Patients: 267 patients aged 18 to 80 years (mean age, 66 years; 69% women) who had neurogenic claudication or radicular radiating pain in the lower limbs that had not responded to ‡3 months of nonoperative care, spinal stenosis verified by magnetic resonance imaging (MRI), and degenerative spondylolisthesis of ‡3mm at the stenotic level verified by standing plain lateral-view radiographs, and who chose to have surgery. Exclusion criteria included foraminal stenosis of grade 3 on MRI, previous surgery at the level of spondylolisthesis, or previous fracture or fusion surgery in the thoracolumbar region. 90% of patients completed follow-up at 2 years.
{"title":"In Spinal Stenosis with Degenerative Spondylolisthesis, Decompression Surgery Alone Was Noninferior to Decompression Surgery with Instrumented Fusion for Reducing Impairment at 2 Years","authors":"Philip K. Louie","doi":"10.2106/JBJS.22.00307","DOIUrl":"https://doi.org/10.2106/JBJS.22.00307","url":null,"abstract":"Patients: 267 patients aged 18 to 80 years (mean age, 66 years; 69% women) who had neurogenic claudication or radicular radiating pain in the lower limbs that had not responded to ‡3 months of nonoperative care, spinal stenosis verified by magnetic resonance imaging (MRI), and degenerative spondylolisthesis of ‡3mm at the stenotic level verified by standing plain lateral-view radiographs, and who chose to have surgery. Exclusion criteria included foraminal stenosis of grade 3 on MRI, previous surgery at the level of spondylolisthesis, or previous fracture or fusion surgery in the thoracolumbar region. 90% of patients completed follow-up at 2 years.","PeriodicalId":22579,"journal":{"name":"The Journal of Bone and Joint Surgery","volume":"11 1","pages":"943 - 943"},"PeriodicalIF":0.0,"publicationDate":"2022-04-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81584426","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}
Tyler J Tantillo, Erik J. Stapleton, Nicholas Frane, M. Gorlin, M. Schilling, D. Armellino, Gus Katsigiorgis, A. Bitterman
Background: Immediate-use steam sterilization (IUSS), formerly termed “flash” sterilization, has been historically used to sterilize surgical instruments in emergency situations. Strict guidelines deter its use, as IUSS has been theorized to increase the risk of surgical site infections (SSIs), leading to increased health-care costs and poor patient outcomes. We sought to examine the association between the use of IUSS and the rate of orthopaedic SSIs. Methods: The cases of 70,600 patients who underwent orthopaedic surgery—total knee or hip arthroplasty, laminectomy, or spinal fusion—from January 2014 to December 2020, were retrospectively reviewed for IUSS use. Of this group, 3,526 patients had had IUSS used during surgery. A propensity score-matched (PSM) analysis was conducted to account for known predictors of SSIs and included a total of 7,052 patients. The risk difference (RD), relative risk (RR), odds ratio (OR), and McNemar test compared the SSI risk for patients whose procedure had included the use of IUSS and those whose procedure had not included IUSS. Results: After propensity score matching, 111 (1.57%) of the 7,052 matched patients developed an SSI. Of the 111 patients, 61 (54.95%) were in the IUSS group and 50 (45.05%) were in the non-IUSS group. The estimated probability for developing an SSI was 1.42% for the patients in the non-IUSS group versus 1.73% for the patients in the IUSS group (RR = 0.82 [95% confidence interval (CI)]: 0.57 to 1.19], RD = –0.3% [95% CI: –0.9% to 0.27%]).There was no evidence that the proportion of SSI was greater in the IUSS group (McNemar test, p > 0.29). Conclusions: SSI rates were not significantly different between IUSS and non-IUSS patients undergoing orthopaedic surgery. Future prospective studies are warranted to further explore the utility of IUSS during orthopaedic procedures. Level of Evidence: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
{"title":"The Association of Immediate-Use Steam Sterilization with the Incidence of Orthopaedic Surgical Site Infections","authors":"Tyler J Tantillo, Erik J. Stapleton, Nicholas Frane, M. Gorlin, M. Schilling, D. Armellino, Gus Katsigiorgis, A. Bitterman","doi":"10.2106/JBJS.21.01275","DOIUrl":"https://doi.org/10.2106/JBJS.21.01275","url":null,"abstract":"Background: Immediate-use steam sterilization (IUSS), formerly termed “flash” sterilization, has been historically used to sterilize surgical instruments in emergency situations. Strict guidelines deter its use, as IUSS has been theorized to increase the risk of surgical site infections (SSIs), leading to increased health-care costs and poor patient outcomes. We sought to examine the association between the use of IUSS and the rate of orthopaedic SSIs. Methods: The cases of 70,600 patients who underwent orthopaedic surgery—total knee or hip arthroplasty, laminectomy, or spinal fusion—from January 2014 to December 2020, were retrospectively reviewed for IUSS use. Of this group, 3,526 patients had had IUSS used during surgery. A propensity score-matched (PSM) analysis was conducted to account for known predictors of SSIs and included a total of 7,052 patients. The risk difference (RD), relative risk (RR), odds ratio (OR), and McNemar test compared the SSI risk for patients whose procedure had included the use of IUSS and those whose procedure had not included IUSS. Results: After propensity score matching, 111 (1.57%) of the 7,052 matched patients developed an SSI. Of the 111 patients, 61 (54.95%) were in the IUSS group and 50 (45.05%) were in the non-IUSS group. The estimated probability for developing an SSI was 1.42% for the patients in the non-IUSS group versus 1.73% for the patients in the IUSS group (RR = 0.82 [95% confidence interval (CI)]: 0.57 to 1.19], RD = –0.3% [95% CI: –0.9% to 0.27%]).There was no evidence that the proportion of SSI was greater in the IUSS group (McNemar test, p > 0.29). Conclusions: SSI rates were not significantly different between IUSS and non-IUSS patients undergoing orthopaedic surgery. Future prospective studies are warranted to further explore the utility of IUSS during orthopaedic procedures. 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":"18 1","pages":"988 - 994"},"PeriodicalIF":0.0,"publicationDate":"2022-03-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79802155","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}
