C. J. Wall, C. Vertullo, S. Kondalsamy-Chennakesavan, M. Lorimer, R. D. de Steiger
Background: The aim of this study was to investigate the relationship of obesity with all-cause revision and revision for infection, loosening, instability, and pain after total knee arthroplasty (TKA) performed in Australia. Methods: Data for patients undergoing primary TKA for osteoarthritis from January 1, 2015, to December 31, 2020, were obtained from the Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR). The rates of all-cause revision and revision for infection, loosening, instability, and pain were compared for non-obese patients (body mass index [BMI], 18.50 to 29.99 kg/m2), class-I and II obese patients (BMI, 30.00 to 39.99 kg/m2), and class-III obese patients (BMI, ≥40.00 kg/m2). The results were adjusted for age, sex, tibial fixation, prosthesis stability, patellar component usage, and computer navigation usage. Results: During the study period, 141,673 patients underwent primary TKA for osteoarthritis in Australia; of these patients, 48.0% were class-I or II obese, and 10.6% were class-III obese. The mean age was 68.2 years, and 54.7% of patients were female. The mean follow-up period was 2.8 years. Of the 2,655 revision procedures identified, the reasons for the procedures included infection in 39.7%, loosening in 14.8%, instability in 12.0%, and pain in 6.1%. Class-I and II obese patients had a higher risk of all-cause revision (hazard ratio [HR], 1.12 [95% confidence interval (CI), 1.03 to 1.22]; p = 0.007) and revision for infection (HR, 1.25 [95% CI, 1.10 to 1.43]; p = 0.001) than non-obese patients. Class-III obese patients had a higher risk of all-cause revision after 1 year (HR, 1.30 [95% CI, 1.14 to 1.52]; p < 0.001), revision for infection after 3 months (HR, 1.72 [95% CI, 1.33 to 2.17]; p < 0.001), and revision for loosening (HR, 1.39 [95% CI, 1.00 to 1.89]; p = 0.047) than non-obese patients. The risks of revision for instability and pain were similar among groups. Conclusions: Obese patients with knee osteoarthritis should be counseled with regard to the increased risks associated with TKA, so they can make informed decisions about their health care. Health services and policymakers need to address the issue of obesity at a population level. Level of Evidence: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
{"title":"A Prospective, Longitudinal Study of the Influence of Obesity on Total Knee Arthroplasty Revision Rate","authors":"C. J. Wall, C. Vertullo, S. Kondalsamy-Chennakesavan, M. Lorimer, R. D. de Steiger","doi":"10.2106/JBJS.21.01491","DOIUrl":"https://doi.org/10.2106/JBJS.21.01491","url":null,"abstract":"Background: The aim of this study was to investigate the relationship of obesity with all-cause revision and revision for infection, loosening, instability, and pain after total knee arthroplasty (TKA) performed in Australia. Methods: Data for patients undergoing primary TKA for osteoarthritis from January 1, 2015, to December 31, 2020, were obtained from the Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR). The rates of all-cause revision and revision for infection, loosening, instability, and pain were compared for non-obese patients (body mass index [BMI], 18.50 to 29.99 kg/m2), class-I and II obese patients (BMI, 30.00 to 39.99 kg/m2), and class-III obese patients (BMI, ≥40.00 kg/m2). The results were adjusted for age, sex, tibial fixation, prosthesis stability, patellar component usage, and computer navigation usage. Results: During the study period, 141,673 patients underwent primary TKA for osteoarthritis in Australia; of these patients, 48.0% were class-I or II obese, and 10.6% were class-III obese. The mean age was 68.2 years, and 54.7% of patients were female. The mean follow-up period was 2.8 years. Of the 2,655 revision procedures identified, the reasons for the procedures included infection in 39.7%, loosening in 14.8%, instability in 12.0%, and pain in 6.1%. Class-I and II obese patients had a higher risk of all-cause revision (hazard ratio [HR], 1.12 [95% confidence interval (CI), 1.03 to 1.22]; p = 0.007) and revision for infection (HR, 1.25 [95% CI, 1.10 to 1.43]; p = 0.001) than non-obese patients. Class-III obese patients had a higher risk of all-cause revision after 1 year (HR, 1.30 [95% CI, 1.14 to 1.52]; p < 0.001), revision for infection after 3 months (HR, 1.72 [95% CI, 1.33 to 2.17]; p < 0.001), and revision for loosening (HR, 1.39 [95% CI, 1.00 to 1.89]; p = 0.047) than non-obese patients. The risks of revision for instability and pain were similar among groups. Conclusions: Obese patients with knee osteoarthritis should be counseled with regard to the increased risks associated with TKA, so they can make informed decisions about their health care. Health services and policymakers need to address the issue of obesity at a population level. Level of Evidence: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.","PeriodicalId":22579,"journal":{"name":"The Journal of Bone and Joint Surgery","volume":"2016 1","pages":"1386 - 1392"},"PeriodicalIF":0.0,"publicationDate":"2022-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86476842","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
