Hss Journal最新文献

Generative artificial intelligence (AI) comprises a class of AI models that generate synthetic outputs based on learning acquired from a dataset that trained the model. This means that they can create entirely new outputs that resemble real-world data despite not being explicitly instructed to do so during training. Regarding technological capabilities, computing power, and data availability, generative AI has given rise to more advanced and versatile models including diffusion and large language models that hold promise in healthcare. In musculoskeletal healthcare, generative AI applications may involve the enhancement of images, generation of audio and video, automation of clinical documentation and administrative tasks, use of surgical planning aids, augmentation of treatment decisions, and personalization of patient communication. Limitations of the use of generative AI in healthcare include hallucinations, model bias, ethical considerations during clinical use, knowledge gaps, and lack of transparency. This review introduces critical concepts of generative AI, presents clinical applications relevant to musculoskeletal healthcare that are in development, and highlights limitations preventing deployment in clinical settings.

Background: Limb deformities remain significant challenges to physical and psychological well-being. The Limb Deformity-Scoliosis Research Society (LD-SRS) tool was developed to evaluate the effect of these deformities on patients' quality of life.

Purpose: To translate, culturally adapt, and validate the LD-SRS tool into Arabic.

Methods: We conducted a prospective study, from March 2024 to May 2024 at King Saud University Medical City in Riyadh, Saudi Arabia, involving participants with limb deformities. Non-native Arabic speakers were excluded. A total of 62 participants completed a survey with demographic questions and the Arabic-translated LD-SRS. This translation was completed using forward and backward translations, expert review, and face validity testing. Thirteen experts confirmed content validity, construct validity via exploratory factor analysis (EFA), and test-retest reliability through a 2-week follow-up survey.

Results: The study's participants were primarily aged 13 to 18 years (45.2%), with a slight male predominance (58.1%). Most assessments occurred before treatment (77.4%); and the thigh was the most commonly affected area (43.5%). Reliability analysis of the Arabic-translated LD-SRS showed excellent internal consistency and almost perfect test-retest reliability. EFA identified 2 factors explaining 62% of the variance: one related to post-surgery items and another to general health.

Conclusion: The findings of our study suggest that the Arabic-translated LD-SRS tool is valid and reliable for use among patients with limb deformities.

Background: Tendinopathies affecting the hip and pelvis include proximal hamstring tendinopathy (PHT), gluteal tendinopathy (greater trochanteric pain syndrome [GTPS]), and calcific tendinopathy (CT). Extracorporeal shockwave therapy (ESWT) is a noninvasive treatment described for the management of lower-extremity tendinopathies. Purpose: We sought to synthesize the evidence on ESWT used in the treatment of hip/pelvis tendinopathies, including protocols, outcomes, and safety. Methods: A comprehensive search of PubMed/Medline, EMBASE, and Cochrane Library databases was performed on November 1, 2024, for studies reporting ESWT data for hip/pelvis tendinopathies. Study design, population, and ESWT-related data (protocols, outcomes, and safety) were extracted. Results: Eighteen studies were included; 9 reported on GTPS, 7 on CT, and 5 on PHT. Most ESWT protocols (72% [n = 13]) implemented 3 to 4 weekly sessions and delivered 2000 to 3000 pulses/session (83% [n = 15]). Eleven studies used radial ESWT and 7 used focused ESWT. ESWT significantly improved pain and functional outcomes for GTPS, CT, and PHT in 17 level-I to level-V studies; only 1 level-V study showed no improvement. Six studies showed superior outcomes post-ESWT vs conservative treatment (PHT/GTPS), sham ESWT (GTPS), ultrasound therapy (GTPS/CT), or corticosteroid injection (GTPS). One study showed comparable outcomes between ESWT and eccentric exercise (GTPS). Two studies reported no outcome differences between radial ESWT and "minimal-dose" ESWT (GTPS) or combined ESWT (PHT). All studies assessing pain showed improvement from 0.5 to 27 months post-ESWT. Six of 18 studies reported adverse events, including increased pain and skin irritation (overall rate: 12% [n = 65/557]). Conclusions: The results of this systematic review suggest that ESWT may be safe and effective for hip/pelvis tendinopathies. Future research using validated outcome measures and ESWT parameters will aid in treatment optimization.

[This corrects the article DOI: 10.1177/15563316241281064.].

Background: The quest for optimal approaches to treating tibial shaft fractures in orthopedic surgery remains a topic of debate.

Purpose: We sought to compare the patellofemoral and radiological outcomes of 2 surgical techniques for treating tibial shaft fractures: the suprapatellar and extra-articular lateral parapatellar (ELP) approaches, both used in intramedullary tibial nailing in a semi-extended position.

