L. Hiemstra, S. Kerslake, Marcia L Clark, C. Temple-Oberle, E. Boynton
Background: Only 13.6% of orthopaedic surgeons in Canada are women, even though there is nothing inherent to the practice of orthopaedic surgery that favors men over women. Clearly, there is a need to identify, define, and measure the barriers faced by women in orthopaedic surgery. Methods: An electronic survey was distributed to 330 female-identifying Canadian orthopaedic surgeons and trainees and included the validated Gender Bias Scale (GBS) and questions about career burnout. The barriers for women in Canadian orthopaedics were identified using the GBS. The relationships between the GBS and burnout were investigated. Open-text questions explored the barriers perceived by female orthopaedic surgeons. Results: The survey was completed by 220 female orthopaedic surgeons and trainees (66.7%). Five barriers to gender equity were identified from the GBS: Constrained Communication, Unequal Standards, Male Culture, Lack of Mentoring, and Workplace Harassment. Career burnout correlated with the GBS domains of Male Privilege (r = 0.215; p < 0.01), Disproportionate Constraints (r = 0.152; p < 0.05), and Devaluation (r = 0.166; p < 0.05). Five main themes emerged from the open-text responses, of which 4 linked closely to the barriers identified in the GBS. Work-life integration was also identified qualitatively as a theme, most notably the difficulty of balancing disproportionate parental and childcare responsibilities alongside career aspirations. Conclusions: In this study, 5 barriers to workplace equity for Canadian female orthopaedic surgeons were identified using the validated GBS and substantiated with qualitative assessment using a mixed-methods approach. Awareness of these barriers is a necessary step toward dismantling them and changing the prevailing culture to be fair and equitable for all. Clinical Relevance: A just and equitable orthopaedic profession is imperative to have healthy and thriving surgeons who are able to provide optimal patient care.
{"title":"Experiences of Canadian Female Orthopaedic Surgeons in the Workplace","authors":"L. Hiemstra, S. Kerslake, Marcia L Clark, C. Temple-Oberle, E. Boynton","doi":"10.2106/JBJS.21.01462","DOIUrl":"https://doi.org/10.2106/JBJS.21.01462","url":null,"abstract":"Background: Only 13.6% of orthopaedic surgeons in Canada are women, even though there is nothing inherent to the practice of orthopaedic surgery that favors men over women. Clearly, there is a need to identify, define, and measure the barriers faced by women in orthopaedic surgery. Methods: An electronic survey was distributed to 330 female-identifying Canadian orthopaedic surgeons and trainees and included the validated Gender Bias Scale (GBS) and questions about career burnout. The barriers for women in Canadian orthopaedics were identified using the GBS. The relationships between the GBS and burnout were investigated. Open-text questions explored the barriers perceived by female orthopaedic surgeons. Results: The survey was completed by 220 female orthopaedic surgeons and trainees (66.7%). Five barriers to gender equity were identified from the GBS: Constrained Communication, Unequal Standards, Male Culture, Lack of Mentoring, and Workplace Harassment. Career burnout correlated with the GBS domains of Male Privilege (r = 0.215; p < 0.01), Disproportionate Constraints (r = 0.152; p < 0.05), and Devaluation (r = 0.166; p < 0.05). Five main themes emerged from the open-text responses, of which 4 linked closely to the barriers identified in the GBS. Work-life integration was also identified qualitatively as a theme, most notably the difficulty of balancing disproportionate parental and childcare responsibilities alongside career aspirations. Conclusions: In this study, 5 barriers to workplace equity for Canadian female orthopaedic surgeons were identified using the validated GBS and substantiated with qualitative assessment using a mixed-methods approach. Awareness of these barriers is a necessary step toward dismantling them and changing the prevailing culture to be fair and equitable for all. Clinical Relevance: A just and equitable orthopaedic profession is imperative to have healthy and thriving surgeons who are able to provide optimal patient care.","PeriodicalId":22579,"journal":{"name":"The Journal of Bone and Joint Surgery","volume":"54 1","pages":"1455 - 1461"},"PeriodicalIF":0.0,"publicationDate":"2022-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74030170","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}
Sarah T. Lander, Caroline P. Thirukumaran, Ahmed Saleh, Krista L. Noble, Emmanuel N. Menga, A. Mesfin, P. Rubery, J. Sanders
