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Do Half of Orthopaedic Surgeons Change Jobs within Their First 2 Years?: An Analysis Using the American Board of Orthopaedic Surgery Database. 是否有半数矫形外科医生在头两年内换了工作?利用美国矫形外科委员会数据库进行的分析。
Pub Date : 2024-09-26 DOI: 10.2106/jbjs.24.00040
Jonathan D McKeeman,Dustin A Greenhill,Akhil Sharma,John J Harrast,David F Martin,Douglas W Lundy
BACKGROUNDThe claim that "50% of orthopaedic surgeons leave their first job within 2 years" did not originate from evidence. The purpose of this study was to investigate practice change rates among board- eligible orthopaedic surgeons using the American Board of Orthopaedic Surgery (ABOS) database.METHODSWe utilized information provided by orthopaedic surgeons taking the ABOS Part II Examination across 6 different years. Surgeons who trained outside of the United States and members of the uniformed services of the U.S. were excluded. Move rates within 2 years of starting practice and before the candidate's Part II examination were determined. All surgeons were then subcategorized as having followed a traditional or nontraditional certification timeline based on whether they took Part II of the examination within 2 practice years after becoming board-eligible. Candidate-specific variables were analyzed according to whether the surgeon did or did not change practices.RESULTSAmong 3,784 orthopaedic surgeons, 215 (5.7%) left their first practice within 2 years. On average, candidates sat for the Part II examination at a mean (and standard deviation) of 2.1 ± 1.1 years (range, 0.7 to 31.9 years) after reporting their first practice location. Seventy-six percent of surgeons took the Part II examination within a traditional timeframe. On average, nontraditional candidates left their first practice at a significantly higher rate than traditional candidates (20.5% versus 1.3%; p < 0.001), changed practices more often (1.5 versus 1.2 moves; p = 0.021), and moved farther (500.1 versus 304.4 miles; p = 0.023). Fellowship training and/or Part II examination subspecialty were not strongly associated with a surgeon leaving his or her first practice.CONCLUSIONSWhile it is possible that >5.7% of orthopaedic surgeons leave their first job during their early career, it is unlikely that many relocate within 2 years. This is especially true among orthopaedic surgeons pursuing ABOS certification within a traditional timeframe.
背景 "50% 的矫形外科医生会在两年内离开他们的第一份工作 "这一说法并非有据可依。本研究的目的是利用美国骨科外科学委员会(ABOS)数据库调查符合委员会资格的骨科医生的执业变动率。方法我们利用了参加 ABOS 第二部分考试的骨科医生在 6 个不同年份提供的信息。不包括在美国境外接受培训的外科医生和美国军警人员。确定了候选人开始执业后两年内和参加第二部分考试前的流动率。然后,根据所有外科医生是否在获得执业资格后的 2 年内参加了第二部分考试,将他们细分为遵循传统或非传统认证时间表的外科医生。结果在 3784 名骨科外科医生中,有 215 人(5.7%)在两年内离开了他们的第一家诊所。考生参加第二部分考试的平均年龄(和标准差)为 2.1 ± 1.1 年(范围为 0.7 至 31.9 年),这与他们首次执业的地点有关。76%的外科医生在传统时间内参加了第二部分考试。平均而言,非传统考生离开首次执业地点的比例明显高于传统考生(20.5% 对 1.3%;p < 0.001),更换执业地点的频率更高(1.5 次对 1.2 次;p = 0.021),搬得更远(500.1 英里对 304.4 英里;p = 0.023)。研究员培训和/或第二部分考试的亚专科与外科医生离开其第一份工作的关系不大。结论虽然可能有超过 5.7% 的骨科医生在其职业生涯早期离开其第一份工作,但不可能有很多人在 2 年内搬迁。在传统时间框架内申请 ABOS 认证的骨科医生尤其如此。
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引用次数: 0
What's Important: Equitable Orthopaedic Care for Patients with Disabilities. 重要的是:为残疾患者提供公平的矫形护理。
Pub Date : 2024-09-26 DOI: 10.2106/jbjs.24.00470
Uma Balachandran,Brocha Z Stern
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引用次数: 0
Association of Technology Usage and Decreased Revision TKA Rates for Low-Volume Surgeons Using an Optimal Prosthesis Combination: An Analysis of 53,264 Primary TKAs. 使用最佳假体组合的低手术量外科医生的技术使用与 TKA 翻修率降低的关系:对53,264例初次TKA的分析。
Pub Date : 2024-09-26 DOI: 10.2106/jbjs.24.00539
Michael McAuliffe,Ibrahim Darwish,Jon Anderson,Alex Nicholls,Sophie Corfield,Dylan Harries,Christopher Vertullo
BACKGROUNDTechnology (navigation and robotics) usage during total knee arthroplasty (TKA) is often supported by literature involving high-volume surgeons and hospitals, but the value of technology for lower-volume surgeons is uncertain. This study aimed to determine if there was a relationship among surgeon volume, technology usage, and revision rate when using an optimal prosthesis combination (OPC).METHODSAustralian Orthopaedic Association National Joint Replacement Registry (AOANJRR) data were obtained from January 1, 2008, to December 31, 2022, for all primary TKA procedures performed for osteoarthritis using an OPC by a known surgeon ≥5 years after their first recorded procedure. The interaction between surgeon volume and conventional-instrumentation (CV) versus technology-assisted (TA) TKA was assessed. The cumulative percent revision (CPR) was determined by Kaplan-Meier estimates. Cox proportional-hazards methods were used to compare rates of revision by surgeon volume and by the interaction of volume and technology. Subanalyses were undertaken to examine major and minor revisions separately, and to assess the