Orthopedics最新文献

Background: This study assessed risk factors related to 30-day unplanned readmission and reoperation after anatomic or reverse total shoulder arthroplasties (TSA). This study intends to enhance decision making for patients undergoing TSA and inform perioperative risk by identifying patient demographics, comorbidities, and procedural features linked to these outcomes.

Materials and methods: Patients who had a primary anatomic or reverse TSA were identified using data from the American College of Surgeons National Surgical Quality Improvement Program database from 2013 to 2023 using the current procedural terminology code 23472. After categorization by 30-day unplanned readmission and reoperation, perioperative variables were compared between groups using Wilcoxon rank sum and chi-square tests, followed by multivariable logistic regression.

Results: The study identified 45,893 patients who underwent a primary TSA between 2013 to 2023 with 1,259 (2.74%) readmissions and 599 (1.31%) reoperations. Readmission was associated with older age, longer operative time, longer hospital stay, inpatient status, American Society of Anesthesiology classification of 4, White or Black race, dependent functional status, smoking, congestive heart failure, steroid use, bleeding disorders, insulin-dependent diabetes mellitus, and anemia. Reoperation was associated with male sex, higher body mass index, longer operative time, longer hospital stay, inpatient status, dependent functional status, smoking, and anemia.

Conclusion: This study identified potential patient variables that can increase the risk of unplanned readmission and/or reoperation after a primary TSA. Understanding the factors that can influence these adverse events can play an important role in clinical decision making and help identify patients who may require additional postoperative monitoring.

Background and objective: The purpose of this study was to evaluate the accuracy of digital templating for primary total knee arthroplasty (TKA) and to evaluate whether accurate templating affects the clinical or radiographic outcome of TKA.

Materials and methods: We retrospectively reviewed 178 primary TKAs performed by a single surgeon with preoperative templating available and minimum 2-year clinical follow-up. Templated size was compared to the implanted size. Postoperative coronal alignment was measured on standing long-leg radiographs by two independent observers. UCLA Activity Scale and Knee Society scores (KSS) were evaluated after 2 years. Categorical variables are reported as number and percentage. Correlative data were analyzed using Spearman's correlation tests and reported as coefficients (r_s) with 95% CI. Significance was set at P<0.05.

Results: Preoperative templating accurately estimated the tibia within one size in 95% of cases (169 TKAs), while the femur was templated within one size in 99% of cases (176 TKAs). Templating accuracy did not correlate with postoperative coronal alignment within 3° of the mechanical axis (tibial accuracy: r_s=0.10, P=0.120; femoral accuracy: r_s= -0.07, P=0.338). Templating accuracy did not correlate with the postoperative UCLA Activity Scale score (tibia P=0.177; femur P=0.354), KSS function (tibia P=0.587; femur P=0.637), KSS expectation (tibia P=0.764; femur P=0.817), or KSS satisfaction (tibia P=0.760; femur P=0.811) at 2 years.

Conclusion: Preoperative digital templating for TKA reliably estimates the implanted femoral and tibial component sizes within one size; however, templating did not correlate with radiographic or clinical outcomes at 2 years.

Background: Unicompartmental knee arthroplasty (UKA) is an increasingly popular surgical option, constituting approximately 10% of knee arthroplasty operations, with an anticipated upward trend. However, UKA presents technical challenges and higher revision rates compared to total knee arthroplasty (TKA). This study evaluates the outcomes and economic implications of using two robotic systems for UKA: the image-based (IBRA-UKA) and image-free (IFRA-UKA) robotic-assisted systems. We hypothesized that the image-free system, while incurring lower costs, would demonstrate clinical outcomes comparable to the image-based system.

Materials and methods: We conducted a retrospective study using the PearlDiver™ Database, selecting patients older than 40 years without previous knee surgeries who underwent robotic-assisted UKA (RA-UKA). Individuals with contralateral knee arthroplasty within 2 years were excluded. The procedures were divided into two cohorts, matched one-to-one for demographics and clinical characteristics. We compared 90-day, 1-year, and 2-year postoperative complications, along with cost analysis of preoperative computed tomography imaging and surgical expenses.