Tyler J. Stavinoha, Sahej D. Randhawa, Sunny Trivedi, Aleksei B. Dingel, K. Shea, S. Frick
Background: Adult literature cites an axillary nerve danger zone of 5 to 7 cm distal to the acromion tip for open or percutaneous shoulder surgery, but that may not be valid for younger patients. This study sought to quantify the course of the axillary nerve in adolescent patients with reference to easily identifiable intraoperative anatomic and radiographic parameters. Methods: A single-institution hospital database was reviewed for shoulder magnetic resonance images (MRIs) in patients 10 to 17 years old. One hundred and one MRIs from patients with a mean age of 15.6 ± 1.2 years (range, 10 to 17 years) were included. Axillary nerve branches were identified in the coronal plane as they passed lateral to the proximal humerus and were measured in relation to identifiable intraoperative surface and radiographic landmarks, including the acromion tip, apex of the humeral head, lateral physis, and central apex of the physis. The physeal apex height (i.e., 1 “mountain”) was defined as the vertical distance between the most lateral point of the humeral physis (LPHP) and the central intraosseous apex of the physis. Results: Axillary nerve branches were found in all specimens, adjacent to the lateral cortex of the proximal humerus. A mean of 3.7 branches (range, 2 to 6) were found. The mean distance from the most proximal branch (BR1) to the most distal branch (BR2) was 11.7 mm. The pediatric danger zone for the axillary nerve branches ranged from 6.6 mm proximal to 33.1 mm distal to the LPHP. The danger zone in relation to percent of physeal apex height included from 62% proximal to 242% distal to the LPHP. Conclusions: All branches were found distal to the apex of the physis (1 “mountain” height proximal to the LPHP). Distal to the LPHP, no branches were found beyond a distance of 3 times the physeal apex height (3 “valleys”). In children and adolescents, percutaneous fixation of the proximal humerus should be performed with cortical penetration outside of this range. These parameters serve as readily identifiable intraoperative radiographic landmarks to minimize iatrogenic nerve injury. Clinical Relevance: This study provides valuable landmarks for percutaneous approaches to the proximal humerus. The surgical approach for the placement of percutaneous implants should be adjusted accordingly (i.e., performed at least 1 mountain proximal or 3 valleys distal to the LPHP) in order to prevent iatrogenic injury to the axillary nerve.
{"title":"The Axillary Nerve Danger Zone in Percutaneous Fixation in the Pediatric Shoulder","authors":"Tyler J. Stavinoha, Sahej D. Randhawa, Sunny Trivedi, Aleksei B. Dingel, K. Shea, S. Frick","doi":"10.2106/JBJS.21.01202","DOIUrl":"https://doi.org/10.2106/JBJS.21.01202","url":null,"abstract":"Background: Adult literature cites an axillary nerve danger zone of 5 to 7 cm distal to the acromion tip for open or percutaneous shoulder surgery, but that may not be valid for younger patients. This study sought to quantify the course of the axillary nerve in adolescent patients with reference to easily identifiable intraoperative anatomic and radiographic parameters. Methods: A single-institution hospital database was reviewed for shoulder magnetic resonance images (MRIs) in patients 10 to 17 years old. One hundred and one MRIs from patients with a mean age of 15.6 ± 1.2 years (range, 10 to 17 years) were included. Axillary nerve branches were identified in the coronal plane as they passed lateral to the proximal humerus and were measured in relation to identifiable intraoperative surface and radiographic landmarks, including the acromion tip, apex of the humeral head, lateral physis, and central apex of the physis. The physeal apex height (i.e., 1 “mountain”) was defined as the vertical distance between the most lateral point of the humeral physis (LPHP) and the central intraosseous apex of the physis. Results: Axillary nerve branches were found in all specimens, adjacent to the lateral cortex of the proximal humerus. A mean of 3.7 branches (range, 2 to 6) were found. The mean distance from the most proximal branch (BR1) to the most distal branch (BR2) was 11.7 mm. The pediatric danger zone for the axillary nerve branches ranged from 6.6 mm proximal to 33.1 mm distal to the LPHP. The danger zone in relation to percent of physeal apex height included from 62% proximal to 242% distal to the LPHP. Conclusions: All branches were found distal to the apex of the physis (1 “mountain” height proximal to the LPHP). Distal to the LPHP, no branches were found beyond a distance of 3 times the physeal apex height (3 “valleys”). In children and adolescents, percutaneous fixation of the proximal humerus should be performed with cortical penetration outside of this range. These parameters serve as readily identifiable