influence of technology on revision rates relative to those of a surgeon undertaking 100 TKA/year.RESULTSOf the 53,264 procedures that met the inclusion criteria, 31,536 were TA-TKA and 21,728 were CV-TKA. Use of technology reduced the all-cause revision rate for surgeons with a volume of <50 TKA/year and the rate of minor revisions for surgeons with a volume of <40 TKA/year. No interaction between surgeon volume and the rate of major revision surgery was found. With CV-TKA by a surgeon with a 100-TKA/year volume as the comparator, all-cause and major revision rates were significantly elevated for surgeons undertaking <50 and <100 TKA/year, respectively. In contrast, analysis of TA-TKA showed no difference in rates of all-cause or major revisions for surgeons undertaking <100 TKA/year compared with 100 TKA/year.CONCLUSIONSTA-TKA was associated with a decrease in the revision rate for lower-volume surgeons but no significant alterations in revision rate for higher-volume surgeons. Preferential use of TA-TKA by lower-volume surgeons should be considered.LEVEL OF EVIDENCETherapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
背景在全膝关节置换术(TKA)中使用技术(导航和机器人技术)通常得到高产量外科医生和医院文献的支持,但技术对低产量外科医生的价值还不确定。本研究旨在确定在使用最佳假体组合(OPC)时,外科医生的工作量、技术使用率和翻修率之间是否存在关系。方法从2008年1月1日到2022年12月31日,获得了澳大利亚矫形外科协会国家关节置换登记处(AOANJRR)的数据,这些数据是由已知的外科医生在首次记录手术后≥5年使用OPC为骨关节炎进行的所有初级TKA手术。评估了外科医生数量和传统器械(CV)与技术辅助(TA)TKA 之间的交互作用。通过 Kaplan-Meier 估计确定了累计翻修率 (CPR)。采用 Cox 比例危险度法比较不同外科医生手术量以及手术量与技术的交互作用所导致的翻修率。还进行了子分析,分别研究了大修率和小修率,并评估了相对于每年进行100例TKA的外科医生而言,技术对修补率的影响。结果 在符合纳入标准的53264例手术中,31536例为TA-TKA,21728例为CV-TKA。使用技术降低了年手术量小于50例TKA的外科医生的全因翻修率,降低了年手术量小于40例TKA的外科医生的轻微翻修率。外科医生的工作量与主要翻修手术率之间没有交互作用。以手术量为100 TKA/年的外科医生进行的CV-TKA为比较对象,手术量<50 TKA/年和<100 TKA/年的外科医生的全因翻修率和重大翻修率分别显著升高。与此相反,对TA-TKA的分析表明,承担<100 TKA/年的外科医生与承担100 TKA/年的外科医生相比,在全因和主要翻修率方面没有差异。结论STA-TKA与低手术量外科医生的翻修率下降有关,但与高手术量外科医生的翻修率没有明显变化有关。应考虑让工作量较少的外科医生优先使用TA-TKA。有关证据等级的完整描述,请参阅 "作者须知"。
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引用次数: 0
Short-Term Complications of Arthroscopic Bristow or Latarjet Procedure with Screw Versus Suture-Button Fixation: A Prospective Study of 308 Consecutive Cases by a Single Surgeon. 采用螺钉固定与缝线扣固定的关节镜 Bristow 或 Latarjet 手术的短期并发症:一位外科医生对 308 例连续病例的前瞻性研究。
Pub Date : 2024-09-26 DOI: 10.2106/jbjs.23.00390
Zhenxing Shao,Yanfang Jiang,Qingfa Song,Hangle Wang,Hao Luo,Xu Cheng,Guoqing Cui
BACKGROUNDThis study aimed to investigate the short-term complications (minimum 1-year follow-up) after either an arthroscopic Bristow or Latarjet procedure for anterior shoulder instability utilizing screw or suture-button fixation.METHODSPatients undergoing arthroscopic Bristow or Latarjet procedures between November 2016 and April 2021 were enrolled. Data were collected at baseline, 3 months, 6 months, and every year after surgery. Risks of postoperative complications and unplanned reoperations were assessed. A multivariable regression model was used to identify risk factors for complications and to determine the association of complications with patient-reported outcomes.RESULTSA total of 412 patients (425 shoulders) undergoing arthroscopic Bristow or Latarjet procedures performed by a single surgeon between November 2016 and April 2021 were reviewed. Two hundred and ninety-nine patients (308 shoulders, 76.2% of 404 eligible) with a mean follow-up of 22.3 ± 4.2 months were included for analysis. Two hundred and sixty-nine shoulders (87.3%) underwent a Bristow procedure (165 with screw and 104 with suture-button fixation), while 39 (12.7%) underwent a Latarjet procedure (18 with screw and 21 with suture-button fixation). Eighty-two patients (83 shoulders) reported a total of 85 complications within 2 years after surgery, with an overall complication rate of 26.9%. The rates of recurrent dislocation or subluxation and infection were 1.9% and 0.6%, respectively, while a total of 4 (1.3%) of the shoulders had unplanned reoperations. The most common complications were graft-related (11.7%), followed by complications involving neurologic symptoms (10.7%). The overall, graft, and neurologic complication rates following Bristow or Latarjet procedures were 27.1% versus 25.6%, 12.3% versus 7.7%, and 10.0% versus 15.4%, respectively. Compared with the Bristow technique with screw fixation, Bristow with suture-button fixation yielded a lower risk of any complications (odds ratio [OR], 0.55; p = 0.04). Paying with rural insurance and poor sleep quality prior to surgery were associated with increased risk of any complications.CONCLUSIONSCompared with arthroscopic Bristow procedures with screw fixation, Bristow procedures with suture-button fixation resulted in a lower overall complication risk. Both patient demographic and implant-specific factors were associated with the development of a complication.LEVEL OF EVIDENCETherapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.