Methodology: This retrospective analysis examined 73 adult patients treated for tibial shaft fracture from January 2018 to December 2023, divided into 2 groups: 42 in the suprapatellar group and 31 in the ELP group. Evaluation metrics included radiographic outcomes, clinical results, and complication rates, focusing on anterior knee pain (measured by visual analog scale) and knee function (Kujala and Lysholm scores).

Results: No significant differences were found in union rate, nail apex distance, reoperation rate, or malalignment between the 2 approaches. However, the ELP approach was associated with significantly better clinical outcomes, with higher Lysholm scores and reduced anterior knee pain. Additionally, the suprapatellar approach (SP) was associated with a higher incidence of painful hemarthrosis during hospitalization.

Conclusion: While this retrospective comparison found both techniques to be effective in treating tibial shaft fractures, the ELP approach was associated with superior functional outcomes as assessed by higher Lysholm scores and Kujala scores, less anterior knee pain, and a lower risk of painful hemarthrosis compared to the SP approach. Further study is warranted.

We describe the treatment of a patient recovering after reconstruction surgery for brachial plexus injury (BPI), which causes damage to the nerves of the arm. We used 3D motion capture to create a 3D "map" of the patient's reachable workspace-that is, how far the patient could reach within his own environment as a measure of how well his arm functioned-and tracked changes over a 2-year period. We also describe the patient's self-reported outcomes and compare them to the workspace measurement.

Background: Bioactive glass (BG) is a promising alternative to conventional autogenous and allogeneic bone grafts with osteoconductive, osteoinductive, and antimicrobial properties. The effects of its use in comparison to allograft in the context of benign bone lesions remain less explored.

Purpose: We sought to compare the efficacy of 45S5 BG granules to allograft in treating benign bone lesions.

Methods: This retrospective study compared the outcomes of 45S5 BG granules and allograft bone in 42 patients undergoing curettage for benign bone lesions. Patients were divided into 2 groups based on the graft material used (n = 21 in each group). Radiological evaluation using the modified Neer classification and functional assessment using the Musculoskeletal Tumor Society (MSTS) score were performed. Complications and time to return to previous activity levels were also recorded.

Results: No significant differences were found between the BG and allograft groups in terms of postoperative Neer scores, postoperative MSTS scores, complication rates, or time to return to previous activity levels. Both groups showed significant improvement in MSTS scores over time, although improvement in MSTS scores for both groups did not reach the minimal clinically important difference, suggesting that the observed changes may not be clinically significant.

Conclusion: This retrospective study found that BG demonstrated comparable efficacy to allograft cancellous bone in the treatment of benign bone lesions, suggesting that it may serve as a suitable alternative. Further study should focus on longer-term follow-up and larger sample sizes to further elucidate the role of BG in the management of these lesions.

Background: It is unclear what influence patient sex and body mass index (BMI) have on perioperative outcomes following total hip arthroplasty (THA), especially regarding anterior versus posterolateral approaches. Purpose/Study Questions: We sought to compare perioperative outcomes of primary THA via direct anterior (DAA) versus posterolateral (PLA) approaches, stratified by patient sex and BMI. Methods: A retrospective review at a single institution identified 8258 patients 18 to 80 years old who underwent primary THA via DAA or PLA for osteoarthritis between February 2019 and April 2022. Patients were stratified by sex and BMI (<30 or 30-40). We compared operative times, lengths of stay (LOS), opioid consumption and prescribing patterns, and achievement of Hip Injury and Osteoarthritis Outcome Score for Joint Replacement (HOOS JR) minimum clinically important difference (MCID), substantial clinical benefit (SCB), and patient acceptable symptom state (PASS) across the cohorts. Results: Median operative time was 6 to 11 minutes longer for DAA than for PLA. Median LOS was shorter for DAA, with the largest difference observed in women with BMI <30 (19-hour difference) and BMI 30 to 40 (20-hour difference). In-hospital milligram morphine equivalents consumed were lower for DAA in men with BMI <30 (45 vs 53), women with BMI <30 (45 vs 53), and women with BMI 30-40 (60 vs 75). There was no difference observed in HOOS JR MCID, SCB, or PASS achievement scores at 1 year for any cohort. Conclusion: This retrospective study found longer operative times for DAA than PLA and shorter LOS in women undergoing DAA than those undergoing PLA. There were minimal clinical differences in in-hospital opioid consumption, 90-day opioid prescription patterns, and patient-reported outcome measures. These findings suggest that patient sex and BMI may have implications on case scheduling and discharge planning for primary THA. Further study is warranted.