Journal of the American Academy of Orthopaedic Surgeons最新文献

Background: As the number of patients undergoing both total hip arthroplasty (THA) and lumbar spinal fusion rises, clinicians must gain a stronger understanding of the biomechanical and clinical associations between these two procedures. This study compared single versus multilevel spinal fusion on spinopelvic parameters, clinical outcomes, and THA dislocation rates in patients with existing THAs.

Methods: Patients with an existing THA undergoing elective spinal fusion were retrospectively identified at a single academic center. Cohorts were stratified by fusion construct length (single or multilevel) and outcomes were followed at least 1 year after surgery.

Results: A total of 392 patients (260 single level, 132 multilevel) were included. Patients who underwent multilevel fusion had less improvement in ∆ visual analogue scale (VAS) Back Scores at 1 year (-1.00 vs. -2.50, P = 0.039), greater hospital length of stay (5.00 vs. 3.00 days, P < 0.001), and lower rates of discharge home (48.5% vs. 81.4%, P < 0.001). They had higher dislocation (4.55% vs. 0.38%, P = 0.007), spinal revision (25.8% vs. 13.5%, P = 0.004), and 90-day readmission rates (12.1% vs. 3.46%, P = 0.002). Radiographically, patients with multilevel constructs had lower preoperative (40.4° vs. 49.1°, P < 0.001), postoperative (43.4° vs. 48.6°, P = 0.004), and 1-year lumbar lordosis (44.4° vs. 50.5°, P = 0.028) and higher postoperative mean anteversion (24.2° vs. 21.0°, P = 0.017). Single-level fusion was an independent predictor for lower VAS leg scores (odds ratio [OR] = -2.57, P = 0.011), fewer readmissions (OR = -0.13, P = 0.001), and fewer complications (OR = -0.25, P < 0.001). Male sex independently predicted increased spinal revisions (OR = 0.13, P = 0.026).

Conclusion: Patients with prior THA undergoing multilevel fusions experienced more dislocations, higher spinal revisions, less frequent discharge home, longer hospital length of stays, and higher 90-day readmission rates. They had less improvement in ∆VAS Back Scores at 1 year, lower lumbar lordosis, and greater anteversion. Patients with existing THA undergoing multilevel fusion have more abnormal spinal sagittal balance and higher risk of dislocation despite higher baseline and postoperative acetabular anteversion.

Hamstring injuries are common in athletes and result in missed time from sport and activities. Recurrent injury is a persistent issue. Injury location and severity dictate treatment. Complete acute proximal hamstring avulsions are typically treated successfully with open or endoscopic surgery, while partial avulsions commonly are initially treated nonsurgically. If required, surgical repair results in high patient-reported outcomes, satisfaction, and return to activities. Chronic complete proximal avulsions have less predictable outcomes. Myotendinous injuries are typically treated nonsurgically; however, lost time and reinjury are common. Distal myotendinous injuries can lead to greater delay in return to sport and higher reinjury rate than their proximal or midsubstance counterparts. Owing to this, there has been a recent interest in surgical repair, but historically nonsurgical treatment has been the standard. Distal hamstring avulsions require a thorough knee evaluation for isolated hamstring and/or concomitant injuries, with surgical treatment being determined based on injury pattern, including location and severity. Return to sport and activities require a graduated physical therapy program focused on restoring tissue length without excessive strain. Hamstring injury prevention programs are efficacious, but implementation and compliance are variable. The purpose of this study was to describe the current understanding of the anatomy, pathology, and treatment of hamstring injuries in athletes.

Orthopaedic surgery is one of the least diverse fields in medicine. Barriers to increasing the racial, gender, and sexual minority diversity of residents include pervasive negative impressions about the culture in orthopaedic surgery; lack of early exposure to and education about orthopaedics; new large-scale diversity, equity, and inclusion initiatives that have yet to become fully established; and lack of mentorship from those with shared backgrounds, gender, sexual orientation, or race. Recently, there have been several pipeline initiatives aimed at exposing women and underrepresented minority students to orthopaedics and medicine early in their careers, which have shown remarkable success. Toward this goal, recent recommendations from Nth Dimensions have provided a toolkit to help recruit and maintain diverse trainees. Furthermore, advocating for further funding and support of initiatives from national organizations that lead the field of orthopaedics will be paramount to institutionalizing efforts of diversity, equity, and inclusion within the orthopaedic community.

Introduction: The publication rate of abstracts presented at the American Academy of Orthopaedic Surgeons (AAOS) Annual Meetings has increased over the past 15 years. The purpose of this study was to (1) analyze and describe the characteristics of abstracts presented at the 2022 and 2023 AAOS Annual Meetings and (2) evaluate whether certain factors were associated with a higher likelihood of publication.

