Journal of surgical orthopaedic advances最新文献

Computer navigation improves component alignment in total and partial knee arthroplasty, but the impact of improving the alignment of implants on survival and clinical outcomes remains unclear. In addition, there is concern about the cost associated with using a computer navigation in the current healthcare economic climate. Despite these concerns, little is known about the reimbursements for unicompartmental knee arthroplasty at both the index and 90-day global periods. Using a large database analysis, the authors asked (1) what is the utilization per year of both conventional unicompartmental knee arthroplasty (UKA) and computer-navigated UKA (CN-UKA) from 2007 to 2016? (2) What are the Medicare reimbursements for both conventional UKA and CN-UKA at the index and 90-day global periods from 2007 to 2016? Four hundred and seventy-five CN-UKAs were matched to 1,887 conventional UKA controls. The mean index reimbursement for CN-UKA was $11,769 ± $8,558. This was $2,706 lower (95% confidence interval [CI] $1,801 - $3,610) than that of conventional UKA ($14,475 ± $9,073, p < 0.001). The mean 90-day global reimbursement for CN-UKA was $17,220 ± $13,630. This was also $2,071 lower (95% CI, CI $857 - $3,288) than that of conventional UKA ($19,292 ± $11,645, p < 0.001). CN-UKA is associated with decreased total reimbursements compared with conventional UKA at the time of index surgery as well as over the 90-day global period. Payers are not recognizing the value of navigation in UKA, despite clear improvements in radiographic alignment and similar survival and functional outcomes. Without equal reimbursements and long-term studies to show its potential impact on clinical outcomes that will convince the payer of its value to the healthcare system, the economic viability of CN-UKA is in jeopardy. The level of evidence is Level III, therapeutic study. (Journal of Surgical Orthopaedic Advances 34(4):188-192, 2025).

The purpose of this study was to compare the incidence of various short-term complications and healthcare utilization between traditional and computer-assisted total knee arthroplasty (CA-TKA). Traditional TKA and CA-TKA cases were extracted from the American College of Surgeons' National Surgical Quality Improvement Program. Patients were matched using patient and demographic variables. Outcomes were compared between the two patient groups after exact matching. Multivariate logistic regression was performed to identify independent risk factors for various outcome measures. The authors identified 159,521 patients that underwent traditional TKA and 3,464 patients that underwent CA-TKA. After matching, CA-TKA patients were more likely to have a nonhome discharge and a hospital length of stay greater than 2 days. Other outcome measures-readmission, reoperation, mortality, and surgical/medical complications-were comparable between groups. Patients undergoing computer-assisted TKA were more likely to have a nonhome discharge and a hospital length of stay greater than 2 days. (Journal of Surgical Orthopaedic Advances 34(3):156-160, 2025).

The Femoral Neck System (FNS) offers high resistance against angular instability and femoral head rotation by simultaneously remaining minimally invasive. This study reports the complication profile of FNS in real-time to assess the risk-benefit of this device. The Manufacturer and User Facility Device Experience (MAUDE) nationwide database was used to identify complications related to the FNS between January 1, 2018 and January 1, 2022. Data collected included the date the reports were received by the FDA, the type of complication, event description, and the source of report. Of the 182 complication entries reported, 67.5% of the complications were related to the FNS, and 94.5% were classified as an injury. The most common reported type of complication was peri-implant fracture (25.8%; 47 entries), of which, 36 entries were specified as subtrochanteric fracture. This study suggests that the FNS offers excellent construct stability; however, potential stress risers in the subtrochanteric region can be formed and predispose patients to peri-implant fractures. (Journal of Surgical Orthopaedic Advances 34(4):178-181, 2025).

Neuraxial anesthesia (NA) has been shown to be safe and beneficial for patients undergoing total joint arthroplasty (TJA). It has not been determined whether it is safe to perform spinal anesthesia (SA) in a location other than the operating room (OR). This is a single-institution, single-surgeon analysis of 471 consecutive primary TJAs performed from November 2016 to March 2020. Rate of complications, length of stay, and disposition were compared. Eighty-nine percent of TJAs were performed under NA. Those receiving SA were less likely to require conversion to general anesthesia (GA) than those receiving epidural anesthesia (1.8% vs. 14.4%, p < 0.001). Conversion to GA cost 12 minutes of OR time. SA room time averaged 13.4 minutes shorter than GA room time (p < 0.001). The rate of complications was similar for all groups. NA administered in the preoperative holding area for TJA is safe and improves OR time. (Journal of Surgical Orthopaedic Advances 34(1):001-005, 2025).

Arthrofibrosis is a complication after total knee arthroplasty (TKA) that can limit functionality and cause dissatisfaction. This study assesses the prevalence of preoperative depressive symptoms amongst patients who required manipulation under anesthesia (MUA) for arthrofibrosis after TKA. Patients who underwent primary TKA with need for subsequent MUA were age and sex matched to control patients who underwent primary TKA without requiring MUA. Preoperative and postoperative Patient-Reported Outcomes Measurement Information System (PROMIS) scores for function, pain, and depression as well as range of motion in both groups were compared. There were 16 MUA patients and 48 non-MUA patients included in this study. There was a significantly higher percentage of patients with preoperative depression in the MUA group (62.5% vs. 10.4%, p < 0.001). (Journal of Surgical Orthopaedic Advances 34(2):078-081, 2025).

