Orthopedics最新文献

Background: Anterior lumbar interbody fusion (ALIF) is frequently performed to treat degenerative spine disease. Outcomes, however, may be affected by obesity and diabetes. Semaglutide, a glucagon-like peptide-1 receptor agonist, improves metabolic health and reduces inflammation, with emerging data suggesting it may aid postoperative recovery. Its specific impact on ALIF remains underexplored. This study evaluates the association between semaglutide use and postoperative complications, length of stay (LOS), and health care costs in ALIF patients.

Materials and methods: We conducted a retrospective cohort study using the PearlDiver Mariner database from 2010 through 2022. Patients undergoing ALIF with active semaglutide prescriptions were propensity score-matched 1:5 to non-users based on age, sex, Elixhauser Comorbidity Index, obesity, tobacco use, and diabetes-related variables. Outcomes included 90-day complications, 2-year surgical complications, LOS, and total costs. Statistical analysis included chi-squared tests and multivariable logistic regression, with Bonferroni-adjusted significance set at P < .003.

Results: A total of 2,939 patients were included in the final analysis (425 semaglutide users, 2,514 matched controls). No significant differences were observed in 90-day or 2-year complication rates between the groups. However, semaglutide users had a significantly shorter LOS by 0.6 days and incurred roughly $10,400 lower same-day surgical costs and about $9,700 lower 90-day postoperative costs (P < .001 for all comparisons).

Conclusion: Semaglutide use was associated with reduced LOS and health care costs in ALIF patients without increasing complication rates. These findings suggest a potential role for semaglutide in optimizing perioperative outcomes and reducing resource use. Further research is warranted to assess long-term benefits.

Background: Traditional guidance after posterior-approach total hip arthroplasty (THA) recommends return to driving at 6-8 weeks. Muscle-sparing direct anterior THA (A-THA) may enable earlier recovery. Our objective was to assess brake reaction time (BRT) before and after right and left A-THA.

Materials and methods: This is a prospective cohort study of 32 patients who underwent an A-THA (21 right, 11 left). BRTs were recorded using Vericom's stationary reaction timer and response software at the patient's last preoperative visit and at 2 and 6 weeks postoperatively. Pain was assessed during each visit using the visual analog scale (VAS); an Oxford Hip Score (OHS) was filled out at the preoperative and 6-week visits.

Results: For patients undergoing right A-THA, mean BRT improved from 0.67 seconds (s) (±0.15) preoperatively to 0.60s (±0.05) at 2 weeks (P = .01) and 0.58s (±0.06) at 6 weeks (P = .03). Eighteen of 21 (85.7%) reached or surpassed baseline by 2 weeks. OHS improved from 36 to 19, and VAS improved from 2.9 to 0.24. Right-foot brakers undergoing left A-THA exhibited no significant BRT change: 0.63s (±0.13) preoperatively; 0.60s (±0.11) at 2 weeks, P = .53; and 0.58s (±0.07) at 6 weeks, P = .31. OHS improved from 37 to 20, and VAS did not change significantly.

Conclusion: Our objective data support consideration of earlier return to driving after A-THA when patients are off narcotics and meet local/insurer requirements.

The anterolateral ligament is a distinct structure found in the anterolateral aspect of the knee that, in recent years, has garnered renewed attention among orthopedic and sports medicine specialists. This review aims to synthesize current anatomical, biomechanical, and clinical evidence to provide a comprehensive overview of the anterolateral ligament, characterize its relevance in knee stability, and optimize management strategies following injury. Injuries to the anterolateral ligament, often concomitant with anterior cruciate ligament tears, were found to exacerbate knee instability. The debate over the necessity and optimal technique for anterolateral ligament reconstruction remains ongoing.