背景本研究旨在调查使用螺钉或缝合扣固定治疗肩关节前侧不稳定的关节镜 Bristow 或 Latarjet 术后的短期并发症(至少随访 1 年)。方法纳入了 2016 年 11 月至 2021 年 4 月间接受关节镜 Bristow 或 Latarjet 术的患者。收集基线、术后 3 个月、6 个月和每年的数据。评估了术后并发症和计划外再次手术的风险。结果在2016年11月至2021年4月期间,共有412名患者(425个肩关节)接受了由一名外科医生实施的关节镜布里斯托或Latarjet手术。纳入分析的患者有 299 人(308 个肩关节,占符合条件的 404 人的 76.2%),平均随访时间为 22.3 ± 4.2 个月。269 例肩关节患者(87.3%)接受了布里斯托手术(165 例采用螺钉固定,104 例采用缝合扣固定),39 例患者(12.7%)接受了拉塔杰特手术(18 例采用螺钉固定,21 例采用缝合扣固定)。82名患者(83个肩关节)在术后两年内共报告了85例并发症,总并发症发生率为26.9%。复发性脱位或半脱位和感染的发生率分别为1.9%和0.6%,共有4例(1.3%)肩关节患者进行了计划外再手术。最常见的并发症是移植物相关并发症(11.7%),其次是神经症状并发症(10.7%)。Bristow或Latarjet手术后的总体、移植物和神经系统并发症发生率分别为27.1%对25.6%、12.3%对7.7%和10.0%对15.4%。与使用螺钉固定的布里斯托技术相比,使用缝合扣固定的布里斯托技术出现任何并发症的风险较低(几率比 [OR],0.55;P = 0.04)。结论与使用螺钉固定的关节镜布里斯托手术相比,使用缝合扣固定的布里斯托手术的总体并发症风险较低。患者人口统计学因素和植入物特异性因素都与并发症的发生有关。有关证据等级的完整描述,请参阅 "作者须知"。
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引用次数: 0
Relationship of Fracture Morphological Characteristics with Posterolateral Corner Injuries in Hyperextension Varus Tibial Plateau Fractures. 胫骨平台过伸性变位骨折的骨折形态特征与后外侧角损伤的关系
Pub Date : 2024-09-25 DOI: 10.2106/jbjs.23.01274
Binghao Wang,Teng Ye,Binbin Zhang,Yukai Wang,Yi Zhu,Congfeng Luo
BACKGROUNDHyperextension varus tibial plateau fracture (HVTPF) is known to present with concomitant injuries to the posterolateral corner (PLC). However, the exact rate and characteristics of these injuries remain unclear. The primary objective of this study was to explore the rate and characteristics of PLC injuries in HVTPFs. The secondary objective was to investigate the relationship between the fracture morphological features and the associated PLC injuries.METHODSPatients with HVTPFs were subdivided into 2 groups: group I (without fracture of the posterior column cortex) and group II (with fracture of the posterior column cortex). Fracture characteristics were summarized qualitatively based on fracture maps and quantitatively based on the counts of morphological parameters. Knee ligamentous and meniscal injuries were assessed using magnetic resonance imaging. The association between fracture characteristics and PLC injuries was analyzed.RESULTSWe included a total of 50 patients with HVTPFs in our study: 28 in group I and 22 in group II. The rate of PLC injuries was 28.6% in group I and 27.3% in group II. In group I, patients with PLC injuries showed fracture lines closer to the anterior rim of the medial plateau and had smaller fracture areas. Furthermore, 6 of the 8 patients with PLC injuries in group I also had posterior cruciate ligament injuries.CONCLUSIONSThe rate of PLC injuries is relatively high in HVTPFs. In HVTPFs without fracture of the posterior column cortex, a small fracture area strongly suggests an accompanying PLC injury, and PLC injury is frequently combined with posterior cruciate ligament injury.LEVEL OF EVIDENCEPrognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
背景过伸性胫骨平台外翻骨折(HVTPF)可伴有胫骨后外侧角(PLC)损伤。然而,这些损伤的确切发生率和特征仍不清楚。本研究的主要目的是探讨 HVTPF 中 PLC 损伤的发生率和特征。方法将 HVTPF 患者分为两组:I 组(柱后皮质无骨折)和 II 组(柱后皮质有骨折)。根据骨折图定性总结骨折特征,根据形态学参数计数定量总结骨折特征。膝关节韧带和半月板损伤通过磁共振成像进行评估。结果我们共纳入了 50 例 HVTPFs 患者:I 组 28 例,II 组 22 例。第一组 PLC 损伤率为 28.6%,第二组为 27.3%。在第一组中,PLC损伤患者的骨折线更靠近内侧平台前缘,骨折面积更小。此外,在第一组的8名PLC损伤患者中,有6名患者还伴有后交叉韧带损伤。在没有后柱皮质骨折的 HVTPF 中,小面积骨折强烈提示伴有 PLC 损伤,并且 PLC 损伤经常与后交叉韧带损伤合并存在。有关证据等级的完整描述,请参阅 "作者须知"。
{"title":"Relationship of Fracture Morphological Characteristics with Posterolateral Corner Injuries in Hyperextension Varus Tibial Plateau Fractures.","authors":"Binghao Wang,Teng Ye,Binbin Zhang,Yukai Wang,Yi Zhu,Congfeng Luo","doi":"10.2106/jbjs.23.01274","DOIUrl":"https://doi.org/10.2106/jbjs.23.01274","url":null,"abstract":"BACKGROUNDHyperextension varus tibial plateau fracture (HVTPF) is known to present with concomitant injuries to the posterolateral corner (PLC). However, the exact rate and characteristics of these injuries remain unclear. The primary objective of this study was to explore the rate and characteristics of PLC injuries in HVTPFs. The secondary objective was to investigate the relationship between the fracture morphological features and the associated PLC injuries.METHODSPatients with HVTPFs were subdivided into 2 groups: group I (without fracture of the posterior column cortex) and group II (with fracture of the posterior column cortex). Fracture characteristics were summarized qualitatively based on fracture maps and quantitatively based on the counts of morphological parameters. Knee ligamentous and meniscal injuries were assessed using magnetic resonance imaging. The