W. Hoskins, Sophia Rainbird, C. Holder, J. Stoney, S. Graves, R. Bingham
Update This article was updated on August 17, 2022, because of previous errors, which were discovered after the preliminary version of the article was posted online. On page 1462, in the first sentence of the Abstract section entitled “Results,” the phrase that had read “and 36-mm heads had fewer dislocations than 28-mm (HR = 0.33 [95% CI, 0.16 to 0.68]; p = 0.003), but more dislocations than 32-mm heads (HR for >2 weeks = 2.25 [95% CI, 1.13 to 4.49]; p = 0.021)” now reads “and 36-mm heads had fewer dislocations than 28-mm (HR = 0.33 [95% CI, 0.16 to 0.68]; p = 0.003) and 32-mm heads (HR for ≥2 weeks = 0.44 [95% CI, 0.22 to 0.88]; p = 0.021).” On page 1468, in the last sentence of the section entitled “Acetabular Components with a Diameter of <51 mm,” the phrase that had read “and HR for ≥2 weeks = 2.25 [95% CI, 1.13 to 4.49; p = 0.021]) (Fig. 3)” now reads “and HR for ≥2 weeks = 0.44 [95% CI, 0.22 to 0.88; p = 0.021]) (Fig. 3).” Finally, on page 1466, in the upper right corner of Figure 3, under “32mm vs 36mm,” the second line that had read “2Wks+: HR=2.25 (1.13, 4.49), p=0.021” now reads “2Wks+: HR=0.44 (0.22, 0.88), p= 0.021.” Background: The acetabular component diameter can influence the choice of femoral head size in total hip arthroplasty (THA). We compared the rates of revision by femoral head size for different acetabular component sizes. Methods: Data from the Australian Orthopaedic Association National Joint Replacement Registry were analyzed for patients undergoing primary THA for a diagnosis of osteoarthritis from September 1999 to December 2019. Acetabular components were stratified into quartiles by size: <51 mm, 51 to 53 mm, 54 to 55 mm, and 56 to 66 mm. Femoral head sizes of 28 mm, 32 mm, and 36 mm were compared for each cup size. The primary outcome was the cumulative percent revision (CPR) for all aseptic causes and for dislocation. The results were adjusted for age, sex, femoral fixation, femoral head material, year of surgery, and surgical approach and were stratified by femoral head material. Results: For acetabular components of <51 mm, 32-mm (hazard ratio [HR] = 0.75 [95% confidence interval (CI), 0.57 to 0.97]; p = 0.031) and 36-mm femoral heads (HR = 0.58 [95% CI, 0.38 to 0.87]; p = 0.008) had a lower CPR for aseptic causes than 28-mm heads; and 36-mm heads had fewer dislocations than 28-mm (HR = 0.33 [95% CI, 0.16 to 0.68]; p = 0.003), and 32-mm heads (HR for ≥2 weeks = 0.44 [95% CI, 0.22 to 0.88]; p = 0.021). For 51 to 53-mm, 54 to 55-mm, and 56 to 66-mm-diameter acetabular components, there was no difference in the CPR for aseptic causes among head sizes. A femoral head size of 36 mm had fewer dislocations in the first 2 weeks than a 32-mm head for the 51 to 53-mm acetabular components (HR for <2 weeks = 3.79 [95% CI, 1.23 to 11.67]; p = 0.020) and for the entire period for 56 to 66-mm acetabular components (HR = 1.53 [95% CI, 1.05 to 2.23]; p = 0.028). The reasons for revision differed for each femoral head size. The
{"title":"A Comparison of Revision Rates and Dislocation After Primary Total Hip Arthroplasty with 28, 32, and 36-mm Femoral Heads and Different Cup Sizes","authors":"W. Hoskins, Sophia Rainbird, C. Holder, J. Stoney, S. Graves, R. Bingham","doi":"10.2106/JBJS.21.01101","DOIUrl":"https://doi.org/10.2106/JBJS.21.01101","url":null,"abstract":"Update This article was updated on August 17, 2022, because of previous errors, which were discovered after the preliminary version of the article was posted online. On page 1462, in the first sentence of the Abstract section entitled “Results,” the phrase that had read “and 36-mm heads had fewer dislocations than 28-mm (HR = 0.33 [95% CI, 0.16 to 0.68]; p = 0.003), but more dislocations than 32-mm heads (HR for >2 weeks = 2.25 [95% CI, 1.13 to 4.49]; p = 0.021)” now reads “and 36-mm heads had fewer dislocations than 28-mm (HR = 0.33 [95% CI, 0.16 to 0.68]; p = 0.003) and 32-mm heads (HR for ≥2 weeks = 0.44 [95% CI, 0.22 to 0.88]; p = 0.021).” On page 1468, in the last sentence of the section entitled “Acetabular Components with a Diameter of <51 mm,” the phrase that had read “and HR for ≥2 weeks = 2.25 [95% CI, 1.13 to 4.49; p = 0.021]) (Fig. 3)” now reads “and HR for ≥2 weeks = 0.44 [95% CI, 0.22 to 0.88; p = 0.021]) (Fig. 3).” Finally, on page 1466, in the upper right corner of Figure 3, under “32mm vs 36mm,” the second line that had read “2Wks+: HR=2.25 (1.13, 4.49), p=0.021” now reads “2Wks+: HR=0.44 (0.22, 0.88), p= 0.021.” Background: The acetabular component diameter can influence the choice of femoral head size in total