Journal of surgical orthopaedic advances最新文献

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).

Total hip arthroplasty (THA) is one of the most successful orthopaedic procedures, offering significant improvements in pain relief, mobility, and overall quality of life for patients with hip pathology. Since its inception, continuous advancements in implant materials, fixation techniques, and surgical approaches have contributed to enhanced implant longevity and functional outcomes. THA has evolved from early designs to incorporate modern biomaterials, robotic-assisted surgery with improved precision, and three-dimensional printing for patient-specific solutions. Despite its success, challenges such as implant wear, prosthetic joint infection, and the need for revision surgeries remain critical concerns for orthopaedic surgeons. The increasing demand for THA, driven by an aging population and expanded indications, underscores its growing societal impact, including economic benefits through improved productivity and reduced healthcare costs. As research and innovation continue to shape the field, THA remains a cornerstone of orthopaedic surgery, with ongoing efforts to optimize outcomes and address the complexities associated with revision procedures. (Journal of Surgical Orthopaedic Advances 34(3):119-123, 2025).

Patients undergoing thumb ligament reconstruction tendon interposition (LRTI) for carpometacarpal (CMC) arthritis are often treated with metacarpophalangeal (MCP) arthrodesis for concomitant MCP hyperextension. The effects of MCP arthrodesis on LRTI were evaluated in this study. Thirty-one LRTI surgeries were compared to 22 LRTIs with MCP arthrodesis surgeries. All patients answered Michigan Hand Outcomes (MHQ), QuickDASH, and Visual Analog Score (VAS) questionnaires. Grip, tip pinch, lateral pinch and opposition were measured. The LRTI alone and LRTI with MCP arthrodesis cohorts were then compared to each other and all of the non-operative thumbs of the same patients. The LRTI and MCP arthrodesis group showed no statistical difference in MHQ, QuickDASH, VAS, or measured strength compared to LRTI alone. This study shows no difference in patient reported outcomes between patients with LRTI alone and LRTI with MCP arthrodesis performed by the same surgeon on average 4 years after surgery. (Journal of Surgical Orthopaedic Advances 34(4):168-173, 2025).

Unicompartmental knee arthroplasty (UKA) and total knee arthroplasty (TKA) can be technically accomplished by either traditional mechanical alignment or by an alternative kinematic alignment. The purpose of this study is to compare post-operative length of hospital stay between these two approaches. A retrospective study at Medstar Washington Hospital Center from 2015 - 2024 identified 167 cases of UKAs, of which 69 were kinematic and 98 were mechanical. During the same period, 420 TKAs were identified where 244 were kinematic and 176 were mechanical. Postoperative length of hospitalization and physical therapy recommendations was then compared with two-sample T-tests and Chi-square tests. Patients undergoing a UKA kinematic procedure were discharged a half day earlier than their mechanical counterparts (p = 0.029), and TKA kinematic patients were discharged nearly a full day earlier (p = 0.0001). Additionally, TKA kinematic patients were more likely to be discharged home with home services rather than to a rehabilitation facility for physical therapy (p < 0.00001). UKA patients of both kinematic and mechanical alignment were recommended to be discharged home (p = 0.312) Postoperative length of stay is significantly decreased by up to a day in patients receiving a knee arthroplasty by kinematic alignment approach. TKA kinematic patients also benefit from a discharge recommendation to home for physical therapy, rather than requiring transfer to a rehabilitative facility. These findings highlight how kinematic alignment may contribute to early improved patient satisfaction, restore early functionality, and decrease disease burden. (Journal of Surgical Orthopaedic Advances 34(3):124-127, 2025).

The rate of complications and case complexity were evaluated in the first 100 total hip arthroplasty (THA) procedures in early-career direct anterior approach (DAA)-trained adult-reconstruction surgeons and midcareer surgeons who switched to DAA from a different approach. The study is a multicenter, retrospective analysis that collected data on 500 DAA THAs performed by three early-career surgeons and two midcareer surgeons. The patients of early-career surgeons were older (66.4 vs. 64.1), had a higher body mass index (29.9 vs. 28.4), and increased Charlson Comorbidity Index (2.21 vs. 1.52) compared with midcareer surgeons (p < 0.05). There were no differences in intraoperative complications or 90-day postoperative adverse events (odds ratio 0.45, 95% confidence interval 0.17 - 1.09, p = 0.87). Operative time was significantly greater for the early-career cohort relative to midcareer surgeons (98.1 min vs. 73.8 min, respectively, p < 0.001). Early-career fellowship-trained arthroplasty surgeons have similar complication rates to experienced surgeons switching from a different approach, with higher complexity patients. (Journal of Surgical Orthopaedic Advances 34(3):138-141, 2025).

