首页 > 最新文献

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

英文 中文
What's Important: Building the Practice Your Community Needs. 重要的是:建立社区所需的实践。
IF 4.4 1区 医学 Q1 ORTHOPEDICS Pub Date : 2024-09-04 Epub Date: 2024-04-04 DOI: 10.2106/JBJS.24.00001
Edwin L Portalatín Pérez
{"title":"What's Important: Building the Practice Your Community Needs.","authors":"Edwin L Portalatín Pérez","doi":"10.2106/JBJS.24.00001","DOIUrl":"10.2106/JBJS.24.00001","url":null,"abstract":"","PeriodicalId":15273,"journal":{"name":"Journal of Bone and Joint Surgery, American Volume","volume":null,"pages":null},"PeriodicalIF":4.4,"publicationDate":"2024-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140849334","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
AOA Critical Issues Symposium: Advancing Diversity, Equity, and Inclusion in Orthopaedic Surgery. AOA 关键问题研讨会:推进矫形外科的多样性、公平性和包容性。
IF 4.4 1区 医学 Q1 ORTHOPEDICS Pub Date : 2024-09-04 Epub Date: 2024-04-18 DOI: 10.2106/JBJS.23.01207
Sean A Tabaie, Sarah Dance, Matthew Schmitz, Lisa Lattanza, Addisu Mesfin

Abstract: In recent years, the medical field has recognized the pivotal role of diversity, equity, and inclusion (DEI) in enhancing patient care and addressing health-care disparities. Orthopaedic surgery has embraced these principles to create a more inclusive and representative workforce. A DEI symposium that was sponsored by the American Orthopaedic Association convened orthopaedic surgeons, researchers, educators, and stakeholders to discuss challenges and strategies for implementing DEI initiatives. The symposium emphasized the importance of equity, and fostered conversations on creating equal opportunities and resources. Speakers covered key topics, including establishing DEI divisions, metrics for success, DEI leadership, and available resources, and promoted excellence and innovation in orthopaedic surgery through a more diverse and inclusive approach.

摘要:近年来,医学界已认识到多样性、公平性和包容性(DEI)在加强患者护理和解决医疗差距方面的关键作用。矫形外科已接受了这些原则,以建立一支更具包容性和代表性的员工队伍。由美国矫形外科协会主办的 "全纳"(DEI)研讨会召集了矫形外科医生、研究人员、教育工作者和利益相关者,共同讨论实施 "全纳 "计划的挑战和策略。研讨会强调了公平的重要性,并促进了关于创造平等机会和资源的对话。发言者讨论了一些关键议题,包括建立DEI部门、成功的衡量标准、DEI领导力和可用资源,并通过更加多元化和包容性的方法促进矫形外科的卓越和创新。
{"title":"AOA Critical Issues Symposium: Advancing Diversity, Equity, and Inclusion in Orthopaedic Surgery.","authors":"Sean A Tabaie, Sarah Dance, Matthew Schmitz, Lisa Lattanza, Addisu Mesfin","doi":"10.2106/JBJS.23.01207","DOIUrl":"10.2106/JBJS.23.01207","url":null,"abstract":"<p><strong>Abstract: </strong>In recent years, the medical field has recognized the pivotal role of diversity, equity, and inclusion (DEI) in enhancing patient care and addressing health-care disparities. Orthopaedic surgery has embraced these principles to create a more inclusive and representative workforce. A DEI symposium that was sponsored by the American Orthopaedic Association convened orthopaedic surgeons, researchers, educators, and stakeholders to discuss challenges and strategies for implementing DEI initiatives. The symposium emphasized the importance of equity, and fostered conversations on creating equal opportunities and resources. Speakers covered key topics, including establishing DEI divisions, metrics for success, DEI leadership, and available resources, and promoted excellence and innovation in orthopaedic surgery through a more diverse and inclusive approach.</p>","PeriodicalId":15273,"journal":{"name":"Journal of Bone and Joint Surgery, American Volume","volume":null,"pages":null},"PeriodicalIF":4.4,"publicationDate":"2024-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140862902","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
The Predictors of Surgery for Symptomatic, Atraumatic Full-Thickness Rotator Cuff Tears Change Over Time: Ten-Year Outcomes of the MOON Shoulder Prospective Cohort. 症状性、创伤性全厚肩袖撕裂手术的预测因素随时间变化:MOON 肩部前瞻性队列的十年结果。
IF 4.4 1区 医学 Q1 ORTHOPEDICS Pub Date : 2024-09-04 Epub Date: 2024-07-09 DOI: 10.2106/JBJS.23.00978
John E Kuhn, Warren R Dunn, Rosemary Sanders, Keith M Baumgarten, Julie Y Bishop, Robert H Brophy, James L Carey, Brian G Holloway, Grant L Jones, C Benjamin Ma, Robert G Marx, Eric C McCarty, Sourav K Poddar, Matthew V Smith, Edwin E Spencer, Armando F Vidal, Brian R Wolf, Rick W Wright

Background: A prospective cohort study was conducted to assess the predictors of failure of nonoperative treatment, defined as the patient undergoing surgery for symptomatic, atraumatic full-thickness rotator cuff tears. We present the 10-year follow-up data of this population to determine if predictors for surgery change over time, and secondarily we report the outcomes of the cohort.

Methods: At the time of enrollment, demographic, symptom, rotator cuff anatomy, and patient-reported outcome data were collected in patients with symptomatic, atraumatic full-thickness rotator cuff tears. Patients underwent a standard physical therapy protocol for 6 to 12 weeks. Patient data were then collected at 1, 2, 5, 7, and 10 years. Failure of nonoperative treatment was defined as the patient electing to undergo surgery.

Results: Of the 452 patients in the original cohort, 20 patients (5%) withdrew from the study, 37 (9%) died before 10 years, and 40 (9%) were otherwise lost to follow-up. A total of 115 patients (27.0%) underwent a surgical procedure at some point during the 10-year follow-up period. Of these patients, 56.5% underwent surgery within 6 months of enrollment and 43.5%, between 6 months and 10 years. Low patient expectations regarding the efficacy of physical therapy were found to be a predictor of early surgery. Workers' Compensation status and activity level were more important predictors of later surgery. Patient-reported outcome measures all improved following physical therapy. For patients who did not undergo a surgical procedure, patient-reported outcome measures did not decline over the 10-year follow-up period.

