{"title":"Recurrently Back to the Drawing Board on Thromboprophylaxis After Spine Surgery: Commentary on an article by Ahmad Essa, MD, MPH, et al.: \"Trends and Impact of Pharmacological VTE Prophylaxis Timing for Traumatic Cervical Spinal Cord Injury Across North American Trauma Centers\".","authors":"Sarkis Sam Kaspar","doi":"10.2106/jbjs.25.01041","DOIUrl":"https://doi.org/10.2106/jbjs.25.01041","url":null,"abstract":"","PeriodicalId":22625,"journal":{"name":"The Journal of Bone & Joint Surgery","volume":"39 1","pages":"1-2"},"PeriodicalIF":0.0,"publicationDate":"2026-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145907826","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":"Evaluating the Wear of a Viscoelastic Spinal Disc in the Context of Hip and Knee Arthroplasties: Commentary on an article by Kingsley R. Chin, MD, et al.: \"Comparative in Vitro Analysis of Wear Particles Generated by a Viscoelastic Disc Versus 2 Articulating Total Disc Replacements\".","authors":"Harry A McKellop","doi":"10.2106/jbjs.25.01201","DOIUrl":"https://doi.org/10.2106/jbjs.25.01201","url":null,"abstract":"","PeriodicalId":22625,"journal":{"name":"The Journal of Bone & Joint Surgery","volume":"24 1","pages":"4-5"},"PeriodicalIF":0.0,"publicationDate":"2026-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145907807","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":"Better Balance for Patients with Lumbar AIS: Commentary on an article by Mun Keong Kwan, MBBS, MSOrth, et al.: \"Prevention of Postoperative Coronal Imbalance in Patients with Adolescent Idiopathic Scoliosis with a Major Lumbar Curve. The Intraoperative Crossbar Coronal-Balancing Technique\".","authors":"Mark J Adamczyk,Todd F Ritzman","doi":"10.2106/jbjs.25.01076","DOIUrl":"https://doi.org/10.2106/jbjs.25.01076","url":null,"abstract":"","PeriodicalId":22625,"journal":{"name":"The Journal of Bone & Joint Surgery","volume":"31 1","pages":"3"},"PeriodicalIF":0.0,"publicationDate":"2026-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145907825","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}
BACKGROUNDArtificial intelligence (AI) in orthopaedics is shifting from passive interfaces in which a surgeon queries a large language model to an era of active participation in which a surgeon empowers a software platform to automate certain tasks on their behalf. The emerging new paradigm called agentic AI involves agents that move beyond decision support tools to becoming semi-autonomous collaborators in research, clinical, and rehabilitation tasks.PURPOSEThe purpose of this review is to summarize how recent advances (April 2022 to October 2025) in automation, prediction, and augmentation agents are poised to transform the practice of orthopaedics; and to outline the conceptual, technical, and ethical foundations of this transition.RECENT FINDINGSAn agent is software that can process information and act independently to execute a set of defined tasks. It can seek knowledge, ask for help, deploy other software, and learn from its actions. Automation, prediction and augmentation agents can be leveraged in multi-agent and federated-learning architectures, working together to create coordinated ecosystems that can manage complex tasks and that improve with clinical use. Collectively, the output of such ecosystems is referred to as agentic AI. However, regulatory and ethical concerns underscore the need for transparency, equity, and the preservation of human agency within these frameworks.SUMMARYAgentic AI marks a transition from passive tools that merely assist clinicians to autonomous systems that act alongside them. The success of this technology in orthopaedics will depend on the depth of human-machine collaboration they enable and how well they align computational precision with the enduring human art of restoring motion and health.