association between fracture characteristics and PLC injuries was analyzed.RESULTSWe included a total of 50 patients with HVTPFs in our study: 28 in group I and 22 in group II. The rate of PLC injuries was 28.6% in group I and 27.3% in group II. In group I, patients with PLC injuries showed fracture lines closer to the anterior rim of the medial plateau and had smaller fracture areas. Furthermore, 6 of the 8 patients with PLC injuries in group I also had posterior cruciate ligament injuries.CONCLUSIONSThe rate of PLC injuries is relatively high in HVTPFs. In HVTPFs without fracture of the posterior column cortex, a small fracture area strongly suggests an accompanying PLC injury, and PLC injury is frequently combined with posterior cruciate ligament injury.LEVEL OF EVIDENCEPrognostic 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":"36 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142324961","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}
引用次数: 0
Simplifying the Orientation of S1 Iliosacral Screws for Placement in the Dysmorphic Sacrum. 简化 S1 髂骶螺钉在畸形骶骨中的放置方向。
Pub Date : 2024-09-25 DOI: 10.2106/jbjs.23.01416
Hongmin Cai,Yingchao Yin,Ruipeng Zhang,Lin Liu,Tao Wang,Zhiyong Hou
BACKGROUNDDetermining the proper iliosacral screw orientation in a dysmorphic S1 sacral segment using a C-arm is difficult, and pelvic computed tomography (CT) is often necessary for the preoperative planning. On the preoperative pelvic axial CT section, the intended screw trajectory can be delineated intraosseously along the axis of the oblique osseous corridor. An inherently accurate orientation would be determined by 2 factors: (1) the trajectory is in the pelvic transverse plane, and (2) it is oriented relative to the coronal plane at a patient-specific angle, which should be measured preoperatively. Based on the above reasoning, we aimed to simplify and verify the orientation.METHODSAfter establishing the starting point on the sacral lateral view, we tested a method of simplifying the guidewire orientation: placing the guidewire in the pelvic transverse plane and then manipulating it to be angled relative to the coronal plane at the preoperatively measured patient-specific angle. The guidewire orientation should then be reproducibly accurate on the pelvic outlet and inlet views. The feasibility and safety of our method were verified through computer-simulated virtual surgical procedures in 95 dysmorphic sacra and clinical surgical procedures in 12 patients. The primary outcome parameters were the guidewire orientation and screw placement accuracy.RESULTSUsing our method, the S1 guidewire orientation was reproducibly accurate on the pelvic outlet and inlet views in all of the virtual and clinical surgical procedures. Ninety-five virtual S1 screws (1 screw in each left hemipelvis) were placed intraosseously in the pelvic transverse plane. Fourteen unilateral S1 screws were placed intraosseously in the pelvic transverse plane in the 12 patients (2 patients had double screws) without iatrogenic injuries.CONCLUSIONSThe guidewire orientation can be simplified by placing the guidewire in the pelvic transverse plane and replicating the preoperatively measured patient-specific angle between the guidewire and the coronal plane. After establishing the starting point on the sacral lateral view, our simplified manipulation yields a reproducibly accurate orientation on the pelvic outlet and inlet views.LEVEL OF EVIDENCETherapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
背景使用 C 型臂确定畸形 S1 骶段的正确髂骶螺钉方向十分困难,通常需要通过骨盆计算机断层扫描(CT)进行术前规划。在术前骨盆轴向 CT 断面图上,可以沿着斜骨走廊的轴线在骨内侧划出预期的螺钉轨迹。精确的方向由两个因素决定:(1) 螺钉轨迹位于骨盆横向平面内,(2) 螺钉轨迹与冠状面的相对方向成特定角度,该角度应在术前测量。方法在骶骨侧视图上确定起点后,我们测试了一种简化导丝方向的方法:将导丝放置在骨盆横向平面上,然后按照术前测量的患者特异角度调整导丝与冠状面的相对角度。这样,骨盆出口和入口切面上的导丝方向就能重复精确。通过对 95 名畸形骶骨患者的计算机模拟虚拟手术过程和 12 名患者的临床手术过程,验证了我们方法的可行性和安全性。结果使用我们的方法,在所有虚拟和临床手术过程中,骨盆出口和入口视图上的 S1 导丝方向都非常准确。在骨盆横切面上骨盆内放置了 95 颗虚拟 S1 螺钉(左半骨盆各 1 颗)。结论将导丝置于骨盆横向平面并复制术前测得的导丝与冠状面之间的患者特异性角度可简化导丝定位。在骶骨侧视图上确定起点后,我们的简化操作可在骨盆出口和入口视图上获得可重复的精确定位。有关证据等级的完整描述,请参阅 "作者须知"。
