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

The unicameral bone cyst (UBC) is a benign lesion that affects children and adolescents between 4 and 14 years of age. They are defined by an osteolytic cavity filled with serous fluid, enclosed by a thin fibrous membrane. Moreover, they are closely associated with skeletal growth and biomechanical stresses during development. Surgical management of UBCs is crucial, particularly in weight-bearing bones, to reduce the risk of pathological fractures and maintain structural stability. These surgical procedures (such as curretage and bone grafting) aim to restore bone stability, prevent recurrence, and enhance long-term functional outcomes. Studying UBCs provides insight into the natural history and behavior of benign bone lesions, emphasizing the importance of growth and mechanical factors in skeletal pathology. This case report seeks to present our experience in managing UBCs of the proximal femur in Riyadh, Saudi Arabia, focusing on the tips needed in the surgical technique that can aid surgeons in the management of such cases.

Introduction: Unfortunately, some lumbar fusion patients will experience psychological distress and a deterioration of mental health postoperatively. At the extreme, these changes can lead to self-harm and suicide. This study evaluated the incidence of self-harm within 1 year of elective lumbar fusion procedures to identify risk factors for self-harm events.

Methods: The PearlDiver Mariner 170 data set from 2010 to 2023 was retrospectively analyzed. Patients undergoing 1-level to 3-level posterior lumbar fusion with minimum 1-year follow-up were included. Patients with a history of self-harm before surgery were excluded. Univariate and multivariate analyses were done to assess risk factors for self-harm. Statistical significance was assessed at P < 0.05.

Results: In total, 138,223 patients were included. The incidence of self-harm within 1 year was 0.40% (549 patients). In the multivariable model, younger age, male sex, and higher Charlson Comorbidity Index scores were risk factors for self-harm. Specific comorbidities associated with increased risk for self-harm included alcohol use disorder, anxiety disorders, depression, tobacco use, and preoperative opioid use (all P < 0.001). The strongest associations between comorbidity and self-harm were seen for depression (odds ratio [OR] = 2.68), anxiety (OR = 2.03), and alcohol use disorder (OR = 1.89).

Conclusion: Self-harm is a rare, yet understudied potential complication of lumbar fusion procedures. In this national database study, the incidence of self-harm was 0.4% in the year after elective lumbar fusion. Although some risk factors for self-harm are nonmodifiable, other behavioral and mental health comorbidities may serve to flag patients as targets for early preventive intervention.

Introduction: This study aimed to determine the effect of preoperative variables and three-dimensional acetabular correction on patient-reported outcome measures after transposition osteotomy of the acetabulum (TOA), a spherical periacetabular osteotomy.

Methods: We retrospectively reviewed 442 patients (582 hips) with hip dysplasia who underwent TOA between 1998 and 2019 and completed validated questionnaires, including the visual analog scale (VAS) for pain and satisfaction and the Hip disability and Osteoarthritis Outcome Score (HOOS). The median follow-up was 12 years. Associations between patient-reported outcome measures and preoperative variables and postoperative acetabular coverage (lateral center-edge angle, anterior wall index, and posterior wall index) were analyzed.

Results: Older age was negatively correlated with HOOS-ADL (r = -0.26, P < 0.001) and HOOS-sports/recreation (r = -0.25, P < 0.001). Male patients reported lower median HOOS-QOL than female patients (P = 0.038). Patients with Tönnis grade 0 had higher median satisfaction-VAS than those with grade 2 (P = 0.031), and higher median HOOS-ADL, sports/recreation, and QOL subscales than those with grade 1 or 2. For postoperative anterior wall index, the deficient group had higher VAS-pain (P = 0.045) and lower HOOS-pain (P = 0.047) than the normal group. For postoperative posterior wall index, the excessive group had lower HOOS-pain than the normal group (P = 0.029).

Conclusion: Even in preserved hips after TOA, sagittal plane acetabular correction influenced postoperative pain, whereas age, sex, and Tönnis grade affected satisfaction, functional capacity, and QOL. These insights have implications for refining surgical indications and acetabular reorientation strategies, improving postoperative patient experience.