Background: Despite its importance for clinical decisions, the long-term consequences of posterior spinal instrumentation and fusion (PSIF) for adolescent idiopathic scoliosis (AIS), particularly in the lower lumbar spine, remain unclear. This study evaluates the long-term health-related quality of life and the need for a further surgical procedure in patients treated with Harrington instrumentation from 1961 to 1977 according to the lowest instrumented vertebra (LIV) and in comparison with age-matched norms. Methods: A search was performed to identify and contact the 314 identified patients with AIS treated with PSIF by Dr. L.A. Goldstein. The assessment included identified subsequent spine surgery, the Oswestry Disability Index (ODI), Scoliosis Research Society-7 (SRS-7), EuroQol-5 Dimensions (EQ-5D), and Patient-Reported Outcomes Measurement Information System-29 (PROMIS-29). The health-related quality of life was compared with U.S. norms and, within the cohort, was compared by patient factors, LIV, and subsequent spine surgery. Results: In this study, 134 patients (42.7%) were identified; 24 (7.6%) had died, 81 (25.8%) consented to participate in the study, and 29 (9.2%) declined participation. The mean follow-up was 45.4 years (range, 40 to 56 years). There were 81 patients who completed the surveys, 77 patients who completed the SRS-7, 77 patients who completed the ODI, and 76 patients who completed the PROMIS-29 and EQ-5D. There were 12.8% of patients with LIV L3 or proximal and 36.4% with LIV L4 or distal who had an additional surgical procedure (odds ratio, 3.98). Comparing the ODI of patients who had undergone an additional surgical procedure with those who had not showed 42% and 73% minimal disability, 53% and 23% moderate disability, and 5% and 2% severe disability. Of the patients who had not undergone an additional surgical procedure, those with LIV L3 or proximal had mean scores of 14.12 points for the ODI and 23.3 points for the SRS-7 and those with LIV L4 or distal had mean scores of 17.9 points for the ODI and 22.7 points for the SRS-7; these differences were not significant. The mean PROMIS-29 and EQ-5D scores were not different from normal U.S. age-based means. Conclusions: Patients with AIS treated with PSIF at a mean 45-year follow-up and LIV L4 or distal had a higher rate of undergoing an additional surgical procedure than those with LIV L3 or proximal. Patients undergoing an additional surgical procedure had lower health-related quality of life than those who did not. Despite this, there was no difference in health-related quality of life for patients with LIV L4 or distal compared with patients with LIV L3 or proximal. This cohort of patients with AIS treated with PSIF demonstrates normal self-reported health-related quality of life compared with the age-matched general population. These long-term outcomes of PSIF for AIS are encouraging. Level of Evidence: Therapeutic Level IV. See Instructions for Authors for a complete
{"title":"Long-Term Health-Related Quality of Life After Harrington Instrumentation and Fusion for Adolescent Idiopathic Scoliosis","authors":"Sarah T. Lander, Caroline P. Thirukumaran, Ahmed Saleh, Krista L. Noble, Emmanuel N. Menga, A. Mesfin, P. Rubery, J. Sanders","doi":"10.2106/JBJS.21.00763","DOIUrl":"https://doi.org/10.2106/JBJS.21.00763","url":null,"abstract":"Background: Despite its importance for clinical decisions, the long-term consequences of posterior spinal instrumentation and fusion (PSIF) for adolescent idiopathic scoliosis (AIS), particularly in the lower lumbar spine, remain unclear. This study evaluates the long-term health-related quality of life and the need for a further surgical procedure in patients treated with Harrington instrumentation from 1961 to 1977 according to the lowest instrumented vertebra (LIV) and in comparison with age-matched norms. Methods: A search was performed to identify and contact the 314 identified patients with AIS treated with PSIF by Dr. L.A. Goldstein. The assessment included identified subsequent spine surgery, the Oswestry Disability Index (ODI), Scoliosis Research Society-7 (SRS-7), EuroQol-5 Dimensions (EQ-5D), and Patient-Reported Outcomes Measurement Information System-29 (PROMIS-29). The health-related quality of life was compared with U.S. norms and, within the cohort, was compared by patient factors, LIV, and subsequent spine surgery. Results: In this study, 134 patients (42.7%) were identified; 24 (7.6%) had died, 81 (25.8%) consented to participate in the study, and 29 (9.2%) declined participation. The mean follow-up was 45.4 years (range, 40 to 56 years). There were 81 patients who completed the surveys, 77 patients who completed the SRS-7, 77 patients who completed the ODI, and 76 patients who completed the PROMIS-29 and EQ-5D. There were 12.8% of patients with LIV L3 or proximal and 36.4% with LIV L4 or distal who had an additional surgical procedure (odds ratio, 3.98). Comparing the ODI of patients who had undergone an additional surgical procedure with those who had not showed 42% and 73% minimal disability, 53% and 23% moderate disability, and 5% and 2% severe disability. Of the patients who had not undergone an additional surgical procedure, those with LIV L3 or proximal had mean scores of 14.12 points for the ODI and 23.3 points for the SRS-7 and those with LIV L4 or distal had mean scores of 17.9 points for the ODI and 22.7 points for the SRS-7; these differences were not significant. The mean PROMIS-29 and EQ-5D scores were not different from normal U.S. age-based means. Conclusions: Patients with AIS treated with PSIF at a mean 45-year