Archives of Bone and Joint Surgery-ABJS最新文献

Objectives: Iran's orthopaedic surgery care is facing significant challenges due to an aging population and the increasing prevalence of chronic medical conditions such as osteoarthritis, fractures, and trauma. These challenges underscore the pressing need for a more equitable distribution of the orthopaedic workforce. This study aimed to assess the per capita ratios and geographical distribution of orthopaedic surgeons (OSs) in Iran, as well as their distribution in academic and non-academic settings. Additionally, the involvement and scientific productivity of women in orthopaedic s were examined.

Methods: This study investigated the distribution, per-capita ratios, and academic status of OSs and trainees in Iran, and compared these parameters with those in Turkey and the UK. This study used data from the Islamic Republic of Iran Medical Council, the Iranian Scientometrics Information Database, and the population census to indicate an uneven distribution of OSs across Iran.

Results: The per capita ratio of OSs in Iran (3.13) is lower than in Turkey (4.00) and the United Kingdom (8.00), highlighting disparities in healthcare infrastructure and economic resources in low-income countries. Notably, 33.6% of Iranian OSs reside in Tehran, contributing to unequal access to care. Furthermore, female representation in orthopaedic s remains limited, with only 3.5% of OSs being women. These academic surgeons have a median H-index of 4, which is lower than that of their counterparts in Canada and the United States.

Conclusion: The study emphasized the significance of governmental reforms and incentives in promoting equitable distribution, gender diversity, and academic progress within Iran's orthopaedic workforce. Financial incentives, advanced facilities, and career advancement opportunities could enhance academic involvement and diversity. Improving the distribution of surgeons, increasing support for women in orthopaedic, and fostering academic interests are essential steps toward achieving equitable healthcare and boosting scientific output in Iran.

Objectives: The study assessed the clinical and functional outcomes of transfemoral amputations following TKA complications, shedding light on a procedure often considered in extreme cases.

Methods: In this retrospective study, six patients undergoing above-knee amputation due to TKA complications were analysed. Diagnosis of periprosthetic joint infection relied on clinical presentation and the Musculoskeletal Infection Society Definition (2011). Patient demographics, comorbidities, and surgical interventions were meticulously recorded. The study aimed to contribute valuable insights into the intricacies of managing complications post-TKA.

Results: The study cohort, constituting 0.002% of total TKA cases, exhibited a mean age of 78.8 years. Comorbidities, predominantly diabetes, were prevalent. The duration between TKA and amputation averaged 6.3 years. Surgical interventions, including revisions, debridements, and aspirations, were numerous, reflecting the complexity of managing complications. All patients underwent above-knee amputation using a single-stage approach, with careful consideration of the surgical site's condition. Post-amputation care, including stump care and prosthetic leg options, was tailored to individual patients' needs. Patients were diligently followed for a minimum of 12 months. Stump wounds healed without requiring revisions, and prosthetic limbs were successfully applied to three patients. Mobility status and disability scores, evaluated through the Sickness Impact Profile (SIP), showed significant improvement.

Conclusion: The study highlights periprosthetic joint infection as the primary cause of multiple failed procedures leading to amputation. Microbiological findings identified common pathogens, including Staphylococcus aureus and Pseudomonas aeruginosa. Challenges posed by biofilm formation underscored the complexities of antibiotic treatment. Transfemoral amputation emerges as a feasible option for patients with multiple failed TKAs, particularly in cases of persistent infection. The decision-making process should encompass a thorough consideration of the number of failed procedures, cost-benefit analysis, and various psychosocial and economic factors. Further research and extensive multicentric studies are imperative to validate and expand upon these findings.

Objectives: Distal biceps repair is a common orthopedic procedure, but there is still debate regarding the optimal post-operative care for patients. The purpose of this study is to assess the efficacy of at-home physical therapy compared to outpatient physical therapy following distal biceps tendon repair.

Methods: A retrospective review of distal biceps repairs performed between 2012 and 2017 by four fellowship-trained orthopedic surgeons at one institution was undertaken. Patients were grouped into outpatient physical therapy and at-home therapy groups. Exclusion criteria included any patients who did not undergo a direct repair of the distal biceps and cases in which allograft augmentation was utilized. Postoperative complications were identified by manual chart review. After a minimum of three years follow-up, demographic information as well as elbow functional outcome scores including the Quick Dash, Mayo Elbow Performance Index, and Oxford Elbow Scores were obtained via phone calls and online surveys.