Conclusions: Low patient expectations regarding the efficacy of physical therapy were found to be a predictor of early surgery, whereas Workers' Compensation status and activity level were predictors of later surgery. Physical therapy was successful in >70% of patients with symptomatic, atraumatic full-thickness rotator cuff tears at 10 years. Outcome measures improved with physical therapy and did not decline over the 10-year follow-up period.

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

研究背景我们开展了一项前瞻性队列研究,以评估非手术治疗失败的预测因素。非手术治疗失败是指无症状、创伤性全厚肩袖撕裂患者接受手术治疗。我们提供了该人群 10 年的随访数据,以确定手术的预测因素是否会随着时间的推移而发生变化,其次我们还报告了该人群的治疗结果:在入组时,我们收集了无症状、创伤性全厚肩袖撕裂患者的人口统计学、症状、肩袖解剖和患者报告的结果数据。患者接受为期 6 至 12 周的标准物理治疗方案。然后分别在1年、2年、5年、7年和10年收集患者数据。非手术治疗失败的定义是患者选择接受手术治疗:在最初的 452 名患者中,有 20 名患者(5%)退出了研究,37 名患者(9%)在 10 年前去世,40 名患者(9%)失去了随访机会。共有 115 名患者(27.0%)在 10 年随访期间的某个时间点接受了手术治疗。其中,56.5%的患者在入组 6 个月内接受了手术,43.5%的患者在 6 个月至 10 年间接受了手术。研究发现,患者对物理治疗疗效的期望值过低是导致早期手术的一个预测因素。工伤赔偿状况和活动水平则是后期手术的重要预测因素。物理治疗后,患者报告的结果均有所改善。对于没有接受手术治疗的患者,在10年的随访期间,患者报告的疗效指标并没有下降:结论:研究发现,患者对物理治疗疗效的期望值过低是导致早期手术的一个预测因素,而工伤赔偿状况和活动水平则是导致后期手术的预测因素。超过70%的无症状、创伤性全厚肩袖撕裂患者在接受物理治疗10年后取得了成功。物理治疗后的结果指标有所改善,并且在10年的随访期间没有下降:有关证据等级的完整描述,请参阅 "作者须知"。
{"title":"The Predictors of Surgery for Symptomatic, Atraumatic Full-Thickness Rotator Cuff Tears Change Over Time: Ten-Year Outcomes of the MOON Shoulder Prospective Cohort.","authors":"John E Kuhn, Warren R Dunn, Rosemary Sanders, Keith M Baumgarten, Julie Y Bishop, Robert H Brophy, James L Carey, Brian G Holloway, Grant L Jones, C Benjamin Ma, Robert G Marx, Eric C McCarty, Sourav K Poddar, Matthew V Smith, Edwin E Spencer, Armando F Vidal, Brian R Wolf, Rick W Wright","doi":"10.2106/JBJS.23.00978","DOIUrl":"10.2106/JBJS.23.00978","url":null,"abstract":"<p><strong>Background: </strong>A prospective cohort study was conducted to assess the predictors of failure of nonoperative treatment, defined as the patient undergoing surgery for symptomatic, atraumatic full-thickness rotator cuff tears. We present the 10-year follow-up data of this population to determine if predictors for surgery change over time, and secondarily we report the outcomes of the cohort.</p><p><strong>Methods: </strong>At the time of enrollment, demographic, symptom, rotator cuff anatomy, and patient-reported outcome data were collected in patients with symptomatic, atraumatic full-thickness rotator cuff tears. Patients underwent a standard physical therapy protocol for 6 to 12 weeks. Patient data were then collected at 1, 2, 5, 7, and 10 years. Failure of nonoperative treatment was defined as the patient electing to undergo surgery.</p><p><strong>Results: </strong>Of the 452 patients in the original cohort, 20 patients (5%) withdrew from the study, 37 (9%) died before 10 years, and 40 (9%) were otherwise lost to follow-up. A total of 115 patients (27.0%) underwent a surgical procedure at some point during the 10-year follow-up period. Of these patients, 56.5% underwent surgery within 6 months of enrollment and 43.5%, between 6 months and 10 years. Low patient expectations regarding the efficacy of physical therapy were found to be a predictor of early surgery. Workers' Compensation status and activity level were more important predictors of later surgery. Patient-reported outcome measures all improved following physical therapy. For patients who did not undergo a surgical procedure, patient-reported outcome measures did not decline over the 10-year follow-up period.</p><p><strong>Conclusions: </strong>Low patient expectations regarding the efficacy of physical therapy were found to be a predictor of early surgery, whereas Workers' Compensation status and activity level were predictors of later surgery. Physical therapy was successful in >70% of patients with symptomatic, atraumatic full-thickness rotator cuff tears at 10 years. Outcome measures improved with physical therapy and did not decline over the 10-year follow-up period.</p><p><strong>Level of evidence: </strong>Prognostic 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":null,"pages":null},"PeriodicalIF":4.4,"publicationDate":"2024-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141563501","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
A Call to Start Implementing the Results of High-Quality Randomized Trials in Daily Orthopaedic Practice: Commentary on an article by Neil J. White, MD, et al.: "Low-Intensity Pulsed Ultrasound Versus Sham in the Treatment of Operatively Managed Scaphoid Nonunions. The SNAPU Randomized Controlled Trial". 呼吁在日常骨科实践中开始实施高质量随机试验的结果:对医学博士 Neil J. White 等人的一篇文章的评论:"低强度脉冲超声与假超声在手术治疗肩胛骨非整复中的对比。SNAPU 随机对照试验"。
IF 4.4 1区 医学 Q1 ORTHOPEDICS Pub Date : 2024-09-04 DOI: 10.2106/JBJS.24.00491
Tom J Crijns
{"title":"A Call to Start Implementing the Results of High-Quality Randomized Trials in Daily Orthopaedic Practice: Commentary on an article by Neil J. White, MD, et al.: \"Low-Intensity Pulsed Ultrasound Versus Sham in the Treatment of Operatively Managed Scaphoid Nonunions. The SNAPU Randomized Controlled Trial\".","authors":"Tom J Crijns","doi":"10.2106/JBJS.24.00491","DOIUrl":"https://doi.org/10.2106/JBJS.24.00491","url":null,"abstract":"","PeriodicalId":15273,"journal":{"name":"Journal of Bone and Joint Surgery, American Volume","volume":null,"pages":null},"PeriodicalIF":4.4,"publicationDate":"2024-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142125868","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
Slope Osteotomies in the Setting of Anterior Cruciate Ligament Deficiency. 前十字韧带缺损情况下的斜坡截骨术
IF 4.4 1区 医学 Q1 ORTHOPEDICS Pub Date : 2024-09-04 Epub Date: 2024-07-25 DOI: 10.2106/JBJS.23.01352
Mahmut Enes Kayaalp, Philipp Winkler, Balint Zsidai, Gian Andrea Lucidi, Armin Runer, Ariana Lott, Jonathan D Hughes, Volker Musahl

