Journal of surgical orthopaedic advances最新文献

This study evaluates the quality and reliability of shoulder arthroplasty videos available on YouTube. Using the search terms "shoulder arthroplasty," "total shoulder arthroplasty," "partial shoulder arthroplasty," and "shoulder arthroplasty procedures," the authors found a total of 150 videos; 91 were assessed, and 82 met inclusion criteria. Two independent reviewers evaluated each video for educational content quality. Further analysis was undertaken using the following variables: upload date; total view count; duration; number of likes, dislikes, and comments; source; and modality. The included videos had an average Global Quality Scale (GQS) score of 2.95, indicating subpar educational content quality. Patient testimonials (10%) scored the lowest average GQS (1.8), while physician-led presentations (26%) scored the highest (3.5). There was no significant difference in average GQS between videos with a higher versus lower view count, or average GQS and days since upload. Most shoulder arthroplasty videos on social media provide low-quality information for patients. (Journal of Surgical Orthopaedic Advances 34(4):163-167, 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).

Total knee arthroplasty (TKA) can be performed using either conventional off-the-shelf (OTS) implants or customized individually made (CIM) implants. This study aims to review existing literature and compare clinical outcomes between patients receiving CIM and OTS implants, specifically in terms of satisfaction, radiographic/alignment outcomes, revision rates, and costs. A review of literature was conducted using Medline, Cochrane, and Embase to identify articles comparing CIM and OTS implants in TKA patients. Data and outcomes were described qualitatively. Overall, based on the current evidence, custom implants have been shown to yield comparable to improved patient-reported and clinical outcomes, anatomic match, and excellent registry survival outcomes as compared with conventional OTS implants for the general population undergoing TKA. (Journal of Surgical Orthopaedic Advances 34(3):114-118, 2025).

The purpose of this study was to quantify femoral rotation in the axial plane for posterior-stabilized total knee replacements performed with a modified gap-balancing technique. In total, 2442 knees were selected from a computer-assisted orthopaedic surgery navigation system database. The knees were stratified into three groups based on preoperative coronal plane alignment. The computer navigation recorded distal femoral and tibial resection angles, and the rotational position of the femoral component. Means were calculated for each of the three groups. There was substantial variation of femoral axial rotation in all three groups. In aggregate, the mean rotational position for all knees was 2.4° external (-10.2° - 20.9°). The mean rotation for the varus group was 2.5° (-9.8° - 15.7°), 2.5° (-9.8° - 20.9°) for the neutral group, and 1.1° (-10.2° - 9.9°) for the valgus group (p < 0.0001). The data indicates that choosing a predetermined rotational position for the femoral component may lead to flexion gap asymmetry more frequently than by adjusting the rotational position intraoperatively to achieve a rectangular flexion space. This is the first study to quantify differences between varus and valgus knees related to flexion gap stability. Correlation of these findings to clinical outcomes is needed. There is no single rotational position for the femoral component that will produce a balanced flexion gap for every knee. There is a statistically significant difference between mean rotational position for femoral components for varus and valgus knees. (Journal of Surgical Orthopaedic Advances 34(4):193-195, 2025).

Bracing decreases curve progression in adolescent idiopathic scoliosis (AIS). However, many curves still progress to a surgical range. The purpose of this study was to evaluate the effects of bracing on the lumbar curve in AIS patients who required posterior spinal fusion (PSF) for thoracic curves that progressed. The records of 432 patients with AIS who underwent PSF from 2005 to 2015 were reviewed. Braced/unbraced patients were matched 1:1 for age, Lenke type, and preoperative thoracic major curve. The unbraced group had a mean lumbar curve (44°) that was greater than the braced group (34°) (p < 0.001), the proportion of Lenke 1A curves was higher in the braced group (81% vs. 39%, p < 0.001), and the unbraced group had greater odds (odds ratio [OR] = 2.3; confidence interval [CI]: 1.2 - 4.5) of spinal fusion caudal to L1. Patients in the braced group had more favorable Lenke lumbar modifiers (type A), smaller preoperative lumbar curves, and fewer fused lumbar vertebrae compared with the unbraced group. (Journal of Surgical Orthopaedic Advances 34(2):082-085, 2025).