follow-up and LIV L4 or distal had a higher rate of undergoing an additional surgical procedure than those with LIV L3 or proximal. Patients undergoing an additional surgical procedure had lower health-related quality of life than those who did not. Despite this, there was no difference in health-related quality of life for patients with LIV L4 or distal compared with patients with LIV L3 or proximal. This cohort of patients with AIS treated with PSIF demonstrates normal self-reported health-related quality of life compared with the age-matched general population. These long-term outcomes of PSIF for AIS are encouraging. Level of Evidence: Therapeutic Level IV. See Instructions for Authors for a complete","PeriodicalId":22579,"journal":{"name":"The Journal of Bone and Joint Surgery","volume":"19 1","pages":"995 - 1003"},"PeriodicalIF":0.0,"publicationDate":"2022-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87529892","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}
Jeffrey O. Okewunmi, M. Mihalopoulos, Hsin-Hui Huang, Madhu Mazumdar, L. Galatz, J. Poeran, C. Moucha
Background: There is a paucity of literature on racial differences across a full total joint arthroplasty (TJA) “episode of care” and beyond. Given various incentives, the Comprehensive Care for Joint Replacement (CJR) program in the U.S. may have impacted preexisting racial differences across this care continuum. The purposes of the present study were (1) to assess trends in racial differences in care/outcome characteristics before, during, and after TJA surgery and (2) to assess if the CJR program coincided with reductions in these racial differences. Methods: This retrospective cohort study includes data on 1,483,221 TJAs (based on Medicare claims data, 2013 to 2018). Racial differences between Black and White patients were assessed for (1) preoperative characteristics (Deyo-Charlson comorbidity index, patient sex, and age), (2) characteristics during hospitalization (length of stay, blood transfusions, and combined complications), and (3) postoperative characteristics (90 and 180-day readmission rates and institutional post-acute care). Additionally, Medicare payments for each period were assessed. Racial differences (Black versus White patients) were expressed in terms of odds ratios (ORs) and 95% confidence intervals (CIs) per year. A “difference-in-differences” analysis (comparing before and after CJR implementation, with non-CJR hospitals being used as controls) estimated the association of the CJR program with changes in racial differences. Results: In both 2013 and 2018, Black patients (n = 74,390; 5.0%) were more likely than White patients to have a higher Deyo-Charlson comorbidity index (score of >0) (OR = 1.32 [95% CI = 1.28 to 1.36] and OR = 1.32 [95% CI = 1.28 to 1.37]), to require more transfusions (OR = 1.55 [95% CI = 1.49 to 1.62] and OR = 1.77 [95% CI = 1.56 to 2.01]), to be discharged to institutional post-acute care (OR = 1.40 [95% CI = 1.36 to 1.44] and OR = 1.49 [95% CI = 1.43 to 1.56]), and to be readmitted within 90 days (OR = 1.38 [95% CI = 1.32 to 1.44] and OR = 1.21 [95% CI = 1.13 to 1.29]) (p < 0.05 for all). Adjusted difference-in-differences analyses demonstrated that the CJR program coincided with reductions in racial differences in 90-day readmission (−1.24%; 95% CI, −2.46% to −0.03%) and 180-day readmission (−1.28%; 95% CI, −2.52% to −0.03%) (p = 0.044 for both). Conclusions: Racial differences persist among patients managed with TJA. The CJR program coincided with reductions in some racial differences, thus identifying bundle design as a potential novel strategy to target racial disparities. Level of Evidence: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
背景:关于全关节置换术(TJA)“护理期”及之后的种族差异的文献很少。鉴于各种激励措施，美国的综合护理关节置换术(CJR)项目可能已经影响了这个护理连续体中先前存在的种族差异。本研究的目的是:(1)评估TJA手术前、手术中和手术后护理/结果特征的种族差异趋势;(2)评估CJR项目是否与这些种族差异的减少相吻合。方法:本回顾性队列研究包括1,483,221名TJAs的数据(基于2013年至2018年的医疗保险索赔数据)。评估黑人和白人患者的种族差异:(1)术前特征(Deyo-Charlson合并症指数、患者性别和年龄)，(2)住院期间特征(住院时间、输血和合并并发症)，(3)术后特征(90和180天再入院率和机构急性后护理)。此外，对每个时期的医疗保险支付进行了评估。种族差异(黑人与白人患者)以每年的优势比(ORs)和95%置信区间(CIs)表示。一项“差异中的差异”分析(比较实施CJR之前和之后，以非CJR医院作为对照)估计了CJR计划与种族差异变化的关联。结果:2013年和2018年，黑人患者(n = 74,390;5.0%)更有可能比白人患者有更高的Deyo-Charlson发病率指数(得分> 0)(或= 1.32 (95% CI = 1.28 - 1.36)或= 1.32 (95% CI = 1.28 - 1.37)),需要更多的输血(或= 1.55 (95% CI = 1.49 - 1.62)或= 1.77 (95% CI = 1.56 - 2.01)),释放机构急性护理(或= 1.40 (95% CI = 1.36 - 1.44)或= 1.49 (95% CI = 1.43 - 1.56)),并在90天内再次入院(OR = 1.38 [95% CI = 1.32 ~ 1.44]和OR = 1.21 [95% CI = 1.13 ~ 1.29]) (p < 0.05)。调整后的差异分析表明，CJR项目与90天再入院的种族差异减少(- 1.24%;95% CI，−2.46%至−0.03%)和180天再入院(−1.28%;95% CI，−2.52% ~−0.03%)(两者p = 0.044)。结论:种族差异在TJA患者中持续存在。CJR计划与一些种族差异的减少相吻合，因此将捆绑设计确定为针对种族差异的潜在新策略。证据等级:预后III级。有关证据水平的完整描述，请参见作者说明。
