Heather A Prentice,Priscilla H Chan,Richard N Chang,Brian H Fasig,Matthew P Kelly,Adrian D Hinman,Steven M Kurtz,Elizabeth W Paxton
BACKGROUNDAlthough the use of highly cross-linked polyethylene (HXLPE) with antioxidants in total knee arthroplasty (TKA) has increased over time, evidence of any benefit in survivorship over HXLPE without antioxidants is lacking. We sought to compare the TKA revision risk for HXLPE with and without antioxidants.METHODSData from the Kaiser Permanente health-care system's total joint replacement registry were used for a cohort study. Adult patients who underwent primary fixed-bearing TKA with patellar resurfacing for osteoarthritis from 2001 to 2023 were included. The study groups were cases of TKA performed with HXLPE with and without antioxidants. The primary outcome was all-cause revision; revisions for septic reasons, any aseptic reasons, wear, and loosening were secondary outcomes. Multivariable Cox proportional-hazards regression was used to evaluate the revision risk by treatment group with an adjustment for covariates.RESULTSThe final study sample included 92,923 TKA cases: 48,846 performed with HXLPE implants with antioxidants and 44,077 performed with HXLPE implants without antioxidants. The mean patient age was 67.7 years, and the mean patient body mass index was 31.2 kg/m2. Most patients were female (64.3%) and White (64.8%) and had an American Society of Anesthesiologists classification of 1 to 2 (65.2%). The 13-year crude revision incidence was 3.4% for the antioxidant group and 4.2% for the group without antioxidants. After we adjusted for confounders, we observed a lower revision risk for the antioxidant group compared with the group without antioxidants (hazard ratio [HR], 0.86 [95% confidence interval (CI), 0.79 to 0.95]). When we investigated revisions for specific reasons, we observed a lower risk for aseptic revision (HR, 0.86 [95% CI, 0.76 to 0.97]) and for wear (HR, 0.41 [95% CI, 0.21 to 0.81]) in the antioxidant group.CONCLUSIONSWe observed a lower risk of al-cause revision and a lower risk of revision specifically for wear in TKA cases performed with HXLPE with antioxidants added.LEVEL OF EVIDENCETherapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
{"title":"Antioxidant-Loaded Highly Cross-Linked Polyethylene May Reduce Revision Risk in Total Knee Arthroplasty: A U.S.-Based Cohort Study.","authors":"Heather A Prentice,Priscilla H Chan,Richard N Chang,Brian H Fasig,Matthew P Kelly,Adrian D Hinman,Steven M Kurtz,Elizabeth W Paxton","doi":"10.2106/jbjs.25.00490","DOIUrl":"https://doi.org/10.2106/jbjs.25.00490","url":null,"abstract":"BACKGROUNDAlthough the use of highly cross-linked polyethylene (HXLPE) with antioxidants in total knee arthroplasty (TKA) has increased over time, evidence of any benefit in survivorship over HXLPE without antioxidants is lacking. We sought to compare the TKA revision risk for HXLPE with and without antioxidants.METHODSData from the Kaiser Permanente health-care system's total joint replacement registry were used for a cohort study. Adult patients who underwent primary fixed-bearing TKA with patellar resurfacing for osteoarthritis from 2001 to 2023 were included. The study groups were cases of TKA performed with HXLPE with and without antioxidants. The primary outcome was all-cause revision; revisions for septic reasons, any aseptic reasons, wear, and loosening were secondary outcomes. Multivariable Cox proportional-hazards regression was used to evaluate the revision risk by treatment group with an adjustment for covariates.RESULTSThe final study sample included 92,923 TKA cases: 48,846 performed with HXLPE implants with antioxidants and 44,077 performed with HXLPE implants without antioxidants. The mean patient age was 67.7 years, and the mean patient body mass index was 31.2 kg/m2. Most patients were female (64.3%) and White (64.8%) and had an American Society of Anesthesiologists classification of 1 to 2 (65.2%). The 13-year crude revision incidence was 3.4% for the antioxidant group and 4.2% for the group without antioxidants. After we adjusted for confounders, we observed a lower revision risk for the antioxidant group compared with the group without antioxidants (hazard ratio [HR], 0.86 [95% confidence interval (CI), 0.79 to 0.95]). When we investigated revisions for specific reasons, we observed a lower risk for aseptic revision (HR, 0.86 [95% CI, 0.76 to 0.97]) and for wear (HR, 0.41 [95% CI, 0.21 to 0.81]) in the antioxidant group.CONCLUSIONSWe observed a lower risk of al-cause revision and a lower risk of revision specifically for wear in TKA cases performed with HXLPE with antioxidants added.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":"29 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145609926","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}
BACKGROUNDAlthough radiographs are the first-line imaging modality, differentiating between neoplastic pathologic fractures and nonpathologic fractures on radiographs can sometimes be challenging. In this study, we aimed to develop and evaluate a deep learning model capable of distinguishing neoplastic pathologic fractures from nonpathologic fractures on hip radiographs to enhance diagnostic accuracy.METHODSThis retrospective, multicenter study analyzed anteroposterior hip radiographs from patients who visited the emergency department at 4 different institutions. The deep learning model was trained on, and tested using, data from 338 patients at a single institution and externally validated on data from 488 patients across 3 additional institutions.RESULTSThe model achieved an overall accuracy of 0.880, with a sensitivity of 0.882 and a specificity of 0.879, on the internal test set. It was then externally validated using the data of 488 patients (67 with neoplastic pathologic fracture and 421 with nonpathologic fracture) from institutions separate from where the model was developed. The model achieved an overall accuracy of 0.848, sensitivity of 0.910, and specificity of 0.786. Its performance was comparable with that of general orthopaedic surgeons.CONCLUSIONSThe developed deep learning model is a reliable and valid tool for distinguishing neoplastic pathologic fractures from nonpathologic fractures on hip radiographs. It has the potential to assist orthopaedic surgeons in resource-limited settings, where optimizing the interpretation of radiographs is critical for patient care. The model is publicly available at https://pathfxdx.org.LEVEL OF EVIDENCEDiagnostic Level III. See Instructions for Authors for a complete description of levels of evidence.
