Journal of the American Academy of Orthopaedic Surgeons Global Research and Reviews最新文献

Introduction: Periprosthetic distal femur fractures (PDFFs) are increasing with rising arthroplasty volumes. An optimal fixation strategy remains debated. This study evaluated outcomes of single lateral locking plate constructs (sLLPs), retrograde intramedullary nails (IMNs), and dual constructs (nail-plate or dual plating).

Methods: A retrospective cohort study was done at a level I trauma center (2012 to 2024). Adults with PDFF (AO/Orthopaedic Trauma Association 33) treated with sLLP, IMN, or dual constructs were included. All patients were assessed for postoperative weight-bearing status, while clinical outcomes required ≥6-month follow-up or earlier documented complications. Outcomes included revision surgery, infection, implant failure, hardware removal, wound dehiscence, and time to weight bearing as tolerated (WBAT).

Results: Of 99 identified patients, 64 met criteria (IMN: n = 20; sLLP: n = 19; dual: n = 25). Mean age was 69.0 years; 75.0% female, 59.4% Black; mean follow-up 391.5 days. Immediate WBAT was ore common in dual (70.7%) and IMN (52.8%) groups than sLLP (9.1%; P < 0.001). Mean time to WBAT was shortest with dual constructs (13.8 days), followed by IMN (26.0) and sLLP (42.8; P = 0.020). On multivariable analysis, sLLP fixation was associated with increased odds of unplanned revision surgery (OR 6.27, 95% confidence interval, 1.29 to 30.50, P = 0.023), while neither IMN (P = 0.157) nor dual constructs (P = 0.071) demonstrated a significant association.

Conclusion: Single lateral locking plate fixation in PDFF was associated with higher odds of unplanned revision surgery. Dual construct patients had the shortest time to postoperative weight bearing and were more frequently permitted WBAT immediately after surgery.

Background: Nonhealing or rupture of the subscapularis after shoulder arthroplasty has been identified as a source of shoulder pain, weakness, and potentially prosthetic instability. Subscapularis-sparing approaches have been developed to mitigate this risk. However, these approaches are rarely used, despite the increasing frequency of shoulder arthroplasty. This review aims to assess the safety and efficacy of subscapularis-sparing approaches for shoulder arthroplasty.

Methods: A PRISMA-compliant review of the English literature in the PubMed/MEDLINE database after January 1, 2014, was conducted to identify clinical studies that reported the use of subscapularis-sparing shoulder arthroplasty in adults. Studies included in relevant systematic reviews were also screened. Baseline demographic data, procedural data including procedure time and blood loss, and treatment characteristics including surgical approach and device used were extracted. Efficacy outcomes included range of motion, functional scores, strength, pain, and implant stability or failure. Safety outcomes included infection, severity of infection, and antibiotic use. Because of the low number of comparative studies, study conclusions were qualitatively compared.

Results: A total of 15 studies (1573 patients) reporting subscapularis-sparing shoulder arthroplasty were identified. Eight studies reported reverse arthroplasty (RSA), whereas seven reported anatomic arthroplasty (TSA), including one reporting hemiarthroplasty. Eight studies directly compared subscapularis-sparing and nonsparing techniques. The comparative studies reported that subscapularis-sparing techniques had comparable outcomes to nonsparing techniques in both TSA and RSA, including range of motion, functional scores, pain, and revision. Findings for subscapularis integrity were similar between studies using TSA and RSA.

Conclusion: Subscapularis-sparing shoulder arthroplasty is a safe and effective technique with comparable patient outcomes to nonsparing techniques. The number of comparative studies is limited, and more randomized controlled trials are needed to confirm these results.

Supracondylar humerus fractures (SCHFs) are common injuries among children and typically occur after a fall on an outstretched hand. SCHFs may present with neurovascular injury specifically to the brachial artery and/or median nerve (or its deep motor branch), ulnar nerve, and/or radial nerve. Thorough examination of a patient's neurovascular status is imperative to appropriately guide treatment and determine whether a referral is needed. Minimally displaced SCHFs may be treated nonsurgically, whereas displaced injuries often require surgery. Displaced SCHFs may be treated nonsurgically with traction and splinting, but providers should expect a high rate of complications and notable disability. Of equal importance to consider is the status of the soft tissues. In resource-limited settings, such as rural or district hospitals, surgery for more severe SCHFs may not be feasible because of lack of fluoroscopy, implants, or staff adequately trained in musculoskeletal trauma. In these situations, referral to a hospital with increased resources and surgical capabilities is recommended when possible. We present an approach to the triage and treatment of SCHFs in various resource-constrained environments, broadly applicable to low- and middle-income countries.

Background: This study analyzes the disease burden of elderly knee osteoarthritis (KOA) and its risk factors in individuals aged 55+ years using Global Burden of Disease data from 1990 to 2021, aiming to inform public health policy and interventions.

