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

Introduction: As total hip arthroplasty and total knee arthroplasty procedures are increasingly performed on younger patients with obesity, the optimal approach to preoperative weight management remains undefined. This study explores national trends among US arthroplasty surgeons regarding body mass index (BMI) cutoffs, weight optimization strategies, and weight loss medication usage.

Methods: A 28-question national survey was distributed through e-mail to members of the American Association of Hip and Knee Surgeons and shared on professional social media platforms (Facebook, ResearchGate, and LinkedIn) between January 1 and August 5, 2024.

Results: Regarding arthroplasty reconstruction fellowship training, 82.58% (441/534) of respondents were fellowship trained, 11.42% (61/534) were not fellowship trained, and 5.99% (32/534) trained in other specialties. In terms of BMI optimization strategies, 82.84% (n = 444/536) recommended structured diet and exercise programs, 77.99% (n = 418/536) recommended dietitian or weight loss specialist programs, and 52.61% (n = 282/536) advocated for bariatric surgery. For total hip arthroplasty, 45.13% of surgeons used a BMI cutoff <40 kg/m2 (n = 241/534), followed by 23.97% advocating for no strict cutoff (n = 128/534). For total knee arthroplasty, 41.65% reported using a cutoff of <40 kg/m2 (n = 222/533), with 24.39% (n = 130/533) reporting no strict BMI cutoff. In addition, 27.62% (n = 58/210) reported that their patients used weight loss medications such as GLP-1 agonists. Notably, 68.0% (n = 356/526) of surgeons allowed up to 1 to 2 years for BMI optimization before surgery.

Conclusion: Although many arthroplasty surgeons use BMI cutoffs, many accommodate patients through nonsurgical interventions to facilitate weight loss. These findings indicate that many respondents report a multidisciplinary approach to preoperative BMI optimization.

Background: Extensor tendon release for tennis elbow is fraught with complications as persistence of pain because of adhesions together with weakness of wrist extension. Denervation of the epicondylar region through division of branches of posterior cutaneous nerve of the forearm (PCNF) was proposed to alleviate pain without drawbacks of tendon release.

Methods: The first group included 19 patients treated through dividing PCNF. The second group included 23 patients treated through tendon release. Inclusion criteria included symptoms for 6 months or longer. Clinical diagnosis was based on positive resisted wrist extension and resisted forearm pronation tests. Division of branches of PCNF in the denervation group and release of extensor carpi radialis brevis tendinous origin in the release group were done.

Results: The follow-up was 37 months. In the denervation group, 17 patients (92%) reported no pain compared with 15 patients (67%) in the release group. In the denervation group, hand grip strength had an average of 72 lb (91%) compared with 63 lb (77%) for the release group (P = 0.04). Patients of the denervation group had an average Mayo Elbow Performance Score of 95 points compared with 87 for the release group (P = 0.37).

Conclusion: Denervation of the elbow for management of tennis elbow is a simple safe procedure.

Introduction: Total knee arthroplasty (TKA) is a highly effective intervention for enhancing function and quality of life in cases with advanced knee osteoarthritis. Although multiple factors have been identified as influencing TKA outcomes, it remains challenging to accurately predict which patients will experience dissatisfaction postoperatively, thereby complicating efforts to optimize their management. This study aimed to evaluate the patient satisfaction outcome after TKA done at our hospital's joint replacement registry using the updated Knee Society Scoring System.

Method: This retrospective observational study was conducted on 900 cases who underwent a TKA. The same surgeon consultant, head of the department, performed all the surgeries.

Results: SF-12 scores and total new knee society scoring (satisfaction subscale, expectation subscale, function activity subscale, and total score) were markedly higher at the end of follow-up than at the baseline (P < 0.05). A negative correlation was found between new knee society scoring, and age and body mass index(P < 0.05). A positive correlation was found between new knee society scoring, and duration of follow and SF-12 as P < 0.05. New knee society scoring was markedly higher in men than women (P = 0.011). New knee society scoring was markedly different among causes of arthroplasty (P = 0.005).