➤ Posterior tibial slope (PTS) of ≥12° represents an important risk factor for both anterior cruciate ligament (ACL) injury and ACL reconstruction failure.➤ PTS measurements can significantly differ on the basis of the imaging modality and the measurement technique used. PTS should be measured on strictly lateral radiographs, with a recommended proximal tibial length of 15 cm in the image. The PTS measurement can be made by placing 2 circles to define the proximal tibial axis, 1 just below the tibial tubercle and another 10 cm below it. PTS measurements are underestimated when made on magnetic resonance imaging and computed tomography.➤ Slope-reducing osteotomies can be performed using a (1) supratuberosity, (2) tubercle-reflecting transtuberosity, or (3) infratuberosity method. The correction target remains a topic of debate. Although it is controversial, some authors recommend overcorrecting the tibial slope slightly to a range of 4° to 6°. For instance, if the initial slope is 12°, a correction of 6° to 8° should be performed, given the target tibial slope of 4° to 6°.➤ Clinical outcomes following slope-reducing osteotomies have been favorable. However, potential complications, limited data with regard to the impact of slope-reducing osteotomies on osteoarthritis, and uncertainty with regard to the effects on the patellofemoral joint are notable concerns.➤ Patients with complex deformities may need biplanar osteotomies to comprehensively address the condition.

➤胫骨后斜度(PTS)≥12°是前交叉韧带(ACL)损伤和前交叉韧带重建失败的重要风险因素。PTS应严格根据侧位X光片进行测量,建议图像中胫骨近端长度为15厘米。可通过放置两个圆圈来确定胫骨近端轴线,其中一个圆圈位于胫骨结节下方,另一个圆圈位于胫骨结节下方 10 厘米处,从而进行 PTS 测量。在磁共振成像和计算机断层扫描上进行的 PTS 测量会被低估➤。可采用(1) 上截骨法、(2) 小结节反射横截骨法或 (3) 下截骨法进行斜坡减低截骨术。矫正目标仍是一个争论不休的话题。尽管存在争议,但一些学者建议将胫骨斜度略微矫正过度至 4° 至 6°。例如,如果初始斜度为 12°,那么在目标胫骨斜度为 4° 至 6° 的情况下,应进行 6° 至 8° 的矫正。然而,潜在的并发症、斜度减小截骨术对骨关节炎影响的数据有限以及对髌股关节影响的不确定性是值得关注的问题。
{"title":"Slope Osteotomies in the Setting of Anterior Cruciate Ligament Deficiency.","authors":"Mahmut Enes Kayaalp, Philipp Winkler, Balint Zsidai, Gian Andrea Lucidi, Armin Runer, Ariana Lott, Jonathan D Hughes, Volker Musahl","doi":"10.2106/JBJS.23.01352","DOIUrl":"10.2106/JBJS.23.01352","url":null,"abstract":"<p><p>➤ Posterior tibial slope (PTS) of ≥12° represents an important risk factor for both anterior cruciate ligament (ACL) injury and ACL reconstruction failure.➤ PTS measurements can significantly differ on the basis of the imaging modality and the measurement technique used. PTS should be measured on strictly lateral radiographs, with a recommended proximal tibial length of 15 cm in the image. The PTS measurement can be made by placing 2 circles to define the proximal tibial axis, 1 just below the tibial tubercle and another 10 cm below it. PTS measurements are underestimated when made on magnetic resonance imaging and computed tomography.➤ Slope-reducing osteotomies can be performed using a (1) supratuberosity, (2) tubercle-reflecting transtuberosity, or (3) infratuberosity method. The correction target remains a topic of debate. Although it is controversial, some authors recommend overcorrecting the tibial slope slightly to a range of 4° to 6°. For instance, if the initial slope is 12°, a correction of 6° to 8° should be performed, given the target tibial slope of 4° to 6°.➤ Clinical outcomes following slope-reducing osteotomies have been favorable. However, potential complications, limited data with regard to the impact of slope-reducing osteotomies on osteoarthritis, and uncertainty with regard to the effects on the patellofemoral joint are notable concerns.➤ Patients with complex deformities may need biplanar osteotomies to comprehensively address the condition.</p>","PeriodicalId":15273,"journal":{"name":"Journal of Bone and Joint Surgery, American Volume","volume":null,"pages":null},"PeriodicalIF":4.4,"publicationDate":"2024-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141788063","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
Pediatric Device Innovation: An Analysis of Food and Drug Administration Authorizations Over Time. 儿科设备创新:食品与药物管理局授权随时间推移的分析。
IF 4.4 1区 医学 Q1 ORTHOPEDICS Pub Date : 2024-09-04 Epub Date: 2024-06-05 DOI: 10.2106/JBJS.23.01211
Jonathan Dubin, Krish Sardesai, Caleb Grote, Caroline Tougas, Katherine Branche, Norman Otsuka

Background: Despite a tremendous increase in the number of orthopaedic devices authorized by the U.S. Food and Drug Administration (FDA), novel devices designed specifically for the pediatric population remain sparse. Surgeons frequently repurpose adult implants for "off-label" use in pediatric patients, with both legal and technical ramifications. This study seeks to objectively quantify and characterize the nature of pediatric device innovation over time.

Methods: The FDA employs 4 pathways for assessing safety and effectiveness of novel devices prior to authorization. Perceived device risk and novelty determine the pathway. Orthopaedic devices were identified from the FDA's online database. All devices approved since inception via the Humanitarian Device Exemption, Pre-Market Approval, and De Novo regulatory pathways were included and grouped as "highly innovative." Because of their number and the rapidity of their development, the evaluation of 510(k) devices was limited to those cleared from January 1, 2018, to December 31, 2022. Such 510(k) devices make up ∼97% of devices and by definition are less risky and less novel. Approval statements were assessed for pediatric indications within the approved labeling. As a secondary analysis, the impact of company size on developing a product with a pediatric indication was analyzed.

