Orthopedics最新文献

Background: Failure after rotator cuff repair is typically due to a loss of integrity of the bone-tendon interface. The BioWick anchor (Zimmer-Biomet) is an interpositional scaffold-anchor that was developed to improve tendon-bone healing. The purpose of this study was to determine the clinical efficacy of this novel anchor compared with a standard anchor with respect to retear rates and patient outcomes.

Materials and methods: We enrolled 99 patients in a double-anonymized, prospective, randomized controlled trial who underwent rotator cuff repair. Fifty patients were randomized to the novel anchor group and 49 patients were randomized to the standard anchor group. The primary outcome was rotator cuff repair integrity assessed via ultrasound at 6 months postoperatively. Secondary outcomes included visual analog scale (VAS) pain score, American Shoulder and Elbow Surgeons (ASES) score, Simple Shoulder Test (SST), strength, and active range of motion (AROM) assessed preoperatively and postoperatively at 3 and 6 months.

Results: There were no statistically significant differences in demographic data, mean rotator cuff tear size, tobacco use, workers' compensation status, or operative side between the groups. At 6-month follow-up, the retear rate was 22% (n=9) for the novel anchor group vs 23% (n=10) for the standard anchor group (P=.8864). Secondary outcomes, including VAS pain score, ASES score, SST, strength, and AROM measurements, did not differ significantly between the groups at 3- or 6-month follow-up. There were no complications identified in either group.

Conclusion: This study did not demonstrate superior clinical improvements or decreased retear rates with the use of this novel anchor compared with a standard anchor. [Orthopedics. 2025;48(1):e33-e39.].

Background: This study sought to characterize the incidence of, timing of, predictive factors for, and reasons for emergency department (ED) visits within 90 days of single-level posterior cervical foraminotomy (PCF). These visits, after PCF, have received limited attention.

Materials and methods: The 2010-2022 M161 PearlDiver database was queried for elective single-level PCFs, excluding multilevel procedures, midline laminectomies, fusions, or other posterior/anterior procedures, as well as indications of trauma, infection, or neoplasm. Patient age, sex, Elixhauser Comorbidity Index (ECI), insurance, and region were extracted. Weekly ED use after PCF was calculated. Multivariate analyses were used to identify predictive factors for ED use, and primary ED diagnoses were categorized.

Results: Of 10,588 PCF patients, 9.09% (n=962) visited the ED within 90 days after surgery, mostly in the first 4 weeks. Multivariate analysis identified that predictors included younger age (odds ratio [OR], 1.02 per decade decrease), female sex (OR, 1.19), higher ECI (OR, 1.28 for ECI 1-2; OR, 1.41 for ECI 3-4; OR, 1.51 for ECI ≥5), Midwest (OR, 1.16) or Northeast (OR, 1.19) region, and Medicare (OR, 1.09) or Medicaid (OR, 1.57) coverage. In the first 4 weeks, 69.9% of ED visits were related to the surgical site; this decreased to 27.1% thereafter.

Conclusion: Almost one-tenth of PCF patients visited the ED within 90 days after surgery. Specific patient characteristics were associated with ED visits, with surgical site-related diagnoses predominating in the acute postoperative period. Tailoring health care interventions based on timing of, risk factors for, and causes of ED visits may enhance outcomes and reduce costs. [Orthopedics. 2025;48(1):51-56.].

Background: Prior work has demonstrated that telemedicine in orthopedic surgery is cost-effective and can yield good clinical outcomes with high patient satisfaction. However, few studies have investigated the use of telemedicine in orthopedic oncology. In this study, we assessed the effect of telemedicine on (1) potential cost savings for orthopedic oncologic patients and (2) clinical outcomes as measured by unexpected in-person clinic visits and missed complications.

Materials and methods: A total of 308 patients who had 528 telemedicine visits in the orthopedic oncology clinic from May 2020 to August 2023 were identified. Demographic and clinical information, travel distance/time to clinic, complications, and instances where a telemedicine visit prompted an in-person evaluation were collected and reported with descriptive statistics. Cost savings were calculated based on travel distance and lost productivity. Patients with and without a complication or an unexpected in-person clinic visit were compared to identify risk factors for these clinical outcomes.

Results: Cost analysis demonstrated that telemedicine offers patients a potential cost savings of up to $475.2±$242.9 per visit. For 4.5% of the patients, a telehealth visit prompted an in-person evaluation. A complication was experienced by 5.5% of the patients. No complications were missed because of telemedicine. A diagnosis of a malignant tumor was associated with a higher rate of complications (P=.01) and unexpected in-person clinic visits (P=.03).

Conclusion: Telemedicine can reduce the financial burden of treatment for orthopedic oncologic patients without negatively impacting clinical outcomes. Care should be taken when considering telehealth for patients with malignant tumors given their higher risk for adverse outcomes. [Orthopedics. 2025;48(1):e27-e32.].

