Hss Journal最新文献

Background: Gaining operative proficiency requires adequate case volume during orthopedic residency training. Numerous surgical fields have demonstrated that male residents report higher case volume than female residents. In general surgery, racially/ethnically underrepresented in medicine residents report lower case volume than White residents.

Purpose: We sought to evaluate differences in case volume between male and female orthopedic surgery residents and between White residents and those of other races and ethnicities at a single orthopedic residency.

Methods: Accreditation Council for Graduate Medical Education case logs were reviewed for orthopedic residents from 2010 to 2023 at a single institution. Overall residency case volume and volume by post-graduate year (PGY) were compared between men and women and between White and "other race" residents.

Results: Of 111 residents included, 80.2% self-reported as men, 19.8% as women, 61.3% as White, non-Hispanic, and 32.4% as any other race (for 6.3%, race/ethnicity was unavailable). Overall, women logged a mean of 1865.6 cases while men logged a mean of 1861.0 cases, showing no difference based on gender. At the PGY-4 level, women logged more cases than men, with a mean of 430.3 for women versus 370.0 for men. There was no difference in overall case volume between White residents and those of "other" race/ethnicity, nor were there race/ethnicity-based differences by PGY level.

Conclusion: In contrast to prior studies, our retrospective single-institution review found no difference in overall case volume for orthopedic residents based on their self-reported gender or race/ethnicity. Institutions and the specialty at large should continue to create equitable surgical opportunities for orthopedic trainees, while future research should assess autonomy within cases.

Background: Total shoulder arthroplasty (TSA) is an effective treatment for advanced osteonecrosis (ON) of the humeral head, a condition involving vascular disruption and bone necrosis. However, systemic comorbidities in ON patients may impact postoperative outcomes.

Purposes: We sought to evaluate health care utilization, systemic complications, and implant-related outcomes in TSA patients with and without ON.

Methods: Using the TriNetX research database, we identified patients who underwent TSA between December 9, 2002, and December 9, 2022. Two cohorts were created: The TSA + ON cohort included patients with any ON diagnosis of the humerus within 1 year leading to their TSA, and the TSA-only cohort excluded patients with ON of the humerus within the same timeframe. Propensity score matching was used to balance comorbidities. Outcomes-including emergency department (ED) visits, readmissions, adverse events, and prosthetic complications-were assessed at 30th day, 90th day, and 1st year. The Benjamini-Hochberg method was applied to control the false discovery rate.

Results: The query identified 1281 patients with ON and 71 201 patients without ON who underwent primary TSA. After matching, each group consisted of 1218 patients. There were no significant differences in ED visits or readmissions between cohorts after correction. Systemic complications were similar, except for acute kidney injury at the 90th day, which was more frequent in the TSA + ON group. No other adverse events reached significance. Implant-related outcomes, including prosthetic joint infection and revision, were comparable.

Conclusion: The findings of this retrospective cohort database study suggest that TSA may be safe and effective in ON patients, with similar implant outcomes to non-ON patients. However, the increased rate of acute kidney injury we found at the 90thday in the TSA + ON cohort suggests the need for closer perioperative renal monitoring and supports individualized risk stratification to improve outcomes in this population.

Level of evidence: Level III: retrospective cohort database study.

Background: Robotic assistance is becoming increasingly popular among surgeons performing total hip arthroplasty (THA). The impact of robotic assistance on the assessment of intraoperative stability and acetabular liner selection is not well described.

Purpose: We sought to compare the incidence of intraoperative conversion from a neutral liner to a non-neutral liner in patients undergoing either robotic-assisted THA or manual THA.

Methods: We conducted a retrospective cohort study of patients who underwent primary THAs at our institution between January 1, 2018 and June 30, 2022. Partial hip arthroplasties, simultaneous bilateral hip arthroplasties, revision surgeries, and navigation-guided THAs were excluded. We identified 9614 primary THAs performed on 8807 patients; of these, 3875 were robotic-assisted THAs and 5739 were manual THAs. Liners were subcategorized into implanted versus wasted and neutral versus non-neutral (eg, elevated, lipped, lateralized, face changing, true constrained, and dual mobility). The primary outcome was the rate of intraoperative conversion from a neutral to non-neutral liner, defined as a wasted neutral liner followed by the implantation of a non-neutral liner.

Results: Neutral liners were more frequently used in robotic-assisted THA than in manual THA (71% vs 42%, respectively), whereas elevated or lipped liners were more commonly used in manual THA than in robotic-assisted THA (34% vs 26%, respectively). After controlling for patient demographics and surgical variables, robotic-assisted THA had lower odds of conversion from a wasted neutral to an implanted non-neutral liner compared to manual THA.

Conclusion: Robotic-assisted THA is associated with a decreased rate of intraoperative liner conversion from a neutral to a non-neutral liner, suggesting that robotic assistance may provide greater stability during intraoperative assessments of implant placement.

Level of evidence: Level III: retrospective cohort study.