The purpose of this study is to determine if differences exist in patient-reported outcome measures (PROMs), revision rates, and postoperative health care utilization between individuals that have a history of taking anti-estrogen medication prior to total joint arthroplasty (TJA) and those who have not in matched cohorts. Patients undergoing primary TJA from 2015 to 2023 were reviewed retrospectively. Demographics, history of medication use, PROMs pre- and post-TJA, revision TJA history, and post-TJA hospital utilization were extracted from medical records. Propensity score matching was then performed at 10:1 control to patients with a history of taking anti-estrogen medication prior to TJA accounting for age, race, American Society of Anesthesiologists physical status classification, and body mass index. Patient PROMs, revision rate, and post-TJA hospital utilization were then compared. After applying exclusion criteria, stratifying the groups into total hip arthroplasty (THA) and total knee arthroplasty (TKA), and propensity score matching, the outcomes of 345 THAs and 549 TKAs were analyzed. Patients taking anti-estrogen medications who underwent THA had significantly higher Patient-Reported Outcome Measures Information System (PROMIS) Pain Interference scores; PROMIS Physical Function scores at 6 weeks, lower PROMIS Physical Function at 1 year; and higher rates of readmission at 90 days. There was no difference in PROMs or hospital utilization between groups in patients that underwent TKA. Patients with a history of taking anti-estrogen medications had meaningful improvement after THA and TKA. Although PROMs were similar between groups after TKA, PROMs suggest that patients taking anti-estrogen medication may have worse pain early after THA as well as worse overall function. (Journal of Surgical Orthopaedic Advances 34(3):142-151, 2025).

Lateral femoral wall failure may cause catastrophic collapse after fixation of intertrochanteric (IT) fractures. Traction internal rotation (TIR) radiographs may provide a more accurate fracture assessment of the lateral wall and alter the preoperative plan and fracture implant selection. Seventy-four consecutive patients with AO Foundation/Orthopaedic Trauma Association AO/OTA 31A1-2 fractures were evaluated. Intervention was fixation of IT fractures by sliding hip screw (SHS) or cephalomedullary nail (CMN). No patient treated with a SHS had lateral wall failure at final follow-up. TIR radiographs of IT fractures can optimize preoperative evaluation of fracture morphology, particularly if an SHS is being considered. (Journal of Surgical Orthopaedic Advances 34(1):020-022, 2025).

This study evaluates the impact of preoperative disposition planning on length of stay (LOS) after total joint arthroplasty (TJA). A retrospective chart review, including patients undergoing primary TJA, was performed. Demographics, social factors, Risk Assessment and Prediction Tool (RAPT) scores, and predicted and actual disposition were used to analyze patients that exceeded their expected LOS. Six hundred seventy-nine patients met the inclusion criteria. Average predicted and actual LOS were 2.4 and 2.7 days, respectively. Three hundred thirty-six patients exceeded their anticipated LOS. The most significant factor for exceeding LOS was a change in disposition (p < 0.001). Eighty-two patients had a change in disposition. Patients that required a higher (40) or lower (42) level of care had prolonged LOS (p < 0.001). A change to either higher or lower levels of care than preoperatively anticipated results in increased LOS after TJA. (Journal of Surgical Orthopaedic Advances 34(2):093-097, 2025).

This systematic review summarizes the state of historically underrepresented minority and gender diversity in foot and ankle surgery (FA) at multiple levels, particularly leadership and research productivity. A literature search was performed following the PRISMA (Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) guidelines. Included studies presented demographics regarding diversity within FA and provided trends in rank, leadership, or research. Ten cross-sectional studies were included and assessed for quality using the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) cross-sectional study checklist. Demographics on hundreds of FA applicants, attendings, fellowship directors, and researchers/research articles were collected. Results show disparity at each level, particularly in leadership with females accounting for one (5.5%) chair, three (15.8%) program directors, five (9.8%) division chiefs, three (4.4%) fellowship directors, and one (0.9%) professor. Although there has been an increase from 12% to 14% females in FA from 2010 to 2019, parity is not met. Recognition of the lack of diversity within FA will allow for targeted approaches to an equitable workforce. (Journal of Surgical Orthopaedic Advances 34(2):062-068, 2025).

The increasing role of artificial intelligence (AI) in healthcare is largely attributed to the fact that, with continual medical advances and digitization, clinical decision-making has become more and more reliant on data. As the volume and complexity of datasets grow, it is understandably difficult for physicians to manually discern meaningful patterns that guide diagnoses and/or treatments. AI applications, with the ability to rapidly identify patterns in large datasets, are being developed to assist physicians for improvements in patient care and workflow efficiencies. This review provides a brief description of AI with a focus on existing and developing applications in hand and upper extremity surgery. Although AI demonstrates great promise, both foreseen and unforeseen challenges remain. (Journal of Surgical Orthopaedic Advances 34(2):059-061, 2025).