{"title":"The Application of Agentic Artificial Intelligence in Orthopaedics.","authors":"Fabrizio Billi,Stefano A Bini","doi":"10.2106/jbjs.25.01497","DOIUrl":"https://doi.org/10.2106/jbjs.25.01497","url":null,"abstract":"BACKGROUNDArtificial intelligence (AI) in orthopaedics is shifting from passive interfaces in which a surgeon queries a large language model to an era of active participation in which a surgeon empowers a software platform to automate certain tasks on their behalf. The emerging new paradigm called agentic AI involves agents that move beyond decision support tools to becoming semi-autonomous collaborators in research, clinical, and rehabilitation tasks.PURPOSEThe purpose of this review is to summarize how recent advances (April 2022 to October 2025) in automation, prediction, and augmentation agents are poised to transform the practice of orthopaedics; and to outline the conceptual, technical, and ethical foundations of this transition.RECENT FINDINGSAn agent is software that can process information and act independently to execute a set of defined tasks. It can seek knowledge, ask for help, deploy other software, and learn from its actions. Automation, prediction and augmentation agents can be leveraged in multi-agent and federated-learning architectures, working together to create coordinated ecosystems that can manage complex tasks and that improve with clinical use. Collectively, the output of such ecosystems is referred to as agentic AI. However, regulatory and ethical concerns underscore the need for transparency, equity, and the preservation of human agency within these frameworks.SUMMARYAgentic AI marks a transition from passive tools that merely assist clinicians to autonomous systems that act alongside them. The success of this technology in orthopaedics will depend on the depth of human-machine collaboration they enable and how well they align computational precision with the enduring human art of restoring motion and health.","PeriodicalId":22625,"journal":{"name":"The Journal of Bone & Joint Surgery","volume":"42 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-01-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145903721","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":"Conducting Systematic Reviews in a Day: Enter Artificial Intelligence.","authors":"Christian Cao,David Moher","doi":"10.2106/jbjs.25.01373","DOIUrl":"https://doi.org/10.2106/jbjs.25.01373","url":null,"abstract":"","PeriodicalId":22625,"journal":{"name":"The Journal of Bone & Joint Surgery","volume":"125 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-01-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145903724","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}
➢ Substantial disparities exist between Latin America and high-income countries in research capacity, and artificial intelligence (AI) has emerged as a powerful tool to accelerate scientific development and reduce this gap.➢ Orthopaedic research in Latin America faces persistent barriers, including limited funding, lack of trained investigators, and insufficient data infrastructure, that restrict innovation and international collaboration.➢ By automating complex and time-consuming tasks, AI can lower research costs, improve efficiency, and enhance project quality across all stages, from data analysis to manuscript preparation.➢ The growing adoption of AI in the region is already strengthening academic productivity, fostering collaboration, and supporting Latin America's transition to a more equitable and innovative research environment.
{"title":"The Transformative Potential of Artificial Intelligence in Latin American Research.","authors":"Ricardo Becker,Michelle Ghert","doi":"10.2106/jbjs.25.01431","DOIUrl":"https://doi.org/10.2106/jbjs.25.01431","url":null,"abstract":"➢ Substantial disparities exist between Latin America and high-income countries in research capacity, and artificial intelligence (AI) has emerged as a powerful tool to accelerate scientific development and reduce this gap.➢ Orthopaedic research in Latin America faces persistent barriers, including limited funding, lack of trained investigators, and insufficient data infrastructure, that restrict innovation and international collaboration.➢ By automating complex and time-consuming tasks, AI can lower research costs, improve efficiency, and enhance project quality across all stages, from data analysis to manuscript preparation.➢ The growing adoption of AI in the region is already strengthening academic productivity, fostering collaboration, and supporting Latin America's transition to a more equitable and innovative research environment.","PeriodicalId":22625,"journal":{"name":"The Journal of Bone & Joint Surgery","volume":"12 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-01-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145903722","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":"Is the Minimal Clinically Important Difference (MCID) Still a Reliable Outcome?: A Call for Conceptual Rethinking.","authors":"Iberê Pereira Datti","doi":"10.2106/jbjs.25.00868","DOIUrl":"https://doi.org/10.2106/jbjs.25.00868","url":null,"abstract":"","PeriodicalId":22625,"journal":{"name":"The Journal of Bone & Joint Surgery","volume":"11 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-01-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145903725","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 femoral pin tracker in robotic-assisted total knee arthroplasty (TKA) can be placed intraincisionally or extraincisionally. The purpose of our study was to determine the impact of these placement methods on soft-tissue tension in the knee joint.METHODSA total of 132 patients undergoing robotic-assisted TKA were prospectively enrolled; of those, 80 were randomized to receive an intraincisional or extraincisional femoral pin tracker during surgery. Soft-tissue tension in the medial and lateral compartments of the knee joint was measured using a sensor before and after the removal of the pin tracker. Measurements were performed at 10°, 45°, 90°, and 120° of knee flexion. Changes in knee joint soft-tissue tension from before to after the removal of the pin tracker were compared between the 2 groups.RESULTSOur trial included 80 patients (mean age, 66.98 ± 38.48 years; 24% male; 100% Han Chinese). The intraincisional group demonstrated significantly greater changes in soft-tissue tension in the medial compartment of the knee at 10° (p < 0.001), 45° (p = 0.028), and 90° (p = 0.046) of knee flexion compared with the extraincisional group. No significant between-group differences were found in the changes in tension in the medial compartment at 120° of knee flexion (p > 0.05) or in the lateral compartment at any angle (p > 0.05).CONCLUSIONSIntraincisional placement of the femoral pin tracker may influence soft-tissue tension in the medial compartment of the knee. Surgeons should be aware of these differences when performing soft-tissue balancing before the removal of the femoral pin tracker.LEVEL OF EVIDENCETherapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.