intraoperative radiographic landmarks to minimize iatrogenic nerve injury. Clinical Relevance: This study provides valuable landmarks for percutaneous approaches to the proximal humerus. The surgical approach for the placement of percutaneous implants should be adjusted accordingly (i.e., performed at least 1 mountain proximal or 3 valleys distal to the LPHP) in order to prevent iatrogenic injury to the axillary nerve.","PeriodicalId":22579,"journal":{"name":"The Journal of Bone and Joint Surgery","volume":"29 1","pages":"1263 - 1268"},"PeriodicalIF":0.0,"publicationDate":"2022-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85690411","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: Improved understanding of the morphological characteristics of knees with osteoarthritis (OA) and various deformities can enable personalized implant positioning and balancing in total knee arthroplasty in an effort to continue improving clinical outcomes and optimizing procedural value. Therefore, the purpose of this study was to outline morphological differences in the medial and lateral distal femur and proximal tibia associated with varus and valgus deformities in knee OA. Methods: A large computed tomography (CT) database was used to identify 1,158 knees, which were divided into normal and osteoarthritic groups; the latter was further divided on the basis of deformity into neutral, varus, and valgus subgroups. Morphological measurements included the non-weight-bearing hip-knee-ankle angle (nwHKA), mechanical lateral distal femoral angle (mLDFA), medial proximal tibial angle (MPTA), rotation of the posterior condylar axis (PCA) relative to the surgical transepicondylar axis (sTEA), ratio of medial to lateral posterior condylar offset, ratio of medial to lateral condylar radius, medial posterior slope (MPS), lateral posterior slope (LPS), medial coronal slope (MCS), and lateral coronal slope (LCS). Results: Compared with the normal group, the OA group was in overall varus (nwHKA, −2.2° ± 5.0° compared with −0.2° ± 2.4°) and had a significantly smaller MPS (8.4° ± 4.0° compared with 9.2° ± 4.0°), larger LPS (9.2° ± 3.6° compared with 7.2° ± 3.3°), and smaller MCS (82.1° ± 4.3° compared with 83.9° ± 3.3°). Differences among the OA subgroups were also observed for the MCS and LCS. Compared with the normal group, the sTEA of the OA group was less externally rotated relative to the PCA (0.3° ± 1.5° compared with 1.2° ± 1.9°), and both the condylar offset ratio (1.01 ± 0.06 compared with 1.04 ± 0.07) and the condylar radius ratio (0.98 ± 0.07 compared with 1.03 ± 0.07) were smaller. Only the condylar radius ratio showed differences among the OA subgroups, with valgus deformity associated with a larger ratio. Conclusions: An analysis of CT scans of 965 healthy and 193 osteoarthritic knees revealed significant differences in PCA, condylar offset, and condylar radius as well as tibial slope in both the sagittal and coronal planes. Clinical Relevance: There is a strong need to evolve toward a more personalized treatment for osteoarthritic knees that utilizes implants and technology to help tailor total knee arthroplasty on the basis of the patient’s morphologic characteristics.
{"title":"Osseous Morphological Differences in Knee Osteoarthritis","authors":"A. Siddiqi, H. Anis, I. Borukhov, N. Piuzzi","doi":"10.2106/JBJS.21.00892","DOIUrl":"https://doi.org/10.2106/JBJS.21.00892","url":null,"abstract":"Background: Improved understanding of the morphological characteristics of knees with osteoarthritis (OA) and various deformities can enable personalized implant positioning and balancing in total knee arthroplasty in an effort to continue improving clinical outcomes and optimizing procedural value. Therefore, the purpose of this study was to outline morphological differences in the medial and lateral distal femur and proximal tibia associated with varus and valgus deformities in knee OA. Methods: A large computed tomography (CT) database was used to identify 1,158 knees, which were divided into normal and osteoarthritic groups; the latter was further divided on the basis of deformity into neutral, varus, and valgus subgroups. Morphological measurements included the non-weight-bearing hip-knee-ankle angle (nwHKA), mechanical lateral distal femoral angle (mLDFA), medial proximal tibial angle (MPTA), rotation of the posterior condylar axis (PCA) relative to the surgical transepicondylar axis (sTEA), ratio of medial to lateral posterior condylar offset, ratio of medial to lateral condylar radius, medial posterior slope (MPS), lateral posterior slope (LPS), medial coronal slope (MCS), and lateral coronal slope (LCS). Results: Compared with the normal group, the OA group was in overall varus (nwHKA, −2.2° ± 5.0° compared with −0.2° ± 2.4°) and had a significantly smaller MPS (8.4° ± 4.0° compared with 9.2° ± 4.0°), larger LPS (9.2° ± 3.6° compared with 7.2° ± 3.3°), and smaller MCS (82.1° ± 4.3° compared with 83.9° ± 3.3°). Differences among the OA subgroups were also observed for the MCS and LCS. Compared with the normal group, the sTEA of the OA group was less externally rotated relative to the PCA (0.3° ± 1.5° compared with 1.2° ± 1.9°), and both the condylar offset ratio (1.01 ± 0.06 compared with 1.04 ± 0.07) and the condylar radius ratio (0.98 ± 0.07 compared with 1.03 ± 0.07) were smaller. Only the condylar radius ratio showed differences among the OA subgroups, with valgus deformity associated with a larger ratio. Conclusions: An analysis of CT scans of 965 healthy and 193 osteoarthritic knees revealed significant differences in PCA, condylar offset, and condylar radius as well as tibial slope in both the sagittal and coronal planes. Clinical Relevance: There is a strong need to evolve toward a more personalized treatment for osteoarthritic knees that utilizes implants and technology to help tailor total knee arthroplasty on the basis of the patient’s morphologic characteristics.","PeriodicalId":22579,"journal":{"name":"The Journal of Bone and Joint Surgery","volume":"28 1","pages":"805 - 812"},"PeriodicalIF":0.0,"publicationDate":"2022-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83750425","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}
