BACKGROUNDThe aim of our study was to explore the effect of local corticosteroids on dysphagia in patients undergoing anterior cervical discectomy and fusion (ACDF). To address a gap in the limited research on this topic, we utilized high-resolution impedance manometry (HRIM) and the Eating Assessment Tool-10 (EAT-10) questionnaire to assess the effects on key swallowing muscles, including the upper esophageal sphincter (UES).METHODSWe randomly assigned patients undergoing ACDF to either the corticosteroid group or the saline solution group. Patients received 10 mg of local triamcinolone or saline solution prevertebrally at the cervical spine level before wound closure. Swallowing function preoperatively and at 1 month postoperatively were compared between the groups with use of HRIM parameters (e.g., UES relaxation, UES opening extent, intrabolus pressure, and pharyngeal contraction) and EAT-10 scores. Patients were also followed for postoperative complications and mortality within 12 months after surgery.RESULTSThirty patients completed the study. The median age was 55 years in the corticosteroid group and 57 years in the saline group, and each group had 8 female patients. All participants were Taiwanese. We found no significant difference in median preoperative UES relaxation pressure between the corticosteroid and saline solution groups (33.8 and 31.3 mm Hg, respectively; p = 0.54). Postoperatively, the corticosteroid group had significantly lower median UES relaxation pressure than the saline solution group (24.5 versus 33.6 mm Hg; p = 0.01). Before and after surgery, all other HRIM parameters and EAT-10 scores were similar between the groups, with the corticosteroid group demonstrating median pre- and postoperative EAT-10 scores of 0 and 4, respectively, and the saline solution group demonstrating scores of 2 and 3, respectively. There were no adverse events.CONCLUSIONSThe findings suggest that local corticosteroids may reduce UES relaxation pressure at 1 month after ACDF, potentially enhancing UES opening. Further research is required to verify our findings.LEVEL OF EVIDENCETherapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.
{"title":"Corticosteroid Effects on Upper Esophageal Sphincter Function in Anterior Cervical Discectomy and Fusion: A Study Using High-Resolution Impedance Manometry.","authors":"Chih-Jun Lai,Jo-Yu Chen,Jing-Rong Jhuang,Ming-Yen Hsiao,Tyng-Guey Wang,Yu-Chang Yeh,Dar-Ming Lai,Fon-Yih Tsuang","doi":"10.2106/jbjs.24.00084","DOIUrl":"https://doi.org/10.2106/jbjs.24.00084","url":null,"abstract":"BACKGROUNDThe aim of our study was to explore the effect of local corticosteroids on dysphagia in patients undergoing anterior cervical discectomy and fusion (ACDF). To address a gap in the limited research on this topic, we utilized high-resolution impedance manometry (HRIM) and the Eating Assessment Tool-10 (EAT-10) questionnaire to assess the effects on key swallowing muscles, including the upper esophageal sphincter (UES).METHODSWe randomly assigned patients undergoing ACDF to either the corticosteroid group or the saline solution group. Patients received 10 mg of local triamcinolone or saline solution prevertebrally at the cervical spine level before wound closure. Swallowing function preoperatively and at 1 month postoperatively were compared between the groups with use of HRIM parameters (e.g., UES relaxation, UES opening extent, intrabolus pressure, and pharyngeal contraction) and EAT-10 scores. Patients were also followed for postoperative complications and mortality within 12 months after surgery.RESULTSThirty patients completed the study. The median age was 55 years in the corticosteroid group and 57 years in the saline group, and each group had 8 female patients. All participants were