The use of glucagon-like peptide-1 receptor agonists (GLP-1RA) in patients with type 2 diabetes mellitus (T2DM) has increased substantially over the past several years. The purpose of this study was to determine whether GLP-1RA use affects outcomes after hip hemiarthroplasty (HA) for femoral neck fractures (FNFs). A retrospective cross-sectional analysis of a local hospital system database was conducted between 2016 and 2023 to identify patients with T2DM aged at least 18 years who underwent HA for FNFs and were on a GLP-1RA at the time of injury. A 1:1 random patient sample of those who underwent HA and were not on a GLP-IRA was used as a control. Patient characteristics and Elixhauser comorbidity index were recorded. Outcomes included hospital length of stay, aspiration pneumonitis during index hospitalization, inpatient readmissions and emergency department encounters within 365 days, medical complications, surgical site infection, implant complications, revision hip surgery, and in-hospital mortality/discharge to hospice within 30, 90, and 365 days. Binary logistic regression was done to assess the 30-day risk of medical and the 365-day risk of implant postoperative outcomes. Four hundred ninety-nine patients (GLP-1RA, N = 248; No GLP-1RA, N = 251), with T2DM, who underwent HA for FNF were included for analysis. GLP-1RA use was not markedly associated with medical complications within 30, 90, or 365 days; implant complications or revision surgery within 365 days; in-hospital mortality/discharge to hospice within 30 or 90 days; postoperative aspiration; length of stay; or inpatient readmissions or emergency department encounters. GLP-IRA use was associated with a decreased risk of in-hospital mortality/discharge to hospice within 365 days. When controlling for confounding variables, the use of GLP-IRA was not associated with any adverse outcome measured in the study (P > 0.05). GLP-1RA use in T2DM patients undergoing HA for FNF is not associated with an increased risk of early postoperative medical and surgical complications.

Introduction: Perioperative nutritional, functional status, and bone health optimization has been supported in the literature before arthroplasty procedures; however, surgeon's perception and implementation of such efforts have yet to be investigated. This study aims to identify the current perception and implementation efforts of arthroplasty surgeons in the nation regarding nutritional, functional status, and bone health optimization.

Methods: A 28-question survey was anonymously distributed to orthopaedic arthroplasty surgeons through the American Association of Hip and Knee Surgeon contact database. Survey responses were compiled and analyzed with chi square.

Results: Sixty-four total arthroplasty surgeons completed the questionnaire with the following geographic distribution: 33% Midwest, 27% Northeast, 23% Southeast, and 16% West. Forty-six percentage of survey participants reported a formal departmental nutrition optimization protocol despite 14% of surgeons doubting the benefits of nutritional optimization. The perceived goals of nutrition intervention were predominantly decreasing complications rates and weight loss. Seventy-five percentage of surveyed respondents report an absence of functional status optimization protocol in place with 38% of surgeons' initial functional assessment begins with patient ambulation dependency. In addition, 13% of surgeon routinely assess bone health with a dual energy x-ray absorptiometry scan for suspicion of osteoporosis, and 87% of surgeons would not delay surgery for bone health optimization.

Conclusion: Despite data suggesting the benefits of perioperative nutritional, functional status, and bone health optimization, many barriers to implementation exist. Predominant barriers include compliance rate and logistical challenges of implementation. Comprehension of current perceptions and common practice can provide information to direct future optimization protocol development.

Introduction: In orthopaedic surgery, intrawound vancomycin has become a widely used strategy to reduce the incidence of surgical site infections, commonly caused by gram-positive microorganisms. This study evaluated the incidence of postoperative orthopaedic complications in patients undergoing ankle arthrodesis with and without the use of intrawound vancomycin.

Methods: This retrospective study used data from the TriNetX Research Network to identify patients who underwent ankle arthrodesis between October 1, 2002, and October 1, 2022. This population was divided into two cohorts: patients who received perioperative cefazolin and local vancomycin (cefazolin-vancomycin) and patients who received perioperative cefazolin but no local vancomycin (cefazolin-only). This study assessed rates of implant-related complications occurring within 2 years of the arthrodesis.

Results: A total of 374 patients in the cefazolin-vancomycin cohort and 5,218 in the cefazolin-only cohort were identified, with an average age of 58.0 ± 14.0 years and 56.6 ± 14.6 years, respectively (P = 0.083). Before matching, the cefazolin-vancomycin cohort had higher rates of comorbidities, including diabetes (30% vs. 21%, P < 0.001), obesity (32% vs. 21%, P < 0.001), and liver disease (13% vs. 5%, P < 0.001). After propensity matching, each cohort had 373 patients. The cefazolin-vancomycin group demonstrated a significantly lower risk of nonunion (13% vs. 19%, P = 0.020), whereas other outcomes showed no statistically significant differences.

