Hss Journal最新文献

Background: Hallux valgus (HV) is recognized as a triplanar deformity. A biplanar locking plate (BLP) system corrects this deformity through first tarsometatarsal joint (TMTJ) arthrodesis, with specialized reduction tools and cutting guides. Yet the optimal surgical technique and fixation construct for first TMTJ arthrodesis remains controversial. Purpose: We sought to compare the BLP system with a modified Lapidus (ML) technique with crossed-screw fixation in terms of radiographic outcomes, complications, and reoperations. Methods: In this retrospective multicenter study, we identified a series of consecutive patients who underwent first TMTJ arthrodesis for HV with either the ML procedure at institution A or the BLP system at institution B. Patients 18 years of age with a minimum of 6 months of postoperative radiographs were included. There were 130 patients, 65 in each group, including 121 women (93.8%) with a median age of 58 years and mean radiographic follow-up of 7.1 months. Data included preoperative and postoperative HV angle (HVA), intermetatarsal angle (IMA), and tibial sesamoid position (TSP), plus complications and reoperations. Statistical testing included Mann-Whitney U, Wilcoxon signed rank, Fisher exact, McNemar, and multivariable regression. Results: After adjusting for confounding variables, the BLP system was associated with significantly greater improvements in postoperative IMA and HVA but not TSP. There were no significant differences in rates of complications (ML: 18.4%; BLP: 9.2%) or reoperations (ML: 4.6%; BLP: 7.7%). Conclusion: This retrospective multicenter review found that the BLP system was associated with greater improvement in radiographic HV parameters compared with the ML procedure using crossed-screw fixation. Clinical significance is unclear as complication and reoperation rates were similar between groups. Further study in this regard is warranted.

Background: Compressive neuropathy of the common fibular nerve (CFN) is increasingly recognized as an etiology for foot drop and falls. Electrodiagnostic (EDX) studies are widely used to evaluate this condition, but such tests are invasive and costly. As with carpal and cubital tunnel syndromes, there may be patients with characteristic symptoms of CFN compressive neuropathy but normal EDX studies in which ultrasound may aid in decision-making.

Purpose: We sought to examine the association between ultrasound and nerve conduction studies (NCS) and electromyography (EMG) in the diagnosis of compressive neuropathy of the CFN.

Methods: We performed a retrospective review identifying 104 patients who underwent CFN decompression from January 1, 2015, to June 30, 2023. Patients were included if they had both ultrasound and NCS/EMG prior to CFN decompression for compressive neuropathy and if they were older than 18 years at time of surgery. Patients were excluded if they had entrapment secondary to trauma, iatrogenic injury, or if they had had superficial fibular decompression alone without CFN decompression. After applying exclusion criteria, 17 patients remained in the cohort.

Results: Mean ultrasound cross-sectional area and side-to-side (STS) ratios were significantly higher in those with abnormal compound muscle action potential (CMAP) amplitudes versus those with normal CMAP amplitudes. The probability of having an abnormal CMAP amplitude when STS ratio was abnormal was 18 times greater compared with those with normal STS ratio. With each unit increase in STS ratio, CMAP amplitude was reduced by 2.79 mV.

Conclusions: This retrospective review found that ultrasound may provide complementary diagnostic information to EMG/NCS for compressive neuropathy of the CFN. Further study is needed to examine the relationship between ultrasound findings for CFN compressive neuropathy and results of surgical decompression.

Background: Hospital networks centralize primary total joint arthroplasty (TJA) within their existing systems to develop specialized service lines with higher surgical volumes to reduce adverse events. It is not known what role hospital network centralization has had on primary TJA outcomes.

Purpose: We sought to determine whether the degree of hospital network centralization for primary TJA is associated with (1) 90-day postoperative complication rates, (2) 90-day hospital readmission rates, or (3) 1-year revision rates.

Methods: We conducted a retrospective database study of Medicare Part A beneficiaries who underwent inpatient primary TJA for osteoarthritis in 2016 and 2017 (n = 523,142 patients); individual hospital-level characteristics and hospital networks were also identified (n = 360 unique networks, n = 3339 hospitals). Patients having surgery at a hospital that was not a member of a health care network were excluded (n = 163,998 patients) because we wanted to examine only the role of network structures on outcomes; this resulted in a cohort of 359,144 patients. Hospital network centralization, which was defined as the percentage of total network cases performed at the highest volume hospital and categorized into quartiles (eg, lowest 25% of networks by concentration, 26%-50% of networks by concentration, etc). Primary outcomes included postoperative 90-day complications, 90-day readmissions, and 1-year revisions. Multivariable logistic and linear regressions evaluated associations of hospital network centralization with outcomes and controlled for relevant patient-level and hospital-level covariates, including hospital network volumes.