背景虽然x线片是一线成像方式，但在x线片上区分肿瘤性病理性骨折和非病理性骨折有时是具有挑战性的。在这项研究中，我们旨在开发和评估一种深度学习模型，该模型能够在髋关节x线片上区分肿瘤病理性骨折和非病理性骨折，以提高诊断准确性。方法：本研究是一项回顾性、多中心研究，分析了4家不同医院急诊科患者的髋关节正位x线片。深度学习模型使用来自单个机构338名患者的数据进行训练和测试，并使用来自另外3个机构488名患者的数据进行外部验证。结果该模型在内部测试集上的总体准确率为0.880，灵敏度为0.882，特异性为0.879。然后使用来自不同机构的488例患者（67例为肿瘤性病理性骨折，421例为非病理性骨折）的数据对模型进行外部验证。该模型的总体准确率为0.848，灵敏度为0.910，特异性为0.786。其性能可与普通骨科医生相媲美。结论所建立的深度学习模型是一种可靠有效的工具，可以在髋部x线片上区分肿瘤病理性骨折和非病理性骨折。在资源有限的情况下，它有可能帮助骨科医生，在这种情况下，优化x光片的解释对患者护理至关重要。该模型可在https://pathfxdx.org.LEVEL OF EVIDENCEDiagnostic Level III上公开获得。有关证据水平的完整描述，请参见作者说明。
{"title":"Deep Learning Model for Differentiating Between Neoplastic Pathologic Fracture and Nonpathologic Fracture Using Hip Radiographs.","authors":"Shinn Kim,Kyoungseob Shin,Han-Soo Kim,Yongsung Kim,June Hyuk Kim,Min Wook Joo,Wanlim Kim,Jay Hoon Park,Yoon Joo Cho,Minsu Kim,Sunghoon Kwon,Ilkyu Han","doi":"10.2106/jbjs.25.00344","DOIUrl":"https://doi.org/10.2106/jbjs.25.00344","url":null,"abstract":"BACKGROUNDAlthough radiographs are the first-line imaging modality, differentiating between neoplastic pathologic fractures and nonpathologic fractures on radiographs can sometimes be challenging. In this study, we aimed to develop and evaluate a deep learning model capable of distinguishing neoplastic pathologic fractures from nonpathologic fractures on hip radiographs to enhance diagnostic accuracy.METHODSThis retrospective, multicenter study analyzed anteroposterior hip radiographs from patients who visited the emergency department at 4 different institutions. The deep learning model was trained on, and tested using, data from 338 patients at a single institution and externally validated on data from 488 patients across 3 additional institutions.RESULTSThe model achieved an overall accuracy of 0.880, with a sensitivity of 0.882 and a specificity of 0.879, on the internal test set. It was then externally validated using the data of 488 patients (67 with neoplastic pathologic fracture and 421 with nonpathologic fracture) from institutions separate from where the model was developed. The model achieved an overall accuracy of 0.848, sensitivity of 0.910, and specificity of 0.786. Its performance was comparable with that of general orthopaedic surgeons.CONCLUSIONSThe developed deep learning model is a reliable and valid tool for distinguishing neoplastic pathologic fractures from nonpathologic fractures on hip radiographs. It has the potential to assist orthopaedic surgeons in resource-limited settings, where optimizing the interpretation of radiographs is critical for patient care. The model is publicly available at https://pathfxdx.org.LEVEL OF EVIDENCEDiagnostic Level III. See Instructions for Authors for a complete description of levels of evidence.","PeriodicalId":22625,"journal":{"name":"The Journal of Bone & Joint Surgery","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145609928","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}
Carol A Mancuso,Roland Duculan,Allina A Nocon,Cynthia A Kahlenberg,Peter K Sculco,Thomas P Sculco
BACKGROUNDUnderstanding the sources of patients' expectations of total knee arthroplasty (TKA) can foster realistic expectations. Sources of expectations may be influenced by clinical and psychological variables, including general disposition or attitude.METHODSPatients undergoing TKA completed a 19-item survey preoperatively that addressed the amount of improvement expected (i.e., "complete" to "a little") for symptoms and physical and psychological well-being. Patients reported the sources of these expectations, which were grouped into categories. Disposition or attitude was assessed for positive affect (e.g., openness to change) and negative affect (e.g., irritability) with use of the Positive and Negative Affect Schedule (PANAS). Clinical status was assessed using the Knee injury and Osteoarthritis Outcome Score-Joint Replacement (KOOS-JR). Expectations and sources of expectations were compared with KOOS-JR and PANAS scores and demographic and clinical characteristics (e.g., symptom duration) with use of statistical analyses.RESULTSA total of 232 patients (mean age, 65 years; 60% women; 17% Latino ethnicity or non-White race) were enrolled 17 ± 8 days preoperatively. Seventy-two percent expected ≥15 of the survey items; complete improvement was expected for 59% of items. Expecting more items was associated with better preoperative KOOS-JR scores (p < 0.0001), more negative affect (p = 0.003), a shorter duration of symptoms (p = 0.01), and not being a college graduate (p = 0.04). Patients volunteered multiple sources of expectations, including favorable outcomes from a previous orthopaedic surgery (11% of patients), knowledge of favorable (56%) and unfavorable (7%) TKA outcomes in others, their current surgeon (15%), avoidance of further knee deterioration (10%), internet information (16%), and general optimism (18%). Citing more sources was associated with worse KOOS-JR scores (p = 0.02) and less positive affect (p = 0.009). Sources of expectations were associated with patient variables; specifically, knowledge of favorable outcomes was associated with better KOOS-JR scores (p = 0.04), knowledge of unfavorable outcomes was associated with more negative affect (p = 0.04), optimism was associated with more positive affect (p = 0.01), and information from the internet was associated with longer symptom duration (p = 0.04) and less negative affect (p = 0.02).CONCLUSIONSPatients had high expectations of TKA and derived these expectations from diverse sources spanning personal and social network experiences. Patients' expectations and/or sources of expectations were associated with functional status and positive and negative affect.LEVEL OF EVIDENCEPrognostic Level II. See Instructions for Authors for a complete description of levels of evidence.