Conclusion: This study evaluated the incidence of postoperative complications in patients undergoing ankle arthrodesis with and without intrawound vancomycin. The analysis demonstrated a markedly lower nonunion rate in the cefazolin-vancomycin group (13%) compared with the cefazolin-only group (19%), aligning with previously reported rates but lower than those seen in high-risk populations. These findings suggest that local vancomycin administration may mitigate nonunion risk and optimize fusion outcomes in ankle arthrodesis by reducing infection.

Introduction: Total hip arthroplasty (THA) is one of the most common orthopaedic procedures. Although unilateral THA is routine, there is limited guidance on managing patients who require bilateral arthroplasty. This study aims to compare the outcomes of simultaneous versus staged bilateral THA.

Methods: This was a cohort retrospective study drawing data from the National Readmissions Database, years 2016 to 2020. Patients undergoing bilateral THA were identified using International Classification of Diseases, 10th Revision, Clinical Modification/Procedure Coding System (ICD-10) codes. For staged procedures, outcomes for each surgery were combined for appropriate comparison with simultaneous surgeries. Propensity score matching was performed to balance patient demographics, socioeconomic status, and comorbidities, between the two groups. Multivariate regression was performed to assess outcomes between groups. Multivariate regression analyses were conducted on the matched cohorts to assess postoperative outcomes, 90-day readmission, and 90-day revision surgery rates.

Results: A total of 82,897 patients, 71,560 (86.3%) undergoing staged bilateral and 11,337 (13.7%) undergoing simultaneous bilateral THA, were included. After successful matching, those undergoing staged bilateral THA had increased medical (odds ratio [OR], 1.26; P < 0.001), but reduced surgical complications (OR, 0.66; P < 0.001), particularly reduced need for blood transfusions (OR, 0.38; P < 0.001). Those undergoing the staged procedure also had reduced odds of revision surgery (OR, 0.85; P = 0.001) but increased odds of readmission (OR, 1.14; P < 0.001), routine discharge (OR, 1.20; P < 0.001), longer lengths of stay (OR, 1.09; P < 0.001), and greater total charges (OR, 1.20; P < 0.001).

Conclusion: When compared with simultaneous THA, staged THA was associated with reduced surgical complications, particularly transfusions, but greater medical complications. Although associated with reduced revision surgeries and resulted in better discharge disposition, staged bilateral THA required more days in the hospital and were more expensive. This suggests that both simultaneous and staged bilateral THA are viable options. Surgeons should consider individual patient risks and preferences when planning bilateral THA.

Study design: Level III; Retrospective Cohort Study.

Introduction: Adhesive capsulitis (AC) is a debilitating condition that markedly affects shoulder mobility and function. Mental health disorders have been associated with poorer outcomes for orthopaedic patients; however, their specific effect on postoperative outcomes after surgery for AC remains underexplored.

Methods: Patients who underwent arthroscopic capsular release or manipulation under anesthesia for AC were identified in the PearlDiver database. Patients with preexisting mental health diagnoses (anxiety, depression, bipolar disorder, or schizophrenia) were matched 1:1 with control subjects based on age, sex, and Charlson Comorbidity Index. Rates of 90-day complications and 2-year surgical outcomes were analyzed through multivariable logistic regression. Kaplan-Meier analyses generated 10-year cumulative incidence rates of postoperative therapeutic modalities, and a Cox proportional hazard ratio (HR) model generated HRs and 95% confidence intervals.