{"title":"Simplifying the Orientation of S1 Iliosacral Screws for Placement in the Dysmorphic Sacrum.","authors":"Hongmin Cai,Yingchao Yin,Ruipeng Zhang,Lin Liu,Tao Wang,Zhiyong Hou","doi":"10.2106/jbjs.23.01416","DOIUrl":"https://doi.org/10.2106/jbjs.23.01416","url":null,"abstract":"BACKGROUNDDetermining the proper iliosacral screw orientation in a dysmorphic S1 sacral segment using a C-arm is difficult, and pelvic computed tomography (CT) is often necessary for the preoperative planning. On the preoperative pelvic axial CT section, the intended screw trajectory can be delineated intraosseously along the axis of the oblique osseous corridor. An inherently accurate orientation would be determined by 2 factors: (1) the trajectory is in the pelvic transverse plane, and (2) it is oriented relative to the coronal plane at a patient-specific angle, which should be measured preoperatively. Based on the above reasoning, we aimed to simplify and verify the orientation.METHODSAfter establishing the starting point on the sacral lateral view, we tested a method of simplifying the guidewire orientation: placing the guidewire in the pelvic transverse plane and then manipulating it to be angled relative to the coronal plane at the preoperatively measured patient-specific angle. The guidewire orientation should then be reproducibly accurate on the pelvic outlet and inlet views. The feasibility and safety of our method were verified through computer-simulated virtual surgical procedures in 95 dysmorphic sacra and clinical surgical procedures in 12 patients. The primary outcome parameters were the guidewire orientation and screw placement accuracy.RESULTSUsing our method, the S1 guidewire orientation was reproducibly accurate on the pelvic outlet and inlet views in all of the virtual and clinical surgical procedures. Ninety-five virtual S1 screws (1 screw in each left hemipelvis) were placed intraosseously in the pelvic transverse plane. Fourteen unilateral S1 screws were placed intraosseously in the pelvic transverse plane in the 12 patients (2 patients had double screws) without iatrogenic injuries.CONCLUSIONSThe guidewire orientation can be simplified by placing the guidewire in the pelvic transverse plane and replicating the preoperatively measured patient-specific angle between the guidewire and the coronal plane. After establishing the starting point on the sacral lateral view, our simplified manipulation yields a reproducibly accurate orientation on the pelvic outlet and inlet views.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":"191 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142324959","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}
引用次数: 0
Outcomes of Total Knee Arthroplasty Following a Sham Incision Procedure in Patients with Previous Knee Incisions. 曾进行过膝关节切口手术的患者在假切口手术后进行全膝关节置换术的效果。
Pub Date : 2024-09-25 DOI: 10.2106/jbjs.24.00114
Thomas M Zink,Alexis G Gonzalez,Gloria Coden,Eric L Smith,James V Bono
BACKGROUNDTenuous blood supply carries a risk of wound-healing problems and subsequent infection following total knee arthroplasty (TKA). This risk may be increased by the presence of previous incisions. Performing a sham incision procedure allows for detection of wound-healing problems prior to performing TKA. The purpose of this retrospective case series is to describe the indications for and technique of a sham incision procedure in patients with previous knee incisions who underwent TKA following this procedure and to report the clinical outcomes observed in these patients following further surgery.METHODSPatients who had prior knee incisions, had undergone a sham incision prior to TKA, and had a minimum follow-up of 2 years were identified, and their cases were retrospectively reviewed. The identified cases typically adhered to the surgeon's standard protocol, which consisted of making a midline incision adventitious to TKA, dissecting down to deep fascia, and closing the wound with suture. Incisions were then observed for at least 4 weeks to determine the viability of the skin flaps before TKA was performed via the same incision.RESULTSA total of 47 knees in 47 patients were included in the study cohort. TKA was performed at an average of 21.1 weeks (range, 4 to 163 weeks) following the sham incision. There were no cases of skin necrosis or periprosthetic joint infection at an average follow-up of 4.6 years (range, 2 to 12 years) after sham incision. A total of 11 patients (23.4%) required manipulation under anesthesia for stiffness.CONCLUSIONSIn our series, no patients developed skin necrosis or periprosthetic joint infection following TKA subsequent to a sham incision procedure, suggesting that healed sham incisions are safe to use for TKA and may be considered prior to TKA in cases in which local previous incisions increase the risk of wound-healing problems.LEVEL OF EVIDENCEPrognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.