Results: A total of 2,490 patients were evaluated, with 1,245 in each cohort. No statistical differences were observed in postoperative complications, including revision rates, between the two cohorts. However, preoperative and surgical costs were significantly higher for the IBRA-UKA cohort compared to the IFRA-UKA cohort. Preoperative computed tomography scan costs averaged $916±$1,092 versus $0 (P<0.001), and surgical costs averaged $5,675±$9,436 versus $3,056±$5,419 (P<0.001).

Conclusion: The similar complication rates highlight the value of robotic technique in UKA regardless of system choice. However, the higher costs of IBRA-UKA raise financial concerns amid diminishing health care reimbursements. Further research is needed to evaluate robotic systems, focusing on intraoperative, postoperative, and functional outcomes.

Background: The primary aim of this study was to evaluate the impact of prior hip arthroscopy on direct anterior approach (DAA) total hip arthroplasty (THA) midterm outcomes, with a secondary analysis based on time to conversion to THA.

Materials and methods: Data were retrospectively reviewed for all patients who underwent THA by the DAA from 2009 to 2018. Eligible patients completed minimum 5-year follow-up patient-reported outcomes (PROs) questionnaires. Patients with a previous hip arthroscopy (THA-PA) were propensity matched in a 1:2 ratio to a control group of primary arthroplasty patients (THA-N-PA). A secondary analysis based on time to conversion to THA from the previous hip arthroscopy was conducted within the study group.

Results: A total of 402 patients were included. Favorable and comparable (P>0.05) outcomes were observed at minimum 5-year follow-up for all PROs evaluated except Visual Analogue Scale pain scale, where the THA-PA group had significantly higher scores (P<0.05). Importantly, the groups reported similar complications and revision surgery rates. Furthermore, the secondary analysis found patients that converted within one year from the previous hip arthroscopy showed significantly lower patient satisfaction.

Conclusion: Patients with a history of hip arthroscopy who underwent THA using the DAA demonstrated comparable and sustainable outcomes across all PROs, with similar complication and revision rates to the control group at midterm follow-up. However, patients who underwent THA within one year of prior hip arthroscopy reported significantly lower satisfaction levels. Careful patient selection and indication for hip arthroscopy are essential to avoid early conversion to THA. [Orthopedics. 2025;48(4):203-209.].

Background: Osteoporotic vertebral compression fractures (OVCFs) frequently occur in older adults. Appropriate surgical treatment of these fractures is still not well understood. This study sought to evaluate the therapeutic effectiveness of percutaneous curved kyphoplasty (PCKP) compared to percutaneous kyphoplasty (PKP) for OVCFs.

Materials and methods: This study retrospectively analyzed 68 OVCF patients who underwent surgeries from July 2021 to June 2022 in Sheyang County People's Hospital. Patients were categorized into two groups based on surgical procedure (PCKP group = 35 patients, PKP group = 33 patients). Surgery duration, amount of x-ray imaging sessions conducted intraoperatively, bone cement injection dose, and outflow rate were compared between the two groups. Visual analogue scale (VAS), anterior vertebral height (AVH), and Cobb angle were measured at 1 week and 12 months after surgery.

Results: Compared with the PKP group, the amount of intraoperative x-ray imaging sessions (P<0.05) and bone cement outflow rate (P<0.05) were noticeably reduced in the PCKP group. The results identified no variation between groups in cement injection dose (P>0.05). No meaningful statistical variation was found in VAS scores (P>0.05), anterior border height of the injured vertebra (P>0.05), or Cobb angle (P>0.05) between two groups at 1 week and 12 months.

Conclusion: This research suggests both PKP and PCKP are efficient and secure for pain relief, restoring vertebral body height, and correcting the Cobb angle. However, PCKP has advantages in reducing surgery duration, amount of intraoperative x-ray imaging sessions, and bone cement outflow rate. [Orthopedics. 2025;48(4):210-214.].

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.].