Discussion: An overall satisfaction rate was there among the studied cases regarding SF-12 score, which measures the activity and mentality of the cases postoperatively; in addition, most of the studied group show a notable improvement in new knee society score.

Introduction: The purpose of this study was to investigate patients' preferences for surgeon attire in sports medicine. We hypothesized that older patients would prefer a white coat with formal business attire and that younger patients, and/or athletes, would prefer attire without a white coat.

Methods: A total of 196 questionnaires were distributed to patients at two orthopaedic sports medicine clinics from July 2020 to June 2021. Photographs of male and female physicians were included in the questionnaire, wearing various attires. Patients were asked about the importance of physician's dress, to rate each attire in five categories, and to rank all six outfits based on overall preference and confidence in surgical expertise.

Results: Overall, 65.8% of patients reported that surgeon attire was not important to them. Similarly, respondents ranked white coat with business attire and white coat with scrubs highest in confidence in surgical expertise and overall preference. Athletes were 43% less likely to prefer surgeons wearing a white coat (P = 0.04) and 54% less likely to agree that dress influences happiness with care (P < 0.001). Female patients were 50% less likely to agree that surgeons should wear a white coat than male patients.

Conclusion: Most patients reported that orthopaedic sports medicine surgeons' dress is not important to them and does not influence confidence in their surgeon. However, many patients preferred physicians wearing a white coat with either business attire or scrubs compared with types of dress without a white coat. Wearing a white coat in an outpatient orthopaedic sports medicine office may improve patient satisfaction and perception.

Introduction: This study aims to describe the cost of publication in orthopaedic journals and correlation to journal impact factor metrics.

Methods: Orthopaedic surgery and sports medicine journals were included for analysis. Data were recorded from publicly available records. Statistical analysis was conducted using R studio version 4.2.3. One-way analysis of variance with post hoc analysis (Tukey, Honest Significant Difference (HSD) was performed to compare SCImago Journal Rank (SJR) scores, H-index, and average cost (including the average submission, publication, or article processing charges [APCs] of a published article) between journals based on SJR quartile. Independent sample t-test and chi square or Fisher exact test were used to compare variables, with a Bonferroni P-value adjustment. Pearson correlation coefficient was calculated for SJR score, H-index, total journal references and publications as of 2022, years in publication, average cost, and APC (ie, the cost of publication associated with Open-Access publication). Correlation strengths were defined as excellent (>0.7), excellent-good (0.61 to 0.7), good (0.31 to 0.6), or poor (0.2 to 0.3). P values ≤0.05 were considered significant.

Results: Of 306 orthopaedic journals, 4.9% had submission fees. Subscription publication was available in 55.56%. The average APC for open-access options was $1,975.69 ± 1,524.53 US dollars (USD). Comparison of publication cost for journals with and without subscription options demonstrated significance ($2,939.19 vs. $857.94 USD, P < 0.005). No strong correlation was found between journal impact factor metrics and publication costs. The top 5 main publishers are listed. The top publisher, Elsevier, responsible for 13.07% of orthopaedic journals, offered subscription publication options for only 32.5% of journals, with an average APC of $2,180.21 ± 1,521.27 USD. The United States published the most (n = 86 journals), followed by the United Kingdom (n = 61).

Discussion: Open-access publication aims to ensure equitable access but is limited by large costs associated with publication charged to the authors, which do not strongly correlate with journal impact factor metrics.

Background: Distal femoral osteotomy (DFO) represents an important intervention for addressing valgus and varus deformity about the knee. Closing wedge DFO (CWDFO) is less used and documented than opening wedge DFO for correcting coronal-plane knee deformities. This study evaluates the safety and efficacy of lateral CWDFO (LCWDFO) and medial CWDFO (MCWDFO) by analyzing complication rates and clinical, radiographic, and patient-reported outcome measures.

