Journal of orthopaedics最新文献

{"title":"Comparing early practice outcomes of the direct anterior approach in total hip arthroplasty vs alternative approaches in direct anterior fellowship trained surgeons","authors":"Spencer E. Talentino ,&nbsp;Nicholas Pappa ,&nbsp;Kathryn Fideler ,&nbsp;Nicholas J. Greco","doi":"10.1016/j.jor.2025.12.033","DOIUrl":"10.1016/j.jor.2025.12.033","url":null,"abstract":"<div><h3>Aims</h3><div>Total hip arthroplasty (THA) approach typically depends on surgeon preference and training. The direct anterior approach (DAA) has increased appeal due to its muscle sparing planes. We evaluated complications of DAA and non-DAA THA by DAA fellowship trained surgeons. We hypothesized complications of DAA THAs would have a noninferior complication profile compared to alternative approaches.</div></div><div><h3>Methods</h3><div>Retrospective review of first 50 DAA and first 50 alternative-approach THAs performed by three fellowship-trained adult reconstruction surgeon's first year practice. Patient demographics, comorbidities, complications, radiographic acetabular inclination, acetabular anteversion, and femoral stem alignment were analyzed. Power analysis, univariate, multivariate regression models completed for analysis.</div></div><div><h3>Results</h3><div>150 cases (DAA) and 150 controls (alternative-approach) with median follow-up of 27.7 weeks (194 days). There was a significant difference in sex (56.7 % vs 35.3 % males) and median BMI (29.2 kg/m2 vs 36.5 kg/m2) between groups and no significant difference in total perioperative complications between cases (n = 51 events) and controls (n = 53 events). There were significantly reduced odds of 30 day re-admissions and 90-day ED visits in the DAA patients in univariate analysis (OR = 0.301, p = 0.008 and OR = 0.553, p = 0.045) but no significance in multivariate regression analysis (OR = 0.071, p = 0.104 and OR = 0.445, p = 0.251). Radiographic acetabular cup inclination (p = 0.31), acetabular cup anteversion (p = 1.00) and femoral stem alignment (p = 0.21) had no significant difference between groups.</div></div><div><h3>Conclusion</h3><div>Formal fellowship training in the DAA, including appropriate technique and patient selection, demonstrates no difference in perioperative complications, 30-day re-admissions, 90-day ED visits compared to alternative approaches, offering DAA fellowship trained surgeons immediate successful outcomes.</div></div>","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":"73 ","pages":"Pages 387-393"},"PeriodicalIF":1.5,"publicationDate":"2025-12-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145837331","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The use of liposomal bupivacaine for pain control after hand and wrist surgery: A systematic review and meta-analysis","authors":"Jorge A. Garavito,&nbsp;Joseph E. Nassar,&nbsp;Jacob Johnson,&nbsp;Manjot Singh,&nbsp;Christopher Got,&nbsp;Joseph A. Gil","doi":"10.1016/j.jor.2025.12.030","DOIUrl":"10.1016/j.jor.2025.12.030","url":null,"abstract":"<div><div>Liposomal bupivacaine (LB) has gained interest as a long-acting local anesthetic, although its utility in hand and wrist surgery remains unclear. This systematic review and meta-analysis evaluated randomized controlled trials (RCTs) comparing LB with conventional anesthetics in patients undergoing hand or wrist surgeries. Searches were performed in PubMed, Embase, Cochrane Library, Web of Science, Scopus, and Google Scholar through July 2025. Eligible studies reported pain scores and opioid consumption from postoperative day (POD) 0–5, and overall benefit of analgesia scores (OBAS) from POD 1 to 4. Pooled analyses calculated weighted means for pain scores, opioid use, and OBAS, with subgroup analyses for carpometacarpal (CMC) arthroplasty and distal radius open reduction internal fixation (ORIF). Four RCTs involving 211 patients (105 LB, 106 control) were included. Pain scores were not significantly different between groups across POD 0–5. Opioid consumption was marginally reduced on POD 1 with no significant other differences. OBAS scores were lower in the LB group on POD 2 and 3 with no other significant differences. This limited study found that LB use does not significantly reduce postoperative pain and opioid use or enhance analgesia satisfaction compared to standard bupivacaine in hand and wrist surgery.</div></div><div><h3>Level of evidence</h3><div>Therapeutic II.