Taiwanese. We found no significant difference in median preoperative UES relaxation pressure between the corticosteroid and saline solution groups (33.8 and 31.3 mm Hg, respectively; p = 0.54). Postoperatively, the corticosteroid group had significantly lower median UES relaxation pressure than the saline solution group (24.5 versus 33.6 mm Hg; p = 0.01). Before and after surgery, all other HRIM parameters and EAT-10 scores were similar between the groups, with the corticosteroid group demonstrating median pre- and postoperative EAT-10 scores of 0 and 4, respectively, and the saline solution group demonstrating scores of 2 and 3, respectively. There were no adverse events.CONCLUSIONSThe findings suggest that local corticosteroids may reduce UES relaxation pressure at 1 month after ACDF, potentially enhancing UES opening. Further research is required to verify our findings.LEVEL OF EVIDENCETherapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.","PeriodicalId":22625,"journal":{"name":"The Journal of Bone & Joint Surgery","volume":"97 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142489491","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}
Steven de Reuver,Jelle F Homans,Michiel L Houben,Tom P C Schlösser,Keita Ito,Moyo C Kruyt,René M Castelein
BACKGROUNDScoliosis is a deformation of the spine and trunk that, in its more severe forms, creates a life-long burden of disease and requires intensive treatment. For its most prevalent form, adolescent idiopathic scoliosis, no underlying condition can be defined, and the pathomechanism appears to be multifactorial; however, it has been suggested that the biomechanics of the spine play a role. For nonidiopathic scoliosis, underlying conditions can be recognized, but what drives the deformity remains unclear. In this study, we examined the early sagittal shape of the spine before the onset of scoliosis in a population with 22q11.2 deletion syndrome (22q11.2DS). This cohort was chosen since children with this syndrome have an approximately 50% chance of developing scoliosis that shares certain characteristics with idiopathic scoliosis, namely, age of onset, curve morphology, and rate of progression.METHODSThis prospective cohort study included patients with 22q11.2DS who were followed with the use of spinal radiographs during adolescent growth. All of the children, who initially had no scoliosis while still skeletally immature (Risser stages 0 and 1), were followed at 2-year intervals until they reached skeletal maturity (Risser stages 3 to 5). We assessed the segment of the spine that has previously been shown to be rotationally unstable, the posteriorly inclined segment, to determine if it was predictive of later scoliosis development. For quantification, the area of the "posteriorly inclined triangle" (PIT), a previously described parameter that integrates both the inclination and length of the at-risk segment, was measured.RESULTSOf the 50 children who initially had no scoliosis (mean age at inclusion, 10.7 ± 1.7 years; mean follow-up, 4.8 ± 1.6 years), 24 (48%) developed scoliosis. Patients with an above-average PIT area (>60 cm2) at inclusion showed a relative risk of 2.55 for scoliosis development (95% confidence interval [CI]:1.22 to 5.34). PIT inclination was correlated with curve type: a taller and steeper hypotenuse predicted later thoracic scoliosis, while a shorter and less steep inclination predicted the development of (thoraco)lumbar scoliosis.CONCLUSIONSThis prospective study identified the pre-scoliotic sagittal shape of the spine as a risk factor for the later development of scoliosis in the population of children with 22q11.2DS.LEVEL OF EVIDENCEPrognostic Level II. See Instructions for Authors for a complete description of levels of evidence.