Results: Of the 1,925 devices cleared via the 510(k) pathway, 9 (0.5%) were designed exclusively for pediatrics and 160 (8.3%) included pediatric indications. Five of the 9 pediatrics-only devices were for spine and 4 were for trauma indications. Of the 97 highly innovative devices, only 2 (2%) were exclusively pediatric and another 2 (2%) included pediatric indications. The 2 pediatrics-only devices were for the spine. Large and medium-sized companies were 1.9 times and 1.6 times more likely to bring to market a device with pediatric indications than a small company, respectively.

Conclusions: Innovation for pediatric orthopaedic devices lags substantially behind that for adult orthopaedic devices. These findings are consistent with clinical experience and the common practice of modifying adult implants for "off-label" use in pediatric patients. Despite long-standing efforts to stimulate innovation for this vulnerable population, our results suggest little progress.

背景:尽管美国食品和药物管理局(FDA)授权的骨科器械数量大幅增加,但专为儿童设计的新型器械仍然很少。外科医生经常将成人植入物重新用于儿科患者的 "标签外 "用途,这既涉及法律问题,也涉及技术问题。本研究旨在客观量化和描述儿科器械创新的性质:美国食品和药物管理局采用 4 种途径对新型器械的安全性和有效性进行授权前评估。感知器械风险和新颖性决定了评估途径。从 FDA 的在线数据库中确定了骨科器械。其中包括了所有自成立以来通过人道主义器械豁免、上市前批准和新产品监管途径获得批准的器械,并将其归类为 "高度创新"。由于 510(k) 设备数量众多且发展迅速,因此对它们的评估仅限于 2018 年 1 月 1 日至 2022 年 12 月 31 日期间获得批准的设备。此类 510(k) 设备占设备总数的 97%,顾名思义,风险较低,新颖性较低。在已批准的标签中,对儿科适应症的批准声明进行了评估。作为辅助分析,还分析了公司规模对开发儿科适应症产品的影响:在通过 510(k) 途径获得批准的 1,925 种器械中,有 9 种(0.5%)专为儿科设计,160 种(8.3%)包含儿科适应症。在 9 款儿科专用器械中,5 款用于脊柱,4 款用于创伤。在 97 种高度创新的器械中,只有 2 种(2%)是专门为儿科设计的,另外 2 种(2%)包括儿科适应症。其中 2 种仅用于儿科的器械用于脊柱。大型公司和中型公司向市场推出儿科适应症器械的可能性分别是小型公司的1.9倍和1.6倍:结论:儿科骨科器械的创新远远落后于成人骨科器械。这些发现与临床经验以及将成人植入物修改为 "标签外 "用于儿科患者的常见做法是一致的。尽管长期以来一直在努力促进针对这一弱势群体的创新,但我们的结果表明进展甚微。
{"title":"Pediatric Device Innovation: An Analysis of Food and Drug Administration Authorizations Over Time.","authors":"Jonathan Dubin, Krish Sardesai, Caleb Grote, Caroline Tougas, Katherine Branche, Norman Otsuka","doi":"10.2106/JBJS.23.01211","DOIUrl":"10.2106/JBJS.23.01211","url":null,"abstract":"<p><strong>Background: </strong>Despite a tremendous increase in the number of orthopaedic devices authorized by the U.S. Food and Drug Administration (FDA), novel devices designed specifically for the pediatric population remain sparse. Surgeons frequently repurpose adult implants for \"off-label\" use in pediatric patients, with both legal and technical ramifications. This study seeks to objectively quantify and characterize the nature of pediatric device innovation over time.</p><p><strong>Methods: </strong>The FDA employs 4 pathways for assessing safety and effectiveness of novel devices prior to authorization. Perceived device risk and novelty determine the pathway. Orthopaedic devices were identified from the FDA's online database. All devices approved since inception via the Humanitarian Device Exemption, Pre-Market Approval, and De Novo regulatory pathways were included and grouped as \"highly innovative.\" Because of their number and the rapidity of their development, the evaluation of 510(k) devices was limited to those cleared from January 1, 2018, to December 31, 2022. Such 510(k) devices make up ∼97% of devices and by definition are less risky and less novel. Approval statements were assessed for pediatric indications within the approved labeling. As a secondary analysis, the impact of company size on developing a product with a pediatric indication was analyzed.</p><p><strong>Results: </strong>Of the 1,925 devices cleared via the 510(k) pathway, 9 (0.5%) were designed exclusively for pediatrics and 160 (8.3%) included pediatric indications. Five of the 9 pediatrics-only devices were for spine and 4 were for trauma indications. Of the 97 highly innovative devices, only 2 (2%) were exclusively pediatric and another 2 (2%) included pediatric indications. The 2 pediatrics-only devices were for the spine. Large and medium-sized companies were 1.9 times and 1.6 times more likely to bring to market a device with pediatric indications than a small company, respectively.</p><p><strong>Conclusions: </strong>Innovation for pediatric orthopaedic devices lags substantially behind that for adult orthopaedic devices. These findings are consistent with clinical experience and the common practice of modifying adult implants for \"off-label\" use in pediatric patients. Despite long-standing efforts to stimulate innovation for this vulnerable population, our results suggest little progress.</p>","PeriodicalId":15273,"journal":{"name":"Journal of Bone and Joint Surgery, American Volume","volume":null,"pages":null},"PeriodicalIF":4.4,"publicationDate":"2024-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141260331","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
A Matched Comparison of Implant and Functional Outcomes of Cemented and Cementless Unicompartmental Knee Replacements: A Study from the National Joint Registry for England, Wales, Northern Ireland and the Isle of Man and the Hospital Episode Statistics Patient Reported Outcome Measures Database. 有骨水泥和无骨水泥单隔间膝关节置换术植入效果和功能效果的匹配比较:来自英格兰、威尔士、北爱尔兰和马恩岛国家关节登记处和医院病例统计患者报告结果措施数据库的研究。
IF 4.4 1区 医学 Q1 ORTHOPEDICS Pub Date : 2024-09-04 Epub Date: 2024-07-09 DOI: 10.2106/JBJS.23.01418
Hasan R Mohammad, Andrew Judge, David W Murray

Background: Unicompartmental knee replacement (UKR) is an effective treatment for end-stage medial compartment osteoarthritis, but there can be problems with fixation. The cementless UKR was introduced to address this issue. It is unknown how its functional outcomes compare with those of the cemented version on a national scale. We performed a matched comparison of the clinical and functional outcomes of cementless and cemented UKRs.