{"title":"Racial Differences in Care and Outcomes After Total Hip and Knee Arthroplasties","authors":"Jeffrey O. Okewunmi, M. Mihalopoulos, Hsin-Hui Huang, Madhu Mazumdar, L. Galatz, J. Poeran, C. Moucha","doi":"10.2106/JBJS.21.00465","DOIUrl":"https://doi.org/10.2106/JBJS.21.00465","url":null,"abstract":"Background: There is a paucity of literature on racial differences across a full total joint arthroplasty (TJA) “episode of care” and beyond. Given various incentives, the Comprehensive Care for Joint Replacement (CJR) program in the U.S. may have impacted preexisting racial differences across this care continuum. The purposes of the present study were (1) to assess trends in racial differences in care/outcome characteristics before, during, and after TJA surgery and (2) to assess if the CJR program coincided with reductions in these racial differences. Methods: This retrospective cohort study includes data on 1,483,221 TJAs (based on Medicare claims data, 2013 to 2018). Racial differences between Black and White patients were assessed for (1) preoperative characteristics (Deyo-Charlson comorbidity index, patient sex, and age), (2) characteristics during hospitalization (length of stay, blood transfusions, and combined complications), and (3) postoperative characteristics (90 and 180-day readmission rates and institutional post-acute care). Additionally, Medicare payments for each period were assessed. Racial differences (Black versus White patients) were expressed in terms of odds ratios (ORs) and 95% confidence intervals (CIs) per year. A “difference-in-differences” analysis (comparing before and after CJR implementation, with non-CJR hospitals being used as controls) estimated the association of the CJR program with changes in racial differences. Results: In both 2013 and 2018, Black patients (n = 74,390; 5.0%) were more likely than White patients to have a higher Deyo-Charlson comorbidity index (score of >0) (OR = 1.32 [95% CI = 1.28 to 1.36] and OR = 1.32 [95% CI = 1.28 to 1.37]), to require more transfusions (OR = 1.55 [95% CI = 1.49 to 1.62] and OR = 1.77 [95% CI = 1.56 to 2.01]), to be discharged to institutional post-acute care (OR = 1.40 [95% CI = 1.36 to 1.44] and OR = 1.49 [95% CI = 1.43 to 1.56]), and to be readmitted within 90 days (OR = 1.38 [95% CI = 1.32 to 1.44] and OR = 1.21 [95% CI = 1.13 to 1.29]) (p < 0.05 for all). Adjusted difference-in-differences analyses demonstrated that the CJR program coincided with reductions in racial differences in 90-day readmission (−1.24%; 95% CI, −2.46% to −0.03%) and 180-day readmission (−1.28%; 95% CI, −2.52% to −0.03%) (p = 0.044 for both). Conclusions: Racial differences persist among patients managed with TJA. The CJR program coincided with reductions in some racial differences, thus identifying bundle design as a potential novel strategy to target racial disparities. 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":"19 1","pages":"949 - 958"},"PeriodicalIF":0.0,"publicationDate":"2022-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83763017","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}
Daniel J. Lorenzana, J. Solomon, R. French, Erin McCrum, Filip Jonkergouw, O. Anakwenze, T. Lassiter, E. Samei, Christopher S. Klifto
Background: Shoulder computed tomography (CT) is commonly utilized in preoperative planning for total shoulder arthroplasty. Conventional-dose shoulder CT may expose patients to more ionizing radiation than is necessary to provide high-quality images for this procedure. The purpose of this study was to evaluate the utility of simulated low-dose CT images for preoperative planning using manual measurements and common preoperative planning software. Methods: Eighteen shoulder CT scans obtained for preoperative arthroplasty planning were used to generate CT images as if they had been acquired at reduced radiation dose (RD) levels of 75%, 50%, and 25% using a simulation technique that mimics decreased x-ray tube current. This technique was validated by quantitative comparison of simulated low-dose scans of a cadaver with actual low-dose scans. Glenoid version, glenoid inclination, and humeral head subluxation were measured using 2 commercially available software platforms and were also measured manually by 3 physicians. These measurements were then analyzed for agreement across RD levels for each patient. Tolerances of 5° of glenoid version, 5° of glenoid inclination, and 10% humeral head subluxation were used as equivalent for preoperative planning purposes. Results: At all RD levels evaluated, the preoperative planning software successfully segmented the CT images. Semiautomated software measurement of 25% RD images was within tolerances in 99.1% of measurements; for 50% RD images, within tolerances in 96.3% of measurements; and for 75% RD images, within tolerances in 100% of measurements. Manual measurements of 25% RD images were within these tolerances in 95.1% of measurements; for 50% RD images, in 98.8% of measurements; and for 75% RD images, in 99.4% of measurements. Conclusions: Simulated low-dose CT images were sufficient for reliable measurement of glenoid version, glenoid inclination, and humeral head subluxation by preoperative planning software as well as by physician-observers. These findings suggest the potential for substantial reduction in RD in preoperative shoulder CT scans without compromising surgical planning. Clinical Relevance: The adoption of low-dose techniques in preoperative shoulder CT may lower radiation exposure for patients undergoing shoulder arthroplasty, without compromising image quality.