hip arthroplasty (THA). We compared the rates of revision by femoral head size for different acetabular component sizes. Methods: Data from the Australian Orthopaedic Association National Joint Replacement Registry were analyzed for patients undergoing primary THA for a diagnosis of osteoarthritis from September 1999 to December 2019. Acetabular components were stratified into quartiles by size: <51 mm, 51 to 53 mm, 54 to 55 mm, and 56 to 66 mm. Femoral head sizes of 28 mm, 32 mm, and 36 mm were compared for each cup size. The primary outcome was the cumulative percent revision (CPR) for all aseptic causes and for dislocation. The results were adjusted for age, sex, femoral fixation, femoral head material, year of surgery, and surgical approach and were stratified by femoral head material. Results: For acetabular components of <51 mm, 32-mm (hazard ratio [HR] = 0.75 [95% confidence interval (CI), 0.57 to 0.97]; p = 0.031) and 36-mm femoral heads (HR = 0.58 [95% CI, 0.38 to 0.87]; p = 0.008) had a lower CPR for aseptic causes than 28-mm heads; and 36-mm heads had fewer dislocations than 28-mm (HR = 0.33 [95% CI, 0.16 to 0.68]; p = 0.003), and 32-mm heads (HR for ≥2 weeks = 0.44 [95% CI, 0.22 to 0.88]; p = 0.021). For 51 to 53-mm, 54 to 55-mm, and 56 to 66-mm-diameter acetabular components, there was no difference in the CPR for aseptic causes among head sizes. A femoral head size of 36 mm had fewer dislocations in the first 2 weeks than a 32-mm head for the 51 to 53-mm acetabular components (HR for <2 weeks = 3.79 [95% CI, 1.23 to 11.67]; p = 0.020) and for the entire period for 56 to 66-mm acetabular components (HR = 1.53 [95% CI, 1.05 to 2.23]; p = 0.028). The reasons for revision differed for each femoral head size. The","PeriodicalId":22579,"journal":{"name":"The Journal of Bone and Joint Surgery","volume":"60 1","pages":"1462 - 1474"},"PeriodicalIF":0.0,"publicationDate":"2022-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88485276","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Patients: 125 patients aged 18 to 64 years (mean age, 42 years; 50%women)who had an ankle fracture within the past 2 weeks that was unstable as indicated by talar displacement on ankle radiographs at presentation or at 1 week after injury. Exclusion criteria included bilateral injuries, ipsilateral lower-limb injury, pilon fractures, or ankle fractures not requiring lateral fixation. 88% of patients completed follow-up at 1 year and 79%at 2 years.
{"title":"In Adults Aged <65 Years with Unstable Ankle Fractures, Fibular Nailing Did Not Differ from Open Reduction and Internal Fixation for Functional Outcome at 1 Year","authors":"P. Grimm","doi":"10.2106/JBJS.22.00486","DOIUrl":"https://doi.org/10.2106/JBJS.22.00486","url":null,"abstract":"Patients: 125 patients aged 18 to 64 years (mean age, 42 years; 50%women)who had an ankle fracture within the past 2 weeks that was unstable as indicated by talar displacement on ankle radiographs at presentation or at 1 week after injury. Exclusion criteria included bilateral injuries, ipsilateral lower-limb injury, pilon fractures, or ankle fractures not requiring lateral fixation. 88% of patients completed follow-up at 1 year and 79%at 2 years.","PeriodicalId":22579,"journal":{"name":"The Journal of Bone and Joint Surgery","volume":"24 1","pages":"1504 - 1504"},"PeriodicalIF":0.0,"publicationDate":"2022-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89351938","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
patellar tendon autograft fi xation at 0 (cid:1) versus 30 (cid:1) results in improved activity scores and a greater proportion of patients achieving the MCID for KOOS pain: a randomized controlled trial.
{"title":"In Single-Bundle ACL Reconstruction Using Patellar Tendon Autograft, Knee Flexion Angle of 0° Versus 30° During Tibial ACL Graft Fixation Did Not Differ for KOOS Subscales, but Improved Activity Level","authors":"N. Marom","doi":"10.2106/JBJS.22.00485","DOIUrl":"https://doi.org/10.2106/JBJS.22.00485","url":null,"abstract":"patellar tendon autograft fi xation at 0 (cid:1) versus 30 (cid:1) results in improved activity scores and a greater proportion of patients achieving the MCID for KOOS pain: a randomized controlled trial.","PeriodicalId":22579,"journal":{"name":"The Journal of Bone and Joint Surgery","volume":"52 1","pages":"1505 - 1505"},"PeriodicalIF":0.0,"publicationDate":"2022-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89470349","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Main outcomemeasures: The primary outcome was theDisabilities of the Arm, Shoulder andHand score at 1 year. Secondary outcomes included Constant-Murley score, visual analogue scale pain score, patient satisfaction, return to work and sports, union, and adverse events at 1 year. Main results: The main results at 1 year are in Table I. There were 2 adverse events in the operative group and 4 in the nonoperative group.