</div></div>","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":"73 ","pages":"Pages 213-220"},"PeriodicalIF":1.5,"publicationDate":"2025-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145787580","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of baseline outcomes between surgical and nonoperative management in youth with lower extremity torsional abnormalities","authors":"M. Gagnon ,&nbsp;J.P. Bauer ,&nbsp;K.M. Kruger ,&nbsp;S. Tavukcu ,&nbsp;H. Altiok ,&nbsp;R. Hamdy ,&nbsp;M. Bernstein ,&nbsp;L.N. Veilleux","doi":"10.1016/j.jor.2025.12.038","DOIUrl":"10.1016/j.jor.2025.12.038","url":null,"abstract":"","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":"73 ","pages":"Pages 227-233"},"PeriodicalIF":1.5,"publicationDate":"2025-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145787690","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Changes in contralateral knee adduction moment and their biomechanical determinants following valgus high tibial osteotomy for medial knee osteoarthritis","authors":"Kazuki Sasaya ,&nbsp;Koji Iwasaki ,&nbsp;Kengo Ukishiro ,&nbsp;Kensaku Kawakami ,&nbsp;Sho'ji Suzuki ,&nbsp;Shigeyuki Sakurai ,&nbsp;Tatsunori Maeda ,&nbsp;Taiki Tokuhiro ,&nbsp;Junki Shiota ,&nbsp;Yuki Suzuki ,&nbsp;Rikiya Baba ,&nbsp;Tomohiro Onodera ,&nbsp;Eiji Kondo ,&nbsp;Norimasa Iwasaki ,&nbsp;Yasumitsu Ohkoshi","doi":"10.1016/j.jor.2025.12.037","DOIUrl":"10.1016/j.jor.2025.12.037","url":null,"abstract":"<div><h3>Background</h3><div>Valgus high tibial osteotomy (HTO) reduces medial knee loading in the operated limb; however, its biomechanical influence on the contralateral knee remains unclear. This study aimed to determine the biomechanical factors associated with changes in contralateral knee adduction moment (KAM) following medial opening wedge HTO (MOWHTO).</div></div><div><h3>Methods</h3><div>A total of 46 limbs that underwent MOWHTO were evaluated with three-dimensional gait analysis preoperatively and at 2 years postoperatively. Contralateral KAM, trunk lean angle, shank adduction angle, and lower-limb alignment (%mechanical axis: %MA) were measured. Determinants of postoperative changes in contralateral KAM were identified using regression models that considered alignment changes in both the operative and contralateral limbs, as well as contralateral kinematic parameters.</div></div><div><h3>Results</h3><div>Group-level contralateral KAM did not change significantly after HTO (2.50 vs 2.36 %Nm/(BW × Ht), P = .37). However, individual changes varied ranging from −2.4 to +1.5 %Nm/(BW × Ht). Regression analysis showed that greater alignment correction of the operated limb (P = .03), increased trunk lean toward the operated side (P = .07), and greater contralateral shank adduction angle (P = .10) were associated with increased contralateral KAM.</div></div><div><h3>Conclusion</h3><div>Contralateral KAM exhibited marked individual variability despite the absence of a significant group-level change. Alignment correction, trunk mechanics, and contralateral shank adduction were identified as key determinants of postoperative increases in contralateral KAM. Because even small increases in KAM can contribute to elevated medial knee loading, the individual change may have clinical relevance. These findings emphasize the importance of considering bilateral lower-limb biomechanics when planning and evaluating HTO.</div></div>","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":"73 ","pages":"Pages 266-271"},"PeriodicalIF":1.5,"publicationDate":"2025-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145787693","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A multi-branch ConvNeXt–MaxViT fusion transformer model for radiographic knee osteoarthritis severity assessment with Grad-CAM++ explainability","authors":"Simran,&nbsp;Vinay Kukreja,&nbsp;Shiva Mehta","doi":"10.1016/j.jor.2025.12.040","DOIUrl":"10.1016/j.jor.2025.12.040","url":null,"abstract":"<div><h3>Context</h3><div>Knee Osteoarthritis (KOA) is a progressive degenerative joint disorder and a major cause of disability worldwide. Radiographic grading using the Kellgren–Lawrence (KL) scale remains the standard diagnostic method, but inherent subjectivity and difficulty in detecting subtle structural changes reduce diagnostic reliability. Thus, an automated, robust, and explainable system is clinically essential.</div></div><div><h3>Objective</h3><div>This study aims to develop an explainable deep learning model capable of accurately classifying KOA severity (KL-0 to KL-4) by integrating both local and global radiographic features, thereby enhancing transparency for clinical decision support.</div></div><div><h3>Method</h3><div>The proposed model introduces a dual-branch fusion architecture combining ConvNeXt-Tiny (Convoluional Neural Network with Next Generation Design) for local feature extraction and MaxViT-Tiny (Multi-Axis Vision Transformer) for global contextual modeling. Mid-level fusion (concatenation + Multi-Layer Perceptron(MLP)) and late fusion (weighted ensemble) are implemented to strengthen discriminative representation. Model performance is evaluated using Accuracy, Precision, Recall, F1-score, Area Under the Curve (AUC), Confusion Matrix, Receiver Operating Characteristics (ROC), and explainability via Gradient-weighted Class Activation Mapping Plus Plus (Grad-CAM++).