{"title":"Comparison of Simulated Low-Dose and Conventional-Dose CT for Preoperative Planning in Shoulder Arthroplasty","authors":"Daniel J. Lorenzana, J. Solomon, R. French, Erin McCrum, Filip Jonkergouw, O. Anakwenze, T. Lassiter, E. Samei, Christopher S. Klifto","doi":"10.2106/JBJS.20.01916","DOIUrl":"https://doi.org/10.2106/JBJS.20.01916","url":null,"abstract":"Background: Shoulder computed tomography (CT) is commonly utilized in preoperative planning for total shoulder arthroplasty. Conventional-dose shoulder CT may expose patients to more ionizing radiation than is necessary to provide high-quality images for this procedure. The purpose of this study was to evaluate the utility of simulated low-dose CT images for preoperative planning using manual measurements and common preoperative planning software. Methods: Eighteen shoulder CT scans obtained for preoperative arthroplasty planning were used to generate CT images as if they had been acquired at reduced radiation dose (RD) levels of 75%, 50%, and 25% using a simulation technique that mimics decreased x-ray tube current. This technique was validated by quantitative comparison of simulated low-dose scans of a cadaver with actual low-dose scans. Glenoid version, glenoid inclination, and humeral head subluxation were measured using 2 commercially available software platforms and were also measured manually by 3 physicians. These measurements were then analyzed for agreement across RD levels for each patient. Tolerances of 5° of glenoid version, 5° of glenoid inclination, and 10% humeral head subluxation were used as equivalent for preoperative planning purposes. Results: At all RD levels evaluated, the preoperative planning software successfully segmented the CT images. Semiautomated software measurement of 25% RD images was within tolerances in 99.1% of measurements; for 50% RD images, within tolerances in 96.3% of measurements; and for 75% RD images, within tolerances in 100% of measurements. Manual measurements of 25% RD images were within these tolerances in 95.1% of measurements; for 50% RD images, in 98.8% of measurements; and for 75% RD images, in 99.4% of measurements. Conclusions: Simulated low-dose CT images were sufficient for reliable measurement of glenoid version, glenoid inclination, and humeral head subluxation by preoperative planning software as well as by physician-observers. These findings suggest the potential for substantial reduction in RD in preoperative shoulder CT scans without compromising surgical planning. Clinical Relevance: The adoption of low-dose techniques in preoperative shoulder CT may lower radiation exposure for patients undergoing shoulder arthroplasty, without compromising image quality.","PeriodicalId":22579,"journal":{"name":"The Journal of Bone and Joint Surgery","volume":"104 1","pages":"1004 - 1014"},"PeriodicalIF":0.0,"publicationDate":"2022-04-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85022130","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}
Karch M. Smith, J. Hotaling, A. Presson, Chong Zhang, J. Horns, L. Cannon-Albright, C. Teerlink, R. Tashjian, P. Chalmers
Background: The purpose of the present study was to analyze the association between sex hormone deficiency and rotator cuff repair (RCR) with use of data from a large United States insurance database. Methods: A retrospective analysis of insured subjects from the Truven Health MarketScan database was conducted, collecting data for RCR cases as well as controls matched for age, sex, and years in the database. Multivariable logistic regression models adjusted for matching variables were utilized to compare RCR status with estrogen deficiency status and testosterone deficiency status. These associations were confirmed with use of data from the Veterans Genealogy Project database, with which the relative risk of RCR was estimated for patients with and without sex hormone deficiency. Results: The odds of RCR for female patients with estrogen deficiency were 48% higher (odds ratio, 1.48; 95% confidence interval, 1.44 to 1.51; p < 0.001) than for those without estrogen deficiency. The odds of RCR for males with testosterone deficiency were 89% higher (odds ratio, 1.89; 95% confidence interval, 1.82 to 1.96; p < 0.001) than for those without testosterone deficiency. Within the Veterans Genealogy Project database, the relative risk of estrogen deficiency among RCR patients was 2.58 (95% confidence interval, 2.15 to 3.06; p < 0.001) and the relative risk of testosterone deficiency was 3.05 (95% confidence interval, 2.67 to 3.47; p < 0.001). Conclusions: Sex hormone deficiency was significantly associated with RCR. Future prospective studies will be necessary to understand the pathophysiology of rotator cuff disease as it relates to sex hormones. Level of Evidence: Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.
{"title":"The Effect of Sex Hormone Deficiency on the Incidence of Rotator Cuff Repair","authors":"Karch M. Smith, J. Hotaling, A. Presson, Chong Zhang, J. Horns, L. Cannon-Albright, C. Teerlink, R. Tashjian, P. Chalmers","doi":"10.2106/JBJS.21.00103","DOIUrl":"https://doi.org/10.2106/JBJS.21.00103","url":null,"abstract":"Background: The purpose of the present study was to analyze the association between sex hormone deficiency and rotator cuff repair (RCR) with use of data from a large United States insurance database. Methods: A retrospective analysis of insured subjects from the Truven Health MarketScan database was conducted, collecting data for RCR cases as well as controls matched for age, sex, and years in the database. Multivariable logistic regression models adjusted for matching variables were utilized to compare RCR status with estrogen deficiency status and testosterone deficiency status. These associations were confirmed with use of data from the Veterans Genealogy Project database, with which the relative risk of RCR was estimated for patients with and without sex hormone deficiency. Results: The odds of RCR for female patients with estrogen deficiency were 48% higher (odds ratio, 1.48; 95% confidence interval, 1.44 to 1.51; p < 0.001) than for those without estrogen deficiency. The odds of RCR for males with testosterone deficiency were 89% higher (odds ratio, 1.89; 95% confidence interval, 1.82 to 1.96; p < 0.001) than for those without testosterone deficiency. Within the Veterans Genealogy Project database, the relative risk of estrogen deficiency among RCR patients was 2.58 (95% confidence interval, 2.15 to 3.06; p < 0.001) and the relative risk of testosterone deficiency was 3.05 (95% confidence interval, 2.67 to 3.47; p < 0.001). Conclusions: Sex hormone deficiency was significantly associated with RCR. Future prospective studies will be necessary to understand the pathophysiology of rotator cuff disease as it relates to sex hormones. Level of Evidence: Prognostic 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":"2 1","pages":"774 - 779"},"PeriodicalIF":0.0,"publicationDate":"2022-04-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90306412","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}
Background: To investigate the collapse mechanism in osteonecrosis of the femoral head (ONFH), we studied the relationship between the femoral head (FH) blood circulation changes and the collapse area histomorphometry characteristics. Methods: A technique involving microvascular perfusion of the FH in vitro to reconstruct the vessels in the FH at different stages of nontraumatic ONFH (40 cases). In addition, we also examined the histomorphometry characteristics in the collapse area during ONFH at different stages using the hard tissue section technique. To investigate the blood supply changes in the FH on pathological involved in the FH collapse process. Results: The results showed that in all FHs, the collapse area always involved the margin of the necrotic lesion of the lateral column. Histologically, the fracture occurred between the thickened and necrotic trabeculae at the junction. We found that the collapse started at the lateral column of the FH in the necrotic lesion and that the lateral column was ischemic, which caused the FH to begin to collapse. Conclusions: Based on the above findings, the relationship between associations of the blood circulation to the collapse showed that if a portion of the blood supply of the lateral column (the superior retinacular artery) was preserved, the prognosis of the natural progression of the diseases was improved, the collapse rate was low and collapse occurred later. The blood circulation of artery in the lateral column was good, and the FH maintained an intact shape even if the internal region was ischemic. Therefore, we can predict the collapse of the FH by measuring the blood flow in the lateral area of the FH, thus providing guidance for the selection of FH-preserving clinical therapy in young and middle-aged patients. Clinical Relevance: This work provides a proof of how to predict the collapse of the FH by measuring the blood flow, providing guidance for FH-preserving clinical therapy in young and middle-aged patients.