{"title":"Sources of Patients' Expectations of Total Knee Arthroplasty.","authors":"Carol A Mancuso,Roland Duculan,Allina A Nocon,Cynthia A Kahlenberg,Peter K Sculco,Thomas P Sculco","doi":"10.2106/jbjs.25.00529","DOIUrl":"https://doi.org/10.2106/jbjs.25.00529","url":null,"abstract":"BACKGROUNDUnderstanding the sources of patients' expectations of total knee arthroplasty (TKA) can foster realistic expectations. Sources of expectations may be influenced by clinical and psychological variables, including general disposition or attitude.METHODSPatients undergoing TKA completed a 19-item survey preoperatively that addressed the amount of improvement expected (i.e., \"complete\" to \"a little\") for symptoms and physical and psychological well-being. Patients reported the sources of these expectations, which were grouped into categories. Disposition or attitude was assessed for positive affect (e.g., openness to change) and negative affect (e.g., irritability) with use of the Positive and Negative Affect Schedule (PANAS). Clinical status was assessed using the Knee injury and Osteoarthritis Outcome Score-Joint Replacement (KOOS-JR). Expectations and sources of expectations were compared with KOOS-JR and PANAS scores and demographic and clinical characteristics (e.g., symptom duration) with use of statistical analyses.RESULTSA total of 232 patients (mean age, 65 years; 60% women; 17% Latino ethnicity or non-White race) were enrolled 17 ± 8 days preoperatively. Seventy-two percent expected ≥15 of the survey items; complete improvement was expected for 59% of items. Expecting more items was associated with better preoperative KOOS-JR scores (p < 0.0001), more negative affect (p = 0.003), a shorter duration of symptoms (p = 0.01), and not being a college graduate (p = 0.04). Patients volunteered multiple sources of expectations, including favorable outcomes from a previous orthopaedic surgery (11% of patients), knowledge of favorable (56%) and unfavorable (7%) TKA outcomes in others, their current surgeon (15%), avoidance of further knee deterioration (10%), internet information (16%), and general optimism (18%). Citing more sources was associated with worse KOOS-JR scores (p = 0.02) and less positive affect (p = 0.009). Sources of expectations were associated with patient variables; specifically, knowledge of favorable outcomes was associated with better KOOS-JR scores (p = 0.04), knowledge of unfavorable outcomes was associated with more negative affect (p = 0.04), optimism was associated with more positive affect (p = 0.01), and information from the internet was associated with longer symptom duration (p = 0.04) and less negative affect (p = 0.02).CONCLUSIONSPatients had high expectations of TKA and derived these expectations from diverse sources spanning personal and social network experiences. Patients' expectations and/or sources of expectations were associated with functional status and positive and negative affect.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":"145 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145609927","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}
BACKGROUNDTotal hip arthroplasty (THA) is a well-established procedure for hip osteoarthritis (OA); however, its clinical outcomes are variable, and the optimal timing for surgery remains unclear. Identifying the preoperative predictors that influence midterm patient-reported outcome measures (PROMs) could improve patient outcomes.METHODSThis retrospective cohort study included 274 Asian patients who underwent primary THA for OA between 2012 and 2018, who completed preoperative physical assessments, and who responded to a postoperative mail survey. Preoperative variables included symptom duration, pain intensity, hip range of motion, lower-limb muscle strength, and 10-m free gait speed. PROMs were assessed using the Oxford Hip Score (OHS) and the Forgotten Joint Score-12 (FJS-12). Clinically meaningful outcomes were assessed using the Patient Acceptable Symptom State (PASS), defined as a score of ≥42 for the OHS and a score of ≥50 for the FJS-12. Additionally, K-means clustering was applied to categorize patients into an excellent outcome group and a control group on the basis of their PROMs.RESULTSMultivariable regression analysis revealed that preoperative gait speed significantly predicted both the OHS and FJS-12 outcomes (p < 0.01). Furthermore, hip flexion range of motion and hip flexion strength were significantly associated with preoperative gait speed (p < 0.01). A receiver operating characteristic (ROC) curve analysis identified a gait speed cutoff value of 0.7 m/s for achieving the PASS for the OHS (area under the curve [AUC]: 0.69; p < 0.01) and a cutoff value of 1.0 m/s for achieving the PASS for the FJS-12 (AUC: 0.60; p = 0.01). K-means clustering identified preoperative gait speed as the sole significant predictor of classification into the excellent outcome group (odds ratio, 5.85; p < 0.01). The ROC curve analysis revealed a gait speed cutoff value of 1.0 m/s for classification into the excellent group (AUC: 0.64; p < 0.01).CONCLUSIONSPreoperative gait speed, which reflects decreased mobility due to hip joint dysfunction, was a significant predictor of midterm PROMs after THA. Maintaining a preoperative gait speed of 1.0 m/s could serve as a critical threshold for achieving favorable postoperative outcomes, regardless of patient age.LEVEL OF EVIDENCEPrognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