{"title":"In Patients with Displaced Type-II Distal Clavicle Fractures, Operative and Nonoperative Therapies Did Not Differ for Functional Outcomes at 1 Year","authors":"N. Chen","doi":"10.2106/JBJS.22.00484","DOIUrl":"https://doi.org/10.2106/JBJS.22.00484","url":null,"abstract":"Main outcomemeasures: The primary outcome was theDisabilities of the Arm, Shoulder andHand score at 1 year. Secondary outcomes included Constant-Murley score, visual analogue scale pain score, patient satisfaction, return to work and sports, union, and adverse events at 1 year. Main results: The main results at 1 year are in Table I. There were 2 adverse events in the operative group and 4 in the nonoperative group.","PeriodicalId":22579,"journal":{"name":"The Journal of Bone and Joint Surgery","volume":"12 1","pages":"1503 - 1503"},"PeriodicalIF":0.0,"publicationDate":"2022-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89908712","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
S. Bartels, Torbjørn B. Kristensen, J. Gjertsen, F. Frihagen, C. Rogmark, Filip C. Dolatowski, W. Figved, J. Benth, S. E. Utvåg
Background: The optimal treatment of displaced femoral neck fractures in patients 55 to 70 years old remains controversial. The aim of the present study was to assess the effect of closed reduction and internal fixation with cannulated screws (IF) compared with total hip arthroplasty (THA) on hip pain and function, with use of data for outcome measures, complications, and reoperations. Methods: This multicenter randomized controlled trial included all patients 55 to 70 years old who presented with a low-energy displaced femoral neck fracture between December 2013 and December 2018. Patients were randomly allocated to undergo either IF or THA. The primary outcome was the Harris Hip Score (HHS) at 12 months postoperatively. Secondary outcomes were the HHS at 4 and 24 months postoperatively, Oxford Hip Score (OHS), Hip Disability and Osteoarthritis Outcome Score (HOOS), health-related quality of life (EQ-5D-3L [EuroQol 5 Dimensions 3 Levels] index score and EQ-VAS [visual analogue scale]), VAS for pain, and VAS for patient satisfaction at 4, 12, and 24 months postoperatively. Complications and reoperations were continuously monitored. The primary analyses were performed according to the intention-to-treat principle. Results: A total of 102 patients with a mean (± standard deviation) age of 63.7 ± 4.2 years were allocated to IF (n = 51) or THA (n = 51). The mean difference in the primary outcome, the HHS at 12 months postoperatively (5.3; 95% confidence interval, 0.9 to 9.7; p = 0.017), was below the predefined minimal clinically important difference of 10 points. However, patients who underwent THA had a significantly higher HHS at 4 and 12 months, better OHS at 4 and 12 months, and better HOOS at 4, 12, and 24 months postoperatively. Patients who underwent THA also reported better health-related quality of life at 4 months postoperatively and reported greater satisfaction and less pain at 4 and 12 months postoperatively. A total of 26 patients in the IF group (51%; 95% confidence interval, 37% to 65%) and 2 patients in the THA group (4%; 95% confidence interval, 0.5% to 13%) underwent a major reoperation. Conclusions: In this randomized controlled trial, we showed that patients between 55 and 70 years old who underwent THA for a low-energy displaced femoral neck fracture experienced better outcomes than those who underwent closed reduction and internal fixation. Level of Evidence: Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.