Background: Given the significant morbidity and mortality associated with primary bone cancer, provision of high-quality end-of-life care concordant with patient preferences is critical. This study aimed to evaluate trends in use of dedicated end-of-life care settings and investigate sociodemographic disparities in location of death among individuals with primary bone cancer.

Materials and methods: A retrospective, population-based review of patients who died of primary bone cancer-related causes was performed using the Underlying Cause of Death public use record from the Centers for Disease Control and Prevention Wide-ranging ONline Data for Epidemiologic Research (WONDER) database for the years 2003 through 2019. A total of 24,557 patients were included.

Results: Over the study period, the proportion of primary bone cancer-related deaths occurring at home and in hospice increased, whereas those occurring in hospital, nursing home, and outpatient medical facility/emergency department settings decreased. Several sociodemographic factors were found to be associated with location of death, including age, marital status, and level of education. Moreover, patients of racial and ethnic minority groups were at significantly lower risk of experiencing death at home or in outpatient medical facility/emergency department settings relative to a hospital compared with White patients.

Conclusion: Although rates of in-hospital death from primary bone cancer are decreasing, marked racial and ethnic disparities in use of dedicated end-of-life care settings exist. These gaps must be addressed to ensure all patients with primary bone cancer have equitable access to high-quality end-of-life care regardless of racial, ethnic, or socioeconomic status. [Orthopedics. 2025;48(1):44-50.].

Background: Expandable lumbar interbody cages (ELICs) are commonly used for interbody fusion and provide lordotic correction by lengthening the anterior column of the vertebral spine. We sought to identify unique failure mechanisms and significant differences in the types of complications associated with ELICs as reported to the Food and Drug Administration (FDA) Manufacturer and User Facility Device Experience (MAUDE) Database.

Materials and methods: The MAUDE Database was analyzed for complication reports submitted for ELIC systems between January 2013 and July 2023. Reports were categorized by manufacturer, brand name, type of expandable cage, type of complication, year of complication, and reporter identity. Reports that were duplicated or had insufficient information were excluded from analysis. The top 5 manufacturers with the most implant-related complications were independently analyzed and compared.

Results: A total of 821 reports were analyzed. The top 5 complications reported across all manufacturers were cage breakage during insertion (25.7%), postoperative migration without collapse (16.0%), postoperative collapse (15.6%), inserter breakage (11.1%), and tubing problems (3.0%). A significant difference was detected in complication type between manufacturers (χ²=557, P<.001). The largest number of reports (120, 14.6%) was in 2016.

Conclusion: With FDA approval of novel ELIC systems and the adoption of newer surgical techniques, understanding the range of potential complications is paramount in ensuring patient safety. This study of the MAUDE Database provides a comprehensive summary of adverse reported events associated with ELICs during the past decade. [Orthopedics. 2025;48(1):e7-e14.].

A 77-year-old woman presented with metastatic urothelial carcinoma as an elbow mass. To our knowledge, this is only the third reported case of urothelial carcinoma metastasizing to the upper extremity. The presence of metastatic disease at the time of diagnosis of urothelial carcinoma is rare, with metastases to the upper extremities even less common. This case is interesting given that the mass occurred after a direct trauma, causing a delay in diagnosis. It highlights the importance of a multidisciplinary oncology approach, and the need for more research to understand the biology of metastases. [Orthopedics. 2025;48(1):e52-e55.].

Background: The goal of this study was to evaluate differences in carpal tunnel release volume, reimbursement, practice styles, and patient populations between male and female surgeons from 2013 to 2021.

Materials and methods: The Medicare Physician & Other Practitioners database was queried from 2013 to 2021. Procedure volume, reimbursement, surgeon information, and patient demographic characteristics were collected for any surgeon who performed at least 10 open carpal tunnel release (OCTR) or endoscopic carpal tunnel release (ECTR) procedures that year. The Welch t test, the Kruskal-Wallis test, and multivariable linear regressions were conducted to compare male and female surgeons and analyze geographic and annual differences.

Results: From 2013 to 2021, the proportion of carpal tunnel releases performed by female surgeons increased for OCTR by 4.5% (7.1% to 11.6%) and for ECTR by 3.3% (4.8% to 8.1%). Female OCTR surgeons on average had fewer beneficiaries per surgeon (443.37 vs 354.20, P<.001), performed fewer billable services per beneficiary (6.37 vs 5.35, P=.03), and performed fewer unique billable services (91.13 vs 77.79, P<.001) compared with male surgeons. Female OCTR surgeons also saw a lower percentage of White patients (88.14 vs 86.48, P=.003) and a higher percentage of female patients (60.06 vs 61.70, P<.001) and dual-enrolled Medicare-Medicaid patients (10.54 vs 11.22, P=.046).