Results: Odds of 90-day complications were lower in the most centralized hospital networks than in least centralized networks (odds ratio [OR] = 0.85; 95% confidence interval [CI]: 0.75, 0.95). Degree of centralization was not associated with readmissions or 1-year revision rates. Non-modifiable patient and individual hospital characteristics appeared to have a greater association with complications, readmissions, and early revision rates than hospital network centralization or volume.

Conclusion: This retrospective database study found that increased centralization of primary TJA within a hospital network was associated with lower 90-day complication rates but not with 90-day readmission or 1-year revision rates. This suggests that structural changes within hospital networks may be beneficial to reduce early complications in this patient population. In addition, our findings suggest that risk adjustment in assessing non-modifiable patient and hospital risk factors may be important when assessing TJA outcomes.

Background: Pedicle screw placement during spine fusion is physically and mentally demanding for surgeons. Consequently, spine surgeons can become fatigued, which has implications for both patient safety and surgeon well-being.

Purpose: We sought to assess the cognitive workload of surgeons placing pedicle screws using robotic-assisted navigation compared with fluoroscopic and computed tomography (CT)-assisted placement.

Methods: We performed a nonrandomized prospective controlled trial to compare the cognitive workload of 3 surgeons performing single-level minimally invasive transforaminal lumbar interbody fusion (MI-TLIF) using robotic, CT, or fluoroscopic navigation on 25 patients (15 in the robotic navigation group and 10 in the nonrobotic group). Immediately after each procedure, surgeons submitted the National Aeronautics and Space Administration-Task Load Index (NASA-TLX), which has 6 subscales: mental demands, physical demands, temporal demands, performance, effort, and frustration. Four tasks associated with pedicle screw placement were assessed independently: (1) screw planning, (2) calibrating robot/obtaining imaging/registration, (3) pedicle cannulation, and (4) screw placement. Patient demographics and surgical characteristics were obtained and reviewed.

Results: Surgeons' self-reported cognitive workload was significantly reduced when using robotic-assisted navigation versus CT/fluoroscopic navigation. Workload was reduced for screw planning, pedicle cannulation, and screw placement. In addition, there were significant reductions in each subdomain for these 3 tasks, encompassing mental demand, physical demand, temporal demand, effort, and frustration with improved task performance.

Conclusions: This study found significant reductions in mental workload with improved perceived performance for robotic-assisted pedicle screw placement compared with fluoroscopic and CT-navigation techniques. Lowering the cognitive burden associated with screw placement may allow surgeons to address the remainder of the operative case with less decision fatigue, prevent complications, and increase surgeon wellness.

Background: Initial fixed-bearing hinge designs for primary total knee arthroplasty (TKA) had high rates of aseptic loosening. There are limited data on contemporary rotating-hinge implants. Purpose: We sought to determine survivorship and functional outcomes of contemporary rotating-hinge implants used in primary TKA. Methods: Retrospective review identified 54 primary rotating-hinge TKAs implanted in 49 patients from 2014 to 2018 at a single institution. Patients identified were 76% women, the mean body mass index was 29 kg/m², the mean age was 65 years, and the mean follow-up was 3 years. The primary diagnosis for TKA in all cases was severe instability and ligamentous compromise. Secondary diagnoses included post-traumatic osteoarthritis (11, 20%), neurologic disease (10, 19%), inflammatory arthritis (10, 19%), connective tissue disease (3, 6%), valgus deformity (16, 30%), varus deformity (2, 4%), and recurvatum (2, 4%). Preoperative, postoperative (within 6 weeks), and most recent radiographs were reviewed. In this study, we collected preoperative, 1-year, and 2-year patient-reported outcome measures (PROMs) for patients with primary rotating-hinge TKA. Patient-reported outcome measures were prospectively collected, including the Knee Injury and Osteoarthritis Outcome Survey for Joint Replacement (KOOS JR) scores and the Mental (MCS) and Physical Component Scores (PCS) of the Veterans RAND 12-Item Health Survey (VR-12). Kaplan-Meier analysis was used to determine implant survivorship. Results: Reoperation was required in 6% (3/54); indications included periprosthetic joint infection (1), peripatellar fibrosis (1), and periprosthetic femur fracture (1). At both 2 and 5 years, survivorship free from all-cause reoperation was 95% and from revision for aseptic loosening was 100%. Mean KOOS JR scores increased from 47 preoperatively to 65 at 2 years postoperatively. On radiographic review, there were no progressive radiolucent lines consistent with aseptic loosening at final follow-up. Conclusion: The findings of this single-center, multi-surgeon retrospective case series on the use of rotating-hinge implants for primary TKA suggest excellent 2-year survivorship free from reoperation and no revisions for aseptic loosening. We report modest improvement in a variety of PROMs at 1-year and 2-year follow-up. Despite improvement, clinical outcomes were poor for a primary implant. Longer-term follow-up is required to monitor the durability of primary hinges.