{"title":"Early Sagittal Shape of the Spine Predicts Scoliosis Development in a Syndromic (22q11.2DS) Population: A Prospective Longitudinal Study.","authors":"Steven de Reuver,Jelle F Homans,Michiel L Houben,Tom P C Schlösser,Keita Ito,Moyo C Kruyt,René M Castelein","doi":"10.2106/jbjs.23.01096","DOIUrl":"https://doi.org/10.2106/jbjs.23.01096","url":null,"abstract":"BACKGROUNDScoliosis is a deformation of the spine and trunk that, in its more severe forms, creates a life-long burden of disease and requires intensive treatment. For its most prevalent form, adolescent idiopathic scoliosis, no underlying condition can be defined, and the pathomechanism appears to be multifactorial; however, it has been suggested that the biomechanics of the spine play a role. For nonidiopathic scoliosis, underlying conditions can be recognized, but what drives the deformity remains unclear. In this study, we examined the early sagittal shape of the spine before the onset of scoliosis in a population with 22q11.2 deletion syndrome (22q11.2DS). This cohort was chosen since children with this syndrome have an approximately 50% chance of developing scoliosis that shares certain characteristics with idiopathic scoliosis, namely, age of onset, curve morphology, and rate of progression.METHODSThis prospective cohort study included patients with 22q11.2DS who were followed with the use of spinal radiographs during adolescent growth. All of the children, who initially had no scoliosis while still skeletally immature (Risser stages 0 and 1), were followed at 2-year intervals until they reached skeletal maturity (Risser stages 3 to 5). We assessed the segment of the spine that has previously been shown to be rotationally unstable, the posteriorly inclined segment, to determine if it was predictive of later scoliosis development. For quantification, the area of the \"posteriorly inclined triangle\" (PIT), a previously described parameter that integrates both the inclination and length of the at-risk segment, was measured.RESULTSOf the 50 children who initially had no scoliosis (mean age at inclusion, 10.7 ± 1.7 years; mean follow-up, 4.8 ± 1.6 years), 24 (48%) developed scoliosis. Patients with an above-average PIT area (>60 cm2) at inclusion showed a relative risk of 2.55 for scoliosis development (95% confidence interval [CI]:1.22 to 5.34). PIT inclination was correlated with curve type: a taller and steeper hypotenuse predicted later thoracic scoliosis, while a shorter and less steep inclination predicted the development of (thoraco)lumbar scoliosis.CONCLUSIONSThis prospective study identified the pre-scoliotic sagittal shape of the spine as a risk factor for the later development of scoliosis in the population of children with 22q11.2DS.LEVEL OF EVIDENCEPrognostic Level II. See Instructions for Authors for a complete description of levels of evidence.","PeriodicalId":22625,"journal":{"name":"The Journal of Bone & Joint Surgery","volume":"89 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142488309","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}
Monti Khatod,Priscilla H Chan,Heather A Prentice,Brian H Fasig,Elizabeth W Paxton,Nithin C Reddy,Matthew P Kelly
BACKGROUNDThe increased availability of dual-mobility acetabular constructs (DMCs) provides surgeons with a newer option to increase the effective femoral head size in revision total hip arthroplasty (rTHA). We sought to evaluate risks of re-revision and prosthetic dislocation following rTHA involving a DMC compared with other articulations.METHODSA cohort study was conducted using data from a U.S. integrated health-care system's Total Joint Replacement Registry. Adult patients who underwent primary THA and went on to undergo an aseptic rTHA in 2002 to 2022 were identified. Patients who received a DMC, a constrained liner, or a metal or ceramic unipolar femoral head on highly cross-linked polyethylene (XLPE) at the time of rTHA were the treatment groups. Subsequent aseptic re-revision and dislocation were the outcomes of interest. Multivariable Cox proportional-hazards regression was used to evaluate the risks of the outcomes, with adjustment for patient, operative, and surgeon confounders.RESULTSThe