Journal of surgical orthopaedic advances最新文献

For patients requiring both total joint replacement (TJR) and lumbar spine surgery, it is unknown whether surgical order influences TJR outcomes. The authors sought to determine if total knee (TKA) or total hip (THA) arthroplasty outcomes differed between patients who underwent TKA/THA before versus after lumbar surgery. A prospectively collected registry was queried for patients who underwent TKA or THA within 3 years of lumbar spine surgery. Patients were divided into TKA before versus after lumbar surgery, and THA before versus after lumbar surgery. Statistical analysis was performed to compare postoperative outcomes. In both the TKA and THA cohorts, no differences could be detected between before and after groups in any postoperative outcome, including knee/hip pain, complications, and reoperations. The order of lumbar and TJR surgeries does not appear to influence TJR outcomes. The severity of symptoms, patient preference, and surgeon discretion should dictate surgical order. (Journal of Surgical Orthopaedic Advances 34(2):098-101, 2025).

This study sought to evaluate recent orthopaedic spine fellowship match results as it relates to the reputation of the respective applicants' residency programs. Applicant's residency program, fellowship match, number of fellowship positions available per program, where each fellowship ranked each applicant, and where each applicant ranked each fellowship program were included. Residency programs were divided into five tiers using the 2018 Doximity orthopaedic residency reputation rankings. Applicants from tier-1 Doximity-ranked residency programs were more likely to be offered interviews, applied to fewer programs, and matched to their first or second ranked fellowship program much more frequently than applicants from all other tiers (p < 0.01). This study suggests that applicants can be more targeted in terms of choosing the number of interviews to attend, and fellowship programs can be more selective with interview strategy. (Journal of Surgical Orthopaedic Advances 34(1):090-092, 2025).

Joint replacements are demanding surgeries that take physical and mental tolls on arthroplasty surgeons. Occupational hazards of joint replacement surgery include musculoskeletal injuries, blood-borne diseases, radiation exposure, noxious chemical exposure, noise exposure, and emotional stress. This article is a review of the available literature surrounding occupational hazards that arthroplasty surgeons face and how they can be prevented. The goal is to address adult reconstruction occupational hazards in order to increase the longevity of arthroplasty surgeons. (Journal of Surgical Orthopaedic Advances 34(3):130-133, 2025).

Early clinical outcomes were assessed for patients who underwent total hip arthroplasty (THA) with the recently released DePuy ACTIS femoral stem for primary osteoarthritis performed through a direct anterior approach. From 2017 to 2018, 226 THAs were retrospectively reviewed on patients with at least one year of postoperative follow-up (average follow-up time was 2.63 years [+/- 0.83]). The primary outcome measure was all-cause revision rate (1.91%), observing for failures related to dislocation (0.48%), aseptic loosening (0.48%), pain (0.48%), infection (0.0%), and fracture (0.48%). Mean preoperative Visual Analogue Scale scores were 6.07 (+/- 2.37) compared with 0.62 (+/- 1.5) postoperatively (p < 0.001). The DePuy ACTIS THA femoral implant demonstrated encouraging early clinical outcomes. Further follow-up and surveillance will evaluate how this stem compares with others in the market, but this study demonstrates reliability in evaluation of short-term outcomes. (Journal of Surgical Orthopaedic Advances 34(3):128-129, 2025).

This study explores the impact of tibiofemoral compartment gaps on patient-reported outcome measures (PROMs) following robotic-assisted total knee arthroplasty (RA-TKA). A retrospective review was conducted on 2,071 patients who underwent RA-TKA between April 2018 and January 2022. Patient demographic data, surgical data, intraoperative tibiofemoral gap measurements, and PROMs (Knee Injury and Osteoarthritis Outcome Score for Joint Replacement [KOOS JR], Visual Analogue Scale [VAS], Forgotten Joint Score [FJS], and Oxford Knee Score [OKS] scores) were collected. Unadjusted analyses were conducted using Kruskal-Wallis and Mann-Whitney U tests. The mean postoperative medial flexion-extension (FE) gap delta was -0.3 mm, with only 0.6% of cases beyond two millimeters, whereas the mean lateral FE gap delta was 1.1 mm, with 16.1% of cases exceeding two millimeters. No significant PROM differences were observed between extreme quartile gap deltas. However, for one surgeon, patients with higher OKS scores had significantly smaller lateral FE gap deltas (p = 0.004). These findings suggest that differences in tibiofemoral compartment gaps following RA-TKA were not associated with clinically significant differences in PROMs. (Journal of Surgical Orthopaedic Advances 34(4):196-202, 2025).

