{"title":"Win Ratio: Enhancing Outcomes Assessment in Orthopaedic RCTs: Commentary on an article by Sofia Bzovsky, MSc, et al.: \"A New Angle on Outcomes: Introducing the Win Ratio to Orthopaedic Research\".","authors":"Michelle Ghert","doi":"10.2106/jbjs.25.00940","DOIUrl":"https://doi.org/10.2106/jbjs.25.00940","url":null,"abstract":"","PeriodicalId":22625,"journal":{"name":"The Journal of Bone & Joint Surgery","volume":"29 1","pages":"2682-2683"},"PeriodicalIF":0.0,"publicationDate":"2025-12-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145765529","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":"Malpractice Litigation in Orthopaedic Surgery: Considerations Regarding Subspecialty and Training Level: Commentary on an article by Peter Boufadel, MD, et al.: \"Medical Malpractice Litigation in Orthopaedic Surgery in the United States. Risk Factors, Outcomes, and Strategies for Navigating Lawsuits, Prevention, and Reform\".","authors":"Zoe H Dailiana","doi":"10.2106/jbjs.25.01372","DOIUrl":"https://doi.org/10.2106/jbjs.25.01372","url":null,"abstract":"","PeriodicalId":22625,"journal":{"name":"The Journal of Bone & Joint Surgery","volume":"29 1","pages":"2684-2685"},"PeriodicalIF":0.0,"publicationDate":"2025-12-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145765528","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}
Amer Sebaaly,Mohammad Daher,Joseph E Nassar,Gaby Kreichati,Khalil Kharrat,Alan H Daniels
Spine surgery in limited-resource environments is challenging due to the complexity of the procedures, which can involve often-costly implants and imaging or navigation tools that may not be available in all regions and markets. Orthopaedic and neurological surgery residents in low to middle-income countries (LMICs) are faced with limited case exposure, faculty shortages, and a lack of simulation tools, resulting in incomplete spine surgery training. International fellowships, telesurgery integration, and global collaboration can help to address these gaps. The high costs of implants, restricted use of intraoperative neuromonitoring, and limited access to advanced technologies such as robotics and endoscopy may hinder optimal surgical care. These challenges could be mediated by the implementation of cost-effective practices, the establishment of clinical guidelines, and the publication of cost-effectiveness data. LMIC contributions to spine research are limited due to a lack of funding, poor research infrastructure, and publication bias. Building research capacity through mentorship, international partnerships, and regional academic platforms is needed to advance global spine care.
{"title":"Obstacles to Spine Surgery in Limited-Resource Environments.","authors":"Amer Sebaaly,Mohammad Daher,Joseph E Nassar,Gaby Kreichati,Khalil Kharrat,Alan H Daniels","doi":"10.2106/jbjs.25.01208","DOIUrl":"https://doi.org/10.2106/jbjs.25.01208","url":null,"abstract":"Spine surgery in limited-resource environments is challenging due to the complexity of the procedures, which can involve often-costly implants and imaging or navigation tools that may not be available in all regions and markets. Orthopaedic and neurological surgery residents in low to middle-income countries (LMICs) are faced with limited case exposure, faculty shortages, and a lack of simulation tools, resulting in incomplete spine surgery training. International fellowships, telesurgery integration, and global collaboration can help to address these gaps. The high costs of implants, restricted use of intraoperative neuromonitoring, and limited access to advanced technologies such as robotics and endoscopy may hinder optimal surgical care. These challenges could be mediated by the implementation of cost-effective practices, the establishment of clinical guidelines, and the publication of cost-effectiveness data. LMIC contributions to spine research are limited due to a lack of funding, poor research infrastructure, and publication bias. Building research capacity through mentorship, international partnerships, and regional academic platforms is needed to advance global spine care.","PeriodicalId":22625,"journal":{"name":"The Journal of Bone & Joint Surgery","volume":"7 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145760039","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}
Hospital technology approval remains a formidable barrier to the adoption of surgical innovations. Despite compelling clinical evidence, technology requests frequently face rejection based on flawed economic models that emphasize the pricing of incumbent technology and time savings in the operating room over genuine value creation. This article provides a strategic framework for winning hospital approval by applying Economic Value to the Customer (EVC) principles and strategies to address managerial agency problems. This approach transforms technology evaluation from frustrating cost-focused rejection to value-centric approval that benefits surgeons and patients seeking access to innovation and vendors requiring market penetration.