analyzed rTHAs comprised 375 with a DMC, 268 with a constrained liner, 995 with a <36-mm head on XLPE, and 2,087 with a ≥36-mm head on XLPE. DMC utilization increased from 1.0% of rTHAs in 2011 to 21.6% in 2022. In adjusted analyses, a higher re-revision risk was observed for the constrained liner (hazard ratio [HR] = 2.43, 95% confidence interval [CI] = 1.29 to 4.59), <36 mm on XLPE (HR = 2.05, 95% CI = 1.13 to 3.75), and ≥36 mm on XLPE (HR = 2.03, 95% CI = 1.19 to 3.48) groups compared with the DMC group. A higher dislocation risk was observed in both XLPE groups (<36 mm: HR = 2.04, 95% CI = 1.33 to 3.14; ≥36 mm: HR = 2.46, 95% CI = 1.69 to 3.57) compared with the DMC group; a nonsignificant trend toward a higher dislocation rate in the group with a constrained liner than in the DMC group was also observed.CONCLUSIONSIn a large U.S.-based cohort, rTHAs using DMCs had the lowest re-revision risk and dislocation risk. Both outcomes were significantly lower than those using a unipolar femoral head on XLPE, re-revision risk was significantly lower than using a constrained liner, and dislocation risk trended toward a lower risk than using a constrained liner.LEVEL OF EVIDENCETherapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
{"title":"Dual-Mobility Articulations in Revision Total Hip Arthroplasty: A Comparison with Metal or Ceramic on Highly Cross-Linked Polyethylene and Constrained Articulations.","authors":"Monti Khatod,Priscilla H Chan,Heather A Prentice,Brian H Fasig,Elizabeth W Paxton,Nithin C Reddy,Matthew P Kelly","doi":"10.2106/jbjs.24.00168","DOIUrl":"https://doi.org/10.2106/jbjs.24.00168","url":null,"abstract":"BACKGROUNDThe increased availability of dual-mobility acetabular constructs (DMCs) provides surgeons with a newer option to increase the effective femoral head size in revision total hip arthroplasty (rTHA). We sought to evaluate risks of re-revision and prosthetic dislocation following rTHA involving a DMC compared with other articulations.METHODSA cohort study was conducted using data from a U.S. integrated health-care system's Total Joint Replacement Registry. Adult patients who underwent primary THA and went on to undergo an aseptic rTHA in 2002 to 2022 were identified. Patients who received a DMC, a constrained liner, or a metal or ceramic unipolar femoral head on highly cross-linked polyethylene (XLPE) at the time of rTHA were the treatment groups. Subsequent aseptic re-revision and dislocation were the outcomes of interest. Multivariable Cox proportional-hazards regression was used to evaluate the risks of the outcomes, with adjustment for patient, operative, and surgeon confounders.RESULTSThe analyzed rTHAs comprised 375 with a DMC, 268 with a constrained liner, 995 with a <36-mm head on XLPE, and 2,087 with a ≥36-mm head on XLPE. DMC utilization increased from 1.0% of rTHAs in 2011 to 21.6% in 2022. In adjusted analyses, a higher re-revision risk was observed for the constrained liner (hazard ratio [HR] = 2.43, 95% confidence interval [CI] = 1.29 to 4.59), <36 mm on XLPE (HR = 2.05, 95% CI = 1.13 to 3.75), and ≥36 mm on XLPE (HR = 2.03, 95% CI = 1.19 to 3.48) groups compared with the DMC group. A higher dislocation risk was observed in both XLPE groups (<36 mm: HR = 2.04, 95% CI = 1.33 to 3.14; ≥36 mm: HR = 2.46, 95% CI = 1.69 to 3.57) compared with the DMC group; a nonsignificant trend toward a higher dislocation rate in the group with a constrained liner than in the DMC group was also observed.CONCLUSIONSIn a large U.S.-based cohort, rTHAs using DMCs had the lowest re-revision risk and dislocation risk. Both outcomes were significantly lower than those using a unipolar femoral head on XLPE, re-revision risk was significantly lower than using a constrained liner, and dislocation risk trended toward a lower risk than using a constrained liner.LEVEL OF EVIDENCETherapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.","PeriodicalId":22625,"journal":{"name":"The Journal of Bone & Joint Surgery","volume":"77 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142449338","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}