Background: Although decompression without fusion is widely performed for lumbar stenosis, the segmental behavior of adjacent disks following decompression alone remains poorly defined. Most prior studies have focused on adjacent segment mechanics after fusion, yet it is unclear whether similar reciprocal changes occur when motion is preserved. This pilot study evaluated changes in sagittal alignment at adjacent segments and lower lumbar lordosis following single-level L4-L5 decompression for lumbar spinal stenosis.

Materials and methods: A retrospective review of 46 patients (21 males, 25 females) undergoing L4-L5 laminectomy, diskectomy, or combined procedures was performed. Standing lumbar radiographs were obtained preoperatively and 6 months postoperatively. Measurements included L1-S1 lumbar lordosis (LL) and disk angles at L3-L4, L4-L5, and L5-S1. Univariate regression analysis identified predictors of cranial (L3-L4) and caudal (L5-S1) changes, including age, sex, body mass index, surgical approach, procedure type, and LL and L4-L5 changes.

Results: Among 46 patients (23 laminectomy, 15 diskectomy, 8 combined), mean LL change was 1.39° (P = .372) and the change in L4-L5 disk angle correlated significantly with change at L3-L4 (β = 0.241, P = .0407), but no predictors met criteria for multivariate inclusion. Subgroup analysis showed consistent L4-L5 to L3-L4 coupling across procedures, strongest for laminectomy (β = 0.236, R² = 0.129, f2 = 0.148, power = 42.1%).

Conclusion: L4-L5 laminectomy demonstrated the strongest association between operated and cranial segment motion, suggesting biomechanical coupling after decompression. Larger, prospective studies are warranted to validate these preliminary findings.

Background: Percutaneous kyphoplasty (PKP) has been widely used for the treatment of osteoporotic vertebral compression fractures (OVCFs). However, the risk factors for refracture are controversial. Many studies have evaluated various factors; paraspinal muscle degeneration is one of them.

Materials and methods: This retrospective analysis was performed on 197 patients who underwent PKP for OLVCFs between July 2017 and December 2022. All patients were divided into the refracture group and the non-refracture group. Univariate logistic regression analysis was performed to determine whether there were differences in sex, age, body mass index (BMI), T-score, fatty infiltration (FI), relative cross-sectional area (rCSA), level of fracture vertebra, presence of lumbar spondylolisthesis, history of hypertension, or history of diabetes between the two groups. Multivariate logistic regression analysis was used to determine the independent risk factors for new vertebral fracture after PKP for OLVCFs, and a nomogram was constructed and validated to predict the risk of refracture.

Results: The refracture rate was 21.8% (43/197). Univariate logistic regression analysis revealed statistically significant differences in age, BMI, T-score, and FI (all P < .1). Multivariate logistic regression analysis showed that the independent risk factors for new vertebral fracture were FI and T-score (all P < .05). The nomogram demonstrated favorable discriminative ability, with area under the curve values of 0.861 (95% CI: 0.793-0.928) in the training set and 0.796 (95% CI: 0.718-0.873) in the validation set (P < .05, respectively). The decision curve analysis indicated satisfactory clinical utility.

Conclusion: A higher FI of the lumbar paraspinal muscle and a lower T-score of the lumbar spine are independent risk factors for new vertebral fracture after PKP for OLVCFs. The nomogram established based on the risk factors demonstrated favorable predictive performance for refracture.

Background: Proper limb length restoration after primary total hip arthroplasty (THA) remains challenging. Current imaging and guidance tools do not account for patient-perceived or examination-based limb length differences. This study defined a three-pronged comprehensive approach to setting patient-specific limb length targets: 1) patient preoperative perception of limb length discrepancy (LLD), 2) surgeon objective examination of LLD, and 3) radiographic hip length measurements based on extent of cartilage and bone loss.

Materials and methods: A total of 102 patients who had hip osteoarthritis undergoing primary direct anterior approach THA were included. Patient-perceived preoperative limb length was collected. Target hip length was then determined using a radiographic goal for lengthening, preoperative hip pathology, patient perception, and physical examination findings of LLD. The primary outcome was the presence of patient-perceived or surgeon-examined LLD at latest follow-up. Secondary outcomes included patient outcome scores.