Results: One hundred and forty-six patients were included in this study at a mean follow-up of 6.3 years for patients who attended outpatient physical therapy and 5.9 years for patients who performed an at-home therapy program. There were twenty-eight patients in the at-home physical therapy group and one hundred eighteen patients in the outpatient physical therapy group. There were two complications: one re-ruptured distal biceps tendon requiring a revision surgery in the at-home patient cohort, and one post-operative posterior interosseous nerve palsy that recovered after 6 months in the outpatient rehabilitation group. We found there was no significant difference between the two groups for any of the three functional elbow scores.

Conclusion: Patients undergoing routine distal biceps repair may achieve similar clinical outcomes with a regimented at-home physical therapy protocol in lieu of formal outpatient physical therapy.

Objectives: The purpose of this study is to compare the Depuy curved (CVD) polyethylene insert to the curved plus (CVD+) design in TKA, which has an increased dished curve for increased articulation congruence and thus secondary anterior to posterior stability.

Methods: A randomized controlled trial with 100 patients was conducted to compare two knee replacement designs (CVD and CVD+ polyethylene inserts) using the Johnson and Johnson DePuy PFC Sigma total knee replacement. All participants, were randomized and blinded to reduce bias. The trial achieved 100% recruitment and maintained blinding throughout the study. Demographics, baseline characteristics, and KOOS scores were recorded pre-operatively, and at 3 and 12 months postoperatively. In addition, physical and mental component scores (PCS and MCS) were collected at 12 months post-operatively.

Results: Sixty patients had preoperative data, split equally into CVD and CVD+ groups. The cohort's average age was 71.47 years, and 72% were female, with no statistically significant demographic differences between groups. Preoperative measures showed no differences in Pain, ADL, or QOL. At 3 months, no significant differences were noted, though the QOL difference was 64.45 ± 16.57 for CVD and 52.94 ± 27.1 for CVD+ (p = 0.15). At 12 months, trends favored the CVD group, but differences in Pain, ADL, QOL, PCS, and MCS were not significant. Complications were similar, except for stiffness, with 0 cases in the CVD group and 3 in the CVD+ group at 3 months; both had 2 additional cases at 12 months.

Conclusion: In our study, there was no difference between designs in terms of pain, activities of daily living, and standard outcomes. Further studies are required to support the benefit of increased congruence in the CVD+ design, even though widespread adoption has been common across the industry.

Objectives: The exact role and safety of arthroscopy in SAH management remain contentious. This systematic review aims to assess the outcomes and complications of arthroscopic treatment, shedding light on its efficacy and safety profile.

Methods: Following PRISMA guidelines, searches were conducted in PubMed, Scopus, Embase, and Web of Science until January 25, 2024. Eligible studies included SAH patients undergoing arthroscopic treatment. Data extraction covered demographics, clinical findings, and functional outcomes. Quality assessment used NIH case series assessment and Newcastle-Ottawa Scale. Quantitative analysis focused on Hip Harris Score, post-operative pain rate, and revision rate using a random-effects model. Comprehensive Meta-Analysis (CMA) software version 3.3 facilitated analyses.

Results: The primary search yielded 1,662 articles, after screening the records, 35 study included. In case report studies, 18 patients were analyzed with an average age of 33.7 years. Complications included joint ankylosis, osteonecrosis, muscle atrophy, and osteopenia. Revision surgery was performed in three cases, with one due to infection. In case series studies, 295 patients with an average age of 15.6 years had complications such as joint collapse, femoral nerve palsy, and avascular necrosis. Thirteen revision cases were reported. Among 18 case series, arthroscopic complications were noted in nine studies, while six studies reported none. Full range of motion was achieved in 13 studies, and pain resolution in 11.

Conclusion: Utilizing arthroscopic techniques for treating septic arthritis of the hip represents a safe, effective, and minimally invasive choice, demonstrating favorable clinical results, relatively low rates of revision and complications, and rapid rehabilitation periods.

Objectives: The United States (US) population is aging with an increasing number of older adults over 90 years old. The primary purpose of this study is to evaluate trends in orthopaedic surgeries in patients 90 years old and greater over the past decade from 2014-2023.

Methods: Patients ≥90 years old at the time of surgery at a single orthopaedic specialty practice from 2014 through 2023 were identified. All patients that underwent nonsurgical treatment were excluded. Surgeries were categorized by musculoskeletal area and procedure type by CPT codes. Musculoskeletal areas include Shoulder, Humerus/Elbow, Forearm/Wrist, Hand/Fingers, Pelvis/Hip, Femur/Knee, Leg/Ankle, Foot/Toes, Spine, Integumentary, Nervous System, and Other.

