Journal of Clinical Orthopaedics and Trauma最新文献

{"title":"Venous thromboembolism prophylaxis in obstetric patients after orthopedic injury: a systematic review","authors":"Linnea Fischer ,&nbsp;Erika Ratcliff ,&nbsp;David N. Hackney ,&nbsp;Emily Hamburg-Shields","doi":"10.1016/j.jcot.2026.103346","DOIUrl":"10.1016/j.jcot.2026.103346","url":null,"abstract":"<div><h3>Background</h3><div>To determine the risk of venous thromboembolism (VTE) and the clinical practice pattern for VTE prophylaxis after orthopedic fracture in pregnant and postpartum patients. This review was registered in PROSPERO (ID CRD42024499753).</div></div><div><h3>Methods</h3><div>Literature searches of PubMed, Embase, Web of Science, and <span><span>Clinicaltrials.gov</span><svg><path></path></svg></span> were performed using key words relating to orthopedic fracture in pregnancy and VTE prophylaxis. Of 640 studies screened, 17 articles were eligible for inclusion. The primary outcome was whether VTE prophylaxis was administered and the medication, dose, and duration. Secondary outcomes included clinical characteristics of the pregnancy and fracture and the occurrence of complications including VTE. Data were analyzed by descriptive statistics and narrative synthesis, as the lack of controlled studies precluded meta-analysis.</div></div><div><h3>Results</h3><div>The 17 eligible studies were all case reports or small case series. 26 cases were reported in which a fracture occurred during the prenatal period. Of the 26 patients, 23 received pharmacologic VTE prophylaxis. The majority received low molecular weight heparin (LMWH) or unfractionated heparin (UFH). Duration of prophylaxis ranged from 6 days to 20 weeks (the remainder of the pregnancy). Only one patient in the eligible reports had a VTE event; this patient had not received VTE prophylaxis. No complications of VTE prophylaxis were reported.</div></div><div><h3>Conclusion</h3><div>Pharmacologic VTE prophylaxis is typically recommended in the general population after major orthopedic surgery and major traumatic injuries. Pregnant patients may be at additionally elevated risk of VTE after orthopedic injury compared to non-pregnant patients. The degree of benefit of VTE prophylaxis and the appropriate duration of therapy is not known due to lack of controlled studies in this population.</div></div>","PeriodicalId":53594,"journal":{"name":"Journal of Clinical Orthopaedics and Trauma","volume":"73 ","pages":"Article 103346"},"PeriodicalIF":0.0,"publicationDate":"2026-01-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145978608","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Global research landscape of artificial intelligence in orthopaedics: A decade of trends from a Scopus-based bibliometric analysis (2015–2025)","authors":"Anil Regmi ,&nbsp;Vivaan Jain ,&nbsp;Surakshya Baral ,&nbsp;Bishwa Bandhu Niraula","doi":"10.1016/j.jcot.2026.103342","DOIUrl":"10.1016/j.jcot.2026.103342","url":null,"abstract":"<div><h3>Background</h3><div>Artificial intelligence (AI) has emerged as a transformative tool in orthopaedics, with its various applications. Despite increasing interest, the global research landscape, collaborative networks, and trends in AI-based orthopaedic research remain incompletely characterized. This research aims to perform a comprehensive bibliometric analysis of AI research in orthopaedics, mapping annual publication trends, document types, leading journals, authors, institutions, countries, funding agencies, and citation impact from 2015 to 2025.</div></div><div><h3>Methods</h3><div>A Scopus-based search was conducted for published documents in AI in Orthoapedics between 2015 and 2025. Bibliographic information including publication year, document type, journal, author names, affiliations, country, funding, and citations was extracted. Descriptive statistics summarized trends, while VOSviewer (v1.6.20) visualized co-authorship, bibliographic coupling, and collaboration networks at author, institution, and country levels.</div></div><div><h3>Results</h3><div>A total of 1629 documents were identified. Publications increased steeply after 2022, peaking in 2025 (n = 544), with original research articles (55.9 %) and reviews (20.7 %) dominating. The United States (34.8 %), China (14.1 %), and India (8.6 %) were the most productive countries. Co-authorship and bibliographic coupling analyses revealed expanding yet fragmented collaborative networks. The National Natural Science Foundation of China and the U.S. National Institutes of Health were the top funding agencies. The dataset accumulated 17,429 citations, with an h-index of 59.</div></div><div><h3>Conclusions</h3><div>AI in orthopaedics has experienced exponential growth over the past decade, driven by high-impact institutions and collaborative networks, yet its clinical translation remains limited, highlighting the need for globally coordinated, methodologically rigorous research to fully realize its transformative potential.