Results: A total of 102 patients (54.90% female) were included, with mean age and body mass index of 66.68 ± 11.79 years and 27.51 ± 4.63 kg/m², respectively. Preoperatively, 32.35% of patients reported perceived LLD. Postoperatively, 99.02% reported no LLD symptoms. Mean Hip Disability and Osteoarthritis Outcome Score, Joint Replacement scores improved from 49.41 ± 15.16 preoperatively to 79.34 ± 16.32 at 1 year.

Conclusion: Appropriate restoration of patient limb length remains an important target and a technical challenge. While different technologies can help surgeons achieve an LLD target, a three-pronged clinical approach to setting target LLD leads to over 99% patient satisfaction with their limb length at 1-year follow-up.

Background: Although various factors have been investigated with the goal of improving orthopedic surgery residents' quality of life, there is limited information on the effect of exercise on this population. The primary purpose of this study was to investigate the effects of physical activity on the quality of life of orthopedic surgery residents, with the secondary aim of comparing the differing effects of aerobic and resistance training in this population. Additionally, this study sought to examine the relationship between burnout and quality of life, with the goal of identifying potential associations that may inform targeted interventions to support resident well-being.

Materials and methods: Sixty-seven orthopedic surgery residents from all postgraduate years were enrolled in this cross-sectional, survey-based quantitative study. Respondents completed the Maslach Burnout Inventory-Human Services Survey for Medical Personnel (MBI-HSS-MP), the International Physical Activity Questionnaire (IPAQ), the World Health Organization Quality of Life questionnaire (WHOQOL-BREF), and the Muscle-Strengthening Exercise Questionnaire (MSEQ) via a secure online platform.

Results: Analysis revealed significant negative correlations between the psychological domain of the WHOQOL-BREF and the emotional exhaustion and depersonalization subscales of the MBI-HSS-MP (r = -0.496, P < .001; r = -0.267, P = .034, respectively). The strongest negative significant correlation was observed between the physical domain of the WHOQOLBREF and emotional exhaustion (r = -0.519, P < .001). Physical activity demonstrated a moderate positive correlation with physical quality of life (r = 0.308, P = .018) and a strong positive correlation with psychological quality of life (r = 0.450, P < .001).

Conclusion: The findings suggest that quality of life and burnout are significantly correlated in the orthopedic resident population. Both aerobic and resistance training showed the greatest association with the psychological domain of quality of life, followed by a notable relationship with the physical domain.

Background: Cementless total knee arthroplasty (TKA) is becoming increasingly common, and new systems warrant continued investigation. In this study, early functional and patient-reported outcome measures (PROMs) were investigated as they relate to the presence of radiolucent lines (RLL) in patients who underwent TKA using a novel cementless fixed-bearing system.

Materials and methods: An institutional database was retrospectively reviewed from November 1, 2022, to April 1, 2024, for primary TKA patients using a novel cementless TKA system. Demographics, range of motion, alignment, PROMs, and radiographs were collected and summarized for the cohort. Postoperative bone length, anteroposterior, and lateral weight-bearing-calibrated radiographs were evaluated for the presence of RLL by two reviewers. Patients were subsequently stratified by presence of RLL, and their functional and PROMs were compared.

Results: A total of 262 TKAs were performed by a single surgeon during the study period. Of these, 36 (13.7%) patients met inclusion criteria. Median Patient-Reported Outcomes Measurement Information System pain interference, physical function, and depression scores, as well as Knee Injury and Osteoarthritis Outcome Score, Joint Replacement, scores all improved 1 year postoperatively compared to preoperatively. Cohen's kappa was 0.34, indicating fair agreement between reviewers in radiographic analysis of RLL. Agreement was greatest for zones 1, 4, 10, 11, and 12. In total, there was at least one RLL detected by both reviewers in the same zone in 66.7% of knees, most commonly in zone 1. Lines were all <2 mm in depth, and no cases of aseptic loosening or revisions were noted.