Methods: Using the National Joint Registry for England, Wales, Northern Ireland and the Isle of Man (NJR), 14,764 Oxford UKRs with linked data regarding patient-reported outcomes were identified. A total of 6,906 UKRs (3,453 cemented and 3,453 cementless) were propensity score matched on the basis of patient, surgical, and implant factors.

Results: The 10-year cumulative implant survival rate was 93.0% (95% confidence interval [CI], 90.0% to 95.1%) for cementless UKRs and 91.3% (95% CI, 89.0% to 93.0%) for cemented UKRs. The cementless UKR group had a significantly lower revision risk (hazard ratio [HR], 0.74; p = 0.02). Subgroup analyses showed a stronger effect size (HR, 0.66) among UKRs performed by high-caseload surgeons (i.e., surgeons performing ≥30 UKRs/year). In the overall cohort, the postoperative Oxford Knee Score (OKS) in the cementless group (mean and standard deviation, 39.1 ± 8.7) was significantly higher (p = 0.001) than that in the cemented group (38.5 ± 8.6). The cementless group gained a mean of 17.6 ± 9.3 points in the OKS postoperatively and the cemented group gained 16.5 ± 9.6 points, with a difference of 1.1 points between the groups (p < 0.001). The difference in OKS points gained postoperatively was highest among UKRs performed by high-caseload surgeons, with the cementless group gaining 1.8 points more (p < 0.001) than the cemented group.

Conclusions: The cementless UKR demonstrated better 10-year implant survival and postoperative functional outcomes than the cemented UKR. The difference was largest among UKRs performed by high-caseload surgeons, with the cementless fixation group having an HR for revision of 0.66 and an approximately 2-point greater improvement in the OKS compared with the cemented fixation group.

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

背景:单室膝关节置换术(UKR)是治疗终末期内侧室骨关节炎的有效方法,但在固定方面可能存在问题。无骨水泥膝关节置换术就是为了解决这一问题而推出的。在全国范围内,其功能结果与有骨水泥型相比如何尚不得而知。我们对无骨水泥和有骨水泥UKR的临床和功能结果进行了匹配比较:通过英格兰、威尔士、北爱尔兰和马恩岛国家关节登记处(NJR),我们确定了14764例牛津UKR,并将患者报告的结果数据关联起来。根据患者、手术和植入物因素,对6906例UKR(3453例骨水泥植入和3453例无骨水泥植入)进行了倾向评分匹配:无骨水泥UKR的10年累积植入存活率为93.0%(95%置信区间[CI],90.0%至95.1%),有骨水泥UKR的10年累积植入存活率为91.3%(95%置信区间[CI],89.0%至93.0%)。无骨水泥UKR组的翻修风险明显较低(危险比[HR],0.74;P = 0.02)。亚组分析表明,由高病例量外科医生(即每年进行≥30例UKR的外科医生)进行的UKR具有更强的效应(HR,0.66)。在整个队列中,无骨水泥组的术后牛津膝关节评分(OKS)(平均值和标准差,39.1 ± 8.7)显著高于有骨水泥组(38.5 ± 8.6)(P = 0.001)。无骨水泥组术后的 OKS 平均值为(17.6 ± 9.3)分,有骨水泥组为(16.5 ± 9.6)分,两组间相差 1.1 分(p < 0.001)。由高工作量外科医生实施的UKR术后获得的OKS积分差异最大,无骨水泥组比有骨水泥组多获得1.8分(p < 0.001):结论:与有骨水泥UKR相比,无骨水泥UKR的10年植入存活率和术后功能效果更好。无骨水泥固定组的翻修HR为0.66,与有骨水泥固定组相比,OKS提高了约2分:预后III级。有关证据等级的完整描述,请参阅 "作者须知"。
{"title":"A Matched Comparison of Implant and Functional Outcomes of Cemented and Cementless Unicompartmental Knee Replacements: A Study from the National Joint Registry for England, Wales, Northern Ireland and the Isle of Man and the Hospital Episode Statistics Patient Reported Outcome Measures Database.","authors":"Hasan R Mohammad, Andrew Judge, David W Murray","doi":"10.2106/JBJS.23.01418","DOIUrl":"10.2106/JBJS.23.01418","url":null,"abstract":"<p><strong>Background: </strong>Unicompartmental knee replacement (UKR) is an effective treatment for end-stage medial compartment osteoarthritis, but there can be problems with fixation. The cementless UKR was introduced to address this issue. It is unknown how its functional outcomes compare with those of the cemented version on a national scale. We performed a matched comparison of the clinical and functional outcomes of cementless and cemented UKRs.</p><p><strong>Methods: </strong>Using the National Joint Registry for England, Wales, Northern Ireland and the Isle of Man (NJR), 14,764 Oxford UKRs with linked data regarding patient-reported outcomes were identified. A total of 6,906 UKRs (3,453 cemented and 3,453 cementless) were propensity score matched on the basis of patient, surgical, and implant factors.</p><p><strong>Results: </strong>The 10-year cumulative implant survival rate was 93.0% (95% confidence interval [CI], 90.0% to 95.1%) for cementless UKRs and 91.3% (95% CI, 89.0% to 93.0%) for cemented UKRs. The cementless UKR group had a significantly lower revision risk (hazard ratio [HR], 0.74; p = 0.02). Subgroup analyses showed a stronger effect size (HR, 0.66) among UKRs performed by high-caseload surgeons (i.e., surgeons performing ≥30 UKRs/year). In the overall cohort, the postoperative Oxford Knee Score (OKS) in the cementless group (mean and standard deviation, 39.1 ± 8.7) was significantly higher (p = 0.001) than that in the cemented group (38.5 ± 8.6). The cementless group gained a mean of 17.6 ± 9.3 points in the OKS postoperatively and the cemented group gained 16.5 ± 9.6 points, with a difference of 1.1 points between the groups (p < 0.001). The difference in OKS points gained postoperatively was highest among UKRs performed by high-caseload surgeons, with the cementless group gaining 1.8 points more (p < 0.001) than the cemented group.</p><p><strong>Conclusions: </strong>The cementless UKR demonstrated better 10-year implant survival and postoperative functional outcomes than the cemented UKR. The difference was largest among UKRs performed by high-caseload surgeons, with the cementless fixation group having an HR for revision of 0.66 and an approximately 2-point greater improvement in the OKS compared with the cemented fixation group.</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":null,"pages":null},"PeriodicalIF":4.4,"publicationDate":"2024-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141563500","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
Cementless Oxford Unicompartmental Knee Replacements: More Data, More Questions: Commentary on an article by Hasan R. Mohammad, MRCS, MRes(Dist), DPhil(Oxon), et al.: "A Matched Comparison of Implant and Functional Outcomes of Cemented and Cementless Unicompartmental Knee Replacements. A Study from the National Registry for England, Wales, Northern Ireland and the Isle of Man and the Hospital Episode Statistics Patient Reported Outcome Measures Database". 无骨水泥牛津膝关节置换术:更多数据,更多问题:评论 Hasan R. Mohammad、MRCS、MRes(Dist)、DPhil(Oxon)等人的文章:"对有骨水泥和无骨水泥单隔间膝关节置换术的植入和功能结果进行匹配比较。来自英格兰、威尔士、北爱尔兰和马恩岛国家登记处和医院病历统计患者报告结果措施数据库的研究"。
IF 4.4 1区 医学 Q1 ORTHOPEDICS Pub Date : 2024-09-04 DOI: 10.2106/JBJS.24.00524
Aaron G Chen, Michael S Reich
{"title":"Cementless Oxford Unicompartmental Knee Replacements: More Data, More Questions: Commentary on an article by Hasan R. Mohammad, MRCS, MRes(Dist), DPhil(Oxon), et al.: \"A Matched Comparison of Implant and Functional Outcomes of Cemented and Cementless Unicompartmental Knee Replacements. A Study from the National Registry for England, Wales, Northern Ireland and the Isle of Man and the Hospital Episode Statistics Patient Reported Outcome Measures Database\".","authors":"Aaron G Chen, Michael S Reich","doi":"10.2106/JBJS.24.00524","DOIUrl":"https://doi.org/10.2106/JBJS.24.00524","url":null,"abstract":"","PeriodicalId":15273,"journal":{"name":"Journal of Bone and Joint Surgery, American Volume","volume":null,"pages":null},"PeriodicalIF":4.4,"publicationDate":"2024-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142125869","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
Low-Intensity Pulsed Ultrasound Versus Sham in the Treatment of Operatively Managed Scaphoid Nonunions: The SNAPU Randomized Controlled Trial. 低强度脉冲超声与假超声治疗手术治疗的肩胛骨骨不连:SNAPU随机对照试验。
IF 4.4 1区 医学 Q1 ORTHOPEDICS Pub Date : 2024-09-04 Epub Date: 2024-07-01 DOI: 10.2106/JBJS.23.00783
Neil J White, Ethan D Patterson, Gurpreet S Dhaliwal, Kevin A Hildebrand