Results: Among 42,862 patients identified, 26.1% had a preoperative mental health diagnosis. After matching, patients with a mental health disorder experienced greater risk for 90-day hospital readmission (odds ratio [OR] = 1.33, P < 0.001), emergency department visits (OR = 1.81, P < 0.001), and several postoperative complications, including acute kidney injury (OR = 1.60, P < 0.001), wound complications (OR = 1.63, P = 0.028), pneumonia (OR = 1.46, P < 0.001), urinary tract infection (OR = 1.22, P < 0.001), and stroke (OR = 1.75, P = 0.005). Patients with mental health disorders were also more likely to undergo physical therapy (OR = 1.18, P < 0.001), intra-articular injections (OR = 1.27, P < 0.001), and any secondary treatment (OR = 1.22, P < 0.001) 2 years after surgery. In addition, preexisting mental health disorders were associated with an increased 10-year cumulative incidence and risk of physical therapy (53.7% versus 52.0%, HR = 1.09, P 0.001), intra-articular injections (32.0% versus 28.6%, HR = 1.20, P < 0.001), and any secondary treatment (64.9% versus 62.7%, HR = 1.10, P < 0.001).

Conclusion: Patients with existing mental health disorders experienced increased rates of complications and a higher risk of secondary treatment utilization over a 10-year period after surgery for AC. Awareness of these risks is essential for optimizing postoperative care and addressing the complex needs of this patient population.

Background: Pediatric diaphyseal both-bone forearm fractures are increasingly treated with elastic stable intramedullary nailing (ESIN) using titanium nails. However, clear guidelines on the type and duration of splint immobilization are lacking. This study aims to assess the necessity of splint immobilization after ESIN for diaphyseal forearm fractures in children.

Methods: A prospective study was conducted on 38 patients with isolated radial and ulnar shaft fractures from 2018 to 2020. Patients were divided into two groups: 14 with splint immobilization for a mean of 3.93 weeks and 24 with only a sling allowing early postoperative movement. The mean ages were 10.3 years (group I) and 10.0 years (group II). Patients were evaluated at 2, 6, 12, and 24 weeks postsurgery. Final range of motion, recovery pace, bone healing, pain, complications, and treatment outcomes were compared.

Results: No notable differences were found between splint immobilization and nonsplint groups regarding bone healing time (3.79 vs. 3.13 months), complications (28.6% vs. 29.2%), and final outcomes. Movement recovery was faster in the nonsplint group, but range of motion was similar at the final follow-up. Pain-free rates at 2 weeks postsurgery were higher in the splint group (85.8% vs. 50%). Pain intensity was similarly low in both groups (mean 2.5 vs. 2.67 on the visual analog scale scale).

Conclusion: Splint immobilization improves pain control in the first 2 weeks postsurgery, but it offers no additional benefits in terms of healing time and functional outcome. Meanwhile, ESIN is a safe, effective treatment for pediatric forearm shaft fractures.

Introduction: Hip-spine syndrome is a complex condition characterized by concurrent degenerative pathologies of the hip and lumbar spine, often leading to significant morbidity. Accurate radiographic measurements are critical for diagnosing and managing this syndrome, particularly in the context of total hip arthroplasty. This study aimed to evaluate the interobserver reliability of sacral slope measurements on pelvic radiographs in healthy individuals to enhance diagnostic accuracy and treatment strategies.

Methods: This cross-sectional study included 30 healthy volunteers (15 male, 15 female) aged 25 to 50 years, with no history of spinal, hip, or pelvic pathology. Lateral pelvic radiographs were taken in both standing and sitting positions. Sacral slope was measured by four independent observers, including radiologists and orthopaedic surgeons. Intraclass correlation coefficients with 95% confidence intervals (CIs) were calculated using linear mixed-effects models to assess interobserver reliability. Data analysis was performed using SAS and SPSS software.

Results: The mean sacral slope measurements for standing and sitting positions were as follows: observer 1 (standing: 39.59° ± 6.67°, sitting: 26.83° ± 10.84°), observer 2 (standing: 38.02° ± 6.76°, sitting: 22.11° ± 10.71°), observer 3 (standing: 41.15° ± 6.63°, sitting: 26.04° ± 12.48°), and observer 4 (standing: 39.53° ± 6.93°, sitting: 24.80° ± 12.00°). The intraclass correlation coefficient for standing sacral slope was 0.956 (95% CI, 0.916 to 0.978) and for sitting sacral slope was 0.974 (95% CI, 0.944 to 0.988), both indicating excellent interobserver reliability.

Discussion: Sacral slope measurements on lateral pelvic radiographs exhibit excellent interobserver reliability, making them reliable indicators of pelvic orientation. This reliability is crucial for the clinical utility of sacral slope as a metric for assessing spinopelvic alignment, particularly in the management of hip-spine syndrome and in patients undergoing total hip arthroplasty.