Conclusion: Female representation among OCTR and ECTR surgeons increased across the country. Male OCTR surgeons billed for more services and performed more services per beneficiary and also treated a higher proportion of White patients and dual Medicare-Medicaid enrollees compared with female surgeons. Future studies are required to identify reasons for and ways to address these disparities. [Orthopedics. 2025;48(1):57-63.].

Background: Total shoulder arthroplasty (TSA), which includes anatomic total shoulder arthroplasty (aTSA) and reverse total shoulder arthroplasty (rTSA), is a technically demanding procedure and limited data exist on the relationship between case volume and complications. We sought to identify volume thresholds for TSA, aTSA, and rTSA at which risk of a major surgical complication decreased and to compare complications of patients treated by high-volume surgeons with those of patients treated by low-volume surgeons.

Materials and methods: Primary, elective TSAs (aTSA and rTSA) from January 1, 2016, to December 31, 2019, were identified in the Premier Healthcare Database. Multivariable logistic regression with restricted cubic splines modeled the relationship between annual TSA, aTSA, and rTSA surgeon volume and 90-day risk of major surgical complications. The 90-day complications of patients treated by high- and low-volume surgeons were compared.

Results: From 2016 to 2019, 3177 surgeons performed 78,639 TSAs. Increasing annual volume was associated with decreasing major surgical complication risk (thresholds: 50 TSAs, 25 aTSAs, and 36 rTSAs). High- and low-volume surgeons performed 24,595 and 54,044 TSAs, respectively. Patients of high-volume surgeons had lower risk of major surgical complications (adjusted odds ratio [aOR], 0.69; 95% CI, 0.56-0.84), myocardial infarction (aOR, 0.59; 95% CI, 0.36-0.97), and readmission (aOR, 0.71; 95% CI, 0.62-0.81). Importantly, 74.9% of high-volume and 93.0% of low-volume surgeon-year units had major surgical complication rates below the mean of all recorded surgeons.

Conclusion: While most high- and low-volume surgeons had major surgical complication rates below the cohort average, increasing TSA volume was associated with a decreased risk of complications. [Orthopedics. 2025;48(1):e15-e21.].

Background: The primary objective of this study was to investigate and substantiate the possible causal connections between measurements of body dimensions and the likelihood of experiencing fractures.

Materials and methods: We employed a two-sample Mendelian randomization (MR) analysis to examine the associations between anthropometric measurements and two specific traits-bone mineral density and fracture risk. To ensure the credibility of our causal conclusions, we used the inverse variance weighted (IVW) method along with various sensitivity analyses.

Results: Our findings suggest a notable link between increased height and the likelihood of fractures. Specifically, employing the IVW method revealed that for every 10-cm increase in height, there was a 6.0% rise in fracture risk (odds ratio [OR], 1.06; 95% CI, 1.06-1.13; P=.0001). This outcome was further supported by both the weighted-median method and the MR-Egger method, with an OR of 1.10 (95% CI, 1.03-1.16; P=.0003) and an OR of 1.11 (95% CI, 1.08-1.17; P=.0020), respectively. No statistically significant associations were observed between other measurements, such as body mass index (BMI), waist-to-hip ratio adjusted for BMI, hip circumference adjusted for BMI, and waist circumference adjusted for BMI, and fracture risk. Sensitivity analyses, including MR-Egger regression's intercept test and multivariate testing, indicated no substantial presence of directional pleiotropy in instrumental variables, ensuring the stability and reliability of our analysis results.

Conclusion: Our study used MR to present genetic evidence supporting height as a distinct causal factor in fracture susceptibility. Our findings underscore the importance of incorporating anthropometric measurements into the development of strategies for preventing and treating osteoporosis. [Orthopedics. 2025;48(1):25-29.].

Background: This study aimed to investigate the quality and quantity of sources cited by insurance payers for computer-assisted navigation (CAN) in total knee arthroplasty (TKA) and to compare these sources with those cited by the American Academy of Orthopaedic Surgeons (AAOS) Clinical Practice Guideline (CPG).

Materials and methods: References were included from insurance payer policies on CAN that discussed the use of CAN in TKA, while every reference from the AAOS CPG for surgical navigation in TKA was included.

Results: Fifty-four unique articles from insurance payers met criteria, with 68.5% being primary journal articles and 18.5% being reviews. The quality of cited studies was relatively evenly distributed between level of evidence (LOE) I/II (42.6%) and LOE III and below (50.0%). The 14 references cited in the AAOS CPG were 100% primary articles and 100% LOE I/II. Only 16.3% of cited insurance references were AAOS CPG articles. Nine of the 14 AAOS CPG studies were not cited by any of the insurance payer policies.

Conclusion: Compared with the AAOS CPG, insurance policies cited older articles with lower LOE. We recommend continued updating of the AAOS CPG and insurance policies as more research into the use of CAN in TKA is published. [Orthopedics. 2025;48(1):8-11.].