Update: This article was updated on September 4, 2024 because of a previous error, which was discovered after the preliminary version of the article was posted online. In the Note listing the members of the Wrist and Elbow Research Group of Canada, the text that had read "Thomas T. Goetz, MD, FRCSC" now reads "Thomas J. Goetz, MD, FRCSC".

Background: The primary goal after open reduction and internal fixation of an established scaphoid nonunion is to achieve union. Low-intensity pulsed ultrasound (LIPUS) has been reported to increase the rate of union and to decrease the time to union for multiple fractures and nonunions in clinical and animal models. The evidence for LIPUS in the treatment of scaphoid nonunion, however, is sparse. The aim of this study was to assess whether active LIPUS (relative to sham LIPUS) accelerates the time to union following surgery for scaphoid nonunion.

Methods: Adults with a scaphoid nonunion indicated for surgery were recruited for a multicenter, prospective, double-blinded randomized controlled trial. After surgery, patients self-administered activated or sham LIPUS units beginning at their first postoperative visit. The primary outcome was the time to union on serial computed tomography (CT) scans starting 6 to 8 weeks postoperatively. Secondary outcomes included patient-reported outcome measures, range of motion, and grip strength.

Results: A total of 142 subjects completed the study (69 in the active LIPUS group and 73 in the sham group). The average age was 27 years, and the cohort was 88% male. There was no difference in time to union (p = 0.854; hazard ratio, 0.965; 95% confidence interval, 0.663 to 1.405). Likewise, there were no differences between the active LIPUS and sham groups with respect to any of the secondary outcomes, except for wrist flexion at baseline (p = 0.008) and at final follow-up (p = 0.043).

Conclusions: Treatment with LIPUS had no effect on reducing time to union in patients who underwent surgical fixation of established scaphoid nonunions.