{"title":"To Provide Care, or to Care for?: The Influence of Language on Medicine.","authors":"Anna L Park,Louise Aronson,Mohammad Diab","doi":"10.2106/jbjs.23.01051","DOIUrl":"https://doi.org/10.2106/jbjs.23.01051","url":null,"abstract":"","PeriodicalId":22625,"journal":{"name":"The Journal of Bone & Joint Surgery","volume":"25 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142449339","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}
BACKGROUNDThis study aimed to determine the acetabular position to optimize hip biomechanics after transposition osteotomy of the acetabulum (TOA), a specific form of periacetabular osteotomy, in patients with hip dysplasia.METHODSWe created patient-specific finite-element models of 46 patients with hip dysplasia to simulate 12 virtual TOA scenarios: lateral rotation to achieve a lateral center-edge angle (LCEA) of 30°, 35°, and 40° combined with anterior rotation of 0°, 5°, 10°, and 15°. Joint contact pressure (CP) on the acetabular cartilage during a single-leg stance and simulated hip range of motion without osseous impingement were calculated. The optimal acetabular position was defined as satisfying both normal joint CP and the required range of motion for activities of daily living. Multivariable logistic regression analysis was used to identify preoperative morphological predictors of osseous impingement after virtual TOA with adequate acetabular correction.RESULTSThe prevalence of hips in the optimal position was highest (65.2%) at an LCEA of 30°, regardless of the amount of anterior rotation. While the acetabular position minimizing peak CP varied among patients, approximately 80% exhibited normalized peak CP at an LCEA of 30° and 35° with 15° of anterior rotation, which were the 2 most favorable configurations among the 12 simulated scenarios. In this context, the preoperative head-neck offset ratio (HNOR) at the 1:30 clock position (p = 0.018) was an independent predictor of postoperative osseous impingement within the required range of motion. Specifically, an HNOR of <0.14 at the 1:30 clock position predicted limitation of required range of motion after virtual TOA (sensitivity, 57%; specificity, 81%; and area under the receiver operating characteristic curve, 0.70).CONCLUSIONSAcetabular reorientation to an LCEA of between 30° and 35° with an additional 15° of anterior rotation may serve as a biomechanics-based target zone for surgeons performing TOA in most patients with hip dysplasia. However, patients with a reduced HNOR at the 1:30 clock position may experience limited range of motion in activities of daily living postoperatively.CLINICAL RELEVANCEThis study provides a biomechanics-based target for refining acetabular reorientation strategies during TOA while considering morphological factors that may limit the required range of motion.
{"title":"A Computer Modeling-Based Target Zone for Transposition Osteotomy of the Acetabulum in Patients with Hip Dysplasia.","authors":"Kenji Kitamura,Masanori Fujii,Goro Motomura,Satoshi Hamai,Shinya Kawahara,Taishi Sato,Ryosuke Yamaguchi,Daisuke Hara,Takeshi Utsunomiya,Yasuharu Nakashima","doi":"10.2106/jbjs.23.01132","DOIUrl":"https://doi.org/10.2106/jbjs.23.01132","url":null,"abstract":"BACKGROUNDThis study aimed to determine the acetabular position to optimize hip biomechanics after transposition osteotomy of the acetabulum (TOA), a specific form of periacetabular osteotomy, in patients with hip dysplasia.METHODSWe created patient-specific finite-element models of 46 patients with hip dysplasia to simulate 12 virtual TOA scenarios: lateral rotation to achieve a lateral center-edge angle (LCEA) of 30°, 35°, and 40° combined with anterior rotation of 0°, 5°, 10°, and 15°. Joint contact pressure (CP) on the acetabular cartilage during a single-leg stance and simulated hip range of motion without osseous impingement were calculated. The optimal acetabular position was defined as satisfying both normal joint CP and the required range of motion for activities of daily living. Multivariable logistic regression analysis was used to identify preoperative morphological predictors of osseous impingement after virtual TOA with adequate acetabular correction.RESULTSThe prevalence of hips in the optimal position was highest (65.2%) at an LCEA of 