{"title":"Total Hip Arthroplasty Leads to Better Results After Low-Energy Displaced Femoral Neck Fracture in Patients Aged 55 to 70 Years","authors":"S. Bartels, Torbjørn B. Kristensen, J. Gjertsen, F. Frihagen, C. Rogmark, Filip C. Dolatowski, W. Figved, J. Benth, S. E. Utvåg","doi":"10.2106/JBJS.21.01411","DOIUrl":"https://doi.org/10.2106/JBJS.21.01411","url":null,"abstract":"Background: The optimal treatment of displaced femoral neck fractures in patients 55 to 70 years old remains controversial. The aim of the present study was to assess the effect of closed reduction and internal fixation with cannulated screws (IF) compared with total hip arthroplasty (THA) on hip pain and function, with use of data for outcome measures, complications, and reoperations. Methods: This multicenter randomized controlled trial included all patients 55 to 70 years old who presented with a low-energy displaced femoral neck fracture between December 2013 and December 2018. Patients were randomly allocated to undergo either IF or THA. The primary outcome was the Harris Hip Score (HHS) at 12 months postoperatively. Secondary outcomes were the HHS at 4 and 24 months postoperatively, Oxford Hip Score (OHS), Hip Disability and Osteoarthritis Outcome Score (HOOS), health-related quality of life (EQ-5D-3L [EuroQol 5 Dimensions 3 Levels] index score and EQ-VAS [visual analogue scale]), VAS for pain, and VAS for patient satisfaction at 4, 12, and 24 months postoperatively. Complications and reoperations were continuously monitored. The primary analyses were performed according to the intention-to-treat principle. Results: A total of 102 patients with a mean (± standard deviation) age of 63.7 ± 4.2 years were allocated to IF (n = 51) or THA (n = 51). The mean difference in the primary outcome, the HHS at 12 months postoperatively (5.3; 95% confidence interval, 0.9 to 9.7; p = 0.017), was below the predefined minimal clinically important difference of 10 points. However, patients who underwent THA had a significantly higher HHS at 4 and 12 months, better OHS at 4 and 12 months, and better HOOS at 4, 12, and 24 months postoperatively. Patients who underwent THA also reported better health-related quality of life at 4 months postoperatively and reported greater satisfaction and less pain at 4 and 12 months postoperatively. A total of 26 patients in the IF group (51%; 95% confidence interval, 37% to 65%) and 2 patients in the THA group (4%; 95% confidence interval, 0.5% to 13%) underwent a major reoperation. Conclusions: In this randomized controlled trial, we showed that patients between 55 and 70 years old who underwent THA for a low-energy displaced femoral neck fracture experienced better outcomes than those who underwent closed reduction and internal fixation. Level of Evidence: Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.","PeriodicalId":22579,"journal":{"name":"The Journal of Bone and Joint Surgery","volume":"25 1","pages":"1341 - 1351"},"PeriodicalIF":0.0,"publicationDate":"2022-05-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91063581","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
D. Rhon, Tina A. Greenlee, Patricia K. Carreño, Jeanne C. Patzkowski, K. Highland
Background: Most individuals undergoing elective surgery expect to discontinue opioid use after surgery, but many do not. Modifiable risk factors including psychosocial factors are associated with poor postsurgical outcomes. We wanted to know whether pain catastrophizing is specifically associated with postsurgical opioid and health-care use. Methods: This was a longitudinal cohort study of trial participants undergoing elective spine (lumbar or cervical) or lower-extremity (hip or knee osteoarthritis) surgery between 2015 and 2018. Primary and secondary outcomes were 12-month postsurgical days’ supply of opioids and surgery-related health-care utilization, respectively. Self-reported and medical record data included presurgical Pain Catastrophizing Scale (PCS) scores, surgical success expectations, opioid use, and pain interference duration. Results: Complete outcomes were analyzed for 240 participants with a median age of 42 years (34% were female, and 56% were active-duty military service members). In the multivariable generalized additive model, greater presurgical days’ supply of opioids (F = 17.23, p < 0.001), higher pain catastrophizing (F = 1.89, p = 0.004), spine versus lower-extremity surgery (coefficient estimate = 1.66 [95% confidence interval (CI), 0.50 to 2.82]; p = 0.005), and female relative to male sex (coefficient estimate = −1.25 [95% CI, −2.38 to −0.12]; p = 0.03) were associated with greater 12-month postsurgical days’ supply of opioids. Presurgical opioid days’ supply (chi-square = 111.95; p < 0.001), pain catastrophizing (chi-square = 96.06; p < 0.001), and lower extremity surgery (coefficient estimate = −0.17 [95% CI, −0.24 to −0.11]; p < 0.001), in addition to age (chi-square = 344.60; p < 0.001), expected recovery after surgery (chi-square = 54.44; p < 0.001), active-duty status (coefficient estimate = 0.58 [95% CI, 0.49 to 0.67]; p < 0.001), and pain interference duration (chi-square = 43.47; p < 0.001) were associated with greater health-care utilization. Conclusions: Greater presurgical days’ supply of opioids and pain catastrophizing accounted for greater postsurgical days’ supply of opioids and health-care utilization. Consideration of several modifiable factors provides an opportunity to improve postsurgical outcomes. Level of Evidence: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