{"title":"Impact of the Femoral Pin Tracker on Soft-Tissue Tension in Robotic-Assisted Total Knee Arthroplasty: A Prospective Randomized Controlled Trial.","authors":"Hao-Ming An,Wei Sun,Wang Gu,Shao-Kui Nan,Rui Li,Wei Chai","doi":"10.2106/jbjs.25.00705","DOIUrl":"https://doi.org/10.2106/jbjs.25.00705","url":null,"abstract":"BACKGROUNDThe femoral pin tracker in robotic-assisted total knee arthroplasty (TKA) can be placed intraincisionally or extraincisionally. The purpose of our study was to determine the impact of these placement methods on soft-tissue tension in the knee joint.METHODSA total of 132 patients undergoing robotic-assisted TKA were prospectively enrolled; of those, 80 were randomized to receive an intraincisional or extraincisional femoral pin tracker during surgery. Soft-tissue tension in the medial and lateral compartments of the knee joint was measured using a sensor before and after the removal of the pin tracker. Measurements were performed at 10°, 45°, 90°, and 120° of knee flexion. Changes in knee joint soft-tissue tension from before to after the removal of the pin tracker were compared between the 2 groups.RESULTSOur trial included 80 patients (mean age, 66.98 ± 38.48 years; 24% male; 100% Han Chinese). The intraincisional group demonstrated significantly greater changes in soft-tissue tension in the medial compartment of the knee at 10° (p < 0.001), 45° (p = 0.028), and 90° (p = 0.046) of knee flexion compared with the extraincisional group. No significant between-group differences were found in the changes in tension in the medial compartment at 120° of knee flexion (p > 0.05) or in the lateral compartment at any angle (p > 0.05).CONCLUSIONSIntraincisional placement of the femoral pin tracker may influence soft-tissue tension in the medial compartment of the knee. Surgeons should be aware of these differences when performing soft-tissue balancing before the removal of the femoral pin tracker.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":"41 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-01-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145903723","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}
Ruikang Guo,Mei Lin Tay,Katy Kim,Mark Zhu,Simon Young
BACKGROUNDUnderstanding the causative microorganisms and initiating appropriate empirical antibiotics early are important in the management of knee periprosthetic joint infections (PJIs). The aim of this study was to identify trends in PJI microorganisms and antibiotic resistance profiles over 24 years to guide empirical antibiotic selection.METHODSThis study included 487 first-episode PJIs identified between 2000 and 2023 following primary total knee arthroplasty (TKA) at 3 large tertiary hospitals. PJIs were classified using the Tsukayama classification, which is based on the timing from the primary TKA and the source of infection. Multivariable logistic regression was used to analyze risk factors for polymicrobial and resistant infections.RESULTSA total of 487 PJI cases with 608 culture specimens were identified. The mean patient age (and standard deviation) was 70 ± 11 years, with 65% male patients and 35% female patients. All ethnicity data were self-reported. Of the patients in this study, 57% were New Zealand European, 14% were other European, 14% were Pacific Islander, 10% were New Zealand Māori, and 6% were Asian. The most common pathogen for PJIs was Staphylococcus aureus. The proportion of resistant cases (19% to 24%) was consistent across the 24-year period. A prosthesis in situ for <1 year was found to be the most important risk factor for polymicrobial infections (11 times more likely) and resistant infections (3 times more likely). Flucloxacillin monotherapy covered 45% of early PJI cases, 57% of chronic PJI cases, and 79% of late hematogenous cases. In comparison, vancomycin monotherapy provided coverage of ≥78% across all 3 PJI classes, and adding a gram-negative antibiotic such as gentamicin or cotrimoxazole increased coverage to >90%.CONCLUSIONSDespite the known emergence of resistant organisms in health-care settings, the primary causative microorganisms remained the same in knee PJIs, with no notable increase in resistant cases, over 24 years. Based on the findings of this study, vancomycin with gram-negative coverage is recommended as the empirical treatment of choice in early PJIs, and beta-lactams, such as flucloxacillin and a first-generation cephalosporin (e.g., cefazolin), were found to still be effective for late hematogenous PJIs. For septic PJI, dual therapy with vancomycin and a gram-negative agent is recommended, regardless of infection timing.LEVEL OF EVIDENCEPrognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