30°, regardless of the amount of anterior rotation. While the acetabular position minimizing peak CP varied among patients, approximately 80% exhibited normalized peak CP at an LCEA of 30° and 35° with 15° of anterior rotation, which were the 2 most favorable configurations among the 12 simulated scenarios. In this context, the preoperative head-neck offset ratio (HNOR) at the 1:30 clock position (p = 0.018) was an independent predictor of postoperative osseous impingement within the required range of motion. Specifically, an HNOR of <0.14 at the 1:30 clock position predicted limitation of required range of motion after virtual TOA (sensitivity, 57%; specificity, 81%; and area under the receiver operating characteristic curve, 0.70).CONCLUSIONSAcetabular reorientation to an LCEA of between 30° and 35° with an additional 15° of anterior rotation may serve as a biomechanics-based target zone for surgeons performing TOA in most patients with hip dysplasia. However, patients with a reduced HNOR at the 1:30 clock position may experience limited range of motion in activities of daily living postoperatively.CLINICAL RELEVANCEThis study provides a biomechanics-based target for refining acetabular reorientation strategies during TOA while considering morphological factors that may limit the required range of motion.","PeriodicalId":22625,"journal":{"name":"The Journal of Bone & Joint Surgery","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142449340","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}
David N Bernstein,Robert Kaspar Wagner,Jacob S Borgida,Mitchel B Harris,Thuan V Ly
{"title":"What's Important: Moving Orthopaedic Patient Care Forward: Tips for Successful Systems Improvement.","authors":"David N Bernstein,Robert Kaspar Wagner,Jacob S Borgida,Mitchel B Harris,Thuan V Ly","doi":"10.2106/jbjs.24.00698","DOIUrl":"https://doi.org/10.2106/jbjs.24.00698","url":null,"abstract":"","PeriodicalId":22625,"journal":{"name":"The Journal of Bone & Joint Surgery","volume":"218 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142329266","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}
Young-Hoo Kim,Jang-Won Park,Young-Soo Jang,Eun-Jung Kim
BACKGROUNDMany authors and the data of multiple registries have suggested that the use of posterior cruciate-substituting (posterior stabilized [PS]) total knee arthroplasty (TKA) leads to a higher risk of revision compared with the use of posterior cruciate-retaining (CR) TKA. The aim of the present prospective, randomized, long-term study was to compare PS and CR TKA with regard to the clinical, radiographic, and computed tomography (CT) results; the prevalence of osteolysis; revision rate; and survivorship.METHODSThis study included a consecutive series of 300 patients (mean age [and standard deviation], 63.6 ± 6 years) who underwent simultaneous, bilateral TKA in the same anesthetic session. Each patient received a NexGen CR-Flex prosthesis on 1 side and a NexGen LPS-Flex prosthesis on the contralateral side. The mean follow-up period was 18 years (range, 17.5 to 19.5 years).RESULTSThere were no significant differences between the NexGen CR and LPS-Flex TKA groups at the latest follow-up with regard to the mean Knee Society knee score (93 versus 92 points, respectively); the Western Ontario and McMaster Universities Osteoarthritis Index score (19.1 points for both); the University of California Los Angeles activity score (6.1 points for both); range of motion (125° ± 6.1° versus 126° ± 6.5°); radiographic and CT results; and revision rate (6.0% versus 6.3%). No knee had osteolysis. The estimated survival rate at 19.5 years was 94% (95% confidence interval [CI], 91% to 100%) for the NexGen CR-Flex prosthesis and 93.7% (95% CI, 91% to 100%) for the LPS-Flex prosthesis, with revision or aseptic loosening as the end point.CONCLUSIONSThe findings of the present, long-term (minimum follow-up of 17.5 years) clinical study showed that NexGen CR-Flex and NexGen LPS-Flex implants produced excellent clinical and radiographic results. There was no notable clinical advantage of a NexGen CR-Flex implant over a NexGen LPS-Flex implant.LEVEL OF EVIDENCETherapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.