</div></div><div><h3>Results</h3><div>The final late-fusion ensemble achieved 96.2 % accuracy, 95.2 % F1-score, 95.4 % precision, 95.1 % recall, and a macro-AUC of 0.981. Class-wise F1-scores were highest for KL-0 (97.1 %) and KL-4 (97.8 %). Five-fold cross-validation confirmed model stability with CI = 96.2 % ± 0.6 %. Grad-CAM++ correctly localized osteophytes, joint-space narrowing, and sclerosis, strengthening interpretability.</div></div><div><h3>Future scope</h3><div>Future work will integrate multi-modal imaging (X-ray and MRI), incorporate longitudinal progression modeling, and evaluate real-world clinical deployment among radiologists to further improve generalizability, robustness, and practical usability of KOA severity assessment systems.</div></div>","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":"73 ","pages":"Pages 353-369"},"PeriodicalIF":1.5,"publicationDate":"2025-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145837319","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation of proximal foot width after fourth generation minimally invasive surgery for hallux valgus","authors":"Ronald Isaac Ramos Ruiz,&nbsp;Cristian Ortiz Mateluna,&nbsp;Manuel Pellegrini Pucci,&nbsp;Giovanni Carcuro Urresti,&nbsp;Felipe Chaparro Ravazzano,&nbsp;Ana Butteri","doi":"10.1016/j.jor.2025.12.043","DOIUrl":"10.1016/j.jor.2025.12.043","url":null,"abstract":"<div><h3>Background</h3><div>Hallux valgus is a common foot deformity that significantly impacts functionality and causes pain. Minimally invasive surgical techniques, such as the Chevron-Akin procedure, have been developed to correct this deformity. This study evaluates the efficacy of the fourth-generation Minimally Invasive Chevron-Akin (MICA) technique in correcting proximal foot width.</div></div><div><h3>Objective</h3><div>We aimed to compare proximal and forefoot foot width (bony and soft tissues) in radiological images pre-vs. post-corrective MICA osteotomy in patients with hallux valgus.</div></div><div><h3>Methods</h3><div>A retrospective comparative study was conducted on 81 patients (132 feet) who underwent MICA surgery for symptomatic hallux valgus. Radiographic measurements of bony and soft tissue widths were taken pre-and postoperatively. Statistical analyses included t-tests, Wilcoxon tests, and Pearson correlation coefficients.</div></div><div><h3>Results</h3><div>postoperatively significant reductions in both forefoot and proximal foot widths were observed. Bony foot width decreased from 83.02 mm to 77.35 mm, and soft tissue foot width decreased from 101.66 mm to 95.23 mm. Proximal bony width reduced from 68.79 mm to 65.82 mm, and proximal soft tissue width from 87.46 mm to 85.92 mm. These changes were significantly correlated with improvements in angular parameters (HVA, IMA, DMAA).</div></div><div><h3>Conclusion</h3><div>The fourth-generation MICA technique effectively reduces both forefoot and proximal foot widths, contributing to high patient satisfaction and optimal surgical outcomes.</div></div>","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":"73 ","pages":"Pages 262-265"},"PeriodicalIF":1.5,"publicationDate":"2025-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145787692","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Finite element analysis of the effects of gap filling and tuberosity union for stability in open-wedge distal tuberosity tibial osteotomy","authors":"Hiroya Akase,&nbsp;Nobuhiro Kaku,&nbsp;Kensei Tanaka,&nbsp;Masashi Hirakawa","doi":"10.1016/j.jor.2025.12.041","DOIUrl":"10.1016/j.jor.2025.12.041","url":null,"abstract":"<div><h3>Background</h3><div>Open-wedge distal tuberosity tibial osteotomy is a joint-preserving surgical procedure that minimally affects the patellofemoral joint. Although it is considered less stable than other osteotomy procedures, few studies have evaluated its stability. Therefore, here, we categorized cases according to the state of bone union and performed a finite-element stability analysis.</div></div><div><h3>Methods</h3><div>Computed tomography (CT) data from a patient (63-year-old female) scheduled for osteotomy at our hospital were analyzed. We created a model with 10 patterns by dividing the progression of gap filling into five stages (0 %, 25 %, 50 %, 75 %, and 100 %) and further subdividing them into two groups based on the presence or absence of descending cut union. The maximum von Mises stress and displacement of the osteotomy site were calculated using specialized software.