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

Background: Robotic total knee arthroplasty (rTKA) has garnered increasing attention in recent years, both clinically and in the media. The purpose of this study was to compare the volume of and messaging in published randomized controlled trials (RCTs) versus media reports on the topic of rTKA.

Methods: This was a systematic review of RCTs and media articles on rTKA. PubMed, Embase, and MEDLINE were searched for RCTs; Factiva was searched for media articles. The number of publications of each type per year was recorded. Media articles were classified on the basis of their primary information source, their general tone toward rTKA, and the benefits and drawbacks of rTKA discussed. The volume, tone, and specific messaging around rTKA were compared between media articles and RCTs.

Results: Fifteen RCTs and 460 media articles, published between 1991 and 2023, were included. The rates of both publication types increased over time, with more rapid increases in recent years. Ninety-five percent of media publications highlighted at least 1 benefit of rTKA. The most commonly cited benefits were more precise implant positioning (82.6%) and faster recovery (28.7%). Fewer than 7% of media publications (n = 30) mentioned downsides to rTKA. Overall, 89.3% of media articles presented a favorable view of rTKA. Ninety percent of RCTs reported that rTKA significantly outperformed manual TKA in terms of component positioning. Four of 6 RCTs reported significantly longer operative times with rTKA. Most RCTs found no significant differences in functional outcomes, opioid use, or complication rates.

Conclusions: The rate of publications on rTKA has increased substantially in media sources and peer-reviewed journals, with the volume of media articles far outpacing RCTs on the topic. More precise component positioning was the most consistently reported benefit of rTKA in RCTs. However, media sources also reported a range of other, less well-supported benefits, and employed overwhelmingly positive tones regarding rTKA, more so than is supported by mixed clinical results. Efforts to ensure that patients and health-care providers receive accurate and evidence-based information about new health technologies are critical.

Clinical relevance: This study demonstrates a clear disparity between news media coverage of rTKA and the best clinical evidence available. This information can help to guide discussions between patients and surgeons regarding the use of rTKA.

Background: Myocardial injury after a hip fracture is common and has a poor prognosis. Patients with a hip fracture and myocardial injury may benefit from accelerated surgery to remove the physiological stress associated with the hip fracture. This study aimed to determine if accelerated surgery is superior to standard care in terms of the 90-day risk of death in patients with a hip fracture who presented with an elevated cardiac biomarker/enzyme measurement at hospital arrival.

Methods: The HIP fracture Accelerated surgical TreaTment And Care tracK (HIP ATTACK) trial was a randomized controlled trial designed to determine whether accelerated surgery for hip fracture was superior to standard care in reducing death or major complications. This substudy is a post-hoc analysis of 1392 patients (from the original study of 2970 patients) who had a cardiac biomarker/enzyme measurement (>99.9% had a troponin measurement and thus "troponin" is the term used throughout the paper) at hospital arrival. The primary outcome was all-cause mortality. The secondary composite outcome included all-cause mortality and non-fatal myocardial infarction, stroke, and congestive heart failure 90 days after randomization.

Results: Three hundred and twenty-two (23%) of the 1392 patients had troponin elevation at hospital arrival. Among the patients with troponin elevation, the median time from hip fracture diagnosis to surgery was 6 hours (interquartile range [IQR] = 5 to 13) in the accelerated surgery group and 29 hours (IQR = 19 to 52) in the standard care group. Patients with troponin elevation had a lower risk of mortality with accelerated surgery compared with standard care (17 [10%] of 163 versus 36 [23%] of 159; hazard ratio [HR] = 0.43 [95% confidence interval (CI) = 0.24 to 0.77]) and a lower risk of the secondary composite outcome (23 [14%] of 163 versus 47 [30%] of 159; HR = 0.43 [95% CI = 0.26 to 0.72]).

Conclusions: One in 5 patients with a hip fracture presented with myocardial injury. Accelerated surgery resulted in a lower mortality risk than standard care for these patients; however, these findings need to be confirmed.

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

Background: We investigated the normal development of the secondary ossification centers of the acetabulum, focusing on their location and the amount of acetabular coverage increased by them.

Methods: We enrolled 132 patients who were 7 to 16 years of age and had no pelvic deformity but did have ≥1 os ischium, os ilium, and/or os pubis on abdominal or pelvic computed tomographic (CT) scans. The locations of the ossification centers were evaluated by adopting an orientation using 0° for the superior acetabulum, 90° for the anterior acetabulum, 180° for the inferior acetabulum, and 270° for the posterior acetabulum, on a reconstructed 3-dimensional (3D) CT image. The acetabular coverage increase by the os ischium, os ilium, or os pubis was defined as the difference in the posterior acetabular sector angle (ΔPASA), posterosuperior acetabular sector angle (ΔPSASA), superior acetabular sector angle (ΔSASA), anterosuperior acetabular sector angle (ΔASASA), or anterior acetabular sector angle (ΔAASA) measured with and without each secondary ossification center. Patients were grouped into 3 age ranges: late childhood, preadolescence, and early adolescence. The location of each ossification center and the increase in acetabular coverage were compared between these groups.

Results: In the late-childhood group, the median start-to-end positions in right hips were 269° to 316° for the os ischium, 345° to 356° for the os ilium, and 81° to 99° for the os pubis. These positions tended to be wider in the early-adolescence group at 252° to 328° for the os ischium (p < 0.001), 338° to 39° for the os ilium (p = 0.005), and 73° to 107° for the os pubis (p = 0.049) in right hips. In right hips in the late-childhood group, the median values were 8.1° for ΔPASA, 14.0° for ΔPSASA, 9.9° for ΔSASA, 11.1° for ΔASASA, and 3.9° for ΔAASA; and in the early-adolescence group, the median values in right hips were 10.7° for ΔPASA, 12.9° for ΔPSASA, 8.4° for ΔSASA, 7.4° for ΔASASA, and 5.6° for ΔAASA. Only the median ΔPASA was larger in the early-adolescence group than in the late-childhood group (p = 0.026). Similar results were observed in left hips.

Conclusions: In early adolescence, the secondary ossification centers appeared at more extended areas along the acetabular rim, and the increase in acetabular coverage by the secondary ossification centers tended to be larger in the posterior area but not in the anterior or superior area.

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