties. However, misplacement of the femoral tunnel remains a major problem that leads to revision after surgery for patellar instability. The C-arm technique for identifying the femoral origin of the MPFL (fMPFL) during surgery may not account for individual variability. Magnetic resonance imaging (MRI) allows for personalized fMPFL identification. The CLASS (Compressed Lateral and Anteroposterior Anatomical Systematic Sequences) method compresses MRI data into a lateral view, similar to intraoperative C-arm imaging. Recent research has shown that C-arm positioning directly affects fMPFL localization. The aim of this study was to investigate how accurate the identification of the femoral MPFL footprint is with the CLASS method and on which side the C-arm must be positioned.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Ten Caucasian cadaveric knees were utilized in this study. MRIs of the native and dissected knee were obtained. The MRIs, with the fMPFL anatomy dissected and marked, were used to create the \"anatomical CLASS\" (aCLASS) data. Additionally, the \"native MRI\" was used to identify the fMPFL in order to simulate preoperative planning, generating the \"planned CLASS\" (pCLASS) data. True-lateral fluoroscopic images with the image receptor contralaterally or ipsilaterally positioned were obtained. Statistical tests included the Wilcoxon signed-rank test for positional comparisons across all groups. A 1-way analysis of variance (ANOVA) with the Bonferroni adjustment was conducted for clinically relevant groups. Significance was set at p &lt; 0.05.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The pCLASS showed no significant differences compared with the aCLASS. The 1-way ANOVA showed significant differences between the ipsilateral group and the pCLASS and between the ipsilateral and contralateral groups only in the distal-proximal axis.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;This time-zero cadaveric study offers a novel method for determining the individual fMPFL. Various locations for femoral MFL attachment have been described in the literature, highlighting the need for individualized assessment methods. The CLASS method offered a reliable and reproducible approach for fMPFL identification. Also, proper intraoperative positioning of the C-arm, with the image receptor kept contralaterally, should be performed to increase the effectiveness of identifying the fMPFL using the CLASS method.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Clinical relevance: &lt;/strong&gt;The CLASS method offers a personalized approach for accurately identifying the fMPFL during surgery, which could potentially reduce tunnel misplacement and revision rates. Proper C-arm positioning with contralateral image receptor placement enhances the effectiveness of this technique, which has the potential to improve outcomes for patients underg","PeriodicalId":15273,"journal":{"name":"Journal of Bone and Joint Surgery, American Volume","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2025-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143522857","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
Weight Loss Before Total Hip Arthroplasty Was Not Associated with Decreased Postoperative Risks.
IF 4.4 1区 医学 Q1 ORTHOPEDICS Pub Date : 2025-02-26 DOI: 10.2106/JBJS.24.01110
Michael W Seward, Jessica A Grimm, Charles P Hannon, Nicholas A Bedard, Daniel J Berry, Matthew P Abdel

Background: Many surgeons use body mass index (BMI) cutoffs when offering total hip arthroplasty (THA). However, little is known about who loses weight before THA, and if weight loss improves outcomes. This study determined how many patients lost weight before primary THA, identified predictors of preoperative weight loss, and evaluated whether preoperative weight loss was associated with improved outcomes.

Methods: Among 53,038 primary THAs that were performed between 2002 and 2019, we identified 2,463 patients who had a BMI of ≥30 kg/m2 (measured 1 to 24 months before surgery) and had their weight measured at the time of surgery. The mean age was 66 years; 47% were women. The mean BMI was 35 kg/m2. Nonparametric models evaluated potential associations with weight loss. Univariable and multivariable logistic regression and Cox proportional hazards models evaluated the impact of preoperative weight change on hospital length of stay, discharge disposition, operative time, periprosthetic joint infection (PJI), complications, revision, and reoperation. The mean follow-up was 5 years.

Results: Overall, 17% of the patients gained >5 pounds (2.27 kg), 38% maintained their weight, 16% lost 5 to <10 pounds (4.54 kg), 17% lost 10 to <20 pounds (9.07 kg), and 12% lost ≥20 pounds before THA. Only 28% of patients with a preoperative BMI of ≥40 kg/m2 achieved a BMI of <40 kg/m2 by the time of surgery; those who did required a mean of 1.3 years to lose the weight. In multivariable analyses, there were no significant improvements in operative time, length of stay, and discharge disposition, or survivorship free of PJI, complication, revision, or reoperation for any weight-loss category when compared with those who maintained their weight.

Conclusions: Only 12% of patients lost ≥20 pounds, and only 28% of patients with a BMI of ≥40 kg/m2 achieved a BMI of <40 kg/m2 before primary THA. There was no decrease in complications, revisions, or reoperations for any preoperative weight-loss category when compared with those who maintained their weight. While weight loss benefits overall health, the results of this study call into question whether preoperative weight loss alone is enough to reduce postoperative complications for most patients.