Methods: A retrospective analysis of all abstracts presented at the 2022 and 2023 AAOS Annual Meeting was done based on the AAOS ePosters archive. PubMed and Google Scholar databases were searched to determine whether the abstract had been followed by publication in a peer-reviewed journal within 1 year of presentation.

Results: A total of 1,987 abstracts were presented at the AAOS Annual Meeting; most were in adult reconstruction (30.1%), and 44% were published. Most studies had a level of evidence of III (71%), and the use of large databases increased between years (9.4% to 13%). Foot and ankle exhibited the highest publication rates among AAOS subspecialties (61%). Abstracts that were published had a markedly higher sample size and a higher rate of men as first authors (P < 0.001). Hand and wrist (30%) and practice management and rehabilitation (25.8%) had the highest rates of women as first and senior authors, respectively.

Conclusion: We found that 44% of the abstracts presented at the 2022 and 2023 AAOS Annual Meetings resulted in publication. Although most abstracts were in adult reconstruction, foot and ankle had the highest publication rate.

Level of evidence: III.

Introduction: From the surgeon's perspective, a successful rotator cuff is one that remains intact. However, it is undetermined which factors contribute to an improved shoulder from the patient's perspective. The aim of this study was to determine the variables that predicted greater patient-rated benefit from presurgery to 6 months postarthroscopic rotator cuff repair.

Methods: Multiple linear regression analysis was conducted on prospectively collected data of 2010 consecutive patients who underwent arthroscopic rotator cuff repair by a single surgeon to determine the predictors of greater patient-rated benefit. Patient-rated shoulder ranking was graded on a five-point Likert scale in response to "How is your shoulder overall?" preoperatively and at 6 months postoperatively. The patient-rated benefit was the difference in rankings between these time points.

Results: Six months following rotator cuff repair, a self-reported benefit was observed in 84% of patients. Patients who rated their shoulder as poor preoperatively reported the greatest benefit (t = 22, P < 0.001). Other preoperative determinants of greater patient-rated benefit were lower patient-rated shoulder stiffness (t = 5, P < 0.001), an injury that was not related to work (t = 4, P < 0.001), stronger internal rotation strength (t = 4, P < 0.002), a more strenuous line of work preinjury (t = 3, P = 0.007), female sex (t = 2, P = 0.019), having a larger tear area (t = 2, P = 0.020), and weaker abduction strength (t = 2, P = 0.046).

Conclusions: Patients who were most likely to perceive a benefit from rotator cuff repair at 6 months postoperation were those who preoperatively rated their shoulder poorly, had a less stiff shoulder, an injury that was not related to work, stronger internal rotation, more strenuous line of work preinjury, were female, had larger tear area, and weaker abduction strength.

Introduction: Symptomatic interlocking screws are common after intramedullary nail fixation of tibia fractures. Low-profile headless interlocking screws recently became available and could potentially reduce the rate of symptomatic screws. The purpose of this study was to compare the rate of symptomatic screws and screw removals between these screw types.

Methods: A retrospective review identified patients with tibia shaft fractures treated with tibia intramedullary nails between August 1, 2018 to September 1, 2023 by 11 surgeons. Low-profile headless interlocking screws became available on June 28, 2021 and were routinely used thereafter. Patients treated with low-profile headless versus standard headed interlocking screws were compared in terms of symptomatic screws, defined as a patient reporting pain or discomfort at the site of a screw head in clinical documentation, symptomatic screw removals, screw failure (breakage or backout), and procedures to promote bone union.

Results: Overall, 79 patients were included in the analysis: 33 patients treated with 144 headless screws and 46 patients treated with 187 standard screws. The median patient age was 35 years, and a majority were male (68.4%, n = 54). The median follow-up length was 8.5 months (interquartile range 5.5 to 8.8 months). The headless screw group, compared with standard screw group, did not differ in age, injury mechanism severity, open fracture classification, tobacco use, American Society of Anesthesiologists classification >2, number of interlocking screws used, or follow-up time ( P > 0.05). The headless screw group was less likely to have symptomatic screws (0.0% vs. 23.9%; P = 0.002), less likely to have symptomatic screw removal (0.0% vs. 13.0%; P = 0.03), and had no difference in procedures to promote bone union (10.0% vs. 6.8%; P = 0.68) or screw backout (0.0% vs. 4.4%; P = 0.50).

Discussion: Standard headed interlocking screws were symptomatic in 23.9% of patients and 13.0% underwent symptomatic screw removal. In comparison, no patients treated with low-profile headless interlocking screws had symptomatic screws.

Level of evidence: Level 3, diagnostic.

