Hss Journal最新文献

Introduction: There is little literature reporting on the efficacy of bone marrow aspirate concentrate (BMAC) in conjunction with hip arthroscopy.

Purpose: We sought to systematically review the literature on BMAC use following hip arthroscopy, in particular, whether its use results in improved patient-reported outcome measures (PROMs).

Methods: The Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines were followed when querying PubMed, Cochrane Central Register of Controlled Trials, and Scopus in January 2023. Articles were included if they reported on pre- and postoperative outcomes for patients undergoing hip arthroscopy with concomitant BMAC and were written in English.

Results: Five articles were included in the review. A total of 252 hips undergoing BMAC and hip arthroscopy performed between 2010 and 2020 were evaluated. The average age of patients in the studies ranged between 32.8 and 48.5 years. All studies reported improved postoperative PROM scores compared to preoperative outcome scores after BMAC and hip arthroscopy. Two studies reported survivorship of 100% and 85.7%. All 5 studies conducted a subanalysis between BMAC and hip arthroscopy and a control group. Three studies reported superior outcomes in the BMAC and hip arthroscopy group, while another study reported findings that trended toward favoring the BMAC and hip arthroscopy group but that did not reach statistical significance.

Conclusion: BMAC may improve outcomes in patients undergoing hip arthroscopy. However, due to the small sample size and lack of standardized control groups, the results of this systematic review are inconclusive.

Background: For orthopedic oncology patients who are poor candidates for open spine surgery, minimally invasive radiofrequency ablation and cementoplasty (RFA/C) is becoming increasingly popular for managing osteolytic vertebral metastases. Purpose: We sought to characterize long-term changes in vertebral body radiographical parameters and potential risk of adjacent fractures occurring. Methods: A single-institution, retrospective study of all patients receiving RFA/C for osteolytic thoracic or lumbar vertebral body metastases from 2017 to 2023 was conducted. Vertebral body integrity was assessed by column height changes (anterior, middle, and posterior 1/3), local vertebral angle, and indirect bone mass assessment (at 3, 6, 12, and 24 months postoperatively). The latter was assessed via Hounsfield unit (HU) changes on axial computed tomography. Adjacent vertebral fractures were defined as within 3 vertebral levels above or below index site. Treatment history including radiation therapy was tracked. Results: A total of 54 vertebral levels (26 patients; mean age 59.8 ± 19.0 years; 18 females) were included (mean follow-up 15.8 ± 13.8 months). HU (bone mass proxy) stabilized after RFA/C. Except for middle column height increasing at 3 months, no column height or local angle deformity changes were detected. Adjacent fracture occurred in 4 patients (15.4%); all 4 demonstrated systemic cancer progression. Conclusions: Our findings suggest that RFA/C may provide effective long-term stabilization of the index site that is maintained for at least 1 year postoperatively. All patients who experienced an adjacent fracture occurrence demonstrated radiographic evidence of cancer progression surrounding the treatment sites that appeared unrelated to the procedure itself.

Background: Prior studies have suggested a possible association between eczema and postoperative surgical site infections (SSI) following anterior cruciate ligament reconstruction (ACL-R), presumably due to higher rates of staphylococcal colonization in patients with eczema. Purpose:We sought to determine if patients with a history of eczema are at an increased risk for postoperative SSI following ACL-R, medial patellofemoral ligament reconstruction (MPFL-R), and/or knee arthroscopy. Methods:We conducted a retrospective matched case-control study of patients aged 5 to 25 years who underwent ACL-R, MPFL-R, and/or knee arthroscopy from February 1, 2016 to February 8, 2023 at a single tertiary care facility. Cases of postoperative infection were identified as those requiring surgical irrigation and debridement (I&D) and/or postoperative oral antibiotics or had a documented visit for postoperative infection with an infectious disease specialist within 6 months of the indexed procedure. Cases and controls were matched 1:2 based on sex, age ±1 year, body mass index ±1 kg/m², and primary Current Procedural Terminology code. Preoperative diagnosis of eczema and postoperative diagnosis of infection were compared between cases and controls. Results:Three hundred patients were analyzed (mean age 18.2 ± 3.8 years); 4% of both cases and controls had a history of eczema. Patients with postoperative SSI did not have greater odds of having an eczema diagnosis preoperatively compared to matched controls. Overall, 32% of cases required an I&D procedure; these patients did not have greater odds of having an eczema diagnosis preoperatively compared to matched controls. Conclusion:This retrospective matched case-control study suggests that a prior or current diagnosis of eczema is not associated with SSI following ACL-R, MPFL-R, or knee arthroscopy in patients aged 5 to 25 years. Level of Evidence: Level III: Case-Control Study.