背景：全髋关节置换术（THA）是治疗髋关节骨关节炎（OA）的一种成熟的手术；然而，其临床结果是可变的，手术的最佳时机仍不清楚。确定术前影响中期患者报告结果测量（PROMs）的预测因素可以改善患者的预后。方法：本回顾性队列研究纳入了274例亚洲患者，这些患者在2012年至2018年期间因OA接受了原发性THA，他们完成了术前身体评估，并对术后邮件调查做出了回应。术前变量包括症状持续时间、疼痛强度、髋关节活动范围、下肢肌肉力量和10米自由步速。使用牛津髋关节评分（OHS）和遗忘关节评分-12 （FJS-12）对prom进行评估。使用患者可接受症状状态（PASS）评估临床有意义的结果，定义为OHS评分≥42分，FJS-12评分≥50分。此外，采用K-means聚类，根据患者的PROMs将患者分为优秀结果组和对照组。结果多变量回归分析显示，术前步态速度对OHS和FJS-12预后均有显著预测作用（p < 0.01）。此外，髋屈曲活动范围和髋屈曲强度与术前步态速度显著相关（p < 0.01）。通过受试者工作特征（ROC）曲线分析，确定了OHS的步态速度截止值为0.7 m/s（曲线下面积[AUC]: 0.69; p < 0.01）， FJS-12的步态速度截止值为1.0 m/s （AUC: 0.60; p = 0.01）。K-means聚类发现术前步态速度是进入优胜者组的唯一显著预测因子（优势比，5.85;p < 0.01）。ROC曲线分析显示，步态速度截断值为1.0 m/s为优组（AUC: 0.64; p < 0.01）。结论术前步态速度反映髋关节功能障碍导致的活动能力下降，是THA术后中期PROMs的重要预测因子。无论患者年龄如何，术前保持1.0 m/s的步速可以作为获得良好术后结果的关键阈值。证据水平：预后III级。有关证据水平的完整描述，请参见作者说明。
{"title":"Preoperative Gait Speed as a Predictor of Patient-Reported Outcomes After Total Hip Arthroplasty: Insights from Patient Acceptable Symptom State and K-Means Clustering Analyses.","authors":"Yuki Nakao,Satoshi Hamai,Satoshi Yamate,Toshiki Konishi,Shinya Kawahara,Goro Motomura,Takeshi Utsunomiya,Yasuharu Nakashima","doi":"10.2106/jbjs.25.00542","DOIUrl":"https://doi.org/10.2106/jbjs.25.00542","url":null,"abstract":"BACKGROUNDTotal hip arthroplasty (THA) is a well-established procedure for hip osteoarthritis (OA); however, its clinical outcomes are variable, and the optimal timing for surgery remains unclear. Identifying the preoperative predictors that influence midterm patient-reported outcome measures (PROMs) could improve patient outcomes.METHODSThis retrospective cohort study included 274 Asian patients who underwent primary THA for OA between 2012 and 2018, who completed preoperative physical assessments, and who responded to a postoperative mail survey. Preoperative variables included symptom duration, pain intensity, hip range of motion, lower-limb muscle strength, and 10-m free gait speed. PROMs were assessed using the Oxford Hip Score (OHS) and the Forgotten Joint Score-12 (FJS-12). Clinically meaningful outcomes were assessed using the Patient Acceptable Symptom State (PASS), defined as a score of ≥42 for the OHS and a score of ≥50 for the FJS-12. Additionally, K-means clustering was applied to categorize patients into an excellent outcome group and a control group on the basis of their PROMs.RESULTSMultivariable regression analysis revealed that preoperative gait speed significantly predicted both the OHS and FJS-12 outcomes (p < 0.01). Furthermore, hip flexion range of motion and hip flexion strength were significantly associated with preoperative gait speed (p < 0.01). A receiver operating characteristic (ROC) curve analysis identified a gait speed cutoff value of 0.7 m/s for achieving the PASS for the OHS (area under the curve [AUC]: 0.69; p < 0.01) and a cutoff value of 1.0 m/s for achieving the PASS for the FJS-12 (AUC: 0.60; p = 0.01). K-means clustering identified preoperative gait speed as the sole significant predictor of classification into the excellent outcome group (odds ratio, 5.85; p < 0.01). The ROC curve analysis revealed a gait speed cutoff value of 1.0 m/s for classification into the excellent group (AUC: 0.64; p < 0.01).CONCLUSIONSPreoperative gait speed, which reflects decreased mobility due to hip joint dysfunction, was a significant predictor of midterm PROMs after THA. Maintaining a preoperative gait speed of 1.0 m/s could serve as a critical threshold for achieving favorable postoperative outcomes, regardless of patient age.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":"204 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145609925","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}
BACKGROUNDIntra-articular (IA) corticosteroid injections are commonly used for pain relief and improved function in patients with knee osteoarthritis (OA). However, the optimal corticosteroid preparation remains controversial. The aim of this study was to compare the efficacy of single-shot long-acting corticosteroid (betamethasone) and intermediate-acting corticosteroid (triamcinolone acetonide) injections in knee OA.METHODSThis single-center, double-blinded, randomized controlled trial included 120 patients with symptomatic knee OA who were randomized to receive either a betamethasone (7-mg) or triamcinolone acetonide (40-mg) IA injection and were followed for 6 months. The primary outcomes were the visual analog scale (VAS) pain scores (0 to 100) at rest and during movement at 6 months. The secondary outcomes were the VAS pain during movement, knee flexion angle, modified Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score, University of California Los