{"title":"To Debride or Not to Debride-That Was the Question: Commentary on an article by Leslie Bisson, MD, et al.: \"Debridement of Unstable Chondral Lesions During Arthroscopic Partial Meniscectomy Provides No Long-Term Benefit. Patient Outcomes 9 Years After the Original ChAMP Trial\".","authors":"Tyler M Hauer,Craig S Mauro","doi":"10.2106/jbjs.25.00502","DOIUrl":"https://doi.org/10.2106/jbjs.25.00502","url":null,"abstract":"","PeriodicalId":22625,"journal":{"name":"The Journal of Bone & Joint Surgery","volume":"113 1","pages":"2589-2590"},"PeriodicalIF":0.0,"publicationDate":"2025-12-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145663956","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}
Qianying Cai,Hao Peng,Vicky Duong,Win Min Oo,Youshui Gao,Yong Feng,Changqing Zhang,Liubov Arbeeva,Daniel K White,David J Hunter,Kai Fu
BACKGROUNDWe examined the association between physical activity (PA) and joint space loss (JSL) over 48 months in individuals with knee osteoarthritis to assess the role of the PA level in knee osteoarthritis progression.METHODSWe analyzed 1,806 participants from the Osteoarthritis Initiative. PA was measured with the Physical Activity Scale for the Elderly (PASE) and was categorized as low, moderate, or high. JSL was defined as a reduction in joint space width of ≥0.7 mm. Analyses were stratified by the baseline Kellgren-Lawrence (KL) grade. Cox proportional-hazards (CoxPH) and joint models assessed the association between baseline PA and changes in longitudinal PA and JSL, adjusting for covariates.RESULTSOver 48 months, 33.8% of the patients experienced JSL. In patients with KL grade 2, the moderate PA tertile was associated with a reduced JSL risk compared with low PA in both standard and marginal CoxPH analyses. However, in patients with KL grade 3, increasing PA in the continuous PASE modeling was associated with increased JSL risk (marginal CoxPH: hazard ratio [HR], 1.002 [95% confidence interval (CI), 1.001 to 1.004]), confirmed by joint models (HR, 1.083 [95% CI, 1.020 to 1.150]). The rate of change of PA over time did not significantly influence progression.CONCLUSIONSModerate or high PA did not increase the 4-year JSL risk in patients with KL grade 2. However, higher current PA was associated with higher JSL risk in patients with KL grade 3, highlighting the need for further research on the complex impact of PA on osteoarthritis. These findings may help clinicians to identify patient subgroups who could benefit from tailored PA recommendations, informing value-based care and personalized osteoarthritis management.LEVEL OF EVIDENCEPrognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
{"title":"Physical Activity and 4-Year Radiographic Medial Joint Space Loss in Knee Osteoarthritis: A Joint Model Analysis.","authors":"Qianying Cai,Hao Peng,Vicky Duong,Win Min Oo,Youshui Gao,Yong Feng,Changqing Zhang,Liubov Arbeeva,Daniel K White,David J Hunter,Kai Fu","doi":"10.2106/jbjs.25.00656","DOIUrl":"https://doi.org/10.2106/jbjs.25.00656","url":null,"abstract":"BACKGROUNDWe examined the association between physical activity (PA) and joint space loss (JSL) over 48 months in individuals with knee osteoarthritis to assess the role of the PA level in knee osteoarthritis progression.METHODSWe analyzed 1,806 participants from the Osteoarthritis Initiative. PA was measured with the Physical Activity Scale for the Elderly (PASE) and was categorized as low, moderate, or high. JSL was defined as a reduction in joint space width of ≥0.7 mm. Analyses were stratified by the baseline Kellgren-Lawrence (KL) grade. Cox proportional-hazards (CoxPH) and joint models assessed the association between baseline PA and changes in longitudinal PA and JSL, adjusting for covariates.RESULTSOver 48 months, 33.8% of the patients experienced JSL. In