背景:全膝关节置换术(TKA)后,持续的血液供应有可能导致伤口愈合问题和后续感染。之前的切口可能会增加这种风险。进行假切口手术可以在进行 TKA 之前发现伤口愈合问题。本回顾性病例系列旨在描述膝关节曾有切口的患者在接受假切口手术后进行 TKA 的适应症和技术,并报告这些患者进一步手术后的临床效果。已确定的病例通常都遵循外科医生的标准方案,包括在 TKA 前进行中线切口,向下剥离至深筋膜,然后缝合伤口。然后对切口进行至少 4 周的观察,以确定皮瓣的存活性,然后再通过同一切口进行 TKA。假切口后平均 21.1 周(4 到 163 周)进行了 TKA。假切口术后平均随访4.6年(2至12年),无皮肤坏死或假体周围关节感染病例。结论在我们的系列研究中,没有患者在假切口手术后发生皮肤坏死或假关节周围感染,这表明愈合的假切口可安全用于 TKA,在局部先前切口增加了伤口愈合问题风险的病例中,可以考虑在 TKA 术前使用假切口。有关证据等级的完整描述,请参阅 "作者须知"。
{"title":"Outcomes of Total Knee Arthroplasty Following a Sham Incision Procedure in Patients with Previous Knee Incisions.","authors":"Thomas M Zink,Alexis G Gonzalez,Gloria Coden,Eric L Smith,James V Bono","doi":"10.2106/jbjs.24.00114","DOIUrl":"https://doi.org/10.2106/jbjs.24.00114","url":null,"abstract":"BACKGROUNDTenuous blood supply carries a risk of wound-healing problems and subsequent infection following total knee arthroplasty (TKA). This risk may be increased by the presence of previous incisions. Performing a sham incision procedure allows for detection of wound-healing problems prior to performing TKA. The purpose of this retrospective case series is to describe the indications for and technique of a sham incision procedure in patients with previous knee incisions who underwent TKA following this procedure and to report the clinical outcomes observed in these patients following further surgery.METHODSPatients who had prior knee incisions, had undergone a sham incision prior to TKA, and had a minimum follow-up of 2 years were identified, and their cases were retrospectively reviewed. The identified cases typically adhered to the surgeon's standard protocol, which consisted of making a midline incision adventitious to TKA, dissecting down to deep fascia, and closing the wound with suture. Incisions were then observed for at least 4 weeks to determine the viability of the skin flaps before TKA was performed via the same incision.RESULTSA total of 47 knees in 47 patients were included in the study cohort. TKA was performed at an average of 21.1 weeks (range, 4 to 163 weeks) following the sham incision. There were no cases of skin necrosis or periprosthetic joint infection at an average follow-up of 4.6 years (range, 2 to 12 years) after sham incision. A total of 11 patients (23.4%) required manipulation under anesthesia for stiffness.CONCLUSIONSIn our series, no patients developed skin necrosis or periprosthetic joint infection following TKA subsequent to a sham incision procedure, suggesting that healed sham incisions are safe to use for TKA and may be considered prior to TKA in cases in which local previous incisions increase the risk of wound-healing problems.LEVEL OF EVIDENCEPrognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.","PeriodicalId":22625,"journal":{"name":"The Journal of Bone & Joint Surgery","volume":"49 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142324962","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}
引用次数: 0
Outcomes of Obese Patients Undergoing Primary Total Knee Arthroplasty: Trends Over 30 Years. 接受初级全膝关节置换术的肥胖患者的疗效:30年来的趋势。
Pub Date : 2024-09-24 DOI: 10.2106/jbjs.23.01413
Mason E Uvodich,Evan M Dugdale,Mark W Pagnano,Daniel J Berry,Matthew P Abdel,Nicholas A Bedard
BACKGROUNDThe rates of obesity among patients undergoing total knee arthroplasty (TKA) have substantially increased. In addition, obesity is a well-established risk factor for complications after TKA. The purpose of this study was to analyze trends in body mass index (BMI) and complication risk among obese patients undergoing primary TKA treated at a single institution over 3 decades.METHODSUtilizing an institutional total joint registry, 13,919 primary TKAs performed to treat osteoarthritis between 1990 and 2019 were identified. Patients were stratified by BMI according to the World Health Organization (WHO) classification into 3 groups: non-obese (BMI, <30 kg/m2), WHO Class-I and II obese (BMI, 30 to 39.9 kg/m2), and WHO Class-III obese (BMI, ≥40 kg/m2). Trends in BMI and survivorship free from reoperation, revision, and periprosthetic joint infection (PJI) were analyzed over time while controlling for age, sex, and the Charlson Comorbidity Index.RESULTSOver the study period, there was a 90% increase in the prevalence of Class-II obesity (13% to 25%) and a 300% increase in Class-III obesity (3% to 12%). Analysis