</div></div>","PeriodicalId":53594,"journal":{"name":"Journal of Clinical Orthopaedics and Trauma","volume":"73 ","pages":"Article 103342"},"PeriodicalIF":0.0,"publicationDate":"2026-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145978610","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Validation of a novel knee harness inertial-cum-ultrasound wearable device as a quantitative measure of knee function","authors":"Zachariah Gene Wing Ow ,&nbsp;Edmund Jia Xi Zhang ,&nbsp;Keng Lin Wong","doi":"10.1016/j.jcot.2026.103338","DOIUrl":"10.1016/j.jcot.2026.103338","url":null,"abstract":"<div><h3>Background</h3><div>Accurate assessment of knee function is essential for diagnosis, monitoring, and rehabilitation of musculoskeletal injuries. Patient-reported outcome measures (PROMs) such as the International Knee Documentation Committee (IKDC) score, although validated, are limited by subjectivity and ceiling effects. This study aimed to validate a novel wearable device, the GATOR system, which integrates inertial measurement units (IMUs) and ultrasound to produce an objective composite knee function score, PRIME.</div></div><div><h3>Methods</h3><div>In a prospective cohort of 90 participants (180 knees), PRIME scores were obtained for healthy, injured, and contralateral knees, with concurrent IKDC scores. Descriptive statistics and non-parametric tests compared groups. Spearman correlation and univariate linear regression assessed the relationship between PRIME and IKDC, with the primary correlation analysis restricted to injured knees. Receiver operating characteristic (ROC) analysis evaluated the ability of PRIME to discriminate injured from healthy knees, and the optimal PRIME cut-off was derived using the Youden index. The minimal detectable change (MDC) of PRIME was estimated from the variability in healthy knees.</div></div><div><h3>Results</h3><div>PRIME scores were highest in healthy knees, intermediate in contralateral knees, and lowest in injured knees, with statistically significant differences between all groups (p &lt; 0.001). In injured knees, PRIME showed a moderate-to-strong correlation with IKDC (ρ = 0.54, p &lt; 0.001), whereas no significant correlation was observed in healthy knees, likely reflecting ceiling effects. ROC analysis yielded an AUC of 0.846. A PRIME cut-off of 71.2 points optimally discriminated injured from healthy knees (sensitivity 74.5 %, specificity 82.1 %). The MDC for PRIME was 39.1 points, suggesting that changes exceeding this threshold likely represent true change beyond measurement error.</div></div><div><h3>Conclusion</h3><div>PRIME appears to be a valid, objective measure of knee function that correlates with patient-reported outcomes in pathological knees and demonstrates good discriminatory performance for detecting knee injury.</div></div>","PeriodicalId":53594,"journal":{"name":"Journal of Clinical Orthopaedics and Trauma","volume":"73 ","pages":"Article 103338"},"PeriodicalIF":0.0,"publicationDate":"2026-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145978609","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical applications of artificial intelligence in hand surgery: A systematic review and meta-analysis","authors":"J. Terrence Jose Jerome ,&nbsp;Vivaan Jain","doi":"10.1016/j.jcot.2026.103335","DOIUrl":"10.1016/j.jcot.2026.103335","url":null,"abstract":"<div><h3>Background</h3><div>Artificial intelligence (AI) is increasingly applied in medicine, yet its clinical integration in hand surgery remains variable and incompletely validated. This systematic review and meta-analysis evaluated current AI applications in hand surgery and benchmarked performance against human comparators where available.</div></div><div><h3>Methods</h3><div>Following PRISMA 2020 guidelines, PubMed/MEDLINE, Embase, Web of Science, and the Cochrane Library were searched through October 2025. Eligible studies evaluated AI systems in hand or wrist surgery with reported performance metrics. Outcomes included diagnostic accuracy, prognostic discrimination, concordance with clinical recommendations, workflow impact, and user satisfaction. Meta-analysis using a bivariate random-effects model was performed when ≥3 comparable studies were available and was restricted to radiograph-based fracture detection (distal radius and scaphoid). All other applications were synthesized narratively due to heterogeneity. The protocol was registered with PROSPERO (CRD420251230505).</div></div><div><h3>Results</h3><div>Of 1228 screened records, 98 studies met inclusion criteria, most addressing diagnostic imaging. For distal radius fractures, pooled AI sensitivity and specificity were 92 % and 89 %, compared with 95 % and 94 % for human readers. For scaphoid fractures, AI demonstrated higher sensitivity (85 % vs. 71 %) but lower specificity (83 % vs. 93 %). Prognostic machine-learning models outperformed clinician estimates in selected retrospective cohorts (mean accuracy 78 % vs. 65 %), although calibration and external validation were inconsistently reported. Large language models demonstrated feasibility in simulated settings, achieving passing specialty-exam scores and generating high-quality documentation (mean satisfaction 4.6/5), while showing high sensitivity but variable specificity in treatment recommendations. Robotic and instrument-tracking applications remain experimental.