Methods: Data from the Global Burden of Disease and Global Health Data Exchange were used to investigate age- and sex-specific trends in KOA incidence, prevalence, and disability-adjusted life years (DALYs). Age-standardized incidence rate (ASIR) and age-standardized disability rate were calculated, and global maps were created to visualize trends. A Bayesian Age-Period-Cohort model predicted the disease burden for 2050. Analyses were done using R software (v4.0.4).

Results: From 1990 to 2021, the number of new KOA cases and DALYs increased globally in both men and women, with higher ASIR and DALYs rates in women. ASIR rose across all sociodemographic index (SDI) strata, with the largest increase in low-middle SDI countries. Regionally, ASIR increased in most areas except high-income Asia Pacific. The highest disease burden was observed in the 55 to 59 years age group, with DALYs peaking in the 75 to 79 years age group. At the country level, China, Myanmar, and Malaysia had the highest incidence, whereas China, India, and the United States had the highest DALYs. High body-mass index emerged as a notable contributor to the disease burden in 2021. Projections indicate rising DALYs rates across all age groups by 2050, particularly in the oldest age groups.

Discussion: The global burden of elderly KOA has increased markedly over three decades, disproportionately affecting women. ASIR rose across all SDI strata, with the largest increase in low-middle SDI countries. These findings provide evidence for the development of elderly health intervention measures.

A 14-year-old male patient sustained a distal femur fracture after a ground-level fall. His history was notable for severe acquired genu valgum secondary to a childhood lawnmower accident, which had required multiple limb salvage procedures including a Syme amputation and soft-tissue skin grafting. Acute correction of the limb deformity was performed concurrently with fracture fixation using a retrograde intramedullary nail and poller blocking screws. Retrograde intramedullary nailing represents a viable treatment option for simultaneous acute correction of acquired genu valgum and stabilization of distal femur fractures.

Background: End-stage ankle osteoarthritis can be treated surgically by either total ankle arthroplasty (TAA) or ankle arthrodesis (AA). The purpose of this systematic literature review is to analyze international publication trends of comparative studies of TAA and AA.

Methods: A systematic literature review was conducted, searching Embase and PubMed for studies comparing the utilization of TAA and AA published between 1 January, 2010, and the search date (March 18, 2022).

Results: Twenty-one publications comparing TAA and AA were included in the literature review, capturing 68,893 TAA procedures and 206,437 AA procedures in seven different countries or regions. Nine studies originated from the United States, and 12 studies from outside the United States (OUS). The number of studies comparing the utilization of TAA and AA declines sharply after 2013. From 2000 to 2013, the volume of TAAs reported increased globally; however, the number of AA procedures reported initially increased globally but declined dramatically in the United States after 2011, while remained steady in OUS.

Conclusion: The number of studies comparing TAA and AA increased in the early 2000s but has decreased for the past 10 years. The available 30-year literature indicates that the interest for TAA procedures has increased in the United States and some Asian countries, while interest for AAs has declined. In Europe, the reported utilization trend of TAA is generally decreasing.

Introduction: The purpose of this study was to evaluate the relationship between 1-month pain scores and 3-month postoperative satisfaction and investigate whether an immediate postoperative pain score cutoff exists between satisfied and dissatisfied patients.

Methods: This was a secondary analysis of a multicenter, longitudinal, cohort study comprised total knee arthroplasty (TKA) patients (n = 1763) using a digital care management platform. Pain was assessed at 1 month postoperatively through an 11-point numeric rating scale (NRS). Satisfaction was assessed at 3 months postoperative through the Knee Society composite satisfaction score (KSS). Patients were stratified into satisfied (KSS >30) and dissatisfied (KSS <30) subgroups. Quantile regression was used to create a best-fit line to identify a cutoff between the 1-month NRS and the 3-month KSS. A logistic regression model was used to classify patients as satisfied or dissatisfied that included comorbidities, 1-month active flexion range of motion, anxiety/depression score, sex, age, and body mass index. The importance of the features in the model was assessed using permutation importance method to create a best-fit line between satisfaction and NRS.

Results: The 1 month mean NRS and satisfaction scores were 3.7 ± 2.0 and 29.4 ± 8.6, respectively. A total of 621 patients (35.2%) were dissatisfied at 3 months postoperatively. A moderate correlation was found between 1-month NRS pain and 3-month satisfaction (r = -0.39, P < 0.001). Based on the best-fit line, the cutoff for dissatisfaction occurs with an NRS for pain of >4.0. The model achieves an area under curve (AUC) of 0.73 (SD = 0.02), with a maximum f1-score of 0.65, corresponding to sensitivity = 0.87 and specificity = 0.44.