Background: Far-lateral lumbar disk herniation (FLLDH) poses a surgical challenge given the difficulty in visualizing the pathology with traditional techniques. Endoscopic microdiscectomy is a novel technique for the treatment of FLLDH with decreased soft tissue disruption. Purposes: We sought to compare the efficacy of tubular versus endoscopic microdiscectomy for FLLDH. Methods: A retrospective cohort study was performed that included patients undergoing uniportal endoscopic or tubular decompression for FLLDH over a 5-year period. The primary outcome was patient-reported outcome measures (PROMs). Secondary outcomes included operative time, intraoperative radiation, length of stay (LOS), and reoperation/complication rates. Comparisons between non-paired continuous variables were done with a 2-tailed independent sample t-test. Categorical variables were compared with a χ² or a Fisher exact test. Significance was assumed at P < .05. Results: We identified 135 patients, 64 having undergone endoscopic and 71 tubular microdiscectomy. There were no differences in operative times (67.7 vs 68.2 minutes) or LOS (945.5 vs 911.1 minutes). Endoscopic microdiscectomy was associated with increased total fluoroscopy time (105.92 vs 34.66 seconds) and intraoperative radiation dose (33.68 vs 19.12 mGy). Postoperatively, both groups had statistically significant improvements in all PROMs at early and late follow-up. There was no difference in the magnitude of improvement or the rate of postoperative complications/reoperations between the groups. Conclusion: This retrospective review found that endoscopic microdiscectomy and tubular decompression were effective techniques for the treatment of FLLDH, showing significant improvement in postoperative PROMs and no differences in postoperative complications. However, endoscopic microdiscectomy is associated with increased intraoperative radiation exposure.

Background: Management of total knee arthroplasty (TKA) periprosthetic joint infection (PJI) can prompt knee fusion or transfemoral amputation, both associated with poor mobility. The titanium transcutaneous osseointegrated nail (TiTON) provides superior mobility versus traditional socket prostheses but has been minimally studied for amputees with prior TKA PJI. Purpose: This study investigated the complications and mobility experience of 9 transfemoral osseointegration patients whose initial amputation was for TKA PJI management. Methods: A retrospective review of a prospectively maintained registry was conducted of 9 patients whose unilateral transfemoral osseointegration was performed following TKA PJI. Complications associated with the implantation of the titanium implant were noted, specifically antibiotic prescription or any additional surgery. K-level mobility performance before and after osseointegration was also compared. Results: Three patients (33.3%) had management for an infectious concern: 2 had a 10-day course of oral doxycycline for periportal drainage, and 1 had operative debridement with implant retention. No other complications (periprosthetic fracture, implant removal, and additional amputation) occurred. Eight patients (88.9%) improved their K-level, while 1 remained at K3. None declined. All achieved at least K2. Three patients were wheelchair-bound (K0) before osseointegration and achieved K3 or better. Conclusions: While infection may occur in patients who have TiTON following TKA PJI, our findings suggest that it does not seem inevitable, severe, or likely to further disable the patient. We noted meaningful mobility improvement that was common and lasting. Although our sample was small, we suggest that TiTON seems safe and reasonable to offer to patients seeking improved mobility and quality of life after amputation for TKA PJI management. Further study is warranted.

Artificial intelligence (AI) and virtual reality (VR) are being used in orthopedic surgery, with goals of enhancing surgical precision, trainee education, patient engagement, and personalized surgical strategies. AI-based predictive modeling, automated computer vision and image analytics, and robotic surgery are changing orthopedic preoperative planning and intraoperative decision-making, with the ultimate aim of improving postoperative outcomes through reduced variability in surgery. VR technologies are being used in orthopedic surgical simulations to provide safe environments for skill development in surgical trainees, helping them practice complex procedures before performing live surgeries. VR platforms are also being studied in-patient rehabilitation, focusing on interactive and gamified approaches that could enhance patients' adherence, recovery, and outcomes. Major pitfalls and challenges that need to be addressed include technical and logistical barriers, ethical concerns surrounding patient data privacy, and resistance to change among surgeons, trainees, and scientists. Improved infrastructure, standardized protocols, and further research to validate the long-term benefits will be imperative for the integration of AI and VR technologies into clinical and surgical workflows.