</div></div><div><h3>Conclusions</h3><div>AI demonstrates promise in selected hand-surgery tasks, particularly fracture detection, outcome prediction, and documentation support. However, evidence is predominantly retrospective and single-center. Prospective multicenter validation and careful attention to bias, transparency, and ethical safeguards are required before routine clinical adoption. AI should augment—not replace—clinical expertise.</div></div><div><h3>Level of evidence</h3><div>II (systematic review/meta-analysis of predominantly Level II–III studies).</div></div>","PeriodicalId":53594,"journal":{"name":"Journal of Clinical Orthopaedics and Trauma","volume":"73 ","pages":"Article 103335"},"PeriodicalIF":0.0,"publicationDate":"2026-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145928358","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reviewer Acknowledgment-2025","authors":"","doi":"10.1016/j.jcot.2025.103332","DOIUrl":"10.1016/j.jcot.2025.103332","url":null,"abstract":"","PeriodicalId":53594,"journal":{"name":"Journal of Clinical Orthopaedics and Trauma","volume":"72 ","pages":"Article 103332"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145938791","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A prospective randomized comparative study of surgeon administered adductor canal block with epidural analgesia in primary TKA","authors":"Gaurav Gupta ,&nbsp;Akshay Ramesh Gupta ,&nbsp;Vinit Kumar Singh","doi":"10.1016/j.jcot.2025.103320","DOIUrl":"10.1016/j.jcot.2025.103320","url":null,"abstract":"<div><h3>Background</h3><div>Total knee replacement stands as a reliable solution for patients experiencing severe knee osteoarthritis, yet persistent discomfort following the procedure can significantly impede the return to mobility and rehabilitation efforts. While epidural techniques have long supported pain control after surgery, they can cause issues like limited movement ability and urinary challenges. This investigation compared intraoperative surgeon-delivered adductor canal blockade with epidural analgesia in patients undergoing primary unilateral total knee replacement, focusing on early analgesia and rehabilitation.</div></div><div><h3>Methods</h3><div>A prospective analysis was performed in a tertiary orthopaedic hospital in northern India, involving 50 individuals undergoing lower limb joint replacement. Patients were divided equally into 2 groups one receiving adductor canal (25) or epidural (25) pain management approaches. All procedures were carried out under regional spinal anaesthetia. Postoperative discomfort was gauged using a Visual Analog Scale (VAS) at set intervals after surgery, and functional outcomes were captured with standardized knee scoring systems and joint movement measurements. Statistics were interpreted using appropriate tests, with significance assumed for values below 0.05.</div></div><div><h3>Results</h3><div>ACB patients reported significantly lower pain scores on postoperative days 0-1 compared to CEA patients (p = 0.0001). Measures of knee function and mobility at day three favoured the adductor canal approach, and a greater proportion of these patients achieved robust knee flexion early in their recovery. Additionally, hospital discharge was expedited, and the return of quadriceps strength was more prevalent among those managed with the adductor canal block.</div></div><div><h3>Conclusion</h3><div>In this small, pragmatic prospective randomized comparative study, surgeon-delivered adductor canal block was associated with lower early postoperative pain scores, reduced opioid consumption, faster functional recovery, and shorter hospital stay compared with continuous epidural analgesia within the first 72 h after total knee arthroplasty.</div></div>","PeriodicalId":53594,"journal":{"name":"Journal of Clinical Orthopaedics and Trauma","volume":"73 ","pages":"Article 103320"},"PeriodicalIF":0.0,"publicationDate":"2025-12-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145928360","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Limb occlusion pressure versus standard tourniquet pressure in total: A prospective comparative study","authors":"Narendra Singh Kushwaha ,&nbsp;Ravi Kumar ,&nbsp;Ravindra Mohan ,&nbsp;Sujeet Kumar Chaudhary ,&nbsp;Rashmi Chandra ,&nbsp;Ashish Kumar","doi":"10.1016/j.jcot.2025.103331","DOIUrl":"10.1016/j.jcot.2025.103331","url":null,"abstract":"<div><h3>Background</h3><div>Tourniquet use during total knee arthroplasty (TKA) facilitates a bloodless surgical field but is associated with postoperative complications such as thigh pain, skin changes, and functional delays. Determining optimal tourniquet pressure individualized to each patient is crucial to minimize these adverse effects. Limb occlusion pressure (LOP) provides a physiologic basis for personalized tourniquet pressure settings.