In the treatment of osteoarthritis and soft tissue injury, early basic science and clinical data have been promising for the use of autologous blood formulations. This review article explores autologous conditioned serum, alpha-2-macroglobulin, and autologous protein solution, which function via overlapping but distinct mechanisms to reduce inflammation, counteract catabolism, and improve joint homeostasis. The ideal timing and quantity of dosing are largely unknown and may vary based on indication. Additional high-quality clinical trials are necessary to define the efficacy of these interventions on both long-term symptomatic improvement and mitigation of osteoarthritic disease progression.

Background: Cervical disc arthroplasty (CDA) has gained widespread recognition as a motion-preserving alternative to anterior cervical discectomy and fusion for treating degenerative cervical disc disease. Over the past decade, the rate of CDA procedures has increased by a remarkable 654%. However, CDA complications can lead to a repeat procedure or can be converted to fusion.

Purpose: We sought to evaluate the time of onset (early, intermediate, or late) of complications following CDA as well as the progression leading to revision surgeries.

Methods: A retrospective review of the Food and Drug Administration Manufacturer and User Facility Device Experience (MAUDE) database examined complications across 9 CDA devices from January 1, 2005, to September 30, 2023. Complications were categorized by postoperative time to occurrence: early (<6 months), intermediate (6-18 months), and late (>18 months). The revision procedures were categorized as either a repeat CDA or conversion to fusion.

Results: A total of 688 CDA revision cases were reviewed, with 265 cases (38.5%) reporting revision onset time (median: 12 months, interquartile range: 3-36). Migration was the most frequent complication in both the early (n = 44, 53.0%) and intermediate (n = 25, 32.1%) periods. Subsidence peaked during the intermediate period (11.5%, n = 9), while neck pain and heterotopic ossification (HO) occurred most in the late postoperative phase, at 22.5% (n = 23) and 7.8% (n = 8), respectively. The specific revision type was recorded in 509 of the revision cases; of these, 8 devices were predominantly associated with fusion (>69%), while Mobi-C showed a lower proportion of fusion revisions (16.2%).

Conclusions: This retrospective review of the MAUDE database showed the timing of complications leading to CDA revision. Migration predominated in the early and intermediate phases, while subsidence peaked in the intermediate phase. In the late phase, neck pain, osteolysis, and HO become more prominent. Conversion to fusion was common across most devices. These data provide insight for clinicians to monitor patients after CDA while considering the relative frequencies of reported complications.

Level of evidence: Level IV: retrospective analysis of a prospectively maintained government database.

Background: While much evidence exists on the epidemiology of and prevention strategies for anterior cruciate ligament (ACL) injuries, there is less information on patellar dislocations.

Purpose: We sought to compare the activities of adolescents who underwent a medial patellofemoral ligament reconstruction (MPFLR) to those who underwent an ACL reconstruction (ACLR).

Methods: We conducted a retrospective review of routinely collected preoperative data of adolescent patients who underwent either an MPFLR or ACLR by 1 of 2 fellowship-trained pediatric sports medicine orthopedic surgeons at a single institution between February 1, 2016, and April 15, 2023. A total of 912 patients were identified, and 540 of these met the final inclusion and exclusion criteria. A total of 228 MPFLR participants were successfully matched to 228 ACLR participants based on sex and age within 1 year at the time of surgery. The mean age was 14.8 ± 2.1 years and 53% were female. The Hospital for Special Surgery Pediatric Functional Activity Brief Scale (HSS Pedi-FABS), Pediatric International Knee Documentation Committee, Patient-Reported Outcomes Measurement Information System (PROMIS) Pain Interference, and PROMIS Mobility were collected.

Results: We found that 61% of the MPFLR cohort and 94% of the ACLR cohort sustained their injuries while playing an organized sport. The MPFLR group had significantly lower HSS Pedi-FABS scores than the ACLR group, suggesting that the MPFLR group had lower preoperative athletic activity levels compared to the ACLR group.

Conclusions: In this retrospective study, participation in organized sports was associated with 61% of patellar dislocations. Among girls, dance was the second most common sport participated in at the time of patellar dislocation. This suggests that further investigation into injury prevention strategies for adolescent female dancers is warranted.

Level of evidence: Level III: Retrospective therapeutic study.

This guest editorial gives an overview of the field of regenerative medicine and the special issue.

The possibility of modifying disease through regenerative medicine applications, particularly stem cell therapies, raises ethical and regulatory challenges in orthopedics. This review article provides historical context of stem cell research, ethical issues such as informed consent, therapeutic misconception, and equitable access, emphasizing the responsibilities of providers offering investigational treatments. It also examines the evolving role of the U.S. Food and Drug Administration (FDA) in regulating regenerative therapies through frameworks like the Regenerative Medicine Advanced Therapy (RMAT) designation, and more point-of-care enforcement discretion policies for therapies such as autologous micro-fragmented adipose tissue and bone marrow aspirate concentrate. The authors underscore the importance of innovative therapies to address unmet needs in musculoskeletal healthcare while acknowledging the need for more rigorous basic and clinical research. They call for a continuous refinement of regulatory and ethical standards as regenerative medicine advances.