{"title":"No Discernible Difference in Revision Rate or Survivorship Between Posterior Cruciate-Retaining and Posterior Cruciate-Substituting TKA.","authors":"Young-Hoo Kim,Jang-Won Park,Young-Soo Jang,Eun-Jung Kim","doi":"10.2106/jbjs.24.00007","DOIUrl":"https://doi.org/10.2106/jbjs.24.00007","url":null,"abstract":"BACKGROUNDMany authors and the data of multiple registries have suggested that the use of posterior cruciate-substituting (posterior stabilized [PS]) total knee arthroplasty (TKA) leads to a higher risk of revision compared with the use of posterior cruciate-retaining (CR) TKA. The aim of the present prospective, randomized, long-term study was to compare PS and CR TKA with regard to the clinical, radiographic, and computed tomography (CT) results; the prevalence of osteolysis; revision rate; and survivorship.METHODSThis study included a consecutive series of 300 patients (mean age [and standard deviation], 63.6 ± 6 years) who underwent simultaneous, bilateral TKA in the same anesthetic session. Each patient received a NexGen CR-Flex prosthesis on 1 side and a NexGen LPS-Flex prosthesis on the contralateral side. The mean follow-up period was 18 years (range, 17.5 to 19.5 years).RESULTSThere were no significant differences between the NexGen CR and LPS-Flex TKA groups at the latest follow-up with regard to the mean Knee Society knee score (93 versus 92 points, respectively); the Western Ontario and McMaster Universities Osteoarthritis Index score (19.1 points for both); the University of California Los Angeles activity score (6.1 points for both); range of motion (125° ± 6.1° versus 126° ± 6.5°); radiographic and CT results; and revision rate (6.0% versus 6.3%). No knee had osteolysis. The estimated survival rate at 19.5 years was 94% (95% confidence interval [CI], 91% to 100%) for the NexGen CR-Flex prosthesis and 93.7% (95% CI, 91% to 100%) for the LPS-Flex prosthesis, with revision or aseptic loosening as the end point.CONCLUSIONSThe findings of the present, long-term (minimum follow-up of 17.5 years) clinical study showed that NexGen CR-Flex and NexGen LPS-Flex implants produced excellent clinical and radiographic results. There was no notable clinical advantage of a NexGen CR-Flex implant over a NexGen LPS-Flex implant.LEVEL OF EVIDENCETherapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.","PeriodicalId":22625,"journal":{"name":"The Journal of Bone & Joint Surgery","volume":"22 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142329267","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}
➢ Sex-based differences are understudied, which has potential consequences for the health of everyone.➢ Women's health is particularly affected given a lack of sex-specific data across many disease states.➢ Journals do not consistently require the inclusion of both sexes and the disaggregation of data by sex in cell, animal model, and human studies.➢ Instructions for investigators and journals regarding the inclusion of sex-specific data are found in guidelines such as those by the Sex and Gender Equity in Research (SAGER) group, but these guidelines are underutilized.➢ Consistency in the inclusion of both sexes in studies (except in studies on diseases affecting only 1 sex), as well as in the disaggregation and reporting of results by sex, has the potential to improve health for all people.
{"title":"Review of the Influences of Sex Differences on Health and Disease: What Is the Role of Journals?","authors":"Judith G Regensteiner,Kimberly Templeton","doi":"10.2106/jbjs.24.00297","DOIUrl":"https://doi.org/10.2106/jbjs.24.00297","url":null,"abstract":"➢ Sex-based differences are understudied, which has potential consequences for the health of everyone.➢ Women's health is particularly affected given a lack of sex-specific data across many disease states.➢ Journals do not consistently require the inclusion of both sexes and the disaggregation of data by sex in cell, animal model, and human studies.➢ Instructions for investigators and journals regarding the inclusion of sex-specific data are found in guidelines such as those by the Sex and Gender Equity in Research (SAGER) group, but these guidelines are underutilized.➢ Consistency in the inclusion of both sexes in studies (except in studies on diseases affecting only 1 sex), as well as in the disaggregation and reporting of results by sex, has the potential to improve health for all people.","PeriodicalId":22625,"journal":{"name":"The Journal of Bone & Joint Surgery","volume":"53 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142328903","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}