Results: Over the last decade, 5,291 orthopaedic surgeries were performed on 4,807 patients 90 years old and older (age range 90-107 years old; 75% female). Of these patients, 91% underwent only one surgery while ≥90 years old, while the remaining underwent between two to five surgeries. The number of surgeries each year ranged from 180 to 680 with a positive correlation between year and number of surgeries and a greater than threefold increase in surgeries 2014-2023. The Pelvis and Hip were the primary musculoskeletal areas of surgery, accounting for 69% of surgeries overall, followed by femur and knee (11%) and nervous system (which includes carpal tunnel release, 5.2%). Most surgeries (69%) were for a fracture or dislocation.

Conclusion: There is an increase in volume of orthopaedic surgery on patients ≥90 years old over the last decade between 2014-2023, the majority of which were performed on the hip and pelvis and for fractures or dislocations. As older adults ≥90 years old continue to increase in the population, we project the surgical volume will continue to grow and place a large financial burden on the US healthcare system.

Objectives: There is no consensus reference standard for diagnosing prosthetic shoulder joint infection (PJI). There may be inadequate distinction between colonization and infection. It is not clear that culture of a common shoulder commensal organism can account for unexpected pain or stiffness after shoulder arthroplasty. In this survey-based experiment, we asked: 1) What patient and surgeon variables are associated with diagnosis of shoulder PJI? And 2) What is the surgeon interobserver agreement for diagnosis of shoulder PJI?

Methods: One hundred seven members of the Science of Variation Group reviewed ten hypothetical patient scenarios with five randomized variables: examination findings, serum markers, synovial fluid markers, histological assessment, and organism cultured from deep tissue specimens. Participants diagnosed the presence or absence of shoulder PJI. Mixed multilevel logistic regression sought variables associated with PJI diagnosis. Interobserver agreement was measured with Fleiss kappa.

Results: Surgeon diagnosis of shoulder PJI was independently associated with deep tissue culture growth of C. acnes (OR=235 [95% CI 19 to 2933]; P < 0.01), S. epidermidis (OR=147 [95% CI 8.4 to 2564]; P < 0.01), and S. aureus (OR=110 [95% CI 6.9 to 1755]; P < 0.01) much more so than presence of a sinus tract on examination (OR=43 [95% CI 3.7 to 505]; P < 0.01), inflammatory histology (OR=15 [95% CI 4.0 to 58]; P < 0.01), inflammatory synovial fluid markers (OR=13 [95% CI 3.9 to 45]; P < 0.01), and serum inflammatory markers (OR=5.8 [95% CI 2.0 to 17]; P < 0.01). The reliability of surgeon diagnosis for shoulder PJI was poor (Fleiss kappa = 0.013 [95% CI -0.0039 to 0.031]).

Conclusion: The observation that surgeons may not adequately distinguish colonization and infection - considering any positive culture as an infection - combined with the low reliability of diagnosis observed, suggests possible overdiagnosis and overtreatment of shoulder PJI.

Objectives: This study aims to identify potential risk factors and assess postoperative outcomes associated with requiring emergency abdominal surgery (EAS) within 30 days following total hip arthroplasty (THA) and total knee arthroplasty (TKA). We hypothesized that patients requiring EAS would carry a higher morbidity and mortality rates compared to patients that underwent the index operation alone.

Methods: We conducted a retrospective analysis using TriNetX, examining data from 2016-2024 from patients over 18 years old who underwent THA/TKA and required EAS within 30 days. Postoperative outcomes, including mortality and hospital readmission, were compared between patients requiring EAS and those who did not. Statistical analyses included measures of association and chi-squared tests. Patient demographic data, including age, sex, and comorbidities were analyzed.

Results: Patients requiring EAS within 30 days of a joint arthroplasty were significantly more likely to be older, overweight or obese, and to be diagnosed with comorbidities including diverticular disease, cholelithiasis, alcohol use disorders, and tobacco use. These patients had significantly higher mortality rates within 60 days of joint arthroplasty compared to patients without EAS, suggesting that the second operation contributed significantly to the increase in adverse outcomes.

Conclusion: This study emphasizes the importance of recognizing key risk factors for severe GI complications that require EAS. These findings highlight the need for careful patient selection, pre-operative evaluation of risk, and vigilant post-operative management, especially in those with many risk factors. Improved identification and management of high-risk patients may help reduce the likelihood of EAS and its associated mortality.