patients with KL grade 2, the moderate PA tertile was associated with a reduced JSL risk compared with low PA in both standard and marginal CoxPH analyses. However, in patients with KL grade 3, increasing PA in the continuous PASE modeling was associated with increased JSL risk (marginal CoxPH: hazard ratio [HR], 1.002 [95% confidence interval (CI), 1.001 to 1.004]), confirmed by joint models (HR, 1.083 [95% CI, 1.020 to 1.150]). The rate of change of PA over time did not significantly influence progression.CONCLUSIONSModerate or high PA did not increase the 4-year JSL risk in patients with KL grade 2. However, higher current PA was associated with higher JSL risk in patients with KL grade 3, highlighting the need for further research on the complex impact of PA on osteoarthritis. These findings may help clinicians to identify patient subgroups who could benefit from tailored PA recommendations, informing value-based care and personalized osteoarthritis management.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":"13 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-12-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145663964","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":"Helical Blade or Lag Screw? It Doesn't Matter as Much as We Thought: Commentary on an article by Kanu Okike, MD, MPH, et al.: \"Helical Blade Versus Lag Screw Fixation in the Cephalomedullary Nailing of Geriatric Hip Fractures\".","authors":"Sean T Campbell","doi":"10.2106/jbjs.25.01046","DOIUrl":"https://doi.org/10.2106/jbjs.25.01046","url":null,"abstract":"","PeriodicalId":22625,"journal":{"name":"The Journal of Bone & Joint Surgery","volume":"55 1","pages":"2593"},"PeriodicalIF":0.0,"publicationDate":"2025-12-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145663950","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":"Obligate Posterosuperior Humeral Head Translation Following the Latarjet Procedure Demonstrates That Its Triple Blocking Effect Is Real: Commentary on an article by Josephine Olsen Kipp, MD, PhD, et al.: \"The Latarjet Procedure May Induce Pathokinematics with Posterior Humeral Head Subluxation. An Experimental Dynamic Radiostereometric Study\".","authors":"Samer S Hasan","doi":"10.2106/jbjs.25.01091","DOIUrl":"https://doi.org/10.2106/jbjs.25.01091","url":null,"abstract":"","PeriodicalId":22625,"journal":{"name":"The Journal of Bone & Joint Surgery","volume":"30 1","pages":"2594-2595"},"PeriodicalIF":0.0,"publicationDate":"2025-12-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145663946","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}
Andrew P Collins,Erika Roddy,William T Davis,Reza Firoozabadi
➢ Sacral insufficiency fractures are associated with high morbidity and mortality rates and are becoming increasingly prevalent in elderly patients with osteoporosis.➢ Prompt identification of these injuries and appropriate treatment for stable and unstable fractures can reduce patient morbidity.➢ The treatment of sacral insufficiency fractures depends on the severity of symptoms, which, in most cases, is associated with the degree of fracture instability. Treatment options include nonoperative measures, pharmacologic therapies, procedural treatments, and operative management.➢ Sacroplasty may be an effective procedural treatment for sacral insufficiency fractures, although there has been a lack of comparative studies, and complication types and rates are concerning.➢ Percutaneous posterior pelvic ring screws demonstrate stable fixation, allowing early patient mobilization. Standard posterior pelvic ring percutaneous fixation has high screw backout rates, although new implants may mitigate these complications.➢ There have been limited comparative data on outcomes following treatment of these injuries across procedural and operative techniques.