</div></div><div><h3>Results</h3><div>The maximum Mises stress decreased by approximately 90 % at 50 % gap filling compared with baseline (0 %), regardless of whether the descending cut had healed. Conversely, under gap filling conditions of 0 % and 25 %, the tibial tuberosity fused, resulting in a 66.7 % reduction in maximum von Mises stress under the 0 % condition and a 66.2 % reduction under the 25 % condition. Similarly, displacement decreased by 87.9 % under the 0 % condition and by 65.1 % under the 25 % condition owing to descending-cut union.</div></div><div><h3>Conclusion</h3><div>When gap filling reached 50 %, both maximum stress and displacement decreased significantly compared with baseline, regardless of whether the descending cut had fused. Furthermore, there was a significant difference in stability depending on whether the descending cut had fused, particularly when gap filling was insufficient. Therefore, in cases where descending cut healing is not achieved, it may be recommended to wait until gap filling reaches close to 50 % before removing the implants; moreover, when considering removal at approximately 25 %, it may be necessary to use tuberosity bone healing as a criterion in the decision.</div></div>","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":"73 ","pages":"Pages 278-282"},"PeriodicalIF":1.5,"publicationDate":"2025-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145787584","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Biomechanical analysis of femoral stress response during squatting: A combined multibody dynamics and finite element approach","authors":"Yafeng Li ,&nbsp;Jiang Liu ,&nbsp;Bopeng Zhang ,&nbsp;Feng Zhang ,&nbsp;Zhifeng Tian ,&nbsp;Jing Zhang","doi":"10.1016/j.jor.2025.12.039","DOIUrl":"10.1016/j.jor.2025.12.039","url":null,"abstract":"<div><h3>Background</h3><div>Inappropriate squat postures are prone to induce femoral musculoskeletal injuries. Knee flexion angle (<em>α</em>) and stance width (<em>L</em>) are critical governing parameters, yet their specific impacts on femoral mechanical responses during squatting have not been fully elucidated. This study aims to analyze the influence mechanisms of these kinematic factors on femoral stress distribution.</div></div><div><h3>Methods</h3><div>This study employed a combined multibody dynamics and finite element analysis (MBD-FEA) method. Hip joint reaction forces during squats under varying <em>α</em> and <em>L</em> conditions were computed via the AnyBody Modeling System and subsequently applied as boundary conditions to a femoral finite element model, to clarify the mechanisms by which <em>α</em> and <em>L</em> influence femoral mechanical responses.</div></div><div><h3>Results</h3><div>The results demonstrated that during squatting, tensile stress on the anterior femoral shaft was consistently greater than compressive stress on the posterior shaft, while tensile stress in Ward's triangle was persistently lower than compressive stress in the posterior femoral neck. As <em>α</em> increased, femoral stress displayed a nonlinear growth pattern characterized by “a rapid initial rise followed by slowing growth.” The effect of <em>L</em> on femoral stress was dependent on <em>α</em>: when <em>α</em> &lt; 105°, stress increased progressively with increasing <em>L</em>; when <em>α</em> &gt; 105°, this trend was reversed.</div></div><div><h3>Conclusion</h3><div>From a biomechanical standpoint, this study provides a theoretical foundation for the optimization of squat postures and the prevention of associated injuries.</div></div>","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":"73 ","pages":"Pages 198-205"},"PeriodicalIF":1.5,"publicationDate":"2025-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145787600","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A systematic review comparing the outcomes of utilizing a tricortical screw, quadricortical screw, or suture button for syndesmotic fixation","authors":"Brent A. Prenger,&nbsp;Casey Uffelmann,&nbsp;James L. Cook,&nbsp;Kyle M. Schweser","doi":"10.1016/j.jor.2025.12.035","DOIUrl":"10.1016/j.jor.2025.12.035","url":null,"abstract":"<div><h3>Introduction</h3><div>Optimal fixation for distal tibiofibular syndesmotic injuries remains debated, with numerous studies comparing syndesmotic screws (SS) to suture-button (SB) devices. However, limited attention has been given to differentiating tricortical screw (TS) from quadricortical screw (QS) fixation.</div></div><div><h3>Purpose</h3><div>To systematically review outcomes of SB, TS, and QS fixation to determine which technique provides superior clinical, radiographic, and patient-reported outcome measures (PROMs), as well as to determine which topics regarding syndesmotic fixation warrant further discussion.