P. Kvarda, Ursina Peterhans, Roman Susdorf, A. Barg, R. Ruiz, B. Hintermann
In the past few decades, total ankle replacement (TAR) has become the backbone of treatment for end-stage ankle osteoarthritis, with improving outcomes. The aim of the present study was to present the long-term survival of the HINTEGRA TAR. This single-center retrospective cohort study included 722 ankles in 683 patients who underwent HINTEGRA TAR for end-stage ankle osteoarthritis. We performed a survival analysis and assessed potential risk factors. Clinical outcomes and patient satisfaction were determined. The cumulative survival rate was 93% (95% confidence interval [CI], 91% to 95%) at 5 years, 86% (95% CI, 83% to 88%) at 10 years, and 82% (95% CI, 78% to 85%) at 15 years. Aseptic loosening was the most common reason for revision, accounting for 54 (43%) of 126 revision procedures. A secondary etiology was associated with a lower risk of revision than primary or posttraumatic. The HINTEGRA TAR results in desirable long-term implant survival with an acceptable revision rate. Coronal-plane instability must be evaluated and addressed at the time of the index surgery. Level of Evidence: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
{"title":"Long-Term Survival of HINTEGRA Total Ankle Replacement in 683 Patients","authors":"P. Kvarda, Ursina Peterhans, Roman Susdorf, A. Barg, R. Ruiz, B. Hintermann","doi":"10.2106/JBJS.21.00899","DOIUrl":"https://doi.org/10.2106/JBJS.21.00899","url":null,"abstract":"In the past few decades, total ankle replacement (TAR) has become the backbone of treatment for end-stage ankle osteoarthritis, with improving outcomes. The aim of the present study was to present the long-term survival of the HINTEGRA TAR. This single-center retrospective cohort study included 722 ankles in 683 patients who underwent HINTEGRA TAR for end-stage ankle osteoarthritis. We performed a survival analysis and assessed potential risk factors. Clinical outcomes and patient satisfaction were determined. The cumulative survival rate was 93% (95% confidence interval [CI], 91% to 95%) at 5 years, 86% (95% CI, 83% to 88%) at 10 years, and 82% (95% CI, 78% to 85%) at 15 years. Aseptic loosening was the most common reason for revision, accounting for 54 (43%) of 126 revision procedures. A secondary etiology was associated with a lower risk of revision than primary or posttraumatic. The HINTEGRA TAR results in desirable long-term implant survival with an acceptable revision rate. Coronal-plane instability must be evaluated and addressed at the time of the index surgery. 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":"20 1","pages":"881 - 888"},"PeriodicalIF":0.0,"publicationDate":"2022-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90153387","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}
Nathan R. Hendrickson, J. Davison, N. Glass, Erin S. Wilson, Aspen Miller, Steven Leary, William Lorentzen, M. Karam, Matthew Hogue, J. Marsh, M. Willey
Background: Postoperative complications and substantial loss of physical function are common after musculoskeletal trauma. We conducted a prospective randomized controlled trial to assess the impact of conditionally essential amino acid (CEAA) supplementation on complications and skeletal muscle mass in adults after operative fixation of acute fractures. Methods: Adults who sustained pelvic and extremity fractures that were indicated for operative fixation at a level-I trauma center were enrolled. The subjects were stratified based on injury characteristics (open fractures and/or polytrauma, fragility fractures, isolated injuries) and randomized to standard nutrition (control group) or oral CEAA supplementation twice daily for 2 weeks. Body composition (fat-free mass [FFM]) was measured at baseline and at 6 and 12 weeks postoperatively. Complications were prospectively collected. An intention-to-treat analysis was performed. The relative risk (RR) of complications for the control group relative to the CEAA group was determined, and linear mixed-effects models were used to model the relationship between CEAA supplementation and changes in FFM. Results: Four hundred subjects (control group: 200; CEAA group: 200) were enrolled. The CEAA group had significantly lower overall complications than the control group (30.5% vs. 43.8%; adjusted RR = 0.71; 95% confidence interval [CI] = 0.55 to 0.92; p = 0.008). The FFM decreased significantly at 6 weeks in the control subjects (–0.9 kg, p = 0.0205), whereas the FFM was maintained at 6 weeks in the CEAA subjects (−0.33 kg, p = 0.3606). This difference in FFM was not seen at subsequent time points. Conclusions: Our results indicate that CEAA supplementation has a protective effect against common complications and early skeletal muscle wasting after operative fixation of extremity and pelvic fractures. Given the potential benefits of this inexpensive, low-risk intervention, multicenter prospective studies in focused trauma populations are warranted. Level of Evidence: Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.