The rates and risk factors of postoperative hyponatremia and acute kidney injury (AKI) were examined in spine surgery patients. A 2-year retrospective review of 348 patients was performed. Patients were instructed to take their routine nonsteroidal anti-inflammatory drugs and antihypertensive medications the morning of surgery. Postoperative hyponatremia and AKI were studied. Statistical analysis included bivariate and multivariable logistic regression analysis with odds ratio and quantile regression model. Thirty-eight percent of patients (133/348) had postoperative hyponatremia (serum sodium < 135 mEq/L). Seven percent (24/348) had AKI (0.3 mg/dL or > 50% increase in baseline serum creatinine). On the multivariable logistic regression model, two factors remained significant for hyponatremia: preoperative sodium level and operative time. Body mass index and use of preoperative angiotensin blocking medications were significant for AKI. Patients with hyponatremia and AKI demonstrated a longer length of hospital stay. In conclusion, postoperative hyponatremia (38%) and AKI (7%) are common following spine surgery. (Journal of Surgical Orthopaedic Advances 34(1):041-045, 2025).

The purpose of this study was to evaluate the efficacy and safety of a minimally invasive, ultrasound-guided, incisionless thread carpal tunnel release (TCTR) compared with mini-open carpal tunnel release (MOR) in a prospective, single-institution, randomized, intrasubject controlled study of patients with bilateral carpal tunnel syndrome (CTS). Patients underwent same-day, immediately sequential bilateral carpal tunnel surgery receiving both a TCTR and an MOR, with randomization occurring in reference to the dominant versus non-dominant extremity. Eleven patients with an average age of 49.8 years were followed for 12 months. There were no clinical or statistical differences between the two procedures at multiple postoperative time periods with respect to functional outcome scores, pain, or strength. All but one patient preferred TCTR over MOR, citing quicker recovery and decreased pain. Ultrasound-guided TCTR is safe and effective with similar functional outcomes, pain, and strength compared with a more traditional MOR. (Journal of Surgical Orthopaedic Advances 34(1):031-036, 2025).

Surgical specialties experienced significant changes during the COVID-19 pandemic including new preoperative testing protocols and altered perioperative workflows, which this study hypothesized led to delays in care for emergent orthopaedic cases. Operative cases performed between January 1, 2019 to March 7, 2021 were identified, with a threshold date separating pre-COVID-era from COVID-era of March 1, 2020. Demographics, perioperative timing, and COVID testing data were examined for 308 pre-COVID and 353 COVID-era cases with posted urgency classification of level 1, 2, or 3. Pre-COVID cases averaged shorter time-to-surgery compared to COVID-era, while even COVID-negative patients saw significantly prolonged times during the COVID-era. There were no significant differences in time-to-surgery between COVID-positive and COVID-negative patients, but COVID-positive patients saw significantly longer post-procedure operating room times during the COVID-era. Emergent orthopaedic surgical cases experienced significantly greater delays in time to procedure start during the COVID-era than cases with the same level of urgency in the pre-COVID-era. (Journal of Surgical Orthopaedic Advances 34(4):181-184, 2025).

The purpose of the study was to determine the relationship between increased body mass index (BMI) and tibial prosthesis characteristics. A retrospective analysis of total knee arthroplasties (TKAs) was completed, and a Cox multivariate regression was performed. In total, 8,548 TKAs were completed, and cumulative survivability was 98.0% at 5 years and 97.1% at 10 years. Age < 70 years (p < 0.01), male sex (p < 0.01), and BMI ≥ 40 kg/m2 (p = 0.04) were significantly related to revision in all implants. Implant type, contact surface area, base plate surface area, and tibial stem length did not have a statistically significant effect on implant survivability (p = 0.62 - 0.91). When stratified based on BMI, there was a significant decrease in survivability for those BMI ≥ 40 kg/m2 (p < 0.01). Patients with high BMI do not necessarily require larger implants, and surface area and stem length do not affect survivability. Patient factors appear to drive survivability outcomes after primary TKA more than the implant factors. (Journal of Surgical Orthopaedic Advances 34(4):203-206, 2025).