{"title":"Pain Catastrophizing Predicts Opioid and Health-Care Utilization After Orthopaedic Surgery","authors":"D. Rhon, Tina A. Greenlee, Patricia K. Carreño, Jeanne C. Patzkowski, K. Highland","doi":"10.2106/JBJS.22.00177","DOIUrl":"https://doi.org/10.2106/JBJS.22.00177","url":null,"abstract":"Background: Most individuals undergoing elective surgery expect to discontinue opioid use after surgery, but many do not. Modifiable risk factors including psychosocial factors are associated with poor postsurgical outcomes. We wanted to know whether pain catastrophizing is specifically associated with postsurgical opioid and health-care use. Methods: This was a longitudinal cohort study of trial participants undergoing elective spine (lumbar or cervical) or lower-extremity (hip or knee osteoarthritis) surgery between 2015 and 2018. Primary and secondary outcomes were 12-month postsurgical days’ supply of opioids and surgery-related health-care utilization, respectively. Self-reported and medical record data included presurgical Pain Catastrophizing Scale (PCS) scores, surgical success expectations, opioid use, and pain interference duration. Results: Complete outcomes were analyzed for 240 participants with a median age of 42 years (34% were female, and 56% were active-duty military service members). In the multivariable generalized additive model, greater presurgical days’ supply of opioids (F = 17.23, p < 0.001), higher pain catastrophizing (F = 1.89, p = 0.004), spine versus lower-extremity surgery (coefficient estimate = 1.66 [95% confidence interval (CI), 0.50 to 2.82]; p = 0.005), and female relative to male sex (coefficient estimate = −1.25 [95% CI, −2.38 to −0.12]; p = 0.03) were associated with greater 12-month postsurgical days’ supply of opioids. Presurgical opioid days’ supply (chi-square = 111.95; p < 0.001), pain catastrophizing (chi-square = 96.06; p < 0.001), and lower extremity surgery (coefficient estimate = −0.17 [95% CI, −0.24 to −0.11]; p < 0.001), in addition to age (chi-square = 344.60; p < 0.001), expected recovery after surgery (chi-square = 54.44; p < 0.001), active-duty status (coefficient estimate = 0.58 [95% CI, 0.49 to 0.67]; p < 0.001), and pain interference duration (chi-square = 43.47; p < 0.001) were associated with greater health-care utilization. Conclusions: Greater presurgical days’ supply of opioids and pain catastrophizing accounted for greater postsurgical days’ supply of opioids and health-care utilization. Consideration of several modifiable factors provides an opportunity to improve postsurgical outcomes. Level of Evidence: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.","PeriodicalId":22579,"journal":{"name":"The Journal of Bone and Joint Surgery","volume":"48 1","pages":"1447 - 1454"},"PeriodicalIF":0.0,"publicationDate":"2022-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90642418","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Leanne Ludwick, N. Shohat, Duncan S Van Nest, J. Paladino, Jonathan Ledesma, J. Parvizi
Background: In recent years, aspirin has become a popular agent for venous thromboembolism (VTE) prophylaxis following total joint arthroplasty (TJA). Yet patients with a history of VTE are often given more aggressive prophylactic agents because of their increased baseline risk. The purpose of this study was to assess whether aspirin is an effective prophylactic agent in patients with a history of VTE. Methods: This was a single-institution, retrospective cohort study. The electronic clinical records of 36,333 patients undergoing TJA between 2008 and 2020 were reviewed. Data on demographic characteristics, comorbidities, intraoperative factors, and postoperative complications were collected. A propensity score-matched analysis was performed, as well as a multivariate regression analysis to account for confounders. Results: Of the 36,333 patients undergoing TJA, 1,087 patients (3.0%) had a history of VTE and were not receiving chronic non-aspirin. The risk for subsequent VTE was significantly higher (p = 0.03) in patients with a history of VTE (1.4%) compared with patients without prior VTE (0.9%). However, the incidence of VTE was not significantly lower (p = 0.208) in patients with a history of VTE who received aspirin (0.4%) compared with patients who received other VTE prophylaxis (1.5%). Propensity score matching showed no difference in VTE rates between the 2 groups (2.2% compared with 0.55%; p = 0.372). In a regression analysis accounting for VTE risk, the administration of aspirin was not associated with an increased risk for subsequent VTE (adjusted odds ratio, 0.32 [95% confidence interval, 0.02 to 1.66]; p = 0.274). Conclusions: Our findings suggest that, although patients with a history of VTE have an increased baseline risk for subsequent VTE, aspirin may be a suitable VTE prophylaxis in this group of patients. Level of Evidence: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
{"title":"Aspirin May Be a Suitable Prophylaxis for Patients with a History of Venous Thromboembolism Undergoing Total Joint Arthroplasty","authors":"Leanne Ludwick, N. Shohat, Duncan S Van Nest, J. Paladino, Jonathan Ledesma, J. Parvizi","doi":"10.2106/JBJS.21.00601","DOIUrl":"https://doi.org/10.2106/JBJS.21.00601","url":null,"abstract":"Background: In recent years, aspirin has become a popular agent for venous thromboembolism (VTE) prophylaxis following total joint arthroplasty (TJA). Yet patients with a history of VTE are often given more aggressive prophylactic agents because of their increased baseline risk. The purpose of this study was to assess whether aspirin is an effective prophylactic agent in patients with a history of VTE. Methods: This was a single-institution, retrospective cohort study. The electronic clinical records of 36,333 patients undergoing TJA between 2008 and 2020 were reviewed. Data on demographic characteristics, comorbidities, intraoperative factors, and postoperative complications were collected. A propensity score-matched analysis was performed, as well as a multivariate