There is a dearth of studies analyzing outcomes in patients with chronic obstructive pulmonary disorder (COPD) receiving total ankle arthroplasty (TAA). The present study aimed to compare preoperative characteristics and 30-day postoperative outcomes for patients with COPD undergoing TAA. The National Surgical Quality Improvement Program (NSQIP) database was queried for primary TAA (CPT: 27702) from 2012 - 2020. Baseline comorbidities were compared using univariable statistics and subsequently multivariable regression was performed to measure the effect of COPD on operative time, LOS, and 30-day readmissions after TAA. In a sample of 1,619 total patients, on multivariate regression, COPD was found to be an independent risk factor predictor for shorter operative time ( b = -0.33; p = 0.037), and hospital LOS (b = 0.37; p = 0.039). In conclusion, it was determined that COPD is an independent risk factor for shorter operative time and increased duration of hospital length of stay in patients undergoing TAA. Clinical level of evidence: Level III. (Journal of Surgical Orthopaedic Advances 34(4):174-177, 2025).

A novel technique for hindfoot arthrodesis using distal fibula strut autograft for talar bone loss is described. A case series of six patients who underwent the novel procedure is presented. Six patients were retrospectively evaluated with traumatic talar injury and subsequent avascular necrosis (AVN) who underwent reconstruction with a novel technique. The primary outcome studied was the rate of radiographic union. Five of the six patients with sufficient follow-up achieved radiographic union. Traumatic talar injury that leads to AVN/posttraumatic arthritis can be successfully reconstructed with an ipsilateral fibular strut autograft and retrograde ankle arthrodesis nail through the graft. More studies are needed to determine the efficacy of the procedure, including studies with increased power and studies with long-term follow-up. However, the authors propose that this novel technique is a promising option for limb salvage in patients with talar bone loss. (Journal of Surgical Orthopaedic Advances 34(4):211-214, 2025).

Controversy exists whether one can perform a clean case subsequent to a dirty case in the same operating room predisposed to infection. A retrospective review of all orthopaedic surgical patients between 2003 and 2010 with a type I surgical wound whose case had been performed immediately after type a IV wound was undertaken. Six hundred seventy-four pairs of type IV wounds immediately followed by type I wounds were identified. Of the type I wounds, 3.3% subsequently developed surgical site infection. The bacterial profile of the infections in type I cases was not identical to the associated type IV cases in any instance. This finding suggests that direct cross-contamination is not a reason for infection in clean cases that are performed immediately subsequent to dirty cases. (Journal of Surgical Orthopaedic Advances 34(1):026-030, 2025).

The purpose of this study is to compare surgical arthroscopy versus arthrotomy for septic arthritis of the knee. The American College of Surgeons National Surgical Quality Improvement Program database was queried for all patients who underwent arthroscopy or arthrotomy for native septic knee arthritis between 2010 and 2019. Demographic, lifestyle, and comorbidity variables were recorded, and 30-day outcome variables were analyzed appropriately. Multiple logistic regression modeling was performed to compare cohorts while controlling for covariates. A sample size of 983 patients were identified. Open irrigation and debridement with arthrotomy was associated with significantly longer mean operative time and hospital stay. Patients who underwent open treatment were less likely to be discharged home and had significantly increased odds of transfusion (OR = 1.31), developing pneumonia (OR = 2.89), and sepsis (OR = 1.55). Arthroscopic irrigation and debridement for septic arthritis of the knee is associated with shorter operative time, decreased length of stay, and increased rate of home discharge. Patients who underwent arthrotomy had an increased risk of transfusion, pneumonia, and sepsis. (Journal of Surgical Orthopaedic Advances 34(2):073-077, 2025).

Large wounds after total knee arthroplasty (TKA) may not be amenable to primary closure and may require soft tissue coverage. A bipedicle fasciocutaneous advancement flap for anterior wounds after TKA that can be achieved without need for a trained microsurgeon is proposed. Retrospective chart review was performed. Sixteen adult patients who had non-closable primary wounds after both primary and revision TKA and received the bipedicle fasciocutaneous advancement flap were included. On average, patients were older than 65 years and had multiple comorbidities. All patients had healed wounds by final follow up, including four who received the flap after revision TKA. The surgical technique for the flap is included. In conclusion, the bipedicle fasciocutaneous advancement flap is a viable coverage option for wounds not amenable to primary closure after TKA, both primary and revision. No microsurgery training or tools are necessary to perform this procedure. (Journal of Surgical Orthopaedic Advances 34(2):086-089, 2025).