{"title":"Your Hospital Says No to Innovation: Here's How to Change That.","authors":"Kamran S Hamid","doi":"10.2106/jbjs.25.00797","DOIUrl":"https://doi.org/10.2106/jbjs.25.00797","url":null,"abstract":"Hospital technology approval remains a formidable barrier to the adoption of surgical innovations. Despite compelling clinical evidence, technology requests frequently face rejection based on flawed economic models that emphasize the pricing of incumbent technology and time savings in the operating room over genuine value creation. This article provides a strategic framework for winning hospital approval by applying Economic Value to the Customer (EVC) principles and strategies to address managerial agency problems. This approach transforms technology evaluation from frustrating cost-focused rejection to value-centric approval that benefits surgeons and patients seeking access to innovation and vendors requiring market penetration.","PeriodicalId":22625,"journal":{"name":"The Journal of Bone & Joint Surgery","volume":"255 11 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145717521","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}
Osama Alzobi,Bahram Mohajer,Jean Fleuriscar,Shadpour Demehri,Bashir A Zikria
BACKGROUNDAnterior cruciate ligament (ACL) injuries may lead to long-term neuromuscular and structural adaptations in thigh muscles. Although quadriceps dysfunction is well reported, chronic changes in other muscle groups, especially in nonoperatively managed ACL-deficient individuals, remain poorly understood.METHODSThe present cohort study utilized Osteoarthritis Initiative data to assess longitudinal thigh muscle changes in individuals with ACL tears confirmed on magnetic resonance imaging (MRI) and no history of reconstruction. A validated deep-learning model segmented muscle cross-sectional area and quantified intra-muscular adipose tissue and contractile percentage. Quantitative MRI data were obtained at baseline and at 4-year follow-up. Propensity score matching (1:2 to 1:3) controlled for baseline covariates. Strength was assessed with use of standardized Osteoarthritis Initiative protocols. Linear mixed-effects models compared longitudinal changes between ACL-deficient and ACL-intact thighs.RESULTSA total of 1,207 thighs were analyzed, including 92 with ACL tears and 1,115 controls, with a mean patient age of 61 ± 9 years. Over 4 years, ACL-deficient thighs exhibited progressive hamstring atrophy (-28.18 mm2/year; 95% confidence interval, -42.43 to -13.92; p < 0.001) and sartorius atrophy (-3.02 mm2/year; 95% confidence interval, -5.15 to -0.89; p = 0.006). No significant differences were observed in quadriceps or adductor cross-sectional area. Hamstring force decreased significantly (-3.49 N/year; 95% confidence interval, -6.62 to -0.36; p = 0.029), whereas quadriceps force and specific force showed no significant changes. Intra-muscular adipose tissue and contractile percentage did not significantly differ between groups. Findings had been similar in unmatched patients.CONCLUSIONSThe present findings highlight selective muscle deterioration in the posterior thigh muscles following ACL injury, with minimal changes in quadriceps morphology, over time. These results underscore the importance of long-term, targeted rehabilitation strategies focusing on hamstring preservation. This study represents the first longitudinal matched-cohort analysis of muscle morphology and fat infiltration in unreconstructed ACL-deficient knees.LEVEL OF EVIDENCEPrognostic Level II. See Instructions for Authors for a complete description of levels of evidence.