Angeles (UCLA) activity score, Timed Up-and-Go test (TUG), 2-minute walk test (2MWT), and side effects. The analysis focused on between-group comparisons using multilevel regression models.RESULTSThe study population consisted of 120 Thai individuals. Both the betamethasone and triamcinolone groups demonstrated significant reductions in VAS pain at rest starting from day 1 and lasting for up to 6 months. At 6 months, the between-group mean difference in VAS pain at rest was -1 (95% confidence interval [CI], -11 to 8; p = 0.77), indicating no significant difference. Similarly, at 6 months, no significant between-group differences were observed in VAS pain during movement (-3 [95% CI, -13 to 7]; p = 0.51), flexion angle (6 [95% CI, 1 to 10]; p = 0.20), WOMAC score (-4 [95% CI, -11 to 4]; p = 0.91), UCLA activity score (0 [95% CI, -0.5 to 0.6]; p = 0.46), TUG (-1 second [95% CI, -3 to 1]; p = 0.88), or 2MWT (9 meters [95% CI, -1 to 19]; p = 0.47). Acetaminophen and tramadol use were numerically, but not significantly, lower in the betamethasone group (p > 0.05). No serious adverse events occurred.CONCLUSIONSNo significant differences were observed between IA betamethasone and triamcinolone acetonide with respect to VAS pain, functional scores, or performance-based outcomes at 6 months.LEVEL OF EVIDENCETherapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.
{"title":"Betamethasone and Triamcinolone Acetonide Have Comparable Efficacy as Single Intra-Articular Injections in Knee Osteoarthritis: A Double-Blinded, Randomized Controlled Trial.","authors":"Kittipong Wattanasirisombat,Krit Boontanapibul,Punnawit Pinitchanon,Piya Pinsornsak","doi":"10.2106/jbjs.25.00100","DOIUrl":"https://doi.org/10.2106/jbjs.25.00100","url":null,"abstract":"BACKGROUNDIntra-articular (IA) corticosteroid injections are commonly used for pain relief and improved function in patients with knee osteoarthritis (OA). However, the optimal corticosteroid preparation remains controversial. The aim of this study was to compare the efficacy of single-shot long-acting corticosteroid (betamethasone) and intermediate-acting corticosteroid (triamcinolone acetonide) injections in knee OA.METHODSThis single-center, double-blinded, randomized controlled trial included 120 patients with symptomatic knee OA who were randomized to receive either a betamethasone (7-mg) or triamcinolone acetonide (40-mg) IA injection and were followed for 6 months. The primary outcomes were the visual analog scale (VAS) pain scores (0 to 100) at rest and during movement at 6 months. The secondary outcomes were the VAS pain during movement, knee flexion angle, modified Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score, University of California Los Angeles (UCLA) activity score, Timed Up-and-Go test (TUG), 2-minute walk test (2MWT), and side effects. The analysis focused on between-group comparisons using multilevel regression models.RESULTSThe study population consisted of 120 Thai individuals. Both the betamethasone and triamcinolone groups demonstrated significant reductions in VAS pain at rest starting from day 1 and lasting for up to 6 months. At 6 months, the between-group mean difference in VAS pain at rest was -1 (95% confidence interval [CI], -11 to 8; p = 0.77), indicating no significant difference. Similarly, at 6 months, no significant between-group differences were observed in VAS pain during movement (-3 [95% CI, -13 to 7]; p = 0.51), flexion angle (6 [95% CI, 1 to 10]; p = 0.20), WOMAC score (-4 [95% CI, -11 to 4]; p = 0.91), UCLA activity score (0 [95% CI, -0.5 to 0.6]; p = 0.46), TUG (-1 second [95% CI, -3 to 1]; p = 0.88), or 2MWT (9 meters [95% CI, -1 to 19]; p = 0.47). Acetaminophen and tramadol use were numerically, but not significantly, lower in the betamethasone group (p > 0.05). No serious adverse events occurred.CONCLUSIONSNo significant differences were observed between IA betamethasone and triamcinolone acetonide with respect to VAS pain, functional scores, or performance-based outcomes at 6 months.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":"8 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145568152","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}
Haley Ponce,Lindsey Turner,John Coverdale,Phuong Nguyen,Mollie Gordon
Human trafficking is a public health crisis with profound physical and psychological consequences. Orthopaedic surgeons, who are often the earliest providers to assess traumatic musculoskeletal injuries, have a unique opportunity to identify victims of trafficking. This article highlights 4 cases of patients with orthopaedic injuries sustained in the context of trafficking or through the subsequent psychological effects of such encounters. Despite the high percentage of human trafficking victims who interact with the health-care system, the recognition and identification of such victims remain low. We advocate for increased awareness of the possibility of patients with orthopaedic injuries having been trafficked and the consideration of human trafficking in trauma-informed care training.
