Journal of surgical orthopaedic advances最新文献

Unicompartmental knee arthroplasty (UKA) is considered favorable over total knee arthroplasty (TKA) due to quicker recovery and high postoperative function; however, UKA failure rates remain high. The purpose of this study was to investigate the role of preoperative magnetic resonance imaging (MRI) in surgical decision-making for medial UKA versus TKA. Ninety-four knees of 85 patients who underwent knee replacement surgery were analyzed retrospectively. Patients deemed candidates for UKA based on stress-view radiographs and physical exam underwent MRIs to assess candidacy. Exclusion criteria included lateral meniscus tears, loose bodies, grade 3 - 4 chondromalacia, anterior cruciate ligament (ACL) tears, sclerosis, and osteoarthritis in more than one compartment. Based on exclusion criteria in the MRI, 47.87% of patients who were initially candidates for UKA were deemed TKA-only candidates. Therefore, although MRIs pose an additional cost, high failure rate of UKA and cost of conversion to TKA make it a beneficial solution. (Journal of Surgical Orthopaedic Advances 34(1):011-014, 2025).

Transfer of the sternal head of the pectoralis major tendon to the inferior pole of the scapula is a well-known intervention for symptomatic medial scapular winging. Axillary approach has not been well represented in the literature but offers similar functional outcomes with improved cosmetics. In this retrospective review, seven patients with chronic medial scapular winging underwent pectoralis major tendon via axillary approach at a single academic institution. Six of the seven patients had improved function, range of motion, and scapular winging. Transfer of the sternal head of the pectoralis major tendon to the inferior pole of the scapula via an axillary approach is a safe and effective option for scapular winging reconstruction with the advantage of direct visualization of neurovascular structures and improved cosmesis. (Journal of Surgical Orthopaedic Advances 34(2):055-058, 2025).

Following total knee arthroplasty (TKA), stiffness can lead to poor outcomes. Manipulation under anesthesia (MUA) is sometimes combined with corticosteroid injection (CSI). This study sought to describe the incidence of CSI with MUA after TKA, as well as the odds of prosthetic joint infection (PJI). A database was queried to identify 754,421 primary TKA patients. The incidences of MUA, injection, revision, and PJI were investigated, along with patient characteristics before and after matching. Overall, 22,015 (2.9%) underwent MUA alone, and 3,272 (14.9% of MUA procedures) underwent MUA with injection. The odds of all-cause revision (1.0, p = 1.0) and revision with PJI (1.1, p = 0.83) were not significantly higher following injection, even after matching (0.9, p = 0.29 and 0.9, p = 0.77, respectively). Overall, the incidence of MUA following TKA within 90 days of index surgery was low and one in seven underwent injection. Injection during MUA did not increase odds of PJI. (Journal of Surgical Orthopaedic Advances 34(3):134-137, 2025).

The objective of this study was to determine accuracy of magnetic resonance imaging (MRI) in detecting lateral ulnar collateral ligament (LUCL) tears. In this retrospective cohort study, two shoulder and elbow surgeons performed blinded review of preoperative MRIs to determine the presence of complete LUCL tears. Consensus interpretations were compared with operative reports. Fifty-nine patients were identified, 11 with LUCL tears confirmed intra-operatively. Sensitivity of the two observers and original radiologists was 90.9%, 90.9%, and 72.7, and specificity was 81.3%, 91.6%, and 97.9%, respectively. Combined consensus sensitivity and specificity of MRI in detecting LUCL tears was 100% and 95.8%, respectively. Inter-observer reliability was moderate (k = 0.54). Positive predictive value and negative predictive value were 84.6% and 100%, respectively. Overall accuracy was 96.6%. Clinical interpretation by shoulder and elbow surgeons results in moderate inter-observer agreement for diagnosis of complete LUCL disruption. Despite modest positive predictive value, data indicate high accuracy, sensitivity, specificity, and negative predictive value using MRI to detect LUCL tears. Level of Evidence: Level III Diagnostic. (Journal of Surgical Orthopaedic Advances 34(4):185-187, 2025).

Racial differences have been reported in the utilization of total knee arthroplasty (TKA), and there exists differences in pain management between African American and Caucasian patients. There are insufficient data concerning racial differences in perioperative pain management for patients after TKA for osteoarthritis of the knee. This is a retrospective study of 804 African American patients who had primary TKA between 2013 and 2022 at a single academic medical center. Patients were matched, 2:1, to Caucasian patients having TKA using American Society of Anesthesiologists score, age, gender, and body mass index. Demographic data and perioperative variables, including pain scores, morphine equivalents required at multiple time points, operative time, length of stay, and opioid refills were evaluated. A significantly higher proportion of African American than Caucasian patients had opioid medication prescribed within 90 days preoperatively (38% African American vs. 22% Caucasian patients). African American patients had significantly higher preoperative pain scores (3.28 vs. 2.26) than Caucasian patients and received significantly higher doses of morphine equivalents both preoperatively and postoperatively. The proportion of African American patients with opioid medication refills within 90 days postoperatively was significantly higher than Caucasian patients (73% vs. 33%). However, African American patients received significantly less intraoperative morphine equivalents. The reasons for the racial differences in perioperative pain management after TKA at one medical center are unknown and require additional study. However, these results suggest that pain management protocols, including standardized opioid medication, be implemented for patients of all races after primary TKA. (Journal of Surgical Orthopaedic Advances 34(3):152-155, 2025).