Conclusion: One-month postoperative pain scores greater than 4.0 were associated with patient dissatisfaction at 3 months postoperatively. Assessing pain in the immediate postoperative period can provide clinicians with diagnostic data that may help detect patients at risk for a poor prognosis 3 months following TKA.

Therapeutic peptides are emerging as promising adjuncts in the management of orthopaedic injuries, grounded in their ability to modulate molecular signaling networks central to cellular medicine. By acting on key pathways such as PI3K/Akt, mTOR, MAPK, TGF-β, and AMPK, peptides exert influence over tissue regeneration, inflammation resolution, and neuromuscular recovery. Wound-healing peptides such as BPC-157, TB-500, and GHK-Cu promote angiogenesis, integrin-mediated extracellular matrix remodeling, and fibroblast activation, whereas growth hormone secretagogues like ipamorelin, CJC-1295, tesamorelin, sermorelin, and AOD-9604 activate IGF-1 signaling and satellite cell repair. Recovery-enhancing agents such as epithalon, delta sleep-inducing peptide, and pinealon target circadian and mitochondrial regulators, and neuroactive peptides like selank, semax, and dihexa enhance brain-derived neurotrophic factor and HGF/c-Met pathways critical to neuroplasticity. Although preclinical studies are promising, there is a current lack of clinical trials. This review integrates current mechanistic insights with orthopaedic relevance, emphasizing safety, efficacy, and future directions for responsible integration into musculoskeletal care.

Background: There has been an increased interest within orthopaedics investigating disparities in outcomes among populations of low socioeconomic status (SES). This study aims to investigate how SES, investigated by proxy through geocoding, affects postoperative outcomes following repair of rotator cuff tears.

Methods: A total of 322 patients undergoing full-thickness rotator cuff tear repair (RCR) at a single institution from 2014 to 2021 were retrospectively reviewed and stratified by median household income and Social Deprivation Index (SDI) per zip code. Primary outcomes included patient-reported outcome measures (PROMs) at 12 months postoperatively. Multiple linear regression examined which variables correlated with American Shoulder and Elbow Surgeons (ASES) and Single Assessment Numeric Evaluation (SANE) scores.

Results: The extremely/very low-income and high SDI patients had significantly decreased ASES, SANE, and satisfaction scores at 12 months postoperatively based on one-way analysis of variance (ANOVA) analysis. Multiple linear regression revealed that low- and medium-income groups had notable positive correlations with ASES and SANE scores. Highest SDI quartile, body mass index, female sex, and current smoking status had notable negative correlations with PROMs.

Conclusion: Based on ANOVA, patients from areas of lowest income and highest SDI had lower PROMs following RCR, although multiple regression demonstrates that PROMs are multifactorial. The results should be interpreted in the context of current literature and used to raise awareness among orthopaedic surgeons of risk factors affecting PROMs following RCR. As health care trends toward patient satisfaction-driven financial models, we stress the importance of risk-adjusted compensation and performance models for orthopaedic surgeons performing RCRs and preoperative expectation counseling.

Background: Corticosteroid injection into the shoulder is a common treatment used for various orthopaedic pathologies. However, it remains unclear if using nonsterile gloves correlate with higher infection risk compared with sterile gloves for such procedures. Although literature in other fields supports the noninferiority of nonsterile gloves toward infection risk, similar studies have not been conducted in orthopaedics. This study seeks to identify if there is an increased infection risk and difference in costs with using nonsterile gloves compared with sterile gloves for shoulder injections.

Methods: A retrospective review of medical records identified patients who received shoulder injections from a single surgeon from February 2023 to July 2024. The surgeon transitioned from using sterile gloves to nonsterile gloves during this period, and a proportionate number of patients were assigned to nonsterile and sterile glove groups. Post hoc power analysis was completed through calculating confidence intervals and minimal detectable effect size through Cohen h. Records were reviewed for demographic information, body mass index, Charlson comorbidity index, follow-up length, and postinjection infection as identified through ICD-10 code T80.29XA. Rate of infection was evaluated at 1, 3, and 6 months following injections. Glove prices were obtained through our institution. Percentages were obtained for categorical variables, and means were calculated for continuous variables. Descriptive statistics were done using Chi-squared tests for percentages and Student t tests for means for any baseline differences between the patient groups.

Results: A total of 641 patients were evaluated with a minimal follow-up period of 6 months. Three hundred seventeen injections were performed using sterile gloves, and 323 injections were performed using nonsterile gloves. No shoulder joint infections were recorded following any injection performed with either glove type, with the study being sufficiently powered to detect within 0.012 infection rate difference. Sterile gloves were 36 times more expensive than nonsterile gloves per injection.

Conclusion: Although sterile gloves are substantially more expensive than nonsterile gloves, no difference was found in infection risk outcomes for corticosteroid shoulder injections in clinical practice.