</div></div><div><h3>Methods</h3><div>A systematic review was conducted according to a registered PROSPERO protocol. PubMed and Scopus databases were searched using a predefined Boolean equation. Randomized controlled trials (RCTs) and cohort studies with at least 1 year of follow-up and having the SB, SS, TS, or QS as a cohort were included. Data extracted included clinical outcomes, radiographic parameters, and PROMs. Risk of bias was assessed using the RoB-2 for randomized studies and ROBINS-I V2 for cohort studies.</div></div><div><h3>Results</h3><div>Forty studies (19 RCTs, 21 cohort studies) met inclusion criteria. Most compared SB to SS fixation, while 4 compared TS to QS. Among cohort studies, 11 were classified as having critical risk of bias. Across studies comparing SB and SS, most outcomes were equivalent. Some RCTs demonstrated improved time to weight-bearing, lower reoperation rates, and superior PROMs in the SB group. Comparison between TS and QS fixation showed no significant differences in any clinical, radiographic, or PROM outcomes, although the few studies that met inclusion were of low-quality evidence.</div></div><div><h3>Conclusion</h3><div>SB fixation may yield marginally improved functional outcomes and reoperation rates compared with SS. The overall evidence remains heterogenous and frequently limited by bias. Studies directly comparing TS to QS is sparse and of insufficient quality, however, there is some belief that TS may be superior. Current gaps in the literature include differentiating which method of fixation is superior in patients with various comorbidities such as diabetes or osteoporosis. Evidence suggests that SB fixation provides comparable or slightly superior outcomes to SS fixation with a lack of evidence to support using a TS or QS. Future studies should focus on the gaps remaining in the literature.</div></div>","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":"73 ","pages":"Pages 283-295"},"PeriodicalIF":1.5,"publicationDate":"2025-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145787626","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Preoperative opioid use negatively impacts pain and met expectations 2 years after hip arthroscopy","authors":"Sourabh Vellala,&nbsp;Kathleen Healey,&nbsp;Michael A. McCurdy,&nbsp;Dominic J. Ventimiglia,&nbsp;Joseph M. Blommer,&nbsp;R. Frank Henn III,&nbsp;Sean J. Meredith","doi":"10.1016/j.jor.2025.12.036","DOIUrl":"10.1016/j.jor.2025.12.036","url":null,"abstract":"<div><h3>Purpose</h3><div>Orthopaedic surgery patients have among the highest rates of preoperative opioid use. Prior literature links preoperative opioid use with worse patient-reported outcomes (PROs) in other orthopedic procedures, but studies examining this relationship 2 years after hip arthroscopy are limited. This study aimed to investigate the impact of preoperative opioid use on 2-year PROs after hip arthroscopy. We hypothesized that preoperative opioid use would be associated with worse pain, function, and mental health at 2-year follow-up.</div></div><div><h3>Methods</h3><div>Patients undergoing hip arthroscopy from October 2015 to February 2022 were retrospectively identified. Patients completed surveys containing multiple PROs, including six Patient-Reported Outcomes Measurement Information System (PROMIS) domains at baseline and 2 years postoperatively. A statewide Prescription Drug Monitoring Program (PDMP) identified opioid prescriptions filled within 3 months preoperatively, standardized as morphine milligram equivalents (MMEs).</div></div><div><h3>Results</h3><div>Of 117 eligible patients, 84 (71.8 %) completed 2-year surveys, and 11 (13 %) filled an opioid prescription within 3 months of surgery. At baseline, preoperative opioid use was associated with worse PROMIS Fatigue (p &lt; .001), Numeric Pain Scale (NPS) operative hip (p = .043), Tegner Activity Scale (TAS) (p = .039), and Marx Activity Rating Scale lower extremity (MARS LE) (p = .036). At 2 years, preoperative opioid use was associated with worse PROMIS Fatigue (54.3 vs 45.7, p = .007), TAS (2.9 vs 4.9, p = .025), and MARS LE (21.1 vs 41.8, p = .047). On regression, preoperative MMEs predicted worse 2-year Musculoskeletal Outcomes Data Evaluation and Management System (MODEMS) met expectations (Est. = -0.001, p = .005) and less improvement in 2-year NPS operative hip (Est. = 8.78e-5, p = .032).</div></div><div><h3>Conclusion</h3><div>Preoperative opioid use was associated with worse 2-year PROMIS Fatigue, TAS, and MARS LE. Preoperative MMEs independently predicted worse MODEMS met expectations and less improvement in NPS operative hip at 2 years. These findings suggest preoperative opioid use negatively affects pain, activity, and expectations after hip arthroscopy.</div></div>","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":"73 ","pages":"Pages 272-277"},"PeriodicalIF":1.5,"publicationDate":"2025-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145787688","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}