Orthopedics最新文献

Background: This study evaluated outcomes of patients meeting Infectious Disease Society of America guidelines for rifampin therapy in treating staphylococcal periprosthetic joint infection (PJI) and explored the role of rifabutin as a substitute when rifampin was contraindicated due to drug-drug interaction (DDI).

Materials and methods: An institutional database at a tertiary referral center was queried for patients who had staphylococcal PJI and underwent debridement and implant retention procedure (DAIR) or one-stage revision from January 1, 2013, to April 30, 2023. Patients were stratified by rifampin treatment, and their rates of successful PJI treatment were compared. Rifampin and rifabutin DDIs were collected for all patients and compared.

Results: Of 935 total patients screened, 87 patients with a mean follow-up time of 4.4 years met IDSA guidelines for rifampin therapy. Of the 35 patients who completed rifampin therapy, 71.4% were successfully treated. Logistic regression analysis showed that those who did not initiate rifampin therapy were less likely to have successful treatment (odds ratio: 0.76 [0.60 to 0.97]; P=0.031). Cox-proportional hazard regression showed that those who did not initiate rifampin therapy were at higher risk of requiring revision for infection (hazard ratio: 2.22 [1.06 to 4.68]; P=0.035). Of the 87 patients in this study, 18.4% had a DDI that contraindicated rifampin; however, only 3.4% had a DDI that contraindicated rifabutin.

Conclusion: This study supports that rifampin as combination therapy with DAIR or one-stage revision in staphylococcal PJI leads to better outcomes; however, its implementation is limited by DDIs. [Orthopedics. 2025;48(4):239-247.].

Background: Pediatric olecranon fractures require optimal fixation to prevent long-term morbidity. Tension band wiring (TBW) has been the gold standard, but tension band suturing (TBS) has emerged as a potential alternative. This study systematically reviews and compares outcomes of TBS and TBW in pediatric olecranon fractures.

Materials and methods: A systematic review and meta-analysis were conducted per Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines. Nine studies were included, with three directly comparing TBS to TBW.

Results: No statistically significant differences were found in pain, non-union, revision fixation, or extension loss (P>0.05). TBS demonstrated fewer hardware-related complications.

Conclusion: TBS is a viable alternative to TBW, offering similar outcomes with reduced hardware complications. Further high-quality studies are needed. [Orthopedics. 2025;48(4):248-255.].

Background: In the 2019/2020 football season, an increase from three to five substitutions was implemented in European football to help players manage a congested match calendar following lockdown due to the COVID-19 pandemic. In this study, we aimed to determine injury rates before and after implementation of five substitutions. Secondary objectives included characteristics and duration of injury and associated risk factors.

Materials and methods: A retrospective review of players injured while playing in the first division of the Spanish professional football league (La-Liga) during the 2017/2018, 2018/2019, 2022/2023, and 2023/2024 seasons were identified from an online database, Transfermarkt. Injury- and player-related characteristics, as well as game play before and after the implementation of five substitutions, were studied. Multivariate regression models were used to assess complications, adjusting for age, minutes played, and appearances.

Results: The overall incidence during the study period was 0.76 injuries per player-season. A total of 1,268 injuries were reported prior to the rule change with an incidence of 0.94 injuries per player-season compared to 711 reported injuries with an incidence of 0.57 injuries per player-season after. There were significantly decreased odds of multiple injuries (odds ratio [OR]: 0.68; 95% CI [0.56, 0.82]; P<0.001) and muscle injuries (OR: 0.72; 95% CI [0.59, 0.87]; P<0.001) after the increase in substitutions.

Conclusion: Implementation of five substitutions was associated with significantly decreased injury rates in LaLiga. Additionally, players had significantly lower odds of sustaining multiple injuries and muscle injuries. [Orthopedics. 2025;48(4):223-228.].

Background: Thumb carpometacarpal (CMC) arthritis is common in the community. There are a variety of ways to perform CMC arthroplasty with the basic technique revolving around trapeziectomy. The purpose of this study was to identify key factors in the determination of cost of CMC arthroplasty and if procedure type affects cost.

Materials and methods: Patients from 2018 to 2022 from a single health care system who received primary CMC arthroplasty using ligament reconstruction tendon interposition (LRTI), simple suture suspensionplasty, or suture tape-based reconstruction techniques were identified. Surgical costs were determined using time-driven activity-based cost accounting.

Results: A total of 173 patients were included. The average age was 63.6 years and 70.5% (n=122) were women. The most common technique was suture suspensionplasty (n=142, 82.1%). The average surgical cost was $2,830.36±$619.41. Suture suspensionplasty had the shortest operative time, followed by LRTI, and lastly suture tape-based reconstruction (62.9±16.0, 70.7±19.6 and 102.7±16.6 minutes, respectively, P<0.001). Procedure type and anchor use predicted surgical costs (R²=0.85, P<0.001).