{"title":"Thigh Muscle Changes in the ACL-Deficient Knee: A 4-Year Longitudinal MRI Study of 1,207 Patients.","authors":"Osama Alzobi,Bahram Mohajer,Jean Fleuriscar,Shadpour Demehri,Bashir A Zikria","doi":"10.2106/jbjs.25.00641","DOIUrl":"https://doi.org/10.2106/jbjs.25.00641","url":null,"abstract":"BACKGROUNDAnterior cruciate ligament (ACL) injuries may lead to long-term neuromuscular and structural adaptations in thigh muscles. Although quadriceps dysfunction is well reported, chronic changes in other muscle groups, especially in nonoperatively managed ACL-deficient individuals, remain poorly understood.METHODSThe present cohort study utilized Osteoarthritis Initiative data to assess longitudinal thigh muscle changes in individuals with ACL tears confirmed on magnetic resonance imaging (MRI) and no history of reconstruction. A validated deep-learning model segmented muscle cross-sectional area and quantified intra-muscular adipose tissue and contractile percentage. Quantitative MRI data were obtained at baseline and at 4-year follow-up. Propensity score matching (1:2 to 1:3) controlled for baseline covariates. Strength was assessed with use of standardized Osteoarthritis Initiative protocols. Linear mixed-effects models compared longitudinal changes between ACL-deficient and ACL-intact thighs.RESULTSA total of 1,207 thighs were analyzed, including 92 with ACL tears and 1,115 controls, with a mean patient age of 61 ± 9 years. Over 4 years, ACL-deficient thighs exhibited progressive hamstring atrophy (-28.18 mm2/year; 95% confidence interval, -42.43 to -13.92; p < 0.001) and sartorius atrophy (-3.02 mm2/year; 95% confidence interval, -5.15 to -0.89; p = 0.006). No significant differences were observed in quadriceps or adductor cross-sectional area. Hamstring force decreased significantly (-3.49 N/year; 95% confidence interval, -6.62 to -0.36; p = 0.029), whereas quadriceps force and specific force showed no significant changes. Intra-muscular adipose tissue and contractile percentage did not significantly differ between groups. Findings had been similar in unmatched patients.CONCLUSIONSThe present findings highlight selective muscle deterioration in the posterior thigh muscles following ACL injury, with minimal changes in quadriceps morphology, over time. These results underscore the importance of long-term, targeted rehabilitation strategies focusing on hamstring preservation. This study represents the first longitudinal matched-cohort analysis of muscle morphology and fat infiltration in unreconstructed ACL-deficient knees.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":"169 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145717520","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":"Weighted Weight-Bearing Radiographs of the Foot and Ankle.","authors":"Vinod K Panchbhavi,Kevin O'Mary","doi":"10.2106/jbjs.25.00499","DOIUrl":"https://doi.org/10.2106/jbjs.25.00499","url":null,"abstract":"","PeriodicalId":22625,"journal":{"name":"The Journal of Bone & Joint Surgery","volume":"44 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-12-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145710922","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}
Nifon K Gkekas,Dimitrios Stamiris,Antonios A Koutalos,Ilias Chantes,George A Komnos,Michael Hantes
BACKGROUNDLateral extra-articular tenodesis (LET) is increasingly used to augment anterior cruciate ligament reconstruction (ACLR), particularly in patients with high-grade rotatory instability. Despite demonstrated biomechanical advantages, the long-term effect of LET on posttraumatic osteoarthritis (OA) remains unclear.METHODSWe hypothesized that adding LET to ACLR reduces development of long-term moderate-to-severe radiographic OA, particularly after meniscectomy. We performed a PRISMA-compliant systematic review and meta-analysis, which was registered with PROSPERO. PubMed, Cochrane CENTRAL, and Scopus were searched through March 2025. Eligible randomized controlled trials (RCTs) or comparative cohort studies reported radiographic moderate-to-severe OA after ACLR with versus without LET, with a minimum follow-up of 5 years. Pooled odds ratios (ORs) with 95% confidence intervals (CIs) were calculated using a random-effects model.RESULTSSix studies with 444 patients (mean follow-up, 13.1 years) were included. LET was associated with a significant reduction in moderate-to-severe OA in the lateral compartment. Subgroup analysis showed a significant reduction in lateral OA as measured using both the Kellgren-Lawrence (K-L) (OR, 2.87; 95% CI, 1.2 to 6.9; p = 0.02) and International Knee Documentation Committee (IKDC) classifications (OR, 4.38; 95% CI, 1.5 to 12.7; p = 0.01). In contrast, no significant difference was found in the medial compartment for either the K-L (OR, 1.26; 95% CI, 0.7 to 2.4; p = 0.49) or IKDC classification (OR, 2.06; 95% CI, 0.6 to 6.8; p = 0.24). In meniscectomized knees, LET significantly reduced OA risk, especially as measured with the IKDC (OR, 6.14; 95% CI, 1.7 to 22.6; p = 0.01) compared with the K-L classification (OR, 3.61; 95% CI, 1.1 to 12.3; p = 0.04). In contrast, although LET also reduced OA risk in non-meniscectomized knees, the difference was not significant. Compartment-specific OA data were unavailable within the meniscal subgroups.CONCLUSIONSThis meta-analysis, the first to assess the long-term effect of LET on OA, indicated that LET significantly reduces moderate-to-severe OA risk, particularly in the lateral compartment and among meniscectomized knees. Findings support selective LET use during ACL reconstruction, especially in cases with compromised meniscal integrity, to help mitigate OA progression.LEVEL OF EVIDENCETherapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.