of the entire cohort demonstrated a decrease in the 2-year risk of any reoperation, any revision, and PJI (p < 0.05 for all) with time. The risk decreased significantly over time for non-obese patients for any reoperation (p = 0.029) and any revision (p = 0.004) and for Class-III obese patients for any reoperation (p = 0.038) and any revision (p = 0.012), but it remained stable for Class-I and II obese patients. The risk of PJI decreased from 1990 to 2019 for non-obese patients (p = 0.005), but there were no significant changes in PJI risk for any obesity group.CONCLUSIONSDespite increasing rates of obesity among our patients who underwent TKA, we observed decreasing risks of reoperation, revision, and PJI over time. The risks of reoperation and revision declined among non-obese patients, remained stable for Class-I and II obese patients, and declined for Class-III obese patients. The PJI risk declined for non-obese patients over the study period, but no such decline occurred for any category of obesity. Despite the decreasing risks of reoperation and revision, further work is needed to improve PJI risk in obese patients.LEVEL OF EVIDENCETherapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
背景接受全膝关节置换术(TKA)的患者肥胖率大幅上升。此外,肥胖也是导致 TKA 术后并发症的一个公认的风险因素。本研究的目的是分析三十年来在一家机构接受初级 TKA 治疗的肥胖患者的体重指数(BMI)和并发症风险的变化趋势。方法利用机构全关节登记处,对 1990 年至 2019 年间为治疗骨关节炎而实施的 13919 例初级 TKA 进行了鉴定。根据世界卫生组织(WHO)的分类,按体重指数将患者分为三组:非肥胖(体重指数<30 kg/m2)、WHO一级和二级肥胖(体重指数30至39.9 kg/m2)以及WHO三级肥胖(体重指数≥40 kg/m2)。结果在研究期间,II级肥胖的患病率增加了90%(从13%增加到25%),III级肥胖的患病率增加了300%(从3%增加到12%)。对整个队列进行的分析表明,随着时间的推移,2 年内再次手术、翻修手术和 PJI 的风险均有所下降(P < 0.05)。非肥胖患者再次手术(p = 0.029)和翻修手术(p = 0.004)的风险随着时间的推移明显降低,III级肥胖患者再次手术(p = 0.038)和翻修手术(p = 0.012)的风险随着时间的推移明显降低,但I级和II级肥胖患者的风险保持稳定。从 1990 年到 2019 年,非肥胖患者的 PJI 风险有所下降(p = 0.005),但任何肥胖组的 PJI 风险均无显著变化。非肥胖患者的再手术和翻修风险下降,I 级和 II 级肥胖患者的风险保持稳定,III 级肥胖患者的风险下降。在研究期间,非肥胖患者的 PJI 风险有所下降,但任何肥胖类别的患者的 PJI 风险都没有下降。尽管再次手术和翻修的风险有所下降,但仍需进一步努力以改善肥胖患者的 PJI 风险。有关证据等级的完整描述,请参阅 "作者须知"。
{"title":"Outcomes of Obese Patients Undergoing Primary Total Knee Arthroplasty: Trends Over 30 Years.","authors":"Mason E Uvodich,Evan M Dugdale,Mark W Pagnano,Daniel J Berry,Matthew P Abdel,Nicholas A Bedard","doi":"10.2106/jbjs.23.01413","DOIUrl":"https://doi.org/10.2106/jbjs.23.01413","url":null,"abstract":"BACKGROUNDThe rates of obesity among patients undergoing total knee arthroplasty (TKA) have substantially increased. In addition, obesity is a well-established risk factor for complications after TKA. The purpose of this study was to analyze trends in body mass index (BMI) and complication risk among obese patients undergoing primary TKA treated at a single institution over 3 decades.METHODSUtilizing an institutional total joint registry, 13,919 primary TKAs performed to treat osteoarthritis between 1990 and 2019 were identified. Patients were stratified by BMI according to the World Health Organization (WHO) classification into 3 groups: non-obese (BMI, <30 kg/m2), WHO Class-I and II obese (BMI, 30 to 39.9 kg/m2), and WHO Class-III obese (BMI, ≥40 kg/m2). Trends in BMI and survivorship free from reoperation, revision, and periprosthetic joint infection (PJI) were analyzed over time while controlling for age, sex, and the Charlson Comorbidity Index.RESULTSOver the study period, there was a 90% increase in the prevalence of Class-II obesity (13% to 25%) and a 300% increase in Class-III obesity (3% to 12%). Analysis of the entire cohort demonstrated a decrease in the 2-year risk of any reoperation, any revision, and PJI (p < 0.05 for all) with time. The risk decreased significantly over time for non-obese patients for any reoperation (p = 0.029) and any revision (p = 0.004) and for Class-III obese patients for any reoperation (p = 0.038) and any revision (p = 0.012), but it remained stable for Class-I and II obese patients. The risk of PJI decreased from 1990 to 2019 for non-obese patients (p = 0.005), but there were no significant changes in PJI risk for any obesity group.CONCLUSIONSDespite increasing rates of obesity among our patients who underwent TKA, we observed decreasing risks of reoperation, revision, and PJI over time. The risks of reoperation and revision declined among non-obese patients, remained stable for Class-I and II obese patients, and declined for Class-III obese patients. The PJI risk declined for non-obese patients over the study period, but no such decline occurred for any category of obesity. Despite the decreasing risks of reoperation and revision, further work is needed to improve PJI risk in obese patients.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":"35 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142321084","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}