Conclusion: Suture suspensionplasty had the shortest operative time and had the lowest cost of CMC arthroplasty techniques. The use of an anchor was associated with increased cost. Surgeons should keep these cost drivers in mind as they develop treatment plans. Surgeons and organizations should collaborate to provide high-value and economically-responsible care. [Orthopedics. 2025;48(4):e177-e181.].

Background: The aims of this study were to analyze trends in National Institutes of Health (NIH) funding for musculoskeletal (MSK) research from 2012 to 2021, compare private industry funding to NIH funding, determine the proportion of total MSK research funding from public versus private sources, and examine how private industry research and development (R&D) spending has evolved in relation to net sales.

Materials and methods: Public research funding from 2012 to 2021 was aggregated using NIH data for MSK conditions with >$10M in funding. Private R&D funding was obtained from the top five orthopedic companies by revenue and compared to net sales to calculate R&D as a percentage of total sales. Annually reported financial statements from Securities Exchange Commission filings were used. Private funding was summed annually and compared to National Institute of Arthritis and Musculoskeletal and Skin Diseases spending using descriptive statistics.

Results: Annual research funding from the top five orthopedic companies is 10.0 times that of the NIH, an increase from 9.2 times in 2017. The top five companies spent a mean of 7.2% of their net sales on R&D. Overall, $7.7 billion is allocated to MSK research annually, with only 9.1% from public sources.

Conclusion: Given this disparity, efforts should assess public investment in orthopedic research while recognizing the critical role of industry in funding musculoskeletal research. [Orthopedics. 2025;48(4):e182-e186.].

Background: Tibial posterior condyle fractures (PCFs) are caused by shearing injuries. This mechanism results in anterior cruciate ligament (ACL) avulsions, which may involve adjacent anterior meniscal roots. The simultaneous occurrence of ACL avulsion and anterior meniscal root tears (AMRTs) in patients with PCF remains unclear. Therefore, we reported the pattern of simultaneous ACL avulsion and AMRT in patients with PCF. Additionally, we investigated which morphological characteristics of PCFs can predict the occurrence of these combined injuries.

Materials and methods: This study included 77 patients with PCF and ACL avulsion. AMRT was diagnosed through arthroscope. PCF morphologies-fragment rotation angle, fragment-plateau ratio, fragment length, and fragment sagittal angle-were measured through computed tomography.

Results: Of the 77 patients, 24 (31%) had AMRT. Patients with AMRT had a longer fragment length than did those without AMRT (5.6±1.0 cm vs 4.2±0.7 cm, respectively; P<.001). A receiver operating characteristic curve revealed a threshold fragment length of 4.4 cm for predicting simultaneous ACL avulsion and AMRT. Multivariate logistic regression indicated a fragment length of ≥4.4 cm was associated 12-fold increased risk of simultaneous ACL avulsion and AMRT (95% CI: 3.29-45.67; P<.001).

Conclusions: AMRT occurs in 31% of all patients with PCF plus ACL avulsion and is an obstacle to ACL reduction. A PCF fragment length of ≥4.4 cm is a significant independent predictor of simultaneous ACL avulsion and AMRT. Our findings may facilitate relevant risk assessment and counseling in patients requiring an intra-articular intervention. [Orthopedics. 2025;48(4):215-222.].

Background: As shared decision-making models gain prominence, patients are taking on more responsibility in deciding whether to undergo surgery. Decisional regret is a key patient-reported outcome (PRO) to evaluate quality of care and surgical success. With increased emphasis on decisional regret, determining the tools to measure regret is of increasing importance. The objectives of this study were to (1) investigate and identify the tools used to measure decisional regret in elective orthopedic surgery and (2) examine the time frame in which regret is measured postoperatively.

Materials and methods: The authors conducted a systematic literature review of PubMed/MEDLINE and Embase databases from database inception until September 5, 2024. All studies that discussed a patient's decisional regret in the context of elective orthopedic surgery were eligible.

Results: Initial results yielded 1,002 articles, and 26 were chosen for inclusion. The Decisional Regret Scale (DRS) was the most used tool, appearing in 54% of the articles. Novel, study-specific questions were used in 19% of the studies, while 15% used question 22 of the Scoliosis Research Society-22 tool and 11% used non-standardized patient interviews. Regret was assessed postoperatively at >24 months in 15% of studies, at 24 months in 17%, at 12 months in 22%, at 6 months in 26%, at multiple time frames in 4%, and was not stated in 8%.