Personal finance is a topic that has historically been shunned as a point of conversation in academia, often avoided and seldom discussed in medical training. However, this aversion leaves trainees and early career surgeons to make complex financial decisions without sufficient understanding while simultaneously facing the pressures of building an orthopaedic practice-a recipe destined for burnout. This simple review serves to equip young orthopaedic surgeons with the fundamental personal financial concepts essential for making wise financial choices early in their careers. Prompt elimination of all high-interest consumer debt and devising a strategy to address student loans are crucial first steps in establishing the foundation for personal financial success. Progressing through training and entering practice bring about enhanced personal discretionary funds that are most effectively deployed through consistent budgeting and automated saving strategies. Malpractice, disability, and life insurances are keys to protecting current and future earnings as well as preventing financial catastrophe. Augmenting these items with a functional understanding of taxation systems, tax diversification, and asset protection is essential to recognize in the early years of practice to set the trajectory for financial independence and a well-deserved retirement.

Background: Although diversity has improved across certain orthopaedic subspecialties, enhancing diversity within spine surgery has remained a challenge. We aimed to investigate the current state of sex, racial, and ethnic diversity among academic orthopaedic spine surgeons in the United States.

Methods: In January 2024, a cross-sectional analysis of orthopaedic spine surgery faculty in the United States was conducted using the Doximity database to identify eligible surgeons. Fellowship-trained orthopaedic spine surgeons (professor, associate professor, and assistant professor) who graduated residency between 1990 and 2022 were included. Race, sex, academic rank, residency year of graduation, and H-Index scores were recorded using publicly available information from faculty profile pages and the Doximity database.

Results: Four hundred fifty-two spine faculty were included in the analysis: 95.1% men and 4.84% women. Across race and ethnicity, 315 surgeons (69.7%) were White, 111 (24.6%) Asian, 15 (3.32%) Black or African American, and 11 (2.43%) Hispanic or Latino or of Spanish origin. Of the 101 professor-level surgeons, 3 (2.97%) were Black men. Among female professors, none were Black, Asian, or Hispanic/Latino. No Hispanic or Latino female professors, associate professors, or assistant professors were identified. The sex and race/ethnicity demographics that have increased in percentage over time include White women (0.92% to 6.08%), Asian men (11.0% to 26.5%), Asian women (0% to 1.66%), and Hispanic/Latino men (1.83% to 3.87%). The surgeon demographic groups that demonstrated minimal fluctuations over time included Black men, Black women, and Hispanic/Latino women.

Conclusion: Our findings demonstrate that underrepresentation among academic spine surgeons remains an ongoing challenge that warrants increased attention. Enhancing the representation of Black and Hispanic men, as well as Black, Asian, and Hispanic women, in spine surgery requires a deliberate effort at every level of orthopaedic training.

Introduction: The purpose was to determine whether computed tomography (CT) Hounsfield units (HU) as a proxy for bone quality can predict postoperative complications following surgical treatment of proximal humerus fractures.

Methods: Sixty-six patients with 2-, 3-, or 4-part proximal humerus fractures who underwent surgical fixation at single institution and had complete radiographic data available were included. Radiographic measurements included the deltoid tuberosity index (DTI) on preoperative anterior-posterior shoulder radiographs, and the HU value from the surgical proximal humerus was determined by measuring the humeral head at the midaxial/coronal/sagittal CT image using a circle-type region of interest (≥35 mm 2 ). Postoperative complications recorded were implant failure, development of osteonecrosis, nonunion, and acute periprosthetic fracture. Patients with and without complications were statistically compared, and binary logistic regression was performed to determine whether preoperative proximal humerus CT HU were predictive of complications.

Results: Eight patients (12.1%) developed 11 overall complications, with three patients experiencing multiple complications each. Complications included osteonecrosis (4), implant failure (5), nonunion (1), and acute periprosthetic fracture (1). No difference was observed in demographics or Neer or AO/OTA classification between those with and without complications. Patients with complications had markedly lower DTI and overall HU as well as HU in the coronal and sagittal planes. Regression analysis for average DTI demonstrated a higher DTI and had a 10 times decreased risk of complication ( P = 0.040, odds ratio = -10.5, 95% confidence interval, 0.000 to 0.616). Regression analysis for average total HU also found a higher HU associated with a decreased risk of complications ( P = 0.034, odds ratio = -0.020, 95% confidence interval, 0.980 to 0.962). Logistic regression analysis, including age, age-adjusted Charlson Comorbidity Index, mean DTI, and mean total HU, only found mean total HU to be notable within the model.

Discussion: CT HU may identify patients with poorer bone quality and thus help predict postoperative complications.

Level of evidence: Diagnostic Level III.