引用次数: 0
Modified Standard Total en bloc Spondylectomy for Solitary Thoracic or Lumbar Spinal Metastasis: A 1-Stage Posterior Approach Under Direct Visualization. 针对单发胸椎或腰椎转移瘤的改良标准全脊椎切除术:直视下的一期后路手术。
Pub Date : 2024-09-20 DOI: 10.2106/jbjs.24.00043
Wei Xu,Shangbin Zhou,Danyang Bai,Pengru Wang,Gan Xu,Hao Yuan,Bo Li,Jianru Xiao
BACKGROUNDSolitary spinal metastasis (SM) is one of the indications for total en bloc spondylectomy (TES). Conventional TES carries the risk of damage to the great vessels anterior to the vertebral column, mainly because of a lack of visualization of the anterior structures. In this study, we devised a modified standard TES technique to achieve direct visualization in a 1-stage posterior approach.METHODSIncluded in this study were patients ≥18 years old with solitary thoracic or lumbar SM who underwent the modified standard TES at our institution between January 2017 and October 2022. Patient data were retrospectively sourced from medical records, and patients had a minimum of 3 months of postoperative follow-up.RESULTSThis study involved 71 East Asian patients (median age, 57 years; 34 males), comprising 38 patients with thoracic SM and 33 with lumbar SM. Lung cancer was the most common tumor histology. Fourteen patients (19.7%) experienced intraoperative complications; pleural rupture was the predominant complication, and there were no cases of injury to the spinal cord or great vessels. The median operative time was 305 minutes (range, 203 to 660 minutes). The median intraoperative blood loss was 1,000 mL (range, 400 to 4,000 mL). The median perioperative blood transfusion was 4 units (range, 0 to 12 units), and the median hospitalization duration was 17 days (range, 14 to 29 days). Additionally, 27 patients (38.0%) had acute (perioperative) complications. Seven patients were lost to follow-up. Significant clinical improvement was achieved 3 months postoperatively. Postoperative early and late complications were observed in 5 patients. Of the 64 patients with completed follow-up, 47 (73.4%) had negative surgical margins, and none received postoperative radiation therapy. Revision surgery for local tumor recurrence was performed in 4.7% of patients. The median follow-up was 31.5 months (range, 3 to 81 months).CONCLUSIONSOur modified standard TES was demonstrated to be a safe and effective surgical technique for solitary thoracolumbar SM.LEVEL OF EVIDENCETherapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
背景孤立性脊柱转移瘤(SM)是全脊椎整体切除术(TES)的适应症之一。传统的全脊椎切除术有损伤椎体前方大血管的风险,这主要是因为无法观察到椎体前方的结构。在本研究中,我们设计了一种改良的标准 TES 技术,以实现 1 级后方入路的直接可视化。方法本研究纳入了 2017 年 1 月至 2022 年 10 月期间在我院接受改良标准 TES 的年龄≥18 岁的单发胸椎或腰椎 SM 患者。患者数据来自病历回顾性资料,患者术后随访至少3个月。结果本研究涉及71名东亚患者(中位年龄57岁;34名男性),其中38名患者为胸椎SM患者,33名患者为腰椎SM患者。肺癌是最常见的肿瘤组织学类型。14名患者(19.7%)出现术中并发症;胸膜破裂是主要并发症,没有脊髓或大血管损伤病例。手术时间中位数为305分钟(203至660分钟不等)。术中出血量中位数为1,000毫升(范围在400至4,000毫升之间)。围手术期输血量的中位数为 4 单位(范围为 0 至 12 单位),住院时间的中位数为 17 天(范围为 14 至 29 天)。此外,27 名患者(38.0%)出现了急性(围手术期)并发症。7 名患者失去了随访机会。术后 3 个月临床症状明显好转。有 5 名患者出现了术后早期和晚期并发症。在完成随访的 64 名患者中,47 人(73.4%)的手术切缘为阴性,没有人在术后接受放射治疗。4.7%的患者因局部肿瘤复发而进行了翻修手术。中位随访时间为 31.5 个月(3 到 81 个月)。结论我们的改良标准 TES 被证明是治疗单发胸腰椎 SM 的安全有效的手术技术。有关证据等级的完整描述,请参阅 "作者须知"。
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引用次数: 0
Reverse Shoulder Arthroplasty Is Superior to Plate Fixation for Displaced Proximal Humeral Fractures in the Elderly: Five-Year Follow-up of the DelPhi Randomized Controlled Trial. 反向肩关节置换术治疗老年人移位的肱骨近端骨折优于钢板固定术:DelPhi随机对照试验五年随访。
Pub Date : 2024-09-20 DOI: 10.2106/jbjs.23.01431
Alexander Nilsskog Fraser,Tone Mehlum Wagle,Anna Cecilia Karlberg,Jan Erik Madsen,Megan Mellberg,Tom Lian,Simone Mader,Lars Eilertsen,Hilde Apold,Leif Børge Larsen,Are Hugo Pripp,Tore Fjalestad
Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.
关于证据等级的完整描述,请参阅 "作者须知"。
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引用次数: 0
期刊
The Journal of Bone & Joint Surgery
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