背景:肌肉骨骼创伤后的术后并发症和大量的身体功能丧失是常见的。我们进行了一项前瞻性随机对照试验，以评估补充条件性必需氨基酸(CEAA)对成人急性骨折手术固定后并发症和骨骼肌质量的影响。方法:纳入了在一级创伤中心接受手术固定的骨盆和四肢骨折的成年人。根据损伤特征(开放性骨折和/或多发伤、脆性骨折、孤立性损伤)对受试者进行分层，随机分为标准营养组(对照组)或口服补充CEAA组，每天两次，持续2周。在基线和术后6周和12周测量体成分(无脂质量[FFM])。前瞻性收集并发症。进行意向治疗分析。测定对照组相对于CEAA组并发症的相对危险度(RR)，并采用线性混合效应模型对补充CEAA与FFM变化的关系进行建模。结果:400例受试者(对照组200例;CEAA组:200例。CEAA组总并发症明显低于对照组(30.5% vs 43.8%;调整后RR = 0.71;95%置信区间[CI] = 0.55 ~ 0.92;P = 0.008)。对照组的FFM在6周时显著下降(-0.9 kg, p = 0.0205)，而CEAA组的FFM在6周时保持不变(- 0.33 kg, p = 0.3606)。在随后的时间点没有观察到FFM的这种差异。结论:我们的研究结果表明，补充CEAA对四肢和骨盆骨折手术固定后常见并发症和早期骨骼肌萎缩具有保护作用。鉴于这种低成本、低风险干预的潜在益处，有必要对重点创伤人群进行多中心前瞻性研究。证据水平:治疗性i级。参见《作者说明》获得证据水平的完整描述。
{"title":"Conditionally Essential Amino Acid Supplementation Reduces Postoperative Complications and Muscle Wasting After Fracture Fixation","authors":"Nathan R. Hendrickson, J. Davison, N. Glass, Erin S. Wilson, Aspen Miller, Steven Leary, William Lorentzen, M. Karam, Matthew Hogue, J. Marsh, M. Willey","doi":"10.2106/JBJS.21.01014","DOIUrl":"https://doi.org/10.2106/JBJS.21.01014","url":null,"abstract":"Background: Postoperative complications and substantial loss of physical function are common after musculoskeletal trauma. We conducted a prospective randomized controlled trial to assess the impact of conditionally essential amino acid (CEAA) supplementation on complications and skeletal muscle mass in adults after operative fixation of acute fractures. Methods: Adults who sustained pelvic and extremity fractures that were indicated for operative fixation at a level-I trauma center were enrolled. The subjects were stratified based on injury characteristics (open fractures and/or polytrauma, fragility fractures, isolated injuries) and randomized to standard nutrition (control group) or oral CEAA supplementation twice daily for 2 weeks. Body composition (fat-free mass [FFM]) was measured at baseline and at 6 and 12 weeks postoperatively. Complications were prospectively collected. An intention-to-treat analysis was performed. The relative risk (RR) of complications for the control group relative to the CEAA group was determined, and linear mixed-effects models were used to model the relationship between CEAA supplementation and changes in FFM. Results: Four hundred subjects (control group: 200; CEAA group: 200) were enrolled. The CEAA group had significantly lower overall complications than the control group (30.5% vs. 43.8%; adjusted RR = 0.71; 95% confidence interval [CI] = 0.55 to 0.92; p = 0.008). The FFM decreased significantly at 6 weeks in the control subjects (–0.9 kg, p = 0.0205), whereas the FFM was maintained at 6 weeks in the CEAA subjects (−0.33 kg, p = 0.3606). This difference in FFM was not seen at subsequent time points. Conclusions: Our results indicate that CEAA supplementation has a protective effect against common complications and early skeletal muscle wasting after operative fixation of extremity and pelvic fractures. Given the potential benefits of this inexpensive, low-risk intervention, multicenter prospective studies in focused trauma populations are warranted. 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":"85 1","pages":"759 - 766"},"PeriodicalIF":0.0,"publicationDate":"2022-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79373221","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}
Ting Cong, Arielle J. Hall, Zhimeng Jia, A. Christiano, H. Elsevier, Zoe B. Cheung, Davis S. Wellman, David A. Forsh, J. Lane
➤ Biological aging can best be conceptualized clinically as a combination of 3 components: frailty, comorbidity, and disability.➤ Despite advancements in the understanding of senescence, chronological age remains the best estimate of biological age. However, a useful exercise for practitioners is to look beyond chronological age in clinical and surgical decision-making.➤ A chronologically aging person does not age biologically at the same rate.➤ The best way to understand frailty is to consider it as a physical phenotype.➤ Physical optimization should parallel medical optimization before elective surgery.➤ The poorer the host (both in terms of bone quality and propensity for healing), the more robust the implant construct must be to minimize reliance on host biology.