Conclusion: Our results showed that this novel cementless system is a viable option for cementless TKA. Although RLL were present in the majority of patients in our cohort, all lines were <2 mm in depth and there were no cases of loosening or needing revision surgery. As expected, all PROMs improved at 1 year postoperatively. Further research is needed to investigate the mid- and long-term outcomes of this implant.

Background: There has been an increase in patient use of electronic patient portal (EPP) messaging. Although it may improve communication, it can be time consuming, and its association with clinical outcomes and additional health care use is not well known in orthopedic surgery.

Materials and methods: Patients undergoing elective orthopedic procedures at an academic medical center between January 2016 and June 2023 were included. Chi-squared and t tests were used to compare characteristics between postoperative messengers and non-messengers for categorical and continuous variables, respectively. Two multivariable logistic regression analyses were conducted to assess factors associated with emergency department (ED) visits without readmission and any readmission.

Results: Overall, 56,427 patients who underwent 64,709 surgeries were included; 580,531 messages were sent within 90 days of surgery. Postoperative EPP messaging was associated with increased odds of ED visits without readmission (odds ratio [OR], 1.22; 95% CI, 1.13-1.31; P < .001). Black race (OR, 1.82; 95% CI, 1.59-2.10; P < .001), Medicaid insurance (OR, 2.21; 95% CI, 1.93-2.53; P < .001), hand procedures (OR, 2.84; 95% CI, 2.55-3.15; P < .001), and foot and ankle procedures (OR, 3.26; 95% CI, 2.52-4.22; P < .001) had the highest odds of ED visits without readmission. Postoperative EPP messaging was associated with increased odds of any readmission (OR, 1.50; 95% CI, 1.41-1.59; P < .001). Hand procedures (OR, 2.26; 95% CI, 2.06-2.47; P < .001) and Medicaid patients (OR, 1.42; 95% CI, 1.24-1.64; P < .001) had the highest odds of any readmission after sending a postoperative message.

Conclusion: Postoperative EPP messages are frequently sent to orthopedic surgeons and their care teams. This research helps to identify those who may be at risk for increased health care use postoperatively. Optimizing postoperative EPP messaging engagement and care is critical to not only patients but health professional team well-being.

Background: Prior anterior cruciate ligament (ACL) reconstruction may introduce technical challenges during total knee arthroplasty (TKA), including altered anatomy and retained hardware. Evidence regarding how prior ACL reconstruction might change TKA outcomes remains limited. The primary objective of this study was to compare perioperative characteristics, patient-reported outcome measures (PROMs), and short-term complications in patients undergoing TKA with and without a history of ACL reconstruction.

Materials and methods: This was a retrospective matched-cohort study of patients who underwent TKA between January 2020 and December 2023 at a high-volume orthopedic hospital. Forty-five patients with prior ACL reconstruction were matched 1:4 to 175 patients undergoing primary TKA for osteoarthritis. Demographics, operative parameters, inpatient outcomes, and PROMs were compared.

Results: Prior to surgery, the ACL group had higher preoperative Knee injury and Osteoarthritis Outcomes Score for Joint Replacement scores (P = .006). The operative time was longer in the ACL group (mean 103.9 vs 88.3 minutes, P < .001). The ACL group reported lower inpatient pain (P = .049) and required fewer opioids (P = .028), but had similar physical therapy outcomes. By 12 weeks, PROMs and pain scores were equivalent between groups and remained similar at 1 year. No differences were observed in 90-day complications.

Conclusion: TKA after ACL reconstruction is associated with increased operative time but yields comparable short-term outcomes to primary TKA. These findings support the safety and effectiveness of TKA in this distinct patient population. Larger, comparative studies are needed to confirm these findings and to better understand the long-term ramifications of prior ACL reconstruction on TKA outcomes.