Background: Women continue to be underrepresented in orthopedic surgery and in orthopedic fellowship programs, especially in orthopedic trauma.

Purpose: We aimed to assess sex diversity among faculty and trainees in orthopedic trauma surgery fellowship programs and investigate whether the presence of female faculty in those programs is associated with the recruitment of female fellows.

Methods: This was a cross-sectional analysis of 63 orthopedic trauma surgery fellowship programs. Information regarding program faculty (as of October 2023) and fellows from 2018 to 2024 was gathered. For programs without publicly accessible information, fellowship coordinators were e-mailed for de-identified sex breakdown of fellows categorized by year. The sex of each fellow and faculty member was categorized as male or female and determined by inference from the fellow's first name and confirmed via Internet search using photos, biographies, and preferred pronouns when available.

Results: Of 63 programs with 323 orthopedic trauma faculty, 30 (47.6%) programs had at least 1 female faculty member, with only 4 (6.4%) programs having female fellowship directors. Women made up 12% (n = 39) of orthopedic trauma faculty. Of 399 total fellows identified over the 6-year period, 67 (16.7%) were women, with a notable increase in the representation of female fellows over time, from 10.8% in 2018 to 25.4% in 2024. Although programs with female faculty had a similar proportion of female fellows over the 6-year period as those without, in the most recent fellowship year (2023-2024), programs with female faculty had a higher proportion of female fellows than those without (38.2% vs 13.5%, respectively).

Conclusion: This cross-sectional, observational study suggests that female surgeons remain underrepresented in orthopedic trauma fellowship director roles, although we observed an increasing number of female trainees entering orthopedic trauma surgery fellowship programs in recent years. In the most recent fellowship class studied, programs with female faculty had more than double the proportion of female fellows compared to programs without any female faculty.

Knee osteoarthritis (OA) remains a common cause of knee pain and dysfunction. Stem cell-based injections have been widely used for the treatment of knee OA, but the types and rates of post-injection complications are not well characterized. We sought to characterize the type and severity of adverse events and quantify the frequency of adverse events associated with stem cell injections used to treat knee OA. We conducted a systematic review that followed the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. We searched the PubMed and the Cochrane library databases for studies on adverse events and complications associated with stem cell-based therapies used to treat knee OA published from January 2000 through June 2021. Inclusion criteria were the use of intra-articular autologous bone marrow stem cells (BMSCs) or bone marrow aspirate concentrate (BMAC), autologous adipose-derived mesenchymal stem cells (ADMSCs) including microfragmented lipoaspirate, concentrated adipose tissue, cultured stem cells, autologous stromal vascular fraction (SVF), or umbilical or placental derived stem cells in human participants. Primary data extracted from included studies were patient demographics, methods of treatment, and reported character, duration, and severity of adverse events. A total of 427 studies were screened, and 48 studies were included, including randomized controlled trials, prospective studies, and retrospective studies. Among the 1924 patients in the analysis, there was an overall 12.3% rate of transient adverse events, the most frequent being swelling and pain at the injection site. Umbilical cord-derived (51.7%) and cultured ADMSC (29.5%) injections had a significantly higher occurrence of these adverse events than BMSC and SVF injections. No other adverse events, including infection, fat embolism, or medical complications, were reported. Despite significant heterogeneity of the included studies in terms of the protocol, formulation, timing, and location of injections, the findings of this systematic review suggest that, in the short term, treatment of knee OA with autologous mesenchymal stem cell injections poses no risk of major complications (infection, sepsis, neoplasm, embolism, or death) and poses moderate risk of swelling and pain at the injection site lasting less than 4 weeks. Further long-term studies are needed to conclusively determine the safety profile of these injections.