{"title":"Relationship Between Blood Flow and Collapse of Nontraumatic Osteonecrosis of the Femoral Head","authors":"Guo-Shuang Zheng, X. Qiu, Ben-Jie Wang, D. Zhao","doi":"10.2106/JBJS.20.00490","DOIUrl":"https://doi.org/10.2106/JBJS.20.00490","url":null,"abstract":"Background: To investigate the collapse mechanism in osteonecrosis of the femoral head (ONFH), we studied the relationship between the femoral head (FH) blood circulation changes and the collapse area histomorphometry characteristics. Methods: A technique involving microvascular perfusion of the FH in vitro to reconstruct the vessels in the FH at different stages of nontraumatic ONFH (40 cases). In addition, we also examined the histomorphometry characteristics in the collapse area during ONFH at different stages using the hard tissue section technique. To investigate the blood supply changes in the FH on pathological involved in the FH collapse process. Results: The results showed that in all FHs, the collapse area always involved the margin of the necrotic lesion of the lateral column. Histologically, the fracture occurred between the thickened and necrotic trabeculae at the junction. We found that the collapse started at the lateral column of the FH in the necrotic lesion and that the lateral column was ischemic, which caused the FH to begin to collapse. Conclusions: Based on the above findings, the relationship between associations of the blood circulation to the collapse showed that if a portion of the blood supply of the lateral column (the superior retinacular artery) was preserved, the prognosis of the natural progression of the diseases was improved, the collapse rate was low and collapse occurred later. The blood circulation of artery in the lateral column was good, and the FH maintained an intact shape even if the internal region was ischemic. Therefore, we can predict the collapse of the FH by measuring the blood flow in the lateral area of the FH, thus providing guidance for the selection of FH-preserving clinical therapy in young and middle-aged patients. Clinical Relevance: This work provides a proof of how to predict the collapse of the FH by measuring the blood flow, providing guidance for FH-preserving clinical therapy in young and middle-aged patients.","PeriodicalId":22579,"journal":{"name":"The Journal of Bone and Joint Surgery","volume":"39 1","pages":"13 - 18"},"PeriodicalIF":0.0,"publicationDate":"2022-04-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90198987","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}
Li-hua Liu, Zi-rong Li, Wei Sun, Yun-ting Wang, F. Gao
Background: The purpose of this study was to analyze the interobserver reliability and intraobserver repeatability of the China-Japan Friendship Hospital (CJFH) typing classification system for nontraumatic osteonecrosis of the femoral head (ONFH). Methods: Image data of 50 hips were randomly selected in 289 patients (433 hips) with ONFH who underwent treatment in the China-Japan Friendship Hospital from 2012 to 2016. Bilateral hip plain radiography, magnetic resonance imaging (MRI), or computerized tomography (CT) were performed in all hips. The assessments were performed by 8 new residents independently, and the repeatability was assessed at 4-week intervals. Evaluation indicators included the size, location, and extent of necrotic lesions. Kappa values were used to determine the reliability and repeatability. Results: According to the CJFH classification system, 2,800 evaluations were performed with an average interobserver Kappa value of 0.711, and 400 assessments were performed with an average intraobserver Kappa value of 0.748. Reliability analysis indicated a higher reliability and repeatability of this classification system. Critical factors affecting the consistency included the accurate selection of the median coronal plane and definitive tri-pillar division of the femoral head. Conclusion: The CJFH classification system is a simple and direct evaluation model for ONFH with substantial inter- and intraobserver reliability.