Methods: A retrospective review was done of 19 patients (average age: 42.2 years; range 23-75) who underwent CWDFO between January 2016 and December 2021, with follow-up through at least 1 year or implant removal. The primary outcome was adverse events including delayed or nonunion, iatrogenic injury, or unplanned surgery. The secondary goal was to report patient clinical performance and patient-reported outcome measures: time to full weight bearing (FWB), passive knee range of motion change, and preoperative and postoperative scores on the Limb Deformity-modified Scoliosis Research Society (LD-SRS) survey. The tertiary goal was to report radiographic outcomes: mechanical tibiofemoral angle, mechanical axis deviation, and mechanical lateral distal femoral angle.

Results: Fifteen patients underwent LCWDFO and four underwent MCWDFO, with mean follow-up of 23.1 ± 17.3 months. Two infections occurred and resolved with antibiotics; no iatrogenic injuries or unplanned surgeries occurred. Patients achieved FWB at 6.48 ± 2.59 (0.14 to 11.43) week and knee motion remained unchanged. The LD-SRS composite score significantly improved (3.4 ± 0.7 vs. 4.2 ± 0.5, P = 0.019), as did three of four subscores: function/activity score (3.3 ± 0.8 vs. 4.1 ± 0.5, P = 0.026), pain score (3.3 ± 0.8 vs. 4.3 ± 0.4, P = 0.006), and self-image score (3.1 ± 0.9 vs. 4.1 ± 0.6, P = 0.014). All radiographic measures collected markedly improved postoperatively.

Conclusion: LCWDFO and MCWDFO both seem safe and effective surgical interventions for improving coronal plane deformity about the knee.

Purpose of study: Although intra-articular corticosteroid hip injections may only delay an inevitable surgery, patient-specific factors and individual psychosocial factors that might dissuade immediate surgery are not fully understood. The purpose of this study was to understand the diverse reasons that patients elect to undergo hip injections and the various timelines to total hip arthroplasty (THA).

Methods: A retrospective review was conducted at a single academic medical center identifying all consecutive patients who had undergone fluoroscopically guided intra-articular surgeon-administered corticosteroid hip injections between June 2018 and February 2023. Data collected included baseline demographics, hip radiographic variables, duration of postinjection pain relief, and if THA was performed. Univariate and multivariate logistic regression analyses identified predictors associated with undergoing THA within 6 and 12 months postinjection.

Results: A total of 93 patients (22 bilateral) with average age of 59.8 ± 1.6 years and body mass index of 31.0 ± 6.3 kg/m2 were reviewed. Reasons for hip injection included the following: 39% due to fear or anxiety of THA; 33% for diagnostic purposes, primarily to discern if the pain stemmed from another source such as the lumbar spine or knee. Most patients showed advanced osteoarthritis: 44% Kellgren-Lawrence (K-L) grade 3 and 35% K-L grade 4. After injection, the average reported pain relief duration was 3.8 ± 4.9 months. Smoking markedly increased the likelihood of undergoing THA within 6 months (OR = 10.889; P = 0.001) and 12 months (OR = 6.375; P = 0.008).

Conclusion: This study elucidated the multifaceted reasons patients opt for conservative management through corticosteroid hip injections. The value of patient-centered care is emphasized in managing hip osteoarthritis, as shown in the high patient retention rates postinjection.

Introduction: Diabetes mellitus (DM) accompanies approximately 30% of hip/knee arthroplasty cases and more than doubles the risk of periprosthetic joint infection (PJI), wound failure, thromboembolism, and readmission. Consensus on perioperative glycemic management remains limited.

Methods: The PubMed/MEDLINE database (January 2000 to March 2025) was queried for English language studies of adults with DM undergoing primary or revision hip or knee arthroplasty. Combinations of "arthroplasty," "diabetes," "HbA1c," "fructosamine," "glycated albumin," "GLP1," "SGLT2," and "negative-pressure wound therapy" identified 162 eligible articles. Each was evaluated using the GRADE framework.