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

背景:肩胛骨骨不连切开复位和内固定术后的主要目标是实现骨不连。据报道,在临床和动物模型中,低强度脉冲超声(LIPUS)可提高多发性骨折和骨不连的愈合率并缩短愈合时间。然而,LIPUS 用于治疗肩胛骨不愈合的证据并不多。本研究旨在评估主动LIPUS(相对于假LIPUS)是否能加快肩胛骨骨不连手术后的愈合时间:方法:这项多中心、前瞻性、双盲随机对照试验招募了有手术指征的肩胛骨骨不连的成年人。手术后,患者从术后第一次就诊开始自行使用激活或假LIPUS单位。主要结果是术后6至8周开始的连续计算机断层扫描(CT)显示的骨结合时间。次要结果包括患者报告的结果测量、活动范围和握力:共有142名受试者完成了研究(主动LIPUS组69人,假LIPUS组73人)。受试者平均年龄为27岁,88%为男性。两组患者的骨结合时间没有差异(P = 0.854;危险比为 0.965;95% 置信区间为 0.663 至 1.405)。同样,除了基线时(p = 0.008)和最终随访时(p = 0.043)的腕关节屈曲度外,积极LIPUS治疗组和假LIPUS治疗组在任何次要结果上都没有差异:结论:LIPUS治疗对缩短肩胛骨骨不连手术固定患者的愈合时间没有影响:有关证据等级的完整描述,请参阅 "作者须知"。
{"title":"Low-Intensity Pulsed Ultrasound Versus Sham in the Treatment of Operatively Managed Scaphoid Nonunions: The SNAPU Randomized Controlled Trial.","authors":"Neil J White, Ethan D Patterson, Gurpreet S Dhaliwal, Kevin A Hildebrand","doi":"10.2106/JBJS.23.00783","DOIUrl":"10.2106/JBJS.23.00783","url":null,"abstract":"<p><strong>Update: </strong>This article was updated on September 4, 2024 because of a previous error, which was discovered after the preliminary version of the article was posted online. In the Note listing the members of the Wrist and Elbow Research Group of Canada, the text that had read \"Thomas T. Goetz, MD, FRCSC\" now reads \"Thomas J. Goetz, MD, FRCSC\".</p><p><strong>Background: </strong>The primary goal after open reduction and internal fixation of an established scaphoid nonunion is to achieve union. Low-intensity pulsed ultrasound (LIPUS) has been reported to increase the rate of union and to decrease the time to union for multiple fractures and nonunions in clinical and animal models. The evidence for LIPUS in the treatment of scaphoid nonunion, however, is sparse. The aim of this study was to assess whether active LIPUS (relative to sham LIPUS) accelerates the time to union following surgery for scaphoid nonunion.</p><p><strong>Methods: </strong>Adults with a scaphoid nonunion indicated for surgery were recruited for a multicenter, prospective, double-blinded randomized controlled trial. After surgery, patients self-administered activated or sham LIPUS units beginning at their first postoperative visit. The primary outcome was the time to union on serial computed tomography (CT) scans starting 6 to 8 weeks postoperatively. Secondary outcomes included patient-reported outcome measures, range of motion, and grip strength.</p><p><strong>Results: </strong>A total of 142 subjects completed the study (69 in the active LIPUS group and 73 in the sham group). The average age was 27 years, and the cohort was 88% male. There was no difference in time to union (p = 0.854; hazard ratio, 0.965; 95% confidence interval, 0.663 to 1.405). Likewise, there were no differences between the active LIPUS and sham groups with respect to any of the secondary outcomes, except for wrist flexion at baseline (p = 0.008) and at final follow-up (p = 0.043).</p><p><strong>Conclusions: </strong>Treatment with LIPUS had no effect on reducing time to union in patients who underwent surgical fixation of established scaphoid nonunions.</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":null,"pages":null},"PeriodicalIF":4.4,"publicationDate":"2024-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141476668","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
An In-Depth Analysis of Public and Private Research Funding in Orthopaedic Surgery from 2015 to 2021. 深入分析 2015 至 2021 年矫形外科领域的公共和私人研究资金。
IF 4.4 1区 医学 Q1 ORTHOPEDICS Pub Date : 2024-09-04 Epub Date: 2024-04-01 DOI: 10.2106/JBJS.23.00598
Aakash K Shah, Robert J Burkhart, Varunil N Shah, Heath P Gould, Alexander J Acuña, Atul F Kamath
<p><strong>Background: </strong>Understanding the trends and patterns of research funding can aid in enhancing growth and innovation in orthopaedic research. We sought to analyze financial trends in public orthopaedic surgery funding and characterize trends in private funding distribution among orthopaedic surgeons and hospitals to explore potential disparities across orthopaedic subspecialties.</p><p><strong>Methods: </strong>We conducted a cross-sectional analysis of private and public orthopaedic research funding from 2015 to 2021 using the Centers for Medicare & Medicaid Services Open Payments database and the National Institutes of Health (NIH) RePORTER through the Blue Ridge Institute for Medical Research, respectively. Institutions receiving funds from both the NIH and the private sector were classified separately as publicly funded and privately funded. Research payment characteristics were categorized according to their respective orthopaedic fellowship subspecialties. Descriptive statistics, Wilcoxon rank-sum tests, and Mann-Kendall tests were employed. A p value of <0.05 was considered significant.</p><p><strong>Results: </strong>Over the study period, $348,428,969 in private and $701,078,031 in public research payments were reported. There were 2,229 unique surgeons receiving funding at 906 different institutions. The data showed that a total of 2,154 male orthopaedic surgeons received $342,939,782 and 75 female orthopaedic surgeons received $5,489,187 from 198 different private entities. The difference in the median payment size between male and female orthopaedic surgeons was not significant. The top 1% of all practicing orthopaedic surgeons received 99% of all private funding in 2021. The top 20 publicly and top 20 privately funded institutions received 77% of the public and 37% of the private funding, respectively. Private funding was greatest (31.5%) for projects exploring adult reconstruction.</p><p><strong>Conclusion: </strong>While the amount of public research funding was more than double the amount of private research funding, the distribution of public research funding was concentrated in fewer institutions when compared with private research funding. This suggests the formation of orthopaedic centers of excellence (CoEs), which are programs that have high concentrations of talent and resources. Furthermore, the similar median payment by gender is indicative of equitable payment size. In the future, orthopaedic funding should follow a distribution model that aligns with the existing approach, giving priority to a nondiscriminatory stance regarding gender, and allocate funds toward CoEs.</p><p><strong>Clinical relevance: </strong>Securing research funding is vital for driving innovation in orthopaedic surgery, which is crucial for enhancing clinical interventions. Thus, understanding the patterns and distribution of research funding can help orthopaedic surgeons tailor their future projects to better align with current fundi