{"title":"Reliability and Repeatability of the China-Japan Friendship Hospital Typing Classification for Nontraumatic Osteonecrosis of the Femoral Head","authors":"Li-hua Liu, Zi-rong Li, Wei Sun, Yun-ting Wang, F. Gao","doi":"10.2106/JBJS.20.00051","DOIUrl":"https://doi.org/10.2106/JBJS.20.00051","url":null,"abstract":"Background: The purpose of this study was to analyze the interobserver reliability and intraobserver repeatability of the China-Japan Friendship Hospital (CJFH) typing classification system for nontraumatic osteonecrosis of the femoral head (ONFH). Methods: Image data of 50 hips were randomly selected in 289 patients (433 hips) with ONFH who underwent treatment in the China-Japan Friendship Hospital from 2012 to 2016. Bilateral hip plain radiography, magnetic resonance imaging (MRI), or computerized tomography (CT) were performed in all hips. The assessments were performed by 8 new residents independently, and the repeatability was assessed at 4-week intervals. Evaluation indicators included the size, location, and extent of necrotic lesions. Kappa values were used to determine the reliability and repeatability. Results: According to the CJFH classification system, 2,800 evaluations were performed with an average interobserver Kappa value of 0.711, and 400 assessments were performed with an average intraobserver Kappa value of 0.748. Reliability analysis indicated a higher reliability and repeatability of this classification system. Critical factors affecting the consistency included the accurate selection of the median coronal plane and definitive tri-pillar division of the femoral head. Conclusion: The CJFH classification system is a simple and direct evaluation model for ONFH with substantial inter- and intraobserver reliability.","PeriodicalId":22579,"journal":{"name":"The Journal of Bone and Joint Surgery","volume":"1 1","pages":"40 - 46"},"PeriodicalIF":0.0,"publicationDate":"2022-04-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83642718","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. Baek, Kwang-Hwan Kim, W. Lee, Wonki Hong, Heejae Won, Shin-Yoon Kim
Background: Abnormal lipid metabolism may play an important role in the development of nontraumatic osteonecrosis of the femoral head (ON). By comparing lipid biomarkers in patients with ON and osteoarthritis (OA) after propensity score matching, we sought to reveal (1) common lipid biomarkers that are abnormal in ON regardless of the etiology and (2) specific lipid biomarkers associated with ON according to the etiology. Methods: Among 2,268 patients who underwent primary THA, 1,021 patients were eligible for this study. According to the Association Research Circulation Osseous criteria, ON was classified as either idiopathic (n = 230), alcohol-associated (n = 293), or glucocorticoid-associated ON (n = 132). Most common cause of OA was hip dysplasia in 106 patients (47%). We investigated patient lipid profiles by assessing total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), triglycerides (TGs), apolipoprotein (Apo) A1 and B, lipoprotein (a) levels and ApoB/A1 ratio. Since age and body mass index affect the lipid profile, we performed propensity score matching to select 304 patients for final analysis and compared lipid profiles between the ON and OA groups. We also compared biomarkers between the ON subgroups and the OA group. Results: Overall, the ON group showed lower HDL-C (p < 0.001), higher TGs (p = 0.001) levels and higher ApoB/A1 ratio (p = 0.003). Idiopathic ON patients demonstrated lower HDL-C (p = 0.032), higher TGs (p = 0.016), ApoB (p = 0.024) levels and ApoB/A1 ratio (p = 0.008). The alcohol-associated ON subgroup showed lower HDL-C (p < 0.001), higher TGs (p = 0.010) levels and ApoB/A1 ratio (p = 0.030). Finally, the steroid-associated ON subgroup demonstrated lower HDL-C (p = 0.003), higher TGs (p = 0.039), lower TC (p = 0.022), LDL-C (p = 0.021), and ApoA1 (p = 0.004) levels. Conclusions: Higher TGs and lower HDL-C levels were associated with nontraumatic ON regardless of the etiology. Additionally, idiopathic ON was associated with higher ApoB levels and ApoB/A1 ratio. Alcohol-associated ON was related to higher ApoB/A1 ratio, and steroid-associated ON paired with decreased TC, LDL-C, and ApoA1 levels. Our findings may support future efforts for prevention and management of nontraumatic ON. Level of Evidence: Diagnostic Level III.
