Orthopedics最新文献

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.

Background: Disruption of the distal tibiofibular syndesmosis is a common complication of ankle fractures that can result in chronic instability and early osteoarthritis. This study aimed to compare syndesmotic widening and complications after plate fixation versus intramedullary fibular nailing. We hypothesized that fibular nailing would be associated with more syndesmotic widening but fewer complications.

Materials and methods: Patients treated with plate or nail fixation for ankle fractures at a level 1 trauma center were identified through query of the electronic medical record. Data included demographics, fracture characteristics, medial clear space (MCS), tibiofibular clear space (TFCS), and complications. Mortise radiographs were assessed preoperatively, intraoperatively, and postoperatively. Syndesmotic widening was defined as MCS >4 mm and TFCS >5 mm at final follow-up.

Results: A total of 143 ankles were included; 84 patients (58.7%) received plate fixation, and 59 patients (41.3%) received fibular nailing. Mean follow-up was 6.1 ± 4.1 months and 6.5 ± 5.3 months, respectively. With the number of patients available, no significant differences were found between cohorts in the change in MCS (P = .663) or TFCS (P = .912) from fluoroscopy to 6 months postoperatively. No significant difference was observed in the proportion of patients with MCS >4 mm (P = .163) or TFCS >5 mm (P = .087) at final follow-up. Complication rates did not significantly differ between cohorts (20.2% plate cohort vs 16.9% nail cohort; P = .621).

Conclusion: Syndesmotic widening after ankle fracture fixation is comparable between plating and fibular nailing, suggesting both methods effectively maintain syndesmotic reduction.

Background: There is a paucity of research on the supply and adequacy of the orthopedic surgeon workforce. This study assessed United States federal government projections on the supply and demand of orthopedic surgeons to 2037.

Materials and methods: This was a cross-sectional analysis of orthopedic surgeons using data from the Health Resources and Services Administration (2025 to 2037). Supply was defined as the number of full-time equivalent (FTE) physicians. Demand was defined as the number of FTE physicians needed to support health care needs. Adequacy was defined as the ratio of supply and demand. Trends were analyzed with linear regression and comparisons were made with chi-squared tests.

Results: From 2025 to 2037, the supply of orthopedic surgeons was projected to decrease from 31,980 to 30,620 (4.3% decrease, P < .001), whereas demand was projected to increase from 33,690 to 35,850 (6.4% increase, P < .001). Orthopedic surgeon adequacy was projected to decrease from 94.9% to 85.4% (P < .001). By 2037, non-metropolitan areas were expected to have less adequacy than metropolitan areas (45.1% vs 91.6%, P < .001). The South (78.4%) had the lowest projected adequacy (P < .001). By 2037, the states with the lowest projected adequacy were West Virginia (54.5%), Arkansas (60.0%), and Delaware (61.5%). By 2037, orthopedic surgery ranked 9 out of 20 for physician adequacy relative to the 20 largest specialties by number of physicians.

Conclusion: There are projected deficiencies in the supply of orthopedic surgeons, which are greatest in non-metropolitan areas, the South, and certain states like West Virginia. Future work is needed to increase the supply of orthopedic surgeons in identified areas.

Background: The use of 3-dimensional (3D)-printed cutting guides for resection of long bone sarcoma may offer advantages over traditional free-hand or navigational osteotomy, including improved margin control and reconstruction accuracy. We evaluated long-term surgical and oncologic outcomes of limb salvage procedures using 3D-printed cutting guides, with updated follow-up from our previously published case series and the addition of new cases focusing on margin status, bony union, and local recurrence.

Materials and methods: We retrospectively reviewed 9 patients from our surgical database who underwent limb salvage surgery for long bone sarcoma using patient-specific 3D-printed cutting guides. This included extended follow-up of 6 previously reported cases and 3 new patients. Clinicopathologic, surgical, and radiographic data were collected and analyzed.

Results: All 9 patients (100%) achieved negative surgical margins (mean, 7.7 mm) with no local recurrences at a mean follow-up of 4.1 years (range, 0.5-11.6 years). Bony union was achieved at 16 of 18 (89%) osteotomy sites, comparing favorably to reported intercalary allograft nonunion rates of 6% to 43%. Two patients (22%) required revision to modular oncology devices due to nonunion. At most recent follow-up, no local recurrences were observed, while 7 grafts (78%) remained. Eight patients (89%) are continuously disease free, and 1 (11%) is alive with metastatic disease.

Conclusion: This expanded case series demonstrates excellent long-term oncologic and surgical outcomes using 3D-printed cutting guides for long bone sarcoma resection. Patient-specific guides achieved 100% negative margins with durable graft retention and no local recurrences at 4.1-year follow-up, supporting their continued use in complex limb salvage procedures.

Background: This study compared fracture healing and reoperation rates between early operative versus nonoperative management of ballistic humeral shaft fractures.

Materials and methods: A retrospective chart review was conducted at an academic trauma center. Patients ≥18 years treated for ballistic humeral shaft fractures (AO 1.2) between 2015 and 2022 were identified. Exclusion criteria included periarticular/intra-articular extension, non-ballistic mechanism, or age <18 years. Patients were stratified into operative versus nonoperative cohorts based on shared decision making. Outcome measures included time of union, postoperative visits, and reoperations. Time-to-event (TTE) analysis assessed duration of follow-up and time to healing. Discrete variables were compared for patients with >12 weeks follow-up using Fisher's exact tests and Student's t tests.

Results: Seventy-four patients (31 nonoperative, 43 operative) were included in TTE analysis. After excluding patients with <12 weeks follow-up, 43 patients (19 nonoperative, 24 operative) were included in discrete analysis (88% male, 86% Black, mean age 31 years). Operatively treated fractures included higher percentages of male patients (100% vs 71%, P < .01) and vascular injuries (25% vs 0%, P = .03), and a larger percentage of fractured humerus (21% vs 15%, P = .03). In TTE analysis, operative fractures demonstrated faster healing (P = .03). Nine patients (47%) in the nonoperative group underwent unplanned operations compared to two patients (8%) in the operative group (P < .01). No differences were found in follow-up visits or time to clinic discontinuation.

Conclusion: Operatively treated ballistic humeral shaft fractures demonstrated faster healing and lower reoperation rates than nonoperatively treated ballistic fractures, despite association with more profound injury.