Orthopedics最新文献

Background: Electronic medical record portals enable real-time communication between patients and surgeons after total knee arthroplasty (TKA). This study evaluated the impact of message timing and frequency on postoperative outcomes and patient-reported outcome measures (PROMs).

Materials and methods: We retrospectively reviewed 9,353 primary TKAs performed at a single academic institution. Of these, 1,219 patients sent messages within 2 weeks of surgery (early), 507 sent messages between 2 and 8 weeks (late), and 7,627 did not message.

Results: Patients who messaged within 2 weeks following surgery had shorter hospital length of stay (LOS) (41.2 vs 47.45 vs 53.40 hours, P < .001) and were more likely to be discharged home (99.5% vs 97.6% vs 96.8%, P < .001) compared to both late messengers and non-messengers. Patients who messaged late were more likely to experience a 90-day readmission surgery (3.2% vs 5.3% vs 3.3%, P = .05). Most messages were sent within 2 weeks (1.76 vs 1.48; P < .001). There was no difference in PROMs regardless of message timing, and there was no association between the number of messages sent and perioperative outcomes or PROMs.

Conclusion: Older age and longer LOS were associated with less patient-initiated contact after TKA. Older patients may be less familiar with digital platforms and less likely to send messages. Early messaging may reflect heightened recognition of postoperative issues, enabling counseling or intervention and reducing readmissions. These findings underscore the importance of preoperative education and equitable access, though long-term effects of messaging warrant further study.

Background: Alcohol use is a known risk factor for impaired wound healing. This study evaluated the impact of acute and chronic alcohol use on fracture-related infection (FRI) incidence in open tibia fractures.

Materials and methods: A retrospective review of skeletally mature patients with open tibia fractures at a level I trauma center from 2017 to 2021 was conducted. Six-month follow-up was required. Missing blood toxicology results were excluded. Ethanol levels >10 mg/dL on admission defined acute alcohol use, and daily alcohol use or documented history defined chronic alcohol use. The primary outcome was FRI. Bivariate and multivariate analyses identified associations between alcohol use and infection rates.

Results: Among 190 fractures (187 patients), 70 (36.8%) developed positive FRI criteria: 15 suggestive, 55 confirmatory. Acute alcohol use and chronic alcohol use were independently associated with suggestive FRI in multivariate analysis (acute: P = .044, odds ratio [OR] 2.96, 95% CI [1.03-8.50]; chronic: P = .022, OR 4.70, 95% CI [1.25-17.70]). In chronic alcohol users, acute alcohol use further increased suggestive FRI risk (P = .036, OR 11.05, 95% CI [1.85-65.86]). Smoking, compartment syndrome, and increasing open fracture severity increased the risk of confirmatory FRI (P = .007, OR 2.30, 95% CI [1.26-4.20]; P = .023, OR 2.75, 95% CI [1.15-6.58]; P = .003, OR 1.57, 95% CI [1.16-2.12], respectively).

Conclusion: Acute and chronic alcohol use significantly increased suggestive FRI risk in open tibia fractures, with compounded risk when both were present. This study examined the relationship between acute alcohol use and FRI in orthopedic trauma, underscoring the need for targeted interventions in this high-risk population.

Pregnancy induces a range of physiological and musculoskeletal changes that can lead to orthopedic issues. This article examines etiologies and management strategies for outpatient orthopedic problems encountered during pregnancy. Hormonal changes, weight gain, and altered biomechanics contribute to common musculoskeletal complaints such as low back pain, pelvic girdle pain, and carpal tunnel syndrome. Although less common, osteoporosis can present during pregnancy. Additionally, domestic violence and interpartner violence are disproportionately more frequent in this population. This review highlights evidence-based approaches for diagnosis and treatment and emphasizes the importance of multidisciplinary care, including obstetricians, orthopedic surgeons, endocrinologists, primary care physicians, and physical therapists.

Background: There is lack of studies to investigate if the side that a patient uses to lie on the examination table induces functional leg length discrepancy (LLD). We aimed to explore this possible correlation, along with the influence of the patient's height and sex.

Materials and methods: Eighty participants, 40 men and 40 women, aged 18 to 50 years with no pre-existing LLD, also known as anisomelia, were included. The difference between leg lengths was assessed in the supine position by measuring the distance from the umbilicus to the medial malleolus when the participants used the right or left side of the table to lie on it. After the technique known as the Weber-Barstow maneuver was performed, leg lengths were found to be equal. Nine participants who still exhibited a length discrepancy even after the corrective maneuver were excluded from the study, as they had true LLD.

Results: There was a significant relationship between the side of the examination table used by the participants and functional LLD. The participants who used the right side of the table to lie on it had a longer left leg, and vice versa. It was observed that taller participants exhibited a significantly greater functional LLD, whereas this difference was not significantly affected by sex.