{"title":"Conceptualizing Biological Aging and Frailty in Orthopaedics","authors":"Ting Cong, Arielle J. Hall, Zhimeng Jia, A. Christiano, H. Elsevier, Zoe B. Cheung, Davis S. Wellman, David A. Forsh, J. Lane","doi":"10.2106/JBJS.21.01053","DOIUrl":"https://doi.org/10.2106/JBJS.21.01053","url":null,"abstract":"➤ Biological aging can best be conceptualized clinically as a combination of 3 components: frailty, comorbidity, and disability.➤ Despite advancements in the understanding of senescence, chronological age remains the best estimate of biological age. However, a useful exercise for practitioners is to look beyond chronological age in clinical and surgical decision-making.➤ A chronologically aging person does not age biologically at the same rate.➤ The best way to understand frailty is to consider it as a physical phenotype.➤ Physical optimization should parallel medical optimization before elective surgery.➤ The poorer the host (both in terms of bone quality and propensity for healing), the more robust the implant construct must be to minimize reliance on host biology.","PeriodicalId":22579,"journal":{"name":"The Journal of Bone and Joint Surgery","volume":"54 1","pages":"1212 - 1222"},"PeriodicalIF":0.0,"publicationDate":"2022-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73707094","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}
N. Heckmann, Gabriel J. Bouz, Amit S. Piple, Brian C. Chung, Jennifer C. Wang, Cory K. Mayfield, J. Stambough, D. Oakes, Alexander B. Christ, J. Lieberman
Background: Despite known surgical volume reductions in 2020 during the height of the COVID-19 pandemic, no study has fully quantified the impact of the pandemic on the number of elective inpatient total hip (THA) and total knee arthroplasty (TKA) cases. The purpose of the present study was to analyze THA and TKA case volumes in the United States during the COVID-19 pandemic. Methods: The Premier Healthcare Database was utilized to identify adults undergoing primary elective THA or TKA from January 2017 to December 2020. The National Inpatient Sample was cross-referenced to provide nationwide representative sampling weights. Patients undergoing revision total joint arthroplasty (TJA) or non-elective surgery were excluded. Two quantitative models were created from both databases to estimate TJA case volume in 2020. Descriptive statistics were utilized to report monthly changes in elective TJA utilization throughout 2020. Univariate analyses were performed to compare differences between subgroups. Results: From 2017 to 2019, it was estimated that 1,006,000 elective inpatient TJAs (64.2% TKA and 35.8% THA) were performed annually. In 2020, an estimated 526,000 to 538,000 cases (62.0% TKA and 38.0% THA) were performed, representing a 46.5% to 47.7% decrease in nationwide volume from the prior 3-year average. Moreover, the elective TJA case volume for April 2020 was 1.9% of the average for that month from 2017 through 2019. Subsequently, case volumes for May and June increased compared with the volumes for those months from 2017 through 2019. There was then a decrease in cases for July, corresponding with the “second wave” of COVID-19, followed by an additional steady monthly decline through December, corresponding with the “third wave.” Finally, the elective TJA cases for December 2020 represented only 41.0% of the average case volume for that month from 2017 through 2019. Conclusions: In the midst of the 2020 COVID-19 pandemic, approximately 526,000 to 538,000 elective inpatient TJA cases were performed, representing a 46.5% to 47.7% decrease compared with the 3 previous years. The effects of the COVID-19 pandemic persisted through the end of that year, with decreased case volume through December 2020.
{"title":"Elective Inpatient Total Joint Arthroplasty Case Volume in the United States in 2020","authors":"N. Heckmann, Gabriel J. Bouz, Amit S. Piple, Brian C. Chung, Jennifer C. Wang, Cory K. Mayfield, J. Stambough, D. Oakes, Alexander B. Christ, J. Lieberman","doi":"10.2106/JBJS.21.00833","DOIUrl":"https://doi.org/10.2106/JBJS.21.00833","url":null,"abstract":"Background: Despite known surgical volume reductions in 2020 during the height of the COVID-19 pandemic, no study has fully quantified the impact of the pandemic on the number of elective inpatient total hip (THA) and total knee arthroplasty (TKA) cases. The purpose of the present study was to analyze THA and TKA case volumes in the United States during the COVID-19 pandemic. Methods: The Premier Healthcare Database was utilized to identify adults undergoing primary elective THA or TKA from January 2017 to December 2020. The National Inpatient Sample was cross-referenced to provide nationwide representative sampling weights. Patients undergoing revision total joint arthroplasty (TJA) or non-elective surgery were excluded. Two quantitative models were created from both databases to estimate TJA case volume in 2020. Descriptive statistics were utilized to report monthly changes in elective TJA utilization throughout 2020. Univariate analyses were performed to compare differences between subgroups. Results: From 2017 to 2019, it was estimated that 1,006,000 elective inpatient TJAs (64.2% TKA and 35.8% THA) were performed annually. In 2020, an estimated 526,000 to 538,000 cases (62.0% TKA and 38.0% THA) were performed, representing a 46.5% to 47.7% decrease in nationwide volume from the prior 3-year average. Moreover, the elective TJA case volume for April 2020 was 1.9% of the average for that month from 2017 through 2019. Subsequently, case volumes for May and June increased compared with the volumes for those months from 2017 through 2019. There was then a