{"title":"Broken But Not Invisible: Identifying Human Trafficking in Victims with Orthopaedic Injuries.","authors":"Haley Ponce,Lindsey Turner,John Coverdale,Phuong Nguyen,Mollie Gordon","doi":"10.2106/jbjs.25.00963","DOIUrl":"https://doi.org/10.2106/jbjs.25.00963","url":null,"abstract":"Human trafficking is a public health crisis with profound physical and psychological consequences. Orthopaedic surgeons, who are often the earliest providers to assess traumatic musculoskeletal injuries, have a unique opportunity to identify victims of trafficking. This article highlights 4 cases of patients with orthopaedic injuries sustained in the context of trafficking or through the subsequent psychological effects of such encounters. Despite the high percentage of human trafficking victims who interact with the health-care system, the recognition and identification of such victims remain low. We advocate for increased awareness of the possibility of patients with orthopaedic injuries having been trafficked and the consideration of human trafficking in trauma-informed care training.","PeriodicalId":22625,"journal":{"name":"The Journal of Bone & Joint Surgery","volume":"160 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145559136","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}
Bernhard J H Frank,Teresa L Krammer,Jakob Pfeiffer-Vogl,Thi Thu Huong Nguyen,Andreas B Diendorfer,Matthias Hackl,Jochen G Hofstaetter
BACKGROUNDDiagnosing hip and knee periprosthetic joint infections (PJIs) is challenging, necessitating sensitive and specific biomarkers for accurate diagnosis. Cell-free microRNAs (miRNAs) are emerging as noninvasive biomarkers. We hypothesized that hip and knee PJIs are associated with unique cell-free miRNA profiles in synovial fluid, which can be used for the diagnosis of infection.METHODSSynovial fluid samples from 173 Caucasian patients undergoing septic or aseptic revision total joint replacement (TJR) of the hip or knee, as well as samples from 6 osteoarthritic knees, were analyzed. The samples were divided into a discovery group (40 samples; 50% septic) and a validation cohort (133 samples; 35% septic). Small RNA next-generation sequencing (NGS) was used to screen miRNAs in the discovery samples, with reverse transcription-quantitative polymerase chain reaction (RT-qPCR) used to confirm the NGS findings and to validate results in the independent, larger cohort. Logistic regression and cross-validation were applied to assess the diagnostic power of individual and combined miRNAs.RESULTSNGS identified 132 miRNAs with significant differences (false discovery rate < 0.05) between the septic and aseptic synovial fluid samples. Of these, 18 miRNAs were further analyzed with use of RT-qPCR in the independent cohort, with miR-223-3p and miR-338-5p showing the highest increases in septic synovial fluid (log2 fold change >4) and miR-151a-3p and miR-214-3p showing the most substantial reductions. To investigate the performance of the multivariable models, logistic regression was performed by dividing the cohort into a training set (60%) and a test set (40%), which showed improved performance relative to that of the univariate models (median area under the curve [AUC] for the multivariable models, 0.96). A subgroup analysis by joint type, gender, and synovial fluid sample preparation confirmed robust miRNA biomarker performance for PJI.CONCLUSIONSCell-free miRNA levels in the synovial fluid of patients undergoing septic hip or knee TJR were altered in response to infection, indicating immune cell activity in the joint. These miRNAs offer sensitive and specific pathogen-independent biomarkers with potential clinical applications in the diagnosis of hip and knee PJI.LEVEL OF EVIDENCEDiagnostic Level III. See Instructions for Authors for a complete description of levels of evidence.
{"title":"Synovial Fluid MicroRNA Biomarkers Enable Accurate Diagnosis of Hip and Knee Periprosthetic Joint Infections.","authors":"Bernhard J H Frank,Teresa L Krammer,Jakob Pfeiffer-Vogl,Thi Thu Huong Nguyen,Andreas B Diendorfer,Matthias Hackl,Jochen G Hofstaetter","doi":"10.2106/jbjs.24.01559","DOIUrl":"https://doi.org/10.2106/jbjs.24.01559","url":null,"abstract":"BACKGROUNDDiagnosing hip and knee periprosthetic joint infections (PJIs) is challenging, necessitating sensitive and specific biomarkers for accurate diagnosis. Cell-free microRNAs (miRNAs) are emerging as noninvasive biomarkers. We hypothesized that hip and knee PJIs are associated with unique cell-free miRNA profiles in synovial fluid, which can be used for the diagnosis of infection.METHODSSynovial fluid samples from 173 Caucasian patients undergoing septic or aseptic revision total joint replacement (TJR) of the hip or knee, as well as samples from 6 osteoarthritic knees, were analyzed. The samples were divided into a discovery group (40 samples; 50% septic) and a validation cohort (133 samples; 35% septic). Small RNA next-generation sequencing (NGS) was used to screen miRNAs in the discovery samples, with reverse transcription-quantitative polymerase chain reaction (RT-qPCR) used to confirm the NGS findings and to validate results in the independent, larger cohort. Logistic regression and cross-validation were applied to assess the diagnostic power of individual and combined miRNAs.RESULTSNGS identified 132 miRNAs with significant differences (false discovery rate < 0.05) between the septic and aseptic synovial fluid samples. Of these, 18 miRNAs were further analyzed with use of RT-qPCR in the independent cohort, with miR-223-3p and miR-338-5p showing the highest increases in septic synovial fluid (log2 fold change >4) and miR-151a-3p and miR-214-3p showing the most substantial reductions. To investigate the performance of the multivariable models, logistic regression was performed by dividing the cohort into a training set (60%) and a test set (40%), which showed improved performance relative to that of the univariate models (median