{"title":"Abnormal Lipid Profiles in Nontraumatic Osteonecrosis of the Femoral Head","authors":"S. Baek, Kwang-Hwan Kim, W. Lee, Wonki Hong, Heejae Won, Shin-Yoon Kim","doi":"10.2106/JBJS.20.00520","DOIUrl":"https://doi.org/10.2106/JBJS.20.00520","url":null,"abstract":"Background: Abnormal lipid metabolism may play an important role in the development of nontraumatic osteonecrosis of the femoral head (ON). By comparing lipid biomarkers in patients with ON and osteoarthritis (OA) after propensity score matching, we sought to reveal (1) common lipid biomarkers that are abnormal in ON regardless of the etiology and (2) specific lipid biomarkers associated with ON according to the etiology. Methods: Among 2,268 patients who underwent primary THA, 1,021 patients were eligible for this study. According to the Association Research Circulation Osseous criteria, ON was classified as either idiopathic (n = 230), alcohol-associated (n = 293), or glucocorticoid-associated ON (n = 132). Most common cause of OA was hip dysplasia in 106 patients (47%). We investigated patient lipid profiles by assessing total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), triglycerides (TGs), apolipoprotein (Apo) A1 and B, lipoprotein (a) levels and ApoB/A1 ratio. Since age and body mass index affect the lipid profile, we performed propensity score matching to select 304 patients for final analysis and compared lipid profiles between the ON and OA groups. We also compared biomarkers between the ON subgroups and the OA group. Results: Overall, the ON group showed lower HDL-C (p < 0.001), higher TGs (p = 0.001) levels and higher ApoB/A1 ratio (p = 0.003). Idiopathic ON patients demonstrated lower HDL-C (p = 0.032), higher TGs (p = 0.016), ApoB (p = 0.024) levels and ApoB/A1 ratio (p = 0.008). The alcohol-associated ON subgroup showed lower HDL-C (p < 0.001), higher TGs (p = 0.010) levels and ApoB/A1 ratio (p = 0.030). Finally, the steroid-associated ON subgroup demonstrated lower HDL-C (p = 0.003), higher TGs (p = 0.039), lower TC (p = 0.022), LDL-C (p = 0.021), and ApoA1 (p = 0.004) levels. Conclusions: Higher TGs and lower HDL-C levels were associated with nontraumatic ON regardless of the etiology. Additionally, idiopathic ON was associated with higher ApoB levels and ApoB/A1 ratio. Alcohol-associated ON was related to higher ApoB/A1 ratio, and steroid-associated ON paired with decreased TC, LDL-C, and ApoA1 levels. Our findings may support future efforts for prevention and management of nontraumatic ON. Level of Evidence: Diagnostic Level III.","PeriodicalId":22579,"journal":{"name":"The Journal of Bone and Joint Surgery","volume":"28 1","pages":"19 - 24"},"PeriodicalIF":0.0,"publicationDate":"2022-04-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80351667","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}
Levels [EQ-5D-3L]), arm pain and neck pain, reoperations, and adjacent segment dis- ease). 146 patients were needed to detect a minimal clinically important 10-point differencein NDI (80% power, 2-sided a = 0.05) between groups, assuming a standard deviation of 18 points and 40% loss to follow-up. Main results: The arthroplasty and fusion group groups did not differ for NDI, EQ-5D-3L, arm pain, or neck pain (Table I), or for reoperations (15% vs. 12%, p = 0.61) or adjacentsegmentdisease(0%vs.1.5%,p = 0.32)at5years. Conclusion: In patients with cervical radiculopathy, arthroplasty and fusion did not differ for disability, quality of life, or pain at 5 years.
{"title":"In Patients with Cervical Radiculopathy, Arthroplasty and Fusion Surgical Treatment Did Not Differ for Disability at 5 Years","authors":"S. Iyer","doi":"10.2106/JBJS.22.00305","DOIUrl":"https://doi.org/10.2106/JBJS.22.00305","url":null,"abstract":"Levels [EQ-5D-3L]), arm pain and neck pain, reoperations, and adjacent segment dis- ease). 146 patients were needed to detect a minimal clinically important 10-point differencein NDI (80% power, 2-sided a = 0.05) between groups, assuming a standard deviation of 18 points and 40% loss to follow-up. Main results: The arthroplasty and fusion group groups did not differ for NDI, EQ-5D-3L, arm pain, or neck pain (Table I), or for reoperations (15% vs. 12%, p = 0.61) or adjacentsegmentdisease(0%vs.1.5%,p = 0.32)at5years. Conclusion: In patients with cervical radiculopathy, arthroplasty and fusion did not differ for disability, quality of life, or pain at 5 years.","PeriodicalId":22579,"journal":{"name":"The Journal of Bone and Joint Surgery","volume":"118 1","pages":"942 - 942"},"PeriodicalIF":0.0,"publicationDate":"2022-04-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77429918","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}
Setting: 2 hospitals in Bangkok, Thailand. Patients: 56 patients ‡18 years of age (mean age, 51 years; 79% men) who had end-stage subtalar arthritis confirmed with weight-bearing radiography or computed tomography (CT), a positive diagnostic lidocaine-injection test, history of sinus tarsi pain, limited subtalar motion, and poor response to ‡6 months of nonoperative treatment. Exclusion criteria were substantial arthritis of adjacent joints, peroneal tendon pathology, need for supplemental bone grafts for bone loss, substantial subtalar joint malalignment, need for calcaneal slide osteotomy or coalition resection for tarsal coalition, or simultaneous surgery in foot or ankle regions. 100% of patients completed follow-up.
{"title":"In Advanced Isolated Subtalar Arthritis, Posterior Arthroscopic Subtalar Arthrodesis Reduced Time to Union, But Not Union Rate, Compared with Open Subtalar Arthrodesis","authors":"G. Guyton","doi":"10.2106/JBJS.22.00308","DOIUrl":"https://doi.org/10.2106/JBJS.22.00308","url":null,"abstract":"Setting: 2 hospitals in Bangkok, Thailand. Patients: 56 patients ‡18 years of age (mean age, 51 years; 79% men) who had end-stage subtalar arthritis confirmed with weight-bearing radiography or computed tomography (CT), a positive diagnostic lidocaine-injection test, history of sinus tarsi pain, limited subtalar motion, and poor response to ‡6 months of nonoperative treatment. Exclusion criteria were substantial arthritis of adjacent joints, peroneal tendon pathology, need for supplemental bone grafts for bone loss, substantial subtalar joint malalignment, need for calcaneal slide osteotomy or coalition resection for tarsal coalition, or simultaneous surgery in foot or ankle regions. 100% of patients completed follow-up.","PeriodicalId":22579,"journal":{"name":"The Journal of Bone and Joint Surgery","volume":"44 1","pages":"941 - 941"},"PeriodicalIF":0.0,"publicationDate":"2022-04-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90634399","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}
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