Conclusion: The side the patient uses to lie on the examination table may create functional LLD, which can be corrected with the Weber-Barstow maneuver. This discrepancy is related to the patient's height but not their sex.

Background: Ankle sprains are among the most common musculoskeletal injuries presenting to United States (US) emergency departments (EDs) and contribute substantially to health care use. This study provides updated national incidence rate estimates and characterizes trends in demographic and injury-related risk factors.

Materials and methods: The National Electronic Injury Surveillance System was queried for all ankle sprain cases treated in US EDs from 2010 to 2024. Incidence rates were calculated per 1,000 person-years using US Census data, and relevant stratified analyses were conducted.

Results: From 2010 to 2024, an estimated 7.4 million ankle sprains presented to US EDs, yielding an incidence of 1.53 per 1,000 person-years. Annual incidence declined from 2.12 in 2010 to 1.19 in 2024, with the lowest rate observed in 2020 (0.89) during the peak of the COVID-19 pandemic. Peak incidence occurred in adolescents aged 15 to 19 years (2.60 per 1,000), with over half of all sprains occurring in individuals aged 10 to 24. Female patients had a higher overall incidence than male patients (1.62 vs 1.44 per 1,000), peaking at ages 10 to 14 compared to 15 to 19, respectively. Athletic activity accounted for 33.2% of all sprains, with basketball alone responsible for 15.8% of cases. Most patients (99.5%) were treated and released without admission.

Conclusion: Ankle sprain incidence in US EDs has declined over the past 15 years but remains highest among adolescents, female patients, and athletes. A significant decline was observed during the COVID-19 pandemic. These findings provide updated national benchmarks and underscore the importance of preventive strategies in high-risk populations.

Background: This study's aim was to quantify the carbon footprint of the 2023 American Academy of Orthopaedic Surgeons (AAOS) Annual Meeting and compare it to an alternative meeting structure.

Materials and methods: We conducted a retrospective analysis of estimated greenhouse gas emissions from the AAOS 2023 Annual Meeting in Las Vegas, NV. We also modeled theoretical meetings held in locations including Chicago, IL, New Orleans, LA, and New York City, NY, as well as a hybrid meeting occurring across four regional hubs. Emissions for air travel were determined by computing emissions of direct flights to Las Vegas and the closest major airport for each state, using an emissions calculator. Attendees were assumed to use ground travel if they lived within a 250-mile radius of the meeting location. Travel by international attendees was also calculated. We also determined the geographic density of surgeons by state using data from the Association of American Medical Colleges workforce report.

Results: The 2023 AAOS Annual Meeting was estimated to have generated 9,458 metric tons of travel-related CO₂ equivalents compared with 7,073 (Chicago), 7,678 (New York City), and 7,396 (New Orleans) metric tons. The hybrid regional hub model, which excluded intercontinental travel, was estimated to generate only 1,368 metric tons.

Conclusion: Total miles traveled had the most significant impact on carbon emissions. This may aid meeting planners in selection of future meeting locations that minimize air travel. In addition, adoption of a regional hub structure with interactive videoconferencing is a potential option for reducing the carbon footprint of the AAOS Annual Meeting.

Background: Whether the implementation of robotic-assisted technology in total knee arthroplasty (Ra-TKA) translates into better clinical results remains uncertain. We investigated the impact of Ra-TKA on quality of life and mental health as measured by patient-reported outcome measures (PROMs).

Materials and methods: In this retrospective review, a consecutive series of 204 patients who underwent Ra-TKA were matched by age, sex, and body mass index in a 1:1 ratio to conventional TKAs. The primary outcome was improvement in Knee Injury and Osteoarthritis Outcome Score (KOOS) and Veterans RAND 12-Item Health Survey (VR-12) as measured by minimal clinically important difference (MCID) and patient acceptable symptom state (PASS) scores. Secondary outcomes included hospital length of stay (LOS), skin-to-skin time, tourniquet time, and active knee range of motion. Bivariate analyses were performed between groups.

Results: A total of 314 patients (Ra-TKA=156; TKA=158) had 1-year PROMS available and were included in the study. Conventional TKA patients had significantly longer LOS and shorter skin-to-skin time and tourniquet time (all P<0.001) than Ra-TKA patients. More patients achieved full extension in the Ra-TKA cohort, but both groups ended up with similar postoperative PROMs at 1-year follow-up. A higher number of patients achieved the VR-12 mental component score MCID in the conventional TKA group compared to the Ra-TKA group (50.3% vs 29.5%, P<0.001).