As wearables are becoming an increasingly important part of wellness and everyday life for many people, their potential in healthcare is also expanding, particularly in personalized and remote healthcare. However, many wearables lack sophistication, relying on simple sensors such as accelerometers and pulse meters to measure heart rate, body composition, and daily activity. Such basic metrics are insufficient for musculoskeletal disease diagnosis, which requires more detailed, multimodal neuromusculoskeletal monitoring. A major challenge in wearables development is the need for precise electromechanical signal measurements, which are difficult to obtain with low-cost systems. Artificial intelligence (AI) holds promise in addressing these analytical challenges and enabling the creation of affordable, sophisticated wearables. While AI has been used for decades in engineering, its clinical application is still emerging, creating an opportunity for the development of AI-enhanced wearables capable of clinical diagnosis. AI can enhance data generated by various sensor types in wearable devices (such as accelerometers, electrical, optical, and acoustic sensors), enabling clinicians to monitor and diagnose complex conditions that require multiple sensing modalities. This review explores current wearable technologies, ongoing research in AI-enhanced wearables, the potential for AI to advance wearable technologies in healthcare, and the future directions in the development of multimodal wearables.

Robotic-assisted surgery is now well-established in spine surgery and total joint arthroplasty, but its application to arthroscopy has only recently emerged in the context of advances in artificial intelligence (AI) and robotic technology. This new application addresses limitations of conventional arthroscopy, including constrained depth perception, variation in technique or anatomy leading to inaccuracies, manual fluid management adjustments, and limitations in dexterity due to the requirement that one hand is occupied by the arthroscope. Early preclinical and cadaveric studies demonstrate submillimeter precision and improved anatomic accuracy in procedures such as anterior cruciate ligament reconstruction, but widespread clinical adoption remains limited by regulatory, economic, and training hurdles. This review article synthesizes the capabilities and applications of current robotic-assisted arthroscopy platforms, surveys the landscape of available technologies, and examines barriers to adoption, thereby looking ahead to the potential use of this technology in redefining arthroscopic surgery.

Artificial intelligence (AI) has emerged in orthopedics with the potential to improve diagnostic accuracy, optimize surgical workflows, and support personalized care. We conducted a narrative review exploring the bioethical considerations of AI use in the orthopedic clinical setting, focusing on 4 core principles-autonomy, beneficence, nonmaleficence, and justice-to provide orthopedists with a practical framework for AI's implementation. We utilized the Preferred Reporting Items for Systematic Reviews and Meta-Analyses framework to conduct a comprehensive PubMed search; 89 articles were evaluated and 23 met our inclusion criteria. Across these studies, bioethical considerations for the clinical implementation of AI tools consistently emerged, most commonly concerning privacy, bias, transparency, informed consent, and regulation. We offer recommendations for strengthening privacy safeguards, adopting bias mitigation strategies, improving transparency through explainable AI tools, and establishing clear regulatory frameworks with lifecycle evaluation.

Artificial intelligence (AI) and digital health (DH) solutions are reshaping musculoskeletal (MSK) care across diagnostics, treatment planning, workflow optimization, and administrative burden reduction. AI-enabled triage systems enhance patient flow efficiency, while automated scheduling, symptom checkers, and AI-powered virtual assistants streamline pre-visit interactions. In MSK radiographic diagnostics, AI augments imaging interpretation, enabling automated fracture detection, opportunistic screening, and quantitative imaging, improving diagnostic accuracy and standardization. Preoperative planning solutions facilitate implant templating, surgical navigation, and patient-specific instrumentation, reducing variability and enhancing surgical precision. Concurrently, digital scribes and AI-driven documentation tools alleviate administrative overhead, mitigating clinician burnout and enabling refocused patient engagement. Predictive analytics optimize treatment pathways by leveraging multimodal patient data for risk stratification and personalized decision support. However, algorithmic bias, model generalizability, regulatory hurdles, and legal ambiguities present substantial implementation barriers, necessitating rigorous validation, adaptive governance, and seamless clinical integration. The U.S. and EU regulatory landscapes diverge in their approaches to AI oversight, with the former favoring expedited market access and the latter imposing stringent compliance mandates under the EU AI Act. AI's integration into MSK care demands robust validation frameworks, standardized interoperability protocols, and dynamic regulatory pathways balancing safety and innovation. Emerging generalist foundation models, open-source large language models (LLMs), and specialized AI-driven medical applications herald a paradigm shift toward precision MSK care. These innovations will require prospective clinical validation to ensure patient benefit and mitigate risk. Addressing ethical considerations, ensuring equitable access, and fostering interdisciplinary collaboration remain paramount in translating AI's potential into tangible improvements in MSK healthcare delivery.