Results: Complication odds increased when preoperative HbA1c exceeded 7.5% or fasting glucose exceeded 115 mg/dL. Short-term biomarkers, fructosamine ≥292 µmol/L or glycated albumin >15.5%, predicted PJI and wound failure more accurately than HbA1c. Protocols that continued metformin, titrated insulin, and introduced preoperative GLP-1 receptor agonists reduced PJI by 43% and 90-day readmissions by 32%. In poorly controlled or obese patients, negative-pressure wound therapy with silver dressings lowered superficial infection rates by 35-40%.

Discussion: Adopting dynamic biomarker panels, prioritizing GLP-1-based regimens, and applying targeted incision management can meaningfully curb diabetes-related complications after arthroplasty. Prospective trials should refine biomarker cutoffs, weigh SGLT-2 risks against transfusion benefits, and define cost-effective wound care pathways.

Introduction: Physical and occupational therapy (PT/OT) services are critical for optimizing outcomes and reducing complications after orthopaedic surgery. Lower socioeconomic status (SES) is associated with reduced access to health care and increased rates of surgical complications. The purpose of our study was to establish the relationship between SES and access to PT/OT.

Methods: We compiled county-level population, land area, and business data from 2020 US Census Bureau Reports. SES data were collected from the 2020 Centers for Disease Control Social Vulnerability Index (SVI) and Area Deprivation Index (ADI). PT/OT businesses were identified using the North American Industry Classification System code 621340. Density of business by county population and land area were calculated, and regression analyses were conducted to determine a correlation between SES and these measures.

Results: Counties with greater density of PT/OT tended to be on the East Coast, whereas those with lower density were located in the Western US. A strong inverse relationship was observed between county-level ADI and PT/OT density (R2 = 0.97 and 0.94). Overall SVI displayed a variable relationship with PT/OT density. The household characteristics and SES domains of the SVI demonstrated an inverse relationship with PT/OT density (R2 = 0.68, 0.49 and R2 = 0.59, 0.28, respectively). Race and ethnicity displayed an inverse parabolic relationship with PT/OT density based on population alone (R2 = 0.83 and 0.57). However, there was a mild positive correlation between race and ethnicity when considering population and land area (R2 = 0.39 and 0.22).

Conclusion: PT/OT services are important for postoperative care; however, notable barriers to access exist. There exists an inverse correlation between the density of PT/OT services and SES measures, particularly ADI. This may affect postoperative recovery and complication rates in orthopaedic patients.

Introduction: Radiographic markers including the crossover sign (COS), ischial spine sign (ISS), and posterior wall sign (PWS) are commonly used to assess acetabular morphology. The aim of this study was to determine the vertical tilt or horizontal rotation needed to elicit sign changes on anterior-posterior (AP) digitally reconstructed radiographs (DRRs).

Methods: CT scans of the pelvis were retrospectively collected and imported into three-dimensional (3D) imaging software to create 3D AP digitally reconstructed radiographs (DRRs). Rendered pelvises were standardized to 0° of tilt and rotation and assessed for positive or negative findings of COS, ISS, and PWS. Then, the DRR was manipulated at 1° intervals (from 0° to 20° in each direction), progressively inducing pelvic tilt in the vertical axis, and the process was then repeated in the horizontal axis. The degree at which the sign changed from positive to negative or vice versa in each hip was recorded.

Results: A total of 20 hips were assessed (five men, five women). On the standardized AP pelvis radiographs, positive COS, ISS, and PWS were 45%, 25%, and 75% respectively. The mean rotation required to change COS, ISS, and PWS from positive to negative or vice versa was 7.92° ± 4.25°, 5.55° ± 2.63°, and 6.37° ± 3.89°, respectively. The mean tilt required to flip COS, ISS, and PWS was 8.80° ± 5.73°, 7.73° ± 3.65°, and 9.55° ± 4.98°.

Conclusion: Close consideration should be given to pelvic position when assessing positive findings of COS, ISS, and PWS because all signs were noted to flip with small degrees of rotation and tilt.