decrease in cases for July, corresponding with the “second wave” of COVID-19, followed by an additional steady monthly decline through December, corresponding with the “third wave.” Finally, the elective TJA cases for December 2020 represented only 41.0% of the average case volume for that month from 2017 through 2019. Conclusions: In the midst of the 2020 COVID-19 pandemic, approximately 526,000 to 538,000 elective inpatient TJA cases were performed, representing a 46.5% to 47.7% decrease compared with the 3 previous years. The effects of the COVID-19 pandemic persisted through the end of that year, with decreased case volume through December 2020.","PeriodicalId":22579,"journal":{"name":"The Journal of Bone and Joint Surgery","volume":"24 1","pages":"e56"},"PeriodicalIF":0.0,"publicationDate":"2022-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89771857","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}
N. Fukase, Y. Murata, Lauren A. Pierpoint, Rui W. Soares, Justin W. Arner, Joseph J. Ruzbarsky, P. Quinn, M. Philippon
Background: Because of the unique theoretical surgical risks, including osteonecrosis, acute iatrogenic slipped capital femoral epiphysis, and epiphyseal injury, the optimal treatment strategy for femoroacetabular impingement (FAI) in growing adolescents has yet to be established. The aim of this study was to compare the clinical outcomes of primary arthroscopic treatment of FAI in growing adolescents with a matched adult group. Methods: Patients with FAI who underwent arthroscopic treatment with a minimum follow-up of 2 years were included. Patients with previous ipsilateral hip surgery, an Outerbridge grade of ≥3, a preoperative Tönnis grade of ≥2, or evidence of dysplasia (lateral center-edge angle of <25°) were excluded. Eligible patients who were ≤19 years old and whose proximal femoral physis had not yet closed were matched to adult (20 to 40-year-old) counterparts in a 1:1 ratio by sex, body mass index, and time of surgery. For the adolescents, cam resection was performed with a physeal-sparing approach. Outcome scores, including the modified Harris hip score (mHHS), Hip Outcome Score-Activities of Daily Living (HOS-ADL), and HOS-Sports-Specific Subscale (HOS-SSS), were prospectively collected. Results: Of the 196 eligible adolescents, 157 (80%) were pair-matched to adult controls, with a median postoperative follow-up of 8.9 and 6.6 years, respectively. Fourteen (9%) of the adolescents required revision hip arthroscopy compared with 18 adults (11%) (p = 0.46). No patient in the adolescent group had conversion to a total hip arthroplasty (THA), while 3 in the adult group had a THA (p = 0.25). For adolescents without subsequent hip surgery, the median mHHS improved from 59 preoperatively to 96 postoperatively; the HOS-ADL, from 71 to 98; and the HOS-SSS, from 44 to 94 (p < 0.001), which were significantly higher postoperative scores than those of the matched adults (p < 0.05) despite similar or inferior baseline scores. No complications were found during the office visit or at the final follow-up. Conclusions: Hip arthroscopy performed with a physeal-sparing approach for FAI in growing adolescents is safe and effective and yields superior clinical outcomes compared with those in a matched adult group. Level of Evidence: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
{"title":"Outcomes and Survivorship at a Median of 8.9 Years Following Hip Arthroscopy in Adolescents with Femoroacetabular Impingement","authors":"N. Fukase, Y. Murata, Lauren A. Pierpoint, Rui W. Soares, Justin W. Arner, Joseph J. Ruzbarsky, P. Quinn, M. Philippon","doi":"10.2106/JBJS.21.00852","DOIUrl":"https://doi.org/10.2106/JBJS.21.00852","url":null,"abstract":"Background: Because of the unique theoretical surgical risks, including osteonecrosis, acute iatrogenic slipped capital femoral epiphysis, and epiphyseal injury, the optimal treatment strategy for femoroacetabular impingement (FAI) in growing adolescents has yet to be established. The aim of this study was to compare the clinical outcomes of primary arthroscopic treatment of FAI in growing adolescents with a matched adult group. Methods: Patients with FAI who underwent arthroscopic treatment with a minimum follow-up of 2 years were included. Patients with previous ipsilateral hip surgery, an Outerbridge grade of ≥3, a preoperative Tönnis grade of ≥2, or evidence of dysplasia (lateral center-edge angle of <25°) were excluded. Eligible patients who were ≤19 years old and whose proximal femoral physis had not yet closed were matched to adult (20 to 40-year-old) counterparts in a 1:1 ratio by sex, body mass index, and time of surgery. For the adolescents, cam resection was performed with a physeal-sparing approach. Outcome scores, including the modified Harris hip score (mHHS), Hip Outcome Score-Activities of Daily Living (HOS-ADL), and HOS-Sports-Specific Subscale (HOS-SSS), were prospectively collected. Results: Of the 196 eligible adolescents, 157 (80%) were pair-matched to adult controls, with a median postoperative follow-up of 8.9 and 6.6 years, respectively. Fourteen (9%) of the adolescents required revision hip arthroscopy compared with 18 adults (11%) (p = 0.46). No patient in the adolescent group had conversion to a total hip arthroplasty (THA), while 3 in the adult group had a THA (p = 0.25). For adolescents without subsequent hip surgery, the median mHHS improved from 59 preoperatively to 96 postoperatively; the HOS-ADL, from 71 to 98; and the HOS-SSS, from 44 to 94 (p < 0.001), which were significantly higher postoperative scores than those of the matched adults (p < 0.05) despite similar or inferior baseline scores. No complications were found during the office visit or at the final follow-up. Conclusions: Hip arthroscopy performed with a physeal-sparing approach for FAI in growing adolescents is safe and effective and yields superior clinical outcomes compared with those in a matched adult group. 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":"16 1","pages":"902 - 909"},"PeriodicalIF":0.0,"publicationDate":"2022-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74678512","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. O’Driscoll, Jorge Rojas Lievano, M. Morrey, J. Sánchez-Sotelo, D. Shukla, T. S. Olson, J. Fitzsimmons, Anthony M. Vaichinger, Maegan N. Shields