Socioeconomic factors have been associated with an increased need for manipulation under anesthesia (MUA) following total knee arthroplasty (TKA). The purpose of this study was to compare the rate of MUA and range of motion (ROM) following primary TKA in English and non-English-speaking patients. The authors conducted a retrospective cohort study of all primary TKAs performed at their institution between 2010 and 2017. A total of 1,099 English-speaking and 163 non-English-speaking patients were included. There was no significant difference in rate of MUA (3.5 vs. 4.9%, p = 0.392) or postoperative ROM (102.2 vs. 100°, p = 0.142) between English and non-English-speaking patients. Younger age (p = 0.001) and female sex (p = 0.005), but not patient language, were associated with need for MUA. Patient language does not appear to impact the rate of MUA or ROM following TKA. (Journal of Surgical Orthopaedic Advances 33(3):158-161, 2024).

Atherosclerotic disease in the vessels that supply the cervical spine may lead to degenerative disease. In angina pectoris (AP), atherosclerotic disease leads to coronary vessel occlusion and resulting symptoms. This study aims to determine the relationship between AP and neck pain. Analysis was focused on respondents who had a history of cervical pain disorders, adjusting for demographic, education, and mental health confounders. A total of 30,461 participated in the survey. Of 1,049 respondents, 21% reported neck pain. Mean age of the respondents was 62.6 ± 16.1 years. Nonwhite race, current everyday smokers, lower family income, hypertension, and diabetes had higher prevalence of neck pain (p < 0.05). On multivariate analysis, AP was associated with increased odds of neck pain (odds ratio [OR] = 1.42 [95% confidence interval (CI) 1.04 to 1.92], p = 0.026). AP was independently associated with 42% increased odds of having neck pain. Further study into the association of cardiovascular disease with degenerative disc disease pain should be performed. (Journal of Surgical Orthopaedic Advances 33(2):093-096, 2024).

When a surgical needle is lost, the protocol is to explore the surgical field and to obtain a plain radiograph if the needle cannot be located. The size of the needle that can be detected with imaging is debated. Plain-film radiographs, C-arm, and mini C-arm fluoroscopy imaging was obtained of a cadaveric hand with retained needle of varying lengths (suture sizes 4-0 - 10-0). The authors performed analyses to determine the sensitivity and specificity of the imaging modalities. There were no differences in diagnostic area under the receiver operating characteristic curve between the three modalities. For plain film, optimal cutoff for needle size was 5.2 mm (sensitivity 0.87, specificity 0.75), for C-arm 6.8 mm (sensitivity 0.84, specificity 0.87), and for mini C-arm 5.9 mm (sensitivity 0.82, specificity 0.86). In the hand, the use of C-arm fluoroscopy is as sensitive as plain-film radiography at detecting retained needles greater than 5.9 mm. (Journal of Surgical Orthopaedic Advances 33(1):026-028, 2024).

This study aims to describe the perception of need for same-sex and same-race mentorship and role models at evolving stages of a medical career and to explore whether these differences affect career choices within the field of medicine. A total of 326 medical students, 309 resident physicians, and 200 faculty attending physicians at the University of California, Davis School of Medicine completed an online survey focused on their perceived value of same-sex and same-race mentorship throughout their stages of medical training and practice. The top three factors influencing specialty choice were lifestyle, time commitment, and supportive department. Although most respondents did not believe same-sex or same-race mentors or role models influenced their specialty choice, there were significant differences in the perceived importance and value of gender or race concordance between male versus female and white versus nonwhite populations. (Journal of Surgical Orthopaedic Advances 33(1):041-048, 2024).

Operating room (OR) personnel are at a high risk for sharp injuries, which can cause serious side effects. The goals of this study are to analyze OR nurses and surgical technologists' experiences and their current level of sharps education. An anonymous survey was sent to a single institution asking whether the participants have been stuck by a sharp, when they were stuck, and their perspective on sharp safety. Forty-two participants responded to the survey. The authors found 69% had sustained a sharp injury, 58.6% being stuck while handling sharps alone. The majority (90.5%) believed handing back sharps protected was the safest. Forty-five percent reported never attending continuing medication education (CME) regarding sharps. Only 59.4% of those who had CME found it helpful. This is the first study the authors know of that looked at OR personnel's perspectives on sharps handling and CME. The authors recommend re-evaluation of current CME. (Journal of Surgical Orthopaedic Advances 33(4):216-218, 2024).