{"title":"Microbial Resistance Patterns in Periprosthetic Joint Infection of the Knee: A 24-Year Longitudinal Study.","authors":"Ruikang Guo,Mei Lin Tay,Katy Kim,Mark Zhu,Simon Young","doi":"10.2106/jbjs.25.00541","DOIUrl":"https://doi.org/10.2106/jbjs.25.00541","url":null,"abstract":"BACKGROUNDUnderstanding the causative microorganisms and initiating appropriate empirical antibiotics early are important in the management of knee periprosthetic joint infections (PJIs). The aim of this study was to identify trends in PJI microorganisms and antibiotic resistance profiles over 24 years to guide empirical antibiotic selection.METHODSThis study included 487 first-episode PJIs identified between 2000 and 2023 following primary total knee arthroplasty (TKA) at 3 large tertiary hospitals. PJIs were classified using the Tsukayama classification, which is based on the timing from the primary TKA and the source of infection. Multivariable logistic regression was used to analyze risk factors for polymicrobial and resistant infections.RESULTSA total of 487 PJI cases with 608 culture specimens were identified. The mean patient age (and standard deviation) was 70 ± 11 years, with 65% male patients and 35% female patients. All ethnicity data were self-reported. Of the patients in this study, 57% were New Zealand European, 14% were other European, 14% were Pacific Islander, 10% were New Zealand Māori, and 6% were Asian. The most common pathogen for PJIs was Staphylococcus aureus. The proportion of resistant cases (19% to 24%) was consistent across the 24-year period. A prosthesis in situ for <1 year was found to be the most important risk factor for polymicrobial infections (11 times more likely) and resistant infections (3 times more likely). Flucloxacillin monotherapy covered 45% of early PJI cases, 57% of chronic PJI cases, and 79% of late hematogenous cases. In comparison, vancomycin monotherapy provided coverage of ≥78% across all 3 PJI classes, and adding a gram-negative antibiotic such as gentamicin or cotrimoxazole increased coverage to >90%.CONCLUSIONSDespite the known emergence of resistant organisms in health-care settings, the primary causative microorganisms remained the same in knee PJIs, with no notable increase in resistant cases, over 24 years. Based on the findings of this study, vancomycin with gram-negative coverage is recommended as the empirical treatment of choice in early PJIs, and beta-lactams, such as flucloxacillin and a first-generation cephalosporin (e.g., cefazolin), were found to still be effective for late hematogenous PJIs. For septic PJI, dual therapy with vancomycin and a gram-negative agent is recommended, regardless of infection timing.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":"27 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-01-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145903726","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}
Babar Kayani,John G Stammers,James Donaldson,Simon Newman,Chethan Jayadev,Jonathan Miles,John A Skinner,Michael Fox
➢ Neurological injury remains the most common reason for ligation following total hip arthroplasty.➢ The main risk factors for neurological injury following total hip arthroplasty are preexisting spinal pathology, revision surgery, complex hip anatomy, female sex, surgeon inexperience, and excessive limb lengthening.➢ Postoperative pelvic computed tomographic scans may be used to assess component positioning and identify any compressive hematomas. Magnetic resonance imaging with a metal artifact reduction protocol may be used to evaluate architectural changes in the affected nerve.➢ Electromyography and nerve conduction studies may help to assess the level and grade of the nerve injury. These tests are most useful when performed in patients who show no signs of neurological improvement 3 to 6 weeks after surgery.➢ The mainstay of nonoperative management is supportive care with physical therapy, an ankle-foot orthosis, and neuropathic pain treatment.➢ The prognosis for a femoral nerve injury is generally more favorable than that for a sciatic nerve injury following total hip arthroplasty.
{"title":"The Management of Neurological Injuries Following Total Hip Arthroplasty.","authors":"Babar Kayani,John G Stammers,James Donaldson,Simon Newman,Chethan Jayadev,Jonathan Miles,John A Skinner,Michael Fox","doi":"10.2106/jbjs.25.00389","DOIUrl":"https://doi.org/10.2106/jbjs.25.00389","url":null,"abstract":"➢ Neurological injury remains the most common reason for ligation following total hip arthroplasty.➢ The main risk factors for neurological injury following total hip arthroplasty are preexisting spinal pathology, revision surgery, complex hip anatomy, female sex, surgeon inexperience, and excessive limb lengthening.➢ Postoperative pelvic computed tomographic scans may be used to assess component positioning and identify any compressive hematomas. Magnetic resonance imaging with a metal artifact reduction protocol may be used to evaluate architectural changes in the affected nerve.➢ Electromyography and nerve conduction studies may help to assess the level and grade of the nerve injury. These tests are most useful when performed in patients who show no signs of neurological improvement 3 to 6 weeks after surgery.➢ The mainstay of nonoperative management is supportive care with physical therapy, an ankle-foot orthosis, and neuropathic pain treatment.➢ The prognosis for a femoral nerve injury is generally more favorable than that for a sciatic nerve injury following total hip arthroplasty.","PeriodicalId":22625,"journal":{"name":"The Journal of Bone & Joint Surgery","volume":"46 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-12-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145835986","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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