Conclusion: Decisional regret is an increasingly important PRO that can help optimize medical interventions. The DRS, used in more than half of the studies analyzed, is the most widely adopted and validated tool for quantifying regret and should be prioritized in future research. While timing of regret assessment varied, the 6-month and 12-month postoperative intervals were the most common and are suggested as standard time points for measuring regret. Additionally, establishing clinical stratifications for regret scores will facilitate meta-analysis and improve risk factor identification, enhancing shared decision-making and patient care. [Orthopedics. 2025;48(4):e153-e161.].

Background: Depictions of skin color in medical journals have been observed to misrepresent the population in other fields but have not been studied in orthopedics. We assessed whether the spectrum of skin color depicted in orthopedic literature appropriately reflects the population and whether that representation has changed over time.

Materials and methods: We examined images of human patients published in four journals: Journal of Bone and Joint Surgery (JBJS), Clinical Orthopaedics and Related Research (CORR), Journal of the American Academy of Orthopaedic Surgeons (JAAOS), and The American Journal of Sports Medicine (AJSM) in 2010 and 2020. Fitzpatrick skin phototypes were used to categorize images as "lighter skin tone" (types I-III) or "darker skin tone" (types IV-VI), with the latter attributed to Black, Asian, Native American, and multiracial individuals. We compared published skin tones to 2020 United States census data (38% of the population being Fitzpatrick types IV-VI) using chi-square analysis.

Results: Of 649 eligible images, 13% depicted Fitzpatrick skin types IV-VI. There was no significant change from 2010 to 2020 (11% vs 16%, P=0.07) in depictions of Fitzpatrick types IV and above. Darker skin tones were underrepresented compared to the US population (13% vs 38%, P<0.001). In US-based articles representation increased from 11% to 18% (P=0.045), but no change was observed in non-US articles (12% vs 12%, P=0.9).

Conclusion: While there has been a mild improvement over time in the diversity of skin colors represented, the depiction of darker skin types in orthopedic literature still falls well short of that seen in the general population. [Orthopedics. 2025;48(4):197-202.].

Background: Each year, more than 1 million patients in the United States receive life-changing musculoskeletal (MSK) tissue transplants. These transformative gifts save and restore lives. Unfortunately, data from organ procurement organizations suggest that orthopedic patients rarely contact donor families to acknowledge the gift, with less than 1% of tissue donor families ever receiving communication from recipients of their loved one's gifts.

Materials and methods: In response, our team launched the "Connecting Lives" initiative in 2015 to address this gap. Initially focused on osteochondral and meniscus allograft, it expanded to all MSK allograft recipients at our facility in 2022.

Results: Among osteochondral and meniscus allograft recipients, this quality improvement initiative increased the percentage of MSK tissue transplant recipients writing to donor families from less than 1% to nearly 18%, comparable to organ donation rates (approximately 20%). The main barrier for non-writers was uncertainty about what to say. Despite this improvement, further efforts are needed to close the Tissue Donation Circle.

Conclusion: Engaging patients before and after transplant surgery can help address emotional and practical barriers, fostering connection and honoring tissue donors. Orthopedic health care teams must contribute to "closing the loop" between allograft recipients and donor families through education, advocacy, resourcing, and support that drive completion of the Tissue Donation Circle. [Orthopedics. 2025;48(4):234-238.].

Background: Despite numerous studies showing postoperative fever can be a common and benign occurrence, there is still a significant and costly workup when fevers occur after surgery, including for orthopedic patients with pelvic ring and acetabular injuries.

Material and methods: A total of 204 patients undergoing pelvis and/or acetabular fixation were analyzed for fever, with positive fever defined as temperature >38° Celsius. Age, sex, substance use, smoking history, body mass index, diabetes, comorbidities, American Society of Anesthesiologists (ASA) score, fracture morphology, polytrauma, surgical treatment, transfusion requirements, operative time, estimated blood loss, use of vancomycin powder, and surgical site infection (SSI) were all recorded. Surgical site infection was defined as an infection at the surgical site requiring reoperation, with positive cultures at time of secondary surgery.

Results: SSI was not associated with postoperative fever in patients undergoing pelvic and/or acetabular fixation. Higher ASA score, polytrauma, combined pelvic ring-acetabular fractures, open pelvic ring injuries, increased intraoperative blood loss, increased surgical time, and transfusions were associated with higher rates of fevers on univariate analysis. Multivariate analysis showed transfusions were the only independent risk factor for developing fever.

Conclusion: Surgeons and clinicians managing orthopedic patients should be aware that postoperative fever is common after pelvis and acetabular fixation and is rarely related to SSI. [Orthopedics. 2025;48(4):229-233.].