{"title":"Combining ACL Reconstruction with Lateral Extra-Articular Tenodesis Reduces Long-Term Osteoarthritis Risk Versus Isolated ACL Reconstruction: A Systematic Review and Meta-Analysis.","authors":"Nifon K Gkekas,Dimitrios Stamiris,Antonios A Koutalos,Ilias Chantes,George A Komnos,Michael Hantes","doi":"10.2106/jbjs.25.00907","DOIUrl":"https://doi.org/10.2106/jbjs.25.00907","url":null,"abstract":"BACKGROUNDLateral extra-articular tenodesis (LET) is increasingly used to augment anterior cruciate ligament reconstruction (ACLR), particularly in patients with high-grade rotatory instability. Despite demonstrated biomechanical advantages, the long-term effect of LET on posttraumatic osteoarthritis (OA) remains unclear.METHODSWe hypothesized that adding LET to ACLR reduces development of long-term moderate-to-severe radiographic OA, particularly after meniscectomy. We performed a PRISMA-compliant systematic review and meta-analysis, which was registered with PROSPERO. PubMed, Cochrane CENTRAL, and Scopus were searched through March 2025. Eligible randomized controlled trials (RCTs) or comparative cohort studies reported radiographic moderate-to-severe OA after ACLR with versus without LET, with a minimum follow-up of 5 years. Pooled odds ratios (ORs) with 95% confidence intervals (CIs) were calculated using a random-effects model.RESULTSSix studies with 444 patients (mean follow-up, 13.1 years) were included. LET was associated with a significant reduction in moderate-to-severe OA in the lateral compartment. Subgroup analysis showed a significant reduction in lateral OA as measured using both the Kellgren-Lawrence (K-L) (OR, 2.87; 95% CI, 1.2 to 6.9; p = 0.02) and International Knee Documentation Committee (IKDC) classifications (OR, 4.38; 95% CI, 1.5 to 12.7; p = 0.01). In contrast, no significant difference was found in the medial compartment for either the K-L (OR, 1.26; 95% CI, 0.7 to 2.4; p = 0.49) or IKDC classification (OR, 2.06; 95% CI, 0.6 to 6.8; p = 0.24). In meniscectomized knees, LET significantly reduced OA risk, especially as measured with the IKDC (OR, 6.14; 95% CI, 1.7 to 22.6; p = 0.01) compared with the K-L classification (OR, 3.61; 95% CI, 1.1 to 12.3; p = 0.04). In contrast, although LET also reduced OA risk in non-meniscectomized knees, the difference was not significant. Compartment-specific OA data were unavailable within the meniscal subgroups.CONCLUSIONSThis meta-analysis, the first to assess the long-term effect of LET on OA, indicated that LET significantly reduces moderate-to-severe OA risk, particularly in the lateral compartment and among meniscectomized knees. Findings support selective LET use during ACL reconstruction, especially in cases with compromised meniscal integrity, to help mitigate OA progression.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":"31 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-12-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145710930","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}
Julian J Hollander,Jari Dahmen,Sjoerd A S Stufkens,Gino M M J Kerkhoffs
Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
治疗性IV级。参见作者说明获得证据级别的完整描述。
{"title":"Sustained Improvement in Pain with Talar OsteoPeriostic Grafting from the Iliac Crest (TOPIC) for Medial Osteochondral Lesions of the Talus: A Concise 5-Year Follow-up of a Previous Report.","authors":"Julian J Hollander,Jari Dahmen,Sjoerd A S Stufkens,Gino M M J Kerkhoffs","doi":"10.2106/jbjs.24.01377","DOIUrl":"https://doi.org/10.2106/jbjs.24.01377","url":null,"abstract":"Therapeutic 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":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-12-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145710904","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}