Conclusion: Our results suggest Ra-TKA results in shorter LOS and better short-term knee extension but no improvement in joint-specific PROMs. Additionally, the association between lower quality of life, mental health outcomes, and Ra-TKA may be mediated by patient expectations. Therefore, documenting the use of Ra-TKA is important when reporting these quality metrics.

Quadriceps tendon rupture is typically caused by severe trauma, such as a fall, leading to substantial restriction of knee joint movements. However, pathological ruptures (one third of all quadriceps ruptures) can occur spontaneously or caused by minor trauma. Pathological ruptures are usually caused by chronic systemic diseases, such as systemic lupus erythematosus, chronic renal failure, and rheumatoid arthritis, and rarely by osteogenesis imperfecta (OI), a genetic disorder that affects the musculoskeletal system. Defective type 1 collagen formation in OI leads to bone fragility, ligamentous laxity, tendon rupture, and short stature. Here, we report the case of a 55-year-old man diagnosed with OI who experienced a pathological rupture of the right quadriceps tendon. The patient also had a leg-length discrepancy in the left leg due to the malunion of several femoral fractures. The rupture was repaired using the Krackow suture technique. The patient regained preinjury range of motion within 3 months postoperatively and could walk without pain.

Background: We characterize outpatient prescribing trends of orthopedic surgery providers in the United States.

Materials and methods: A retrospective analysis of the Medicare Part D Prescribers - by Provider and Drug was conducted between 2013 and 2021, including anti-osteoporotic medications (AOMs), antibiotics, opioids, and nonsteroidal anti-inflammatory drugs (NSAIDs). Outcomes included claims, claims per 1,000 prescribers, combined annual growth rate, and percentage growth.

Results: Claims for AOMs decreased from 29,024 in 2013 to 12,500 in 2021. Claims for alendro-nate, ibandronate, risedronate, and teriparatide all significantly decreased, whereas claims for abaloparatide and romosozumab significantly increased (P<0.05). Antibiotic claims increased from 304,817 (2013) to 580,736 (2021). Claims for amoxicillin, amoxicillin/clavulanic acid, cefadroxil, cephalexin, clindamycin, doxycycline, mupirocin, penicillin V, and sulfamethoxazole/trimethoprim significantly increased, whereas use of azithromycin, ciprofloxacin, levofloxacin, and vancomycin significantly decreased (P<0.05). Claims for opioids decreased from 3,224,572 (2013) to 2,070,423 (2021). Use of hydrocodone/acetaminophen, oxycodone/acetaminophen, and tramadol/acetaminophen also significantly decreased (P<0.05). Use of oxycodone and oxycodone myristate significantly increased (P<0.05). Claims for fentanyl, methadone, and morphine all significantly decreased (P<0.05). Claims for NSAIDs increased from 1,300,279 (2013) to 1,796,419 (2021). Claims for celecoxib, diclofenac, ibuprofen, ketorolac, and meloxicam all significantly increased, whereas claims for etodolac, indomethacin, nabumetone, naproxen, piroxicam, and sulindac all significantly decreased (P<0.05).

Conclusion: In line with national guidelines, claims for NSAIDs are increasing and claims for opioid pain medications and AOMs are decreasing. Claims for outpatient antibiotics are increasing, which is of significant concern, given renewed focus on antibiotic stewardship.

Background: Obstructive sleep apnea (OSA) has shown significant effects on complication rates in total joint arthroplasty (TJA) patients. Current research lacks appropriate propensity score matching of this comorbidity as well as data surrounding treated OSA compared to untreated OSA among TJA patients. This study examined if patients with treated and untreated OSA were at higher risk for 90-day postoperative complications following TJA.

Materials and methods: 17,272 patient charts were retrospectively examined, with 3,876 having OSA and 13,396 not. Following propensity score matching of 7,014 patients, 3,507 were identified to have OSA and 3,507 not. Patients were matched based on age, sex, body mass index, American Society of Anesthesiologists (ASA) class, and type of surgery, then further divided into untreated versus treated OSA based on continuous positive airway pressure use. Chi-square analyses compared patient characteristics, and a multivariable logistic regression model assessed the effect of OSA on 90-day complication rates.

Results: OSA alone was not an indicator for 90-day postoperative complications in our propensity-matched sample. Higher ASA classes (P<0.01) and higher Charlson Comorbidity Index (CCI; P<0.01) were associated with a significant increase in 90-day complication rates compared with patients with ASA classes I-II and lower CCI, respectively. There was no significant difference in complications between patients with untreated and treated OSA (P=0.29).

Conclusion: Using propensity score matching, this study indicates that OSA alone is not associated with an increased risk of 90-day postoperative complications in primary TJA. While associated comorbidities of OSA may contribute to increased complication rates, surgeons can be reassured that OSA alone may not be a significant factor in short-term postoperative outcomes.