area under the curve [AUC] for the multivariable models, 0.96). A subgroup analysis by joint type, gender, and synovial fluid sample preparation confirmed robust miRNA biomarker performance for PJI.CONCLUSIONSCell-free miRNA levels in the synovial fluid of patients undergoing septic hip or knee TJR were altered in response to infection, indicating immune cell activity in the joint. These miRNAs offer sensitive and specific pathogen-independent biomarkers with potential clinical applications in the diagnosis of hip and knee PJI.LEVEL OF EVIDENCEDiagnostic Level III. See Instructions for Authors for a complete description of levels of evidence.","PeriodicalId":22625,"journal":{"name":"The Journal of Bone & Joint Surgery","volume":"23 1","pages":"2561-2573"},"PeriodicalIF":0.0,"publicationDate":"2025-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145613313","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":"International Consensus Meeting on Infection: Top 10 Evidence-Backed Recommendations and Insights.","authors":" ","doi":"10.2106/jbjs.25.00934","DOIUrl":"https://doi.org/10.2106/jbjs.25.00934","url":null,"abstract":"","PeriodicalId":22625,"journal":{"name":"The Journal of Bone & Joint Surgery","volume":"175 1","pages":"2537-2540"},"PeriodicalIF":0.0,"publicationDate":"2025-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145613317","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}
Roman M Natoli,Lucas S Marchand,Sofia Bzovsky,Jennifer E Hagen,Mark J Gage,Christina A Stennett,Nathan N O'Hara,Kyle J Jeray,Brad Petrisor,Sheila Sprague,Gerard P Slobogean, , ,
BACKGROUNDInfection and nonunion are common sequelae of open fractures. Studies have shown infection and nonunion rates ranging from 2% to 52% and 12% to 17%, respectively. The present article describes the rates of surgical site infection (SSI) and delayed union/nonunion following open fractures in a large contemporary series of patients from prospective clinical trials with adjudicated outcomes.METHODSA descriptive analysis was performed with use of patient data from the FLOW, Aqueous-PREP, and PREPARE-Open studies. These studies, published within the past 10 years, included multiple international trauma centers and shared definitions for SSI and delayed union/nonunion. SSI and delayed union/nonunion rates were stratified by the OTA/AO fracture and Gustilo-Anderson open fracture classification systems. Kaplan-Meier estimators were utilized to obtain point estimates, and the log-log transformation approach was utilized to calculate 95% confidence intervals (CIs) for outcome rates.RESULTSA total of 6,042 open fractures were included. The cumulative SSI rates at 12 months for Gustilo-Anderson Types 1, 2, 3A, 3B, and 3C were 5.1%, 9.7%, 13.8%, 28.9%, and 26.2%, respectively. The cumulative rates of delayed union/nonunion at 12 months for Gustilo-Anderson Types 1, 2, 3A, 3B, and 3C were 3.0%, 5.2%, 8.0%, 14.0%, and 17.0%, respectively. Utilizing the OTA/AO fracture classification to increase the point estimate granularity, the estimated 12-month SSI and delayed union/nonunion rates in 156 Gustilo-Anderson type 3B open tibial shaft fractures (OTA/AO 42) were 34.7% (95% CI, 26.7% to 41.9%) and 18.4% (95% CI, 12.0% to 24.4%), respectively. A companion website with SSI and delayed union/nonunion rates was developed to supplement this article.CONCLUSIONSOpen fractures are a substantial problem with complications that include infection and nonunion. The present data are useful for prognosis, research study design, and informing public awareness and policy. These results show that, despite current treatment approaches, the rates of SSI and delayed union/nonunion following treatment of open fractures remain high at 1 year and are not substantially improved from historical rates spanning several decades. Although open fracture sequelae remain a burden for patients, orthopaedic surgeons, and health-care systems, there may be opportunities for improvement in outcomes.LEVEL OF EVIDENCEPrognostic Level I. See Instructions for Authors for a complete description of levels of evidence.
{"title":"Infection and Nonunion Rates in Open Fractures: Description of 6,042 Fractures from the FLOW and PREP-IT Trials.","authors":"Roman M Natoli,Lucas S Marchand,Sofia Bzovsky,Jennifer E Hagen,Mark J Gage,Christina A Stennett,Nathan N O'Hara,Kyle J Jeray,Brad Petrisor,Sheila Sprague,Gerard P Slobogean, , , ","doi":"10.2106/jbjs.24.01055","DOIUrl":"https://doi.org/10.2106/jbjs.24.01055","url":null,"abstract":"BACKGROUNDInfection and nonunion are common sequelae of open fractures. Studies have shown infection and nonunion rates ranging from 2% to 52% and 12% to 17%, respectively. The present article describes the rates of surgical site infection (SSI) and delayed union/nonunion following open fractures in a large contemporary series of patients from prospective clinical trials with adjudicated outcomes.METHODSA descriptive analysis was performed with use of patient data from the FLOW, Aqueous-PREP, and PREPARE-Open studies. These studies, published within the past 10 years, included multiple international trauma centers and shared definitions for SSI and delayed union/nonunion. SSI and delayed union/nonunion rates were stratified by the OTA/AO fracture and Gustilo-Anderson open fracture classification systems. Kaplan-Meier estimators were utilized to obtain point estimates, and the log-log transformation approach was utilized to calculate 95% confidence intervals (CIs) for outcome rates.RESULTSA total of 6,042 open fractures were included. The cumulative SSI rates at 12 months for Gustilo-Anderson Types 1, 2, 3A, 3B, and 3C were 5.1%, 9.7%, 13.8%, 28.9%, and 26.2%, respectively. The cumulative rates of delayed union/nonunion at 12 months for Gustilo-Anderson Types 1, 2, 3A, 3B, and 3C were 3.0%, 5.2%, 8.0%, 14.0%, and 17.0%, respectively. Utilizing the OTA/AO fracture classification to increase the point estimate granularity, the estimated 12-month