regression analysis to account for confounders. Results: Of the 36,333 patients undergoing TJA, 1,087 patients (3.0%) had a history of VTE and were not receiving chronic non-aspirin. The risk for subsequent VTE was significantly higher (p = 0.03) in patients with a history of VTE (1.4%) compared with patients without prior VTE (0.9%). However, the incidence of VTE was not significantly lower (p = 0.208) in patients with a history of VTE who received aspirin (0.4%) compared with patients who received other VTE prophylaxis (1.5%). Propensity score matching showed no difference in VTE rates between the 2 groups (2.2% compared with 0.55%; p = 0.372). In a regression analysis accounting for VTE risk, the administration of aspirin was not associated with an increased risk for subsequent VTE (adjusted odds ratio, 0.32 [95% confidence interval, 0.02 to 1.66]; p = 0.274). Conclusions: Our findings suggest that, although patients with a history of VTE have an increased baseline risk for subsequent VTE, aspirin may be a suitable VTE prophylaxis in this group of patients. Level of Evidence: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.","PeriodicalId":22579,"journal":{"name":"The Journal of Bone and Joint Surgery","volume":"15 1","pages":"1438 - 1446"},"PeriodicalIF":0.0,"publicationDate":"2022-05-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90763452","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Y. Etani, M. Hirao, K. Ebina, H. Tsuboi, T. Noguchi, G. Okamura, A. Miyama, K. Takami, A. Nampei, S. Tsuji, H. Owaki, S. Okada, J. Hashimoto
Background: Patients who have noninflammatory arthritis of the feet may develop destructive changes on the first metatarsal head and painful dislocation of the metatarsophalangeal (MTP) joint of 1 or more lesser toes. This aim of this study was to compare feet with noninflammatory arthritis and those with rheumatoid arthritis (RA) with respect to the clinical and radiographic outcomes after treatment of these destructive deformities with a modified Scarf osteotomy with medial capsular interposition into the newly formed first MTP joint, combined with metatarsal shortening offset osteotomy. Methods: A retrospective observational study of 93 feet (31 with noninflammatory arthritis and 62 with RA) was performed. Hallux and lesser-toe scores on the Japanese Society for Surgery of the Foot (JSSF) scoring system, a self-administered foot evaluation questionnaire (SAFE-Q), and preoperative and postoperative radiographic parameters were evaluated. Results: There were significant improvements at the time of the final follow-up in the mean scores on the hallux and lesser-toe scales of the JSSF system and in the SAFE-Q score. The postoperative JSSF lesser-toes function score was better for the feet with noninflammatory arthritis feet than the feet with RA. There was no significant difference in the hallux valgus angle (HVA) between 1 month postoperatively and the final follow-up for both groups. Furthermore, the HVA showed a strong correlation between the 1-month and final follow-up values. Conclusions: The combination of the modified Scarf osteotomy with medial capsular interposition and shortening metatarsal offset osteotomy was useful and safe in feet with noninflammatory arthritis. The HVA at 1 month after surgery is useful to predict the HVA within 5 years after surgery. The postoperative clinical score for the lesser toes was better in the feet with noninflammatory arthritis. Level of Evidence: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
{"title":"Modified Scarf Osteotomy with Medial Capsular Interposition Combined with Metatarsal Shortening Offset Osteotomy","authors":"Y. Etani, M. Hirao, K. Ebina, H. Tsuboi, T. Noguchi, G. Okamura, A. Miyama, K. Takami, A. Nampei, S. Tsuji, H. Owaki, S. Okada, J. Hashimoto","doi":"10.2106/JBJS.21.01486","DOIUrl":"https://doi.org/10.2106/JBJS.21.01486","url":null,"abstract":"Background: Patients who have noninflammatory arthritis of the feet may develop destructive changes on the first metatarsal head and painful dislocation of the metatarsophalangeal (MTP) joint of 1 or more lesser toes. This aim of this study was to compare feet with noninflammatory arthritis and those with rheumatoid arthritis (RA) with respect to the clinical and radiographic outcomes after treatment of these destructive deformities with a modified Scarf osteotomy with medial capsular interposition into the newly formed first MTP joint, combined with metatarsal shortening offset osteotomy. Methods: A retrospective observational study of 93 feet (31 with noninflammatory arthritis and 62 with RA) was performed. Hallux and lesser-toe scores on the Japanese Society for Surgery of the Foot (JSSF) scoring system, a self-administered foot evaluation questionnaire (SAFE-Q), and preoperative and postoperative radiographic parameters were evaluated. Results: There were significant improvements at the time of the final follow-up in the mean scores on the hallux and lesser-toe scales of the JSSF system and in the SAFE-Q score. The postoperative JSSF lesser-toes function score was better for the feet with noninflammatory arthritis feet than the feet with RA. There was no significant difference in the hallux valgus angle (HVA) between 1 month postoperatively and the final follow-up for both groups. Furthermore, the HVA showed a strong correlation between the 1-month and final follow-up values. Conclusions: The combination of the modified Scarf osteotomy with medial capsular interposition and shortening metatarsal offset osteotomy was useful and safe in feet with noninflammatory arthritis. The HVA at 1 month after surgery is useful to predict the HVA within 5 years after surgery. The postoperative clinical score for the lesser toes was better in the feet with noninflammatory arthritis. Level of Evidence: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.","PeriodicalId":22579,"journal":{"name":"The Journal of Bone and Joint Surgery","volume":"11 3 1","pages":"1269 - 1280"},"PeriodicalIF":0.0,"publicationDate":"2022-05-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83841355","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Atsuhiro Fukai, A. Nimura, M. Tsutsumi, Hitomi Fujishiro, K. Fujita, J. Imatani, K. Akita