Background: Continuous passive motion (CPM) has been used for decades, but we are not aware of any randomized controlled trials (RCTs) in which CPM has been compared with physical therapy (PT) for rehabilitation following release of elbow contracture. Methods: In this single-blinded, single-center RCT, we randomly assigned patients undergoing arthroscopic release of elbow contracture to a rehabilitation protocol involving either CPM or PT. The primary outcomes were the rate of recovery and the arc of elbow motion (range of motion) at 1 year. The rate of recovery was evaluated by measuring range of motion at 6 weeks and 3 months. The secondary outcomes included other range-of-motion-related outcomes, patient-reported outcome measures (PROMs), flexion strength and endurance, grip strength, and forearm circumference at multiple time points. Results: A total of 24 patients were assigned to receive CPM, and 27 were assigned to receive PT. At 1 year, CPM was superior to PT with regard to the range of motion, with an estimated treatment difference of 9° (95% confidence interval [CI], 3° to 16°; p = 0.007). Similarly, the use of CPM led to a greater range of motion at 6 weeks and 3 months than PT. The percentage of lost motion recovered at 1 year was higher in the CPM group (51%) than in the PT group (36%) (p = 0.01). The probability of restoring a functional range of motion at 1 year was 62% higher in the CPM group than in the PT group (risk ratio for functional range of motion, 1.62; 95% CI, 1.01 to 2.61; p = 0.04). PROM scores were similar in the 2 groups at all time points, except for a difference in the American Shoulder and Elbow Surgeons (ASES) elbow function subscale, in favor of CPM, at 6 weeks. The use of CPM decreased swelling and reduced the loss of flexion strength, flexion endurance, and grip strength on day 3, with no between-group differences thereafter. Conclusions: Among patients undergoing arthroscopic release of elbow contracture, those who received CPM obtained a faster recovery and a greater range of motion at 1 year, with a higher chance of restoration of functional elbow motion than those who underwent routine PT. Level of Evidence: Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.
{"title":"Prospective Randomized Trial of Continuous Passive Motion Versus Physical Therapy After Arthroscopic Release of Elbow Contracture","authors":"S. O’Driscoll, Jorge Rojas Lievano, M. Morrey, J. Sánchez-Sotelo, D. Shukla, T. S. Olson, J. Fitzsimmons, Anthony M. Vaichinger, Maegan N. Shields","doi":"10.2106/JBJS.21.00685","DOIUrl":"https://doi.org/10.2106/JBJS.21.00685","url":null,"abstract":"Background: Continuous passive motion (CPM) has been used for decades, but we are not aware of any randomized controlled trials (RCTs) in which CPM has been compared with physical therapy (PT) for rehabilitation following release of elbow contracture. Methods: In this single-blinded, single-center RCT, we randomly assigned patients undergoing arthroscopic release of elbow contracture to a rehabilitation protocol involving either CPM or PT. The primary outcomes were the rate of recovery and the arc of elbow motion (range of motion) at 1 year. The rate of recovery was evaluated by measuring range of motion at 6 weeks and 3 months. The secondary outcomes included other range-of-motion-related outcomes, patient-reported outcome measures (PROMs), flexion strength and endurance, grip strength, and forearm circumference at multiple time points. Results: A total of 24 patients were assigned to receive CPM, and 27 were assigned to receive PT. At 1 year, CPM was superior to PT with regard to the range of motion, with an estimated treatment difference of 9° (95% confidence interval [CI], 3° to 16°; p = 0.007). Similarly, the use of CPM led to a greater range of motion at 6 weeks and 3 months than PT. The percentage of lost motion recovered at 1 year was higher in the CPM group (51%) than in the PT group (36%) (p = 0.01). The probability of restoring a functional range of motion at 1 year was 62% higher in the CPM group than in the PT group (risk ratio for functional range of motion, 1.62; 95% CI, 1.01 to 2.61; p = 0.04). PROM scores were similar in the 2 groups at all time points, except for a difference in the American Shoulder and Elbow Surgeons (ASES) elbow function subscale, in favor of CPM, at 6 weeks. The use of CPM decreased swelling and reduced the loss of flexion strength, flexion endurance, and grip strength on day 3, with no between-group differences thereafter. Conclusions: Among patients undergoing arthroscopic release of elbow contracture, those who received CPM obtained a faster recovery and a greater range of motion at 1 year, with a higher chance of restoration of functional elbow motion than those who underwent routine PT. 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":"33 1","pages":"430 - 440"},"PeriodicalIF":0.0,"publicationDate":"2022-03-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86854824","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：