{"title":"Sacral Insufficiency Fractures: Pathology, Management, and Outcomes.","authors":"Andrew P Collins,Erika Roddy,William T Davis,Reza Firoozabadi","doi":"10.2106/jbjs.25.00482","DOIUrl":"https://doi.org/10.2106/jbjs.25.00482","url":null,"abstract":"➢ Sacral insufficiency fractures are associated with high morbidity and mortality rates and are becoming increasingly prevalent in elderly patients with osteoporosis.➢ Prompt identification of these injuries and appropriate treatment for stable and unstable fractures can reduce patient morbidity.➢ The treatment of sacral insufficiency fractures depends on the severity of symptoms, which, in most cases, is associated with the degree of fracture instability. Treatment options include nonoperative measures, pharmacologic therapies, procedural treatments, and operative management.➢ Sacroplasty may be an effective procedural treatment for sacral insufficiency fractures, although there has been a lack of comparative studies, and complication types and rates are concerning.➢ Percutaneous posterior pelvic ring screws demonstrate stable fixation, allowing early patient mobilization. Standard posterior pelvic ring percutaneous fixation has high screw backout rates, although new implants may mitigate these complications.➢ There have been limited comparative data on outcomes following treatment of these injuries across procedural and operative techniques.","PeriodicalId":22625,"journal":{"name":"The Journal of Bone & Joint Surgery","volume":"30 1","pages":"2627-2635"},"PeriodicalIF":0.0,"publicationDate":"2025-12-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145663947","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":"Excessive Laxity as an Indicator for a Secondary Procedure to Protect Posterior Cruciate Ligament Reconstruction: Is the Juice Worth the Squeeze?: Commentary on an article by Kyoung Ho Yoon, MD, PhD, et al.: \"Posterior Cruciate Ligament (PCL) Versus Combined PCL and Posterolateral Corner Reconstruction in Isolated PCL Grade-III Injuries\".","authors":"John A Grant","doi":"10.2106/jbjs.25.01233","DOIUrl":"https://doi.org/10.2106/jbjs.25.01233","url":null,"abstract":"","PeriodicalId":22625,"journal":{"name":"The Journal of Bone & Joint Surgery","volume":"157 1","pages":"2591-2592"},"PeriodicalIF":0.0,"publicationDate":"2025-12-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145663949","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}
Jason Zarahi Amaral,Antony Kallur,Lori A Dolan,Austin Q Nguyen,Rebecca J Schultz,Benjamin M Martin,Pablo Coello,Jacob P Scioscia,Barkha N Chhabra,Darrell S Hanson,Frank T Gerow,Brian G Smith
BACKGROUNDWhether the sensory and behavioral traits of autism spectrum disorder (ASD) affect bracing outcomes in adolescent idiopathic scoliosis (AIS) remains unclear. This study evaluated the impact of ASD on bracing success, curve progression, and patient-reported outcomes in patients with AIS.METHODSThis retrospective study included patients 10 to 18 years of age who were treated for AIS with bracing between 2011 and 2024. A total of 58 patients with ASD were matched in a 1:2 ratio to 116 controls with use of nearest-neighbor matching based on BrAIST-Calc predicted probabilities. Exclusions included non-idiopathic scoliosis, early-onset scoliosis, kyphoscoliosis, a Risser stage of >2, pre-treatment curves of <25° or >40°, and inadequate follow-up. Progression to the surgical threshold was defined as a major curve of ≥45°. Firth logistic regression was used to model the association between ASD and progression to the surgical threshold, adjusting for residual imbalances.RESULTSThe matched cohort (n = 174; 51% male; 40% White, 25% Hispanic, 21% Black, 10% Asian, and 5% not specified) demonstrated balanced propensity scores (SMD = 0.006). Compared with patients without ASD, those with ASD had higher rates of progression to the surgical threshold (40% versus 20%; p = 0.005), a curve progression of ≥6° (60% versus 38%; p = 0.005), noncompliance (36% versus 22%; p = 0.04), brace-related issues (22% versus 8%; p = 0.006), and surgery being recommended or performed (33% versus 13%; p = 0.002). In the multivariable analysis, ASD (odds ratio [OR], 3.12 [95% confidence interval (CI), 1.32 to 7.35]; p = 0.009), noncompliance (OR, 4.00 [95% CI, 1.65 to 9.71]; p = 0.002), and a greater initial curve magnitude (OR per degree, 1.26 [95% CI, 1.15 to 1.38]; p < 0.001) significantly increased the odds of progression to the surgical threshold. Within the ASD group, Scoliosis Research Society-22 revised (SRS-22r) self-image, management, and total scores improved significantly over time. No significant between-group differences in change scores were observed.CONCLUSIONSAdolescents with ASD were >3 times more likely to progress to the surgical threshold and had higher rates of noncompliance, brace-related issues, and surgery being recommended or performed. ASD may represent a risk factor for bracing failure, potentially related to sensory or behavioral intolerance. Nonetheless, 60% of patients with ASD avoided progression to the surgical threshold, and within-group improvements in SRS-22r scores were observed. These findings support bracing as a viable treatment option for patients with ASD, although it is likely best paired with individualized care and closer follow-up. Future studies should aim to improve brace tolerance and adherence in this population.LEVEL OF EVIDENCETherapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