Background: To improve the clinical results of lateral ulnar collateral ligament (LUCL) reconstruction of the elbow joint, better understanding of the anatomy of the aponeuroses and joint capsule could be relevant. This study considers the previously described anatomy of the LUCL in relation to the related aponeuroses and joint capsule rather than as a discrete ligament. We hypothesized that the deep aponeuroses of the superficial extensor muscles and supinator form a relevant portion of the joint capsule previously defined as the LUCL. Methods: Twenty-four elbows (12 right) from 21 embalmed cadavers (age at the time of death, 54 to 99 years) were included in the study. Twenty elbows were studied macroscopically and 4, histologically. The joint capsule was detached from the bones, and local thickness was quantitatively analyzed using micro-computed tomography (micro-CT). Results: The supinator aponeurosis and joint capsule intermingled to form a thick membrane (mean and standard deviation, 4.8 ± 1.2 mm), which we termed “the capsulo-aponeurotic membrane.” It was thicker than the anterior (1.3 ± 0.4 mm) and posterior (2.5 ± 0.9 mm) parts of the capsule of the humeroradial joint (p < 0.001). The capsulo-aponeurotic membrane had a wide attachment on the distal part of the extensor digitorum communis and extensor digiti minimi (EDC/EDM) origin of the humerus, the lateral part of the coronoid process, and the posterior part of the radial notch of the ulna. The humeral attachment had a fibrocartilaginous structure. The deep aponeuroses of the EDC and extensor carpi ulnaris (ECU) were connected to the capsulo-aponeurotic membrane. Conclusions: The capsulo-aponeurotic membrane was composed of the supinator aponeurosis and joint capsule and was attached to the lateral epicondyle of the humerus, radial side of the coronoid process, and posterior part of the radial notch on the ulna. The entire structure appeared identical to the commonly defined lateral collateral ligament. The most posterior part was connected to the EDC and ECU aponeuroses, which is commonly labeled the LUCL but does not exist as a discrete ligament. Clinical Relevance: Consideration of the accurate anatomy of the extensive attachment of the capsulo-aponeurotic membrane could provide useful clues for improvement in techniques of LUCL reconstruction and lateral epicondylitis pathology.
{"title":"Lateral Ulnar Collateral Ligament of the Elbow Joint","authors":"Atsuhiro Fukai, A. Nimura, M. Tsutsumi, Hitomi Fujishiro, K. Fujita, J. Imatani, K. Akita","doi":"10.2106/JBJS.21.01406","DOIUrl":"https://doi.org/10.2106/JBJS.21.01406","url":null,"abstract":"Background: To improve the clinical results of lateral ulnar collateral ligament (LUCL) reconstruction of the elbow joint, better understanding of the anatomy of the aponeuroses and joint capsule could be relevant. This study considers the previously described anatomy of the LUCL in relation to the related aponeuroses and joint capsule rather than as a discrete ligament. We hypothesized that the deep aponeuroses of the superficial extensor muscles and supinator form a relevant portion of the joint capsule previously defined as the LUCL. Methods: Twenty-four elbows (12 right) from 21 embalmed cadavers (age at the time of death, 54 to 99 years) were included in the study. Twenty elbows were studied macroscopically and 4, histologically. The joint capsule was detached from the bones, and local thickness was quantitatively analyzed using micro-computed tomography (micro-CT). Results: The supinator aponeurosis and joint capsule intermingled to form a thick membrane (mean and standard deviation, 4.8 ± 1.2 mm), which we termed “the capsulo-aponeurotic membrane.” It was thicker than the anterior (1.3 ± 0.4 mm) and posterior (2.5 ± 0.9 mm) parts of the capsule of the humeroradial joint (p < 0.001). The capsulo-aponeurotic membrane had a wide attachment on the distal part of the extensor digitorum communis and extensor digiti minimi (EDC/EDM) origin of the humerus, the lateral part of the coronoid process, and the posterior part of the radial notch of the ulna. The humeral attachment had a fibrocartilaginous structure. The deep aponeuroses of the EDC and extensor carpi ulnaris (ECU) were connected to the capsulo-aponeurotic membrane. Conclusions: The capsulo-aponeurotic membrane was composed of the supinator aponeurosis and joint capsule and was attached to the lateral epicondyle of the humerus, radial side of the coronoid process, and posterior part of the radial notch on the ulna. The entire structure appeared identical to the commonly defined lateral collateral ligament. The most posterior part was connected to the EDC and ECU aponeuroses, which is commonly labeled the LUCL but does not exist as a discrete ligament. Clinical Relevance: Consideration of the accurate anatomy of the extensive attachment of the capsulo-aponeurotic membrane could provide useful clues for improvement in techniques of LUCL reconstruction and lateral epicondylitis pathology.","PeriodicalId":22579,"journal":{"name":"The Journal of Bone and Joint Surgery","volume":"24 1","pages":"1370 - 1379"},"PeriodicalIF":0.0,"publicationDate":"2022-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78719460","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
京公网安备 11010802042870号
京ICP备2023020795号-1
扫码关注我们
求助内容：
应助结果提醒方式：