BACKGROUNDThe effect of tourniquet use on cement penetration in primary total knee arthroplasty (TKA) remains controversial. Current assessments rely primarily on radiograph-based 2D measurements, which limit the precision and comprehensiveness of analysis. Therefore, this study investigated the effect of tourniquet use on 3D cement penetration and the association of tourniquet use with mid-term implant stability.METHODSIn this prospective randomized controlled trial, 141 Han Chinese (East Asian) patients (mean age, 68.3 years; 85% female) were allocated to 1 of 3 groups: tourniquet (Group A), no tourniquet (Group B), and tourniquet during cementation only (Group C). The primary outcomes were 3D cement penetration (thickness, volume, surface area) and mid-term implant stability assessed on the basis of radiolucent lines (RLLs) and survivorship. Cement penetration metrics across femoral and tibial components were systematically quantified through 3D morphological analysis of metal artifact reduction-computed tomography (MAR-CT) images reconstructed using Avizo software (Thermo Fisher Scientific). Secondary outcomes included blood loss, inflammatory and muscle-injury biomarkers, pain scores, functional scores, postoperative length of stay, and complication rates.RESULTSAll participants were followed for 5 years. No significant intergroup differences in cement penetration (thickness, volume, surface area) around the tibial (p = 0.847, p = 0.473, and p = 0.395, respectively) and femoral (p = 0.203, 0.201, 0.399) components were observed. Cement thickness correlated with preoperative knee deformity but not with implant size. Additionally, Group B demonstrated superior clinical outcomes versus Groups A and C: lower levels of inflammatory and muscle-injury biomarkers, lower early pain scores, and a shorter hospital stay, with enhanced 3-month knee function demonstrated in Groups B and C versus Group A. Total blood loss, mid-term outcomes, and complication rates were comparable. No RLLs or revisions were observed, and the 5-year implant survival rate was 100%.CONCLUSIONSTourniquet use showed no significant effect on cement penetration and mid-term implant stability in primary TKA, and omitting intraoperative tourniquet use was associated with better early postoperative functional recovery in patients undergoing TKA.LEVEL OF EVIDENCETherapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.
背景：在初次全膝关节置换术（TKA）中，止血带对水泥穿透的影响仍然存在争议。目前的评估主要依赖于基于x射线的二维测量，这限制了分析的准确性和全面性。因此，本研究探讨了止血带使用对三维水泥穿透的影响，以及止血带使用与植入物中期稳定性的关系。方法在本前瞻性随机对照试验中，141例汉族（东亚）患者（平均年龄68.3岁，85%为女性）被分为3组：带止血带（A组）、不带止血带（B组）和仅在骨水泥过程中带止血带（C组）。主要结果是3D骨水泥穿透（厚度、体积、表面积）和基于放射光线（rll）和存活评估的中期种植体稳定性。通过使用Avizo软件（Thermo Fisher Scientific）重建的金属伪迹还原计算机断层扫描（MAR-CT）图像的3D形态分析，系统地量化了股骨和胫骨部件的水泥穿透指标。次要结局包括失血、炎症和肌肉损伤生物标志物、疼痛评分、功能评分、术后住院时间和并发症发生率。结果随访5年。胫骨周围（p = 0.847, p = 0.473, p = 0.395）和股骨周围（p = 0.203, 0.201, 0.399）骨水泥穿透（厚度、体积、表面积）各组间差异均无统计学意义。骨水泥厚度与术前膝关节畸形相关，而与植入物大小无关。此外，B组表现出优于A组和C组的临床结果：炎症和肌肉损伤生物标志物水平较低，早期疼痛评分较低，住院时间较短，与A组相比，B组和C组3个月膝关节功能增强。总失血量、中期结局和并发症发生率具有可比性。未观察到再损伤或修复，5年种植体存活率为100%。结论止血带的使用对原发性TKA患者骨水泥穿透性和中期植入物稳定性无显著影响，术中不使用止血带可使TKA患者术后早期功能恢复较好。证据级别：治疗性i级。参见《作者说明》获得证据级别的完整描述。
{"title":"Effect of Tourniquet Use on 3D Cement Penetration and Mid-Term Implant Stability in Primary Total Knee Arthroplasty: A Randomized Controlled Trial.","authors":"Fu-Li Peng,Jian Cao,Xi-Shan Zhu,Hong-Jun Peng,Xiao Yang,Yi Zeng,Xiang-Dong Zhu,Bin Shen","doi":"10.2106/jbjs.25.00536","DOIUrl":"https://doi.org/10.2106/jbjs.25.00536","url":null,"abstract":"BACKGROUNDThe effect of tourniquet use on cement penetration in primary total knee arthroplasty (TKA) remains controversial. Current assessments rely primarily on radiograph-based 2D measurements, which limit the precision and comprehensiveness of analysis. Therefore, this study investigated the effect of tourniquet use on 3D cement penetration and the association of tourniquet use with mid-term implant stability.METHODSIn this prospective randomized controlled trial, 141 Han Chinese (East Asian) patients (mean age, 68.3 years; 85% female) were allocated to 1 of 3 groups: tourniquet (Group A), no tourniquet (Group B), and tourniquet during cementation only (Group C). The primary outcomes were 3D cement penetration (thickness, volume, surface area) and mid-term implant stability assessed on the basis of radiolucent lines (RLLs) and survivorship. Cement penetration metrics across femoral and tibial components were systematically quantified through 3D morphological analysis of metal artifact reduction-computed tomography (MAR-CT) images reconstructed using Avizo software (Thermo Fisher Scientific). Secondary outcomes included blood loss, inflammatory and muscle-injury