SSI and delayed union/nonunion rates in 156 Gustilo-Anderson type 3B open tibial shaft fractures (OTA/AO 42) were 34.7% (95% CI, 26.7% to 41.9%) and 18.4% (95% CI, 12.0% to 24.4%), respectively. A companion website with SSI and delayed union/nonunion rates was developed to supplement this article.CONCLUSIONSOpen fractures are a substantial problem with complications that include infection and nonunion. The present data are useful for prognosis, research study design, and informing public awareness and policy. These results show that, despite current treatment approaches, the rates of SSI and delayed union/nonunion following treatment of open fractures remain high at 1 year and are not substantially improved from historical rates spanning several decades. Although open fracture sequelae remain a burden for patients, orthopaedic surgeons, and health-care systems, there may be opportunities for improvement in outcomes.LEVEL OF EVIDENCEPrognostic 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":"130 1","pages":"2541-2553"},"PeriodicalIF":0.0,"publicationDate":"2025-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145613367","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}
BACKGROUNDNumerous biomarkers have been identified for the diagnosis of periprosthetic joint infection (PJI), but no single biomarker has been proven to have definitive accuracy. Alpha-defensin is an excellent biomarker that is included as a minor criterion in the 2nd International Consensus Meeting (ICM) PJI diagnostic criteria; however, its high cost limits its accessibility at many general medical facilities. Consequently, alternative biomarkers for PJI diagnosis are under investigation. Myeloperoxidase (MPO), an enzyme with microbicidal properties through the catalysis of hypochlorous acid production, has emerged as a promising alternative. MPO has previously been reported as an effective biomarker for PJI. In the present study, we conducted a rapid MPO test as a point-of-care test (POCT) and evaluated its diagnostic utility.METHODSPatients with a suspected infection after total joint arthroplasty were categorized into the PJI or aseptic failure groups according to the 2nd ICM PJI diagnostic criteria. MPO and alpha-defensin levels in synovial fluid that was collected during surgery were quantified using an enzyme-linked immunosorbent assay (ELISA), and their diagnostic accuracy was compared. Additionally, an MPO POCT was conducted, and its diagnostic accuracy was assessed.RESULTSThe investigation included 23 patients with PJI and 23 with aseptic failure. All were Japanese. MPO and alpha-defensin ELISAs exhibited a strong correlation, and, at the optimal cutoff, both tests demonstrated a sensitivity of 0.957 and a specificity of 0.957. The MPO POCT produced results in just 10 minutes and achieved a sensitivity of 1.00 and a specificity of 0.913.CONCLUSIONSThe MPO ELISA demonstrated high diagnostic accuracy for PJI, equivalent to that of the alpha-defensin test. Furthermore, the MPO POCT showed similarly high diagnostic accuracy. The MPO POCT is a promising and rapid tool for diagnosing PJI and could serve as an alternative to the alpha-defensin test.LEVEL OF EVIDENCEDiagnostic Level II. See Instructions for Authors for a complete description of levels of evidence.
{"title":"Diagnostic Utility of a Rapid Myeloperoxidase Test in Synovial Fluid for Chronic Periprosthetic Joint Infection.","authors":"Shinsuke Ikeda,Katsufumi Uchiyama,Yojiro Minegishi,Masaki Nakamura,Shotaro Maehana,Ryotaro Eda,Makoto Kubo,Gen Inoue,Masashi Takaso","doi":"10.2106/jbjs.24.01514","DOIUrl":"https://doi.org/10.2106/jbjs.24.01514","url":null,"abstract":"BACKGROUNDNumerous biomarkers have been identified for the diagnosis of periprosthetic joint infection (PJI), but no single biomarker has been proven to have definitive accuracy. Alpha-defensin is an excellent biomarker that is included as a minor criterion in the 2nd International Consensus Meeting (ICM) PJI diagnostic criteria; however, its high cost limits its accessibility at many general medical facilities. Consequently, alternative biomarkers for PJI diagnosis are under investigation. Myeloperoxidase (MPO), an enzyme with microbicidal properties through the catalysis of hypochlorous acid production, has emerged as a promising alternative. MPO has previously been reported as an effective biomarker for PJI. In the present study, we conducted a rapid MPO test as a point-of-care test (POCT) and evaluated its diagnostic utility.METHODSPatients with a suspected infection after total joint arthroplasty were categorized into the PJI or aseptic failure groups according to the 2nd ICM PJI diagnostic criteria. MPO and alpha-defensin levels in synovial fluid that was collected during surgery were quantified using an enzyme-linked immunosorbent assay (ELISA), and their diagnostic accuracy was compared. Additionally, an MPO POCT was conducted, and its diagnostic accuracy was assessed.RESULTSThe investigation included 23 patients with PJI and 23 with aseptic failure. All were Japanese. MPO and alpha-defensin ELISAs exhibited a strong correlation, and, at the optimal cutoff, both tests demonstrated a sensitivity of 0.957 and a specificity of 0.957. The MPO POCT produced results in just 10 minutes and achieved a sensitivity of 1.00 and a specificity of 0.913.CONCLUSIONSThe MPO ELISA demonstrated high diagnostic accuracy for PJI, equivalent to that of the alpha-defensin test. Furthermore, the MPO POCT showed similarly high diagnostic accuracy. The MPO POCT is a promising and rapid tool for diagnosing PJI and could serve as an alternative to the alpha-defensin test.LEVEL OF EVIDENCEDiagnostic 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":"39 1","pages":"2574-2581"},"PeriodicalIF":0.0,"publicationDate":"2025-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145613366","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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