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

{"title":"Weight Loss Before Total Hip Arthroplasty Was Not Associated with Decreased Postoperative Risks.","authors":"Michael W Seward, Jessica A Grimm, Charles P Hannon, Nicholas A Bedard, Daniel J Berry, Matthew P Abdel","doi":"10.2106/JBJS.24.01110","DOIUrl":"https://doi.org/10.2106/JBJS.24.01110","url":null,"abstract":"<p><strong>Background: </strong>Many surgeons use body mass index (BMI) cutoffs when offering total hip arthroplasty (THA). However, little is known about who loses weight before THA, and if weight loss improves outcomes. This study determined how many patients lost weight before primary THA, identified predictors of preoperative weight loss, and evaluated whether preoperative weight loss was associated with improved outcomes.</p><p><strong>Methods: </strong>Among 53,038 primary THAs that were performed between 2002 and 2019, we identified 2,463 patients who had a BMI of ≥30 kg/m2 (measured 1 to 24 months before surgery) and had their weight measured at the time of surgery. The mean age was 66 years; 47% were women. The mean BMI was 35 kg/m2. Nonparametric models evaluated potential associations with weight loss. Univariable and multivariable logistic regression and Cox proportional hazards models evaluated the impact of preoperative weight change on hospital length of stay, discharge disposition, operative time, periprosthetic joint infection (PJI), complications, revision, and reoperation. The mean follow-up was 5 years.</p><p><strong>Results: </strong>Overall, 17% of the patients gained >5 pounds (2.27 kg), 38% maintained their weight, 16% lost 5 to <10 pounds (4.54 kg), 17% lost 10 to <20 pounds (9.07 kg), and 12% lost ≥20 pounds before THA. Only 28% of patients with a preoperative BMI of ≥40 kg/m2 achieved a BMI of <40 kg/m2 by the time of surgery; those who did required a mean of 1.3 years to lose the weight. In multivariable analyses, there were no significant improvements in operative time, length of stay, and discharge disposition, or survivorship free of PJI, complication, revision, or reoperation for any weight-loss category when compared with those who maintained their weight.</p><p><strong>Conclusions: </strong>Only 12% of patients lost ≥20 pounds, and only 28% of patients with a BMI of ≥40 kg/m2 achieved a BMI of <40 kg/m2 before primary THA. There was no decrease in complications, revisions, or reoperations for any preoperative weight-loss category when compared with those who maintained their weight. While weight loss benefits overall health, the results of this study call into question whether preoperative weight loss alone is enough to reduce postoperative complications for most patients.</p><p><strong>Level of evidence: </strong>Prognostic Level III. 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":""},"PeriodicalIF":4.4,"publicationDate":"2025-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143515826","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
Medical Training Is Like Driver's Education.
IF 4.4 1区 医学 Q1 ORTHOPEDICS Pub Date : 2025-02-25 DOI: 10.2106/JBJS.24.01521
Adam D Bitterman
{"title":"Medical Training Is Like Driver's Education.","authors":"Adam D Bitterman","doi":"10.2106/JBJS.24.01521","DOIUrl":"https://doi.org/10.2106/JBJS.24.01521","url":null,"abstract":"","PeriodicalId":15273,"journal":{"name":"Journal of Bone and Joint Surgery, American Volume","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2025-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143501482","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
Admission Neutrophil-to-Lymphocyte Ratio Is Superior to WBC Count at Predicting the Presence and Severity of Pediatric Musculoskeletal Infection.
IF 4.4 1区 医学 Q1 ORTHOPEDICS Pub Date : 2025-02-25 DOI: 10.2106/JBJS.24.00481
Brian Q Hou, Anoop S Chandrashekar, Naadir H Jamal, William F Hefley, Malini Anand, Katherine S Hajdu, Stephen W Chenard, Michael Greenberg, Hui Nian, Jacquelyn S Pennings, Ryan A Seltzer, James E Cassat, Stephanie N Moore-Lotridge, Jonathan G Schoenecker

Background: Accurately determining the presence and severity of pediatric musculoskeletal infection (MSKI) is crucial for effective triage and treatment. Although the white blood-cell (WBC) count is often used as a marker for MSKI, we hypothesized that the use of the WBC count is limited by age-related variability in children. We proposed that the absolute neutrophil-to-lymphocyte ratio (NLR), which has less age-related variability, is a more reliable indicator for both diagnosing and assessing the severity of MSKI. The present study aims to compare the utility of WBC against that of the NLR, as well as C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR), for predicting MSKI presence and severity in children.

Methods: A retrospective cohort study was conducted with use of a database of pediatric orthopaedic consultations for suspected MSKI between January 2013 and July 2022. Diagnoses were categorized as MSKI or no infection, and the severity of any present infection was stratified as local or disseminated. Admission laboratory values were collected. Statistical modeling was performed to assess the capabilities of the WBC, NLR, CRP, and ESR to diagnose MSKI and to assess infection severity, with cutoff thresholds established for clinical use.

Results: This study included 650 patients (median age, 5.2 years; 63% male; 75% White). Of these, 247 patients had no infection, while 403 were diagnosed with an MSKI. Median WBC count, NLR, CRP, and ESR were all significantly higher in pediatric cases of confirmed MSKI. WBC was a poor predictor of infection severity, whereas NLR, CRP, and ESR each positively correlated with infection severity. At the time of admission, an NLR of 4 was highly specific for detecting the presence of infection, and an NLR of 5.8 was highly specific for predicting infection dissemination. CRP was the best predictor of both infection presence and severity, demonstrating the highest specificity and sensitivity, followed by NLR, which outperformed ESR and WBC.

Conclusions: Because of considerable age-related variability, the predictive value of the WBC count for pediatric MSKI presence and severity is limited. NLR, which is less affected by age-related variability, is superior at predicting MSKI severity. Although CRP remains the benchmark, the NLR offers a valuable alternative to the WBC. Our study provides a comparative framework for these biomarkers, enhancing MSKI assessment across various clinical settings.

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

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Journal of Bone and Joint Surgery, American Volume
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