biomarkers, pain scores, functional scores, postoperative length of stay, and complication rates.RESULTSAll participants were followed for 5 years. No significant intergroup differences in cement penetration (thickness, volume, surface area) around the tibial (p = 0.847, p = 0.473, and p = 0.395, respectively) and femoral (p = 0.203, 0.201, 0.399) components were observed. Cement thickness correlated with preoperative knee deformity but not with implant size. Additionally, Group B demonstrated superior clinical outcomes versus Groups A and C: lower levels of inflammatory and muscle-injury biomarkers, lower early pain scores, and a shorter hospital stay, with enhanced 3-month knee function demonstrated in Groups B and C versus Group A. Total blood loss, mid-term outcomes, and complication rates were comparable. No RLLs or revisions were observed, and the 5-year implant survival rate was 100%.CONCLUSIONSTourniquet use showed no significant effect on cement penetration and mid-term implant stability in primary TKA, and omitting intraoperative tourniquet use was associated with better early postoperative functional recovery in patients undergoing TKA.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":"5 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-12-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145710923","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}
R Rojas-Sayol,M Monfort-Mira,P Martínez de Albornoz,A Ortega-Briones,M Bernaus
➢ The Spanish National Health System delivers equitable, high-quality musculoskeletal care through a nationwide network that connects community-based primary care with tertiary trauma and orthopaedic referral centers.➢ The highly competitive and standardized residency program in trauma and orthopaedic surgery in Spain ensures uniform training quality, the possibility for subspecialization, and well-grounded clinical and surgical competency across all regions.➢ Orthopaedic research in Spain has expanded considerably. It is supported by national and regional networks, an increasing participation in multicenter international trials and cross-border collaboration, and a growing academic output of global relevance.➢ The integration of women in Spanish orthopaedics has been increasing, such that the proportion of female orthopaedic residents in Spain was well above that of many other countries in 2022.➢ Spain combines a broadly extended hospital network with a dynamic academic ecosystem, positioning the country as a leading European hub for trauma and orthopaedic innovation, research, and education.
{"title":"Trauma and Orthopaedic Surgery: The Spanish Model.","authors":"R Rojas-Sayol,M Monfort-Mira,P Martínez de Albornoz,A Ortega-Briones,M Bernaus","doi":"10.2106/jbjs.25.01408","DOIUrl":"https://doi.org/10.2106/jbjs.25.01408","url":null,"abstract":"➢ The Spanish National Health System delivers equitable, high-quality musculoskeletal care through a nationwide network that connects community-based primary care with tertiary trauma and orthopaedic referral centers.➢ The highly competitive and standardized residency program in trauma and orthopaedic surgery in Spain ensures uniform training quality, the possibility for subspecialization, and well-grounded clinical and surgical competency across all regions.➢ Orthopaedic research in Spain has expanded considerably. It is supported by national and regional networks, an increasing participation in multicenter international trials and cross-border collaboration, and a growing academic output of global relevance.➢ The integration of women in Spanish orthopaedics has been increasing, such that the proportion of female orthopaedic residents in Spain was well above that of many other countries in 2022.➢ Spain combines a broadly extended hospital network with a dynamic academic ecosystem, positioning the country as a leading European hub for trauma and orthopaedic innovation, research, and education.","PeriodicalId":22625,"journal":{"name":"The Journal of Bone & Joint Surgery","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-12-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145765036","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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