Avascular necrosis of the metacarpal head, or Dietrich's disease, is a rare entity with approximately 40 reported cases in the literature since the original description. No consensus exists on optimal treatment. The purpose of this case series is to report the presentation and outcome of avascular necrosis (AVN) of the metacarpal head in skeletally immature patients treated with osteochondral autograft system. The authors prospectively assessed two male skeletally immature patients and three metacarpal heads who underwent osteochondral autograft transfer systems (OATS) from the ipsilateral knee for avascular necrosis of metacarpal heads after failure of conservative treatment. Outcome measures included patient-reported pain, metacarpophalangeal joint (MPJ) range of motion (ROM) and Disability of the Arm, Shoulder, and Hand (DASH) questionnaire. Two years after surgery, both patients returned to sporting activities with pain-free finger motion. Mean MPJ ROM improved from a range of 0 - 60 degrees to a range of 5 degrees of hyperextension to 75 degrees of flexion postoperatively. Mean DASH score improved from 27 preoperatively to 1.25 postoperatively. Radiographs revealed consolidation of osteochondral graft without signs of arthritis. OATS is a viable treatment option for young, high-demand patients presenting with avascular necrosis of the metacarpal head. (Journal of Surgical Orthopaedic Advances 34(2):069-072, 2025).

Patellar crepitus and patellar clunk syndrome are potential complications seen in patients undergoing total knee arthroplasty (TKA). The etiology of this phenomenon is incompletely understood. A retrospective chart review was performed to identify a consecutive series of patients who underwent primary TKA with either a traditional posterior-stabilized implant (group 1, 728 TKAs) or a cruciate substituting implant (group 2, 393 TKAs). All surgical procedures were performed by a single surgeon at the same institution using the same surgical technique, including selective patellar resurfacing and release of the posterior cruciate ligament. The incidence of patellar clunk requiring arthroscopic debridement was recorded. Statistical analysis was performed. The incidence of patellar clunk requiring arthroscopic debridement was significantly higher in group 1 versus group 2 (6.6% vs. 0% respectively, p < 0.001) with standardization of surgeon and technique factors, suggesting implant design is a critical variable in the development of this complication. (Journal of Surgical Orthopaedic Advances 34(1):046-049, 2025).

The authors sought to examine the racial trends of relative unicompartmental knee arthroplasty (UKA) to total knee arthroplasty (TKA) utilization and complications over 10 years. The National Surgical Quality Improvement Program (NSQIP) database was utilized from 2010 to 2020. Adjusted incidence rate ratios (IRR) were derived for UKA:TKA among African American (AA), Asian, American Indian (AI), and Caucasian racial groups. Multivariate regression was used to compare complications; 406,684 patients were included. AA and AI patients underwent UKA at a lower rate than Caucasian patients (IRR = 0.42, 0.48, respectively, p < 0.001), while Asian patients underwent UKA at a higher rate (IRR = 1.4, p < 0.001). From 2010 to 2020, the IRR among AA patients decreased from 0.71 to 0.57 (p < 0.001), and the IRR for Asian patients increased from 0.38 to 2.07 (p < 0.001). There were no differences in complications. In conclusion, racial disparities in UKA utilization have widened over the past decade, despite similar rates of short-term complications after UKA. Level of Evidence: Prognostic - III. (Journal of Surgical Orthopaedic Advances 34(4):207-210, 2025).

This study assessed whether multimodal pain modalities are effective at decreasing narcotic utilization following ankle fracture surgery. A retrospective chart review of opioid-naive patients aged 18 - 65 undergoing ankle fracture surgery was performed. Patients were prescribed a multimodal pain regimen of acetaminophen, ibuprofen, gabapentin, tramadol, and two sealed envelopes each containing a prescription for 10 tablets of hydrocodone/acetaminophen 5/325 mg. Fourteen of 35 (40%) did not fill any hydrocodone/acetaminophen tablets, 14 (40%) filled 10, 7 (20%) filled 20, and no patients filled more than 20. Most patients rated their pain favorably at their first postoperative visit. There was no correlation with pain control and number of fractures fixed, obesity, or sex. Previously, the custom and practice at this study's institution was to prescribe 30 - 50 tablets of hydrocodone/acetaminophen 5/325 mg. Patients needed much less narcotics than previously believed. This study hopes to provide a prescribing guideline that may decrease reliance on opioid analgesia. (Journal of Surgical Orthopaedic Advances 34(1):023-025, 2025).

Sleep disturbance within the orthopaedic patient population is gaining more headway. As more research is completed, the effects of sleep disturbance on the orthopaedic patient both preoperatively and postoperatively are evident. Overall, there is a lack of research; however, early research suggests that physicians should screen patients for sleep disturbance, as it plays a role in pain and healing. Here, the authors provide a review of the literature as well as guide further research within the topic of sleep disturbance in orthopaedic surgery and provide guidance for the orthopaedic surgeon encountering this topic within their patient population. (Journal of Surgical Orthopaedic Advances 34(1):006-010, 2025).