{"title":"What's Important: Breaking Bread Together, Finding an Extracurricular Pursuit.","authors":"Stephen P Maier","doi":"10.2106/jbjs.24.00718","DOIUrl":"https://doi.org/10.2106/jbjs.24.00718","url":null,"abstract":"","PeriodicalId":22625,"journal":{"name":"The Journal of Bone & Joint Surgery","volume":"45 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142328897","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}
Rebecca J Schultz,Jason Z Amaral,Matthew J Parham,Raymond L Kitziger,Tiffany M Lee,Scott D McKay,Basel M Touban
BACKGROUNDTibial tubercle fractures (TTFs) are uncommon injuries, comprising <3% of all proximal tibial fractures. These fractures occasionally occur in conjunction with a patellar tendon injury (PTI). We aimed to identify risk factors associated with combined TTF and PTI.METHODSA retrospective review was performed of patients presenting to a single, tertiary children's hospital with TTF between 2012 and 2023. Demographic data, operative details, radiographs, and injury patterns were analyzed. Radiographs were assessed for the epiphyseal union stage (EUS), Ogden classification, and fracture patterns. Multiple logistic regression models were used to assess the impact of body mass index, comminution, fracture fragment rotation, EUS, bilateral injury, and Ogden classification on injury type.RESULTSWe identified 262 fractures in 252 patients (mean age, 13.9 ± 1.31 years). Of the patients, 6% were female and 48% were Black. Of the 262 fractures, 228 (87%) were isolated TTFs and 34 (13%) were TTFs with PTI. Multivariable analysis demonstrated fragment rotation on lateral radiographs (p < 0.0001) and Ogden Type-I classification (p < 0.0001) to be the most predictive risk factors for a combined injury. Rotation was associated with a substantial increase in the odds of a combined injury, with an odds ratio of 22.1 (95% confidence interval [CI], 6.1 to 80.1). Ogden Type-I fracture was another significant risk factor, with an odds ratio of 10.2 (95% CI, 3.4 to 30.4).CONCLUSIONSThe Ogden classification and fragment rotation are the most useful features for distinguishing between isolated TTF and combined TTF with PTI. This is the first study to identify risk factors for TTF combined with PTI. Surgeons may use this information to aid in preoperative planning.LEVEL OF EVIDENCEDiagnostic Level III. See Instructions for Authors for a complete description of levels of evidence.
{"title":"Sagittal Fragment Rotation and Ogden Type-I Classification Are Hallmarks of Combined Tibial Tubercle Fracture and Patellar Tendon Injury.","authors":"Rebecca J Schultz,Jason Z Amaral,Matthew J Parham,Raymond L Kitziger,Tiffany M Lee,Scott D McKay,Basel M Touban","doi":"10.2106/jbjs.24.00300","DOIUrl":"https://doi.org/10.2106/jbjs.24.00300","url":null,"abstract":"BACKGROUNDTibial tubercle fractures (TTFs) are uncommon injuries, comprising <3% of all proximal tibial fractures. These fractures occasionally occur in conjunction with a patellar tendon injury (PTI). We aimed to identify risk factors associated with combined TTF and PTI.METHODSA retrospective review was performed of patients presenting to a single, tertiary children's hospital with TTF between 2012 and 2023. Demographic data, operative details, radiographs, and injury patterns were analyzed. Radiographs were assessed for the epiphyseal union stage (EUS), Ogden classification, and fracture patterns. Multiple logistic regression models were used to assess the impact of body mass index, comminution, fracture fragment rotation, EUS, bilateral injury, and Ogden classification on injury type.RESULTSWe identified 262 fractures in 252 patients (mean age, 13.9 ± 1.31 years). Of the patients, 6% were female and 48% were Black. Of the 262 fractures, 228 (87%) were isolated TTFs and 34 (13%) were TTFs with PTI. Multivariable analysis demonstrated fragment rotation on lateral radiographs (p < 0.0001) and Ogden Type-I classification (p < 0.0001) to be the most predictive risk factors for a combined injury. Rotation was associated with a substantial increase in the odds of a combined injury, with an odds ratio of 22.1 (95% confidence interval [CI], 6.1 to 80.1). Ogden Type-I fracture was another significant risk factor, with an odds ratio of 10.2 (95% CI, 3.4 to 30.4).CONCLUSIONSThe Ogden classification and fragment rotation are the most useful features for distinguishing between isolated TTF and combined TTF with PTI. This is the first study to identify risk factors for TTF combined with PTI. Surgeons may use this information to aid in preoperative planning.LEVEL OF EVIDENCEDiagnostic Level III. See Instructions for Authors for a complete description of levels of evidence.","PeriodicalId":22625,"journal":{"name":"The Journal of Bone & Joint Surgery","volume":"85 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142328899","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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