背景:了解研究经费的趋势和模式有助于促进骨科研究的发展和创新。我们试图分析公共骨科手术资助的财务趋势,并描述骨科医生和医院之间私人资助分配的趋势,以探索骨科亚专科之间的潜在差异:我们分别使用美国医疗保险与医疗补助服务中心(Centers for Medicare & Medicaid Services)的公开支付数据库和美国国立卫生研究院(NIH)通过蓝岭医学研究所(Blue Ridge Institute for Medical Research)发布的RePORTER,对2015年至2021年的私人和公共骨科研究经费进行了横向分析。同时从美国国立卫生研究院和私营部门获得资金的机构被分别归类为公共资助机构和私人资助机构。研究经费的支付特征根据其各自的骨科研究金亚专科进行分类。采用了描述性统计、Wilcoxon 秩和检验和 Mann-Kendall 检验。结果在研究期间,共报告了 348,428,969 美元的私人研究经费和 701,078,031 美元的公共研究经费。共有 906 家不同机构的 2,229 名外科医生获得了资助。数据显示,共有 2,154 名骨科男外科医生和 75 名骨科女外科医生分别从 198 家不同的私人机构获得了 342,939,782 美元和 5,489,187 美元的资助。骨科男女外科医生的薪酬中位数差异不大。2021 年,所有执业骨科医生中排名前 1%的人获得了 99% 的私人资助。公共资助排名前 20 位的机构和私人资助排名前 20 位的机构分别获得了 77% 的公共资助和 37% 的私人资助。其中,研究成人重建的项目获得的私人资助最多(31.5%):结论:虽然公共研究资金的数额是私人研究资金的两倍多,但与私人研究资金相比,公共研究资金的分布集中在较少的机构。这表明骨科卓越中心(CoE)的形成,即人才和资源高度集中的项目。此外,不同性别的研究经费中位数相似,这也表明了研究经费的公平性。未来,骨科资金的分配模式应与现有方法保持一致,优先考虑对性别不歧视的立场,并将资金分配给CoEs:临床相关性:获得研究资金对于推动矫形外科的创新至关重要,而矫形外科的创新对于加强临床干预措施也至关重要。因此,了解研究经费的模式和分配情况可以帮助矫形外科医生调整其未来项目,使其更好地适应当前的经费趋势,从而提高其工作获得支持的可能性。
{"title":"An In-Depth Analysis of Public and Private Research Funding in Orthopaedic Surgery from 2015 to 2021.","authors":"Aakash K Shah, Robert J Burkhart, Varunil N Shah, Heath P Gould, Alexander J Acuña, Atul F Kamath","doi":"10.2106/JBJS.23.00598","DOIUrl":"10.2106/JBJS.23.00598","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Understanding the trends and patterns of research funding can aid in enhancing growth and innovation in orthopaedic research. We sought to analyze financial trends in public orthopaedic surgery funding and characterize trends in private funding distribution among orthopaedic surgeons and hospitals to explore potential disparities across orthopaedic subspecialties.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;We conducted a cross-sectional analysis of private and public orthopaedic research funding from 2015 to 2021 using the Centers for Medicare & Medicaid Services Open Payments database and the National Institutes of Health (NIH) RePORTER through the Blue Ridge Institute for Medical Research, respectively. Institutions receiving funds from both the NIH and the private sector were classified separately as publicly funded and privately funded. Research payment characteristics were categorized according to their respective orthopaedic fellowship subspecialties. Descriptive statistics, Wilcoxon rank-sum tests, and Mann-Kendall tests were employed. A p value of &lt;0.05 was considered significant.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Over the study period, $348,428,969 in private and $701,078,031 in public research payments were reported. There were 2,229 unique surgeons receiving funding at 906 different institutions. The data showed that a total of 2,154 male orthopaedic surgeons received $342,939,782 and 75 female orthopaedic surgeons received $5,489,187 from 198 different private entities. The difference in the median payment size between male and female orthopaedic surgeons was not significant. The top 1% of all practicing orthopaedic surgeons received 99% of all private funding in 2021. The top 20 publicly and top 20 privately funded institutions received 77% of the public and 37% of the private funding, respectively. Private funding was greatest (31.5%) for projects exploring adult reconstruction.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;While the amount of public research funding was more than double the amount of private research funding, the distribution of public research funding was concentrated in fewer institutions when compared with private research funding. This suggests the formation of orthopaedic centers of excellence (CoEs), which are programs that have high concentrations of talent and resources. Furthermore, the similar median payment by gender is indicative of equitable payment size. In the future, orthopaedic funding should follow a distribution model that aligns with the existing approach, giving priority to a nondiscriminatory stance regarding gender, and allocate funds toward CoEs.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Clinical relevance: &lt;/strong&gt;Securing research funding is vital for driving innovation in orthopaedic surgery, which is crucial for enhancing clinical interventions. Thus, understanding the patterns and distribution of research funding can help orthopaedic surgeons tailor their future projects to better align with current fundi","PeriodicalId":15273,"journal":{"name":"Journal of Bone and Joint Surgery, American Volume","volume":null,"pages":null},"PeriodicalIF":4.4,"publicationDate":"2024-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140859687","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
期刊
Journal of Bone and Joint Surgery, American Volume
全部 Acc. Chem. Res. ACS Applied Bio Materials ACS Appl. Electron. Mater. ACS Appl. Energy Mater. ACS Appl. Mater. Interfaces ACS Appl. Nano Mater. ACS Appl. Polym. Mater. ACS BIOMATER-SCI ENG ACS Catal. ACS Cent. Sci. ACS Chem. Biol. ACS Chemical Health & Safety ACS Chem. Neurosci. ACS Comb. Sci. ACS Earth Space Chem. ACS Energy Lett. ACS Infect. Dis. ACS Macro Lett. ACS Mater. Lett. ACS Med. Chem. Lett. ACS Nano ACS Omega ACS Photonics ACS Sens. ACS Sustainable Chem. Eng. ACS Synth. Biol. Anal. Chem. BIOCHEMISTRY-US Bioconjugate Chem. BIOMACROMOLECULES Chem. Res. Toxicol. Chem. Rev. Chem. Mater. CRYST GROWTH DES ENERG FUEL Environ. Sci. Technol. Environ. Sci. Technol. Lett. Eur. J. Inorg. Chem. IND ENG CHEM RES Inorg. Chem. J. Agric. Food. Chem. J. Chem. Eng. Data J. Chem. Educ. J. Chem. Inf. Model. J. Chem. Theory Comput. J. Med. Chem. J. Nat. Prod. J PROTEOME RES J. Am. Chem. Soc. LANGMUIR MACROMOLECULES Mol. Pharmaceutics Nano Lett. Org. Lett. ORG PROCESS RES DEV ORGANOMETALLICS J. Org. Chem. J. Phys. Chem. J. Phys. Chem. A J. Phys. Chem. B J. Phys. Chem. C J. Phys. Chem. Lett. Analyst Anal. Methods Biomater. Sci. Catal. Sci. Technol. Chem. Commun. Chem. Soc. Rev. CHEM EDUC RES PRACT CRYSTENGCOMM Dalton Trans. Energy Environ. Sci. ENVIRON SCI-NANO ENVIRON SCI-PROC IMP ENVIRON SCI-WAT RES Faraday Discuss. Food Funct. Green Chem. Inorg. Chem. Front. Integr. Biol. J. Anal. At. Spectrom. J. Mater. Chem. A J. Mater. Chem. B J. Mater. Chem. C Lab Chip Mater. Chem. Front. Mater. Horiz. MEDCHEMCOMM Metallomics Mol. Biosyst. Mol. Syst. Des. Eng. Nanoscale Nanoscale Horiz. Nat. Prod. Rep. New J. Chem. Org. Biomol. Chem. Org. Chem. Front. PHOTOCH PHOTOBIO SCI PCCP Polym. Chem.
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
0
微信
客服QQ
Book学术公众号 扫码关注我们
反馈
×
意见反馈
请填写您的意见或建议
请填写您的手机或邮箱
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
现在去查看 取消
×
提示
确定
Book学术官方微信
Book学术文献互助
Book学术文献互助群
群 号:481959085
Book学术
文献互助 智能选刊 最新文献 互助须知 联系我们:info@booksci.cn
Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。
Copyright © 2023 Book学术 All rights reserved.
ghs 京公网安备 11010802042870号 京ICP备2023020795号-1