{"title":"Bracing Outcomes and Risk of Curve Progression in Adolescents with Idiopathic Scoliosis and Autism Spectrum Disorder.","authors":"Jason Zarahi Amaral,Antony Kallur,Lori A Dolan,Austin Q Nguyen,Rebecca J Schultz,Benjamin M Martin,Pablo Coello,Jacob P Scioscia,Barkha N Chhabra,Darrell S Hanson,Frank T Gerow,Brian G Smith","doi":"10.2106/jbjs.25.00668","DOIUrl":"https://doi.org/10.2106/jbjs.25.00668","url":null,"abstract":"BACKGROUNDWhether the sensory and behavioral traits of autism spectrum disorder (ASD) affect bracing outcomes in adolescent idiopathic scoliosis (AIS) remains unclear. This study evaluated the impact of ASD on bracing success, curve progression, and patient-reported outcomes in patients with AIS.METHODSThis retrospective study included patients 10 to 18 years of age who were treated for AIS with bracing between 2011 and 2024. A total of 58 patients with ASD were matched in a 1:2 ratio to 116 controls with use of nearest-neighbor matching based on BrAIST-Calc predicted probabilities. Exclusions included non-idiopathic scoliosis, early-onset scoliosis, kyphoscoliosis, a Risser stage of >2, pre-treatment curves of <25° or >40°, and inadequate follow-up. Progression to the surgical threshold was defined as a major curve of ≥45°. Firth logistic regression was used to model the association between ASD and progression to the surgical threshold, adjusting for residual imbalances.RESULTSThe matched cohort (n = 174; 51% male; 40% White, 25% Hispanic, 21% Black, 10% Asian, and 5% not specified) demonstrated balanced propensity scores (SMD = 0.006). Compared with patients without ASD, those with ASD had higher rates of progression to the surgical threshold (40% versus 20%; p = 0.005), a curve progression of ≥6° (60% versus 38%; p = 0.005), noncompliance (36% versus 22%; p = 0.04), brace-related issues (22% versus 8%; p = 0.006), and surgery being recommended or performed (33% versus 13%; p = 0.002). In the multivariable analysis, ASD (odds ratio [OR], 3.12 [95% confidence interval (CI), 1.32 to 7.35]; p = 0.009), noncompliance (OR, 4.00 [95% CI, 1.65 to 9.71]; p = 0.002), and a greater initial curve magnitude (OR per degree, 1.26 [95% CI, 1.15 to 1.38]; p < 0.001) significantly increased the odds of progression to the surgical threshold. Within the ASD group, Scoliosis Research Society-22 revised (SRS-22r) self-image, management, and total scores improved significantly over time. No significant between-group differences in change scores were observed.CONCLUSIONSAdolescents with ASD were >3 times more likely to progress to the surgical threshold and had higher rates of noncompliance, brace-related issues, and surgery being recommended or performed. ASD may represent a risk factor for bracing failure, potentially related to sensory or behavioral intolerance. Nonetheless, 60% of patients with ASD avoided progression to the surgical threshold, and within-group improvements in SRS-22r scores were observed. These findings support bracing as a viable treatment option for patients with ASD, although it is likely best paired with individualized care and closer follow-up. Future studies should aim to improve brace tolerance and adherence in this population.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":"115 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-12-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145663952","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":"Fractures of the Femur After Hip Joint Replacement: The Vancouver Classification After 30 Years.","authors":"Clive P Duncan,Bassam A Masri","doi":"10.2106/jbjs.25.00336","DOIUrl":"https://doi.org/10.2106/jbjs.25.00336","url":null,"abstract":"","PeriodicalId":22625,"journal":{"name":"The Journal of Bone & Joint Surgery","volume":"10 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145656831","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":"When Half of Humanity Is Invisible: Reflections on the Erasure of Female Surgeons.","authors":"Agathe Yvinou","doi":"10.2106/jbjs.25.00108","DOIUrl":"https://doi.org/10.2106/jbjs.25.00108","url":null,"abstract":"","PeriodicalId":22625,"journal":{"name":"The Journal of Bone & Joint Surgery","volume":"30 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145613312","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}
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}
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