</div></div><div><h3>Methods</h3><div>This prospective randomized study enrolled 60 patients undergoing primary TKA, randomized equally into two groups. Group A had tourniquet pressure set using automated LOP measurement plus a safety margin, while Group B used a fixed standard pressure of 300 mmHg. Primary outcomes included tourniquet-site pain (VAS), wound complications (Southampton score), and functional recovery (Oxford Knee Score) at 6 weeks. Secondary measures included intraoperative blood loss and safety events.</div></div><div><h3>Results</h3><div>Group A had significantly lower tourniquet pressures (222.0 ± 28.6 mmHg vs. 300 mmHg, p &lt; 0.001) without increased blood loss (744.2 ± 256.4 ml vs. 709.8 ± 283.7 ml, p = 0.458). Postoperative pain was notably reduced in Group A, with 60 % scoring ≤2 on VAS compared to 20 % in Group B (p = 0.015). Wound healing was superior in Group A (60 % perfect healing vs. 20 %, p = 0.002), with fewer incidences of erythema, blistering, and bruising. Functional outcomes were better in Group A (Oxford Knee Score 35.9 ± 3.0 vs. 32.6 ± 1.7, p &lt; 0.001). No significant neurovascular or thromboembolic complications were reported.</div></div><div><h3>Conclusion</h3><div>LOP-guided individualized tourniquet pressure in TKA significantly reduces postoperative pain and wound complications while maintaining an effective bloodless field and comparable blood loss. Personalized pressure settings enhance early functional recovery and patient comfort, supporting routine LOP use for tourniquet management in orthopedic surgery.</div></div>","PeriodicalId":53594,"journal":{"name":"Journal of Clinical Orthopaedics and Trauma","volume":"73 ","pages":"Article 103331"},"PeriodicalIF":0.0,"publicationDate":"2025-12-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145852498","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Open vs. closed patella Fractures: Difference in incidence, treatment and outcomes","authors":"Ellen Lutnick ,&nbsp;Ryan Riley ,&nbsp;Emilie Harley ,&nbsp;Idem Essien ,&nbsp;Nicholas Frappa ,&nbsp;Christopher Mutty","doi":"10.1016/j.jcot.2025.103315","DOIUrl":"10.1016/j.jcot.2025.103315","url":null,"abstract":"<div><h3>Background</h3><div>This study aims to describe the incidence and compare treatment and outcomes of open versus closed patella fractures at one institution.</div></div><div><h3>Methods</h3><div>Adult patients presenting to one American College of Surgeons Level 1 trauma hospital from 01/01/2001-12/31/2020 with patella fracture(s), screened by ICD codes were retrospectively reviewed. The primary outcome was the incidence of peri-injury or perioperative complications, including nonunion, superficial or deep infection, contracture/arthrofibrosis, deep venous thrombosis (DVT), hardware failure, patellar tendon rupture, painful hardware, wound healing complications, or return to the operating room (RTOR). Rates of postoperative complications were compared between fracture types (open vs closed) and treatment strategies (operative vs non-operative). All analyses were performed in R version 4.5.0. P-value &lt;0.05 was significant.</div></div><div><h3>Results</h3><div>Of 451 patients, (median age 52 years), 35.3 % were open fractures, and 62.3 % underwent operative treatment. Patients with open fractures were younger (mean age 38.84 ± 15.67 vs. 58.27 ± 19.45 years; p &lt; 0.001) and more commonly smokers (37.1 % vs. 27.4 %; p = 0.043). Open fractures had higher Injury Severity Scores (ISS) (12.81 ± 8.41 vs. 10.30 ± 8.28; p = 0.003) and were treated operatively more frequently than closed fractures (84.9 % vs. 50.0 %; p &lt; 0.001). Open fractures demonstrated a higher rate of any complication (38 [23.9 %] vs 42 [14.2 %], p = 0.014), as did patients treated operatively (78 [27.8 %] vs 2 [1.2 %], p &lt; 0.001). Patients who underwent RTOR were younger than those who did not (median 42.9 vs 53.7 years; p &lt; 0.001). Open fracture and postoperative complications were significantly associated with RTOR.</div></div><div><h3>Conclusion</h3><div>In this cohort, open patella fractures occurred at a higher rate than previously described in the literature at 35.3 %. Open fracture was significantly associated with increased risk of complications and unplanned RTOR.</div></div>","PeriodicalId":53594,"journal":{"name":"Journal of Clinical Orthopaedics and Trauma","volume":"72 ","pages":"Article 103315"},"PeriodicalIF":0.0,"publicationDate":"2025-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145839739","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Geometric optimization of femoral rotational alignment in total knee arthroplasty using minimal surface theory versus anatomical reference axes: a computational simulation study","authors":"Horacio Rivarola ,&nbsp;Cristian Collazo ,&nbsp;Marcos Palanconi ,&nbsp;Marcos Meninato ,&nbsp;Gonzalo Arteaga ,&nbsp;Francisco Endara Urresta","doi":"10.1016/j.jcot.2025.103309","DOIUrl":"10.1016/j.jcot.2025.103309","url":null,"abstract":"<div><h3>Background</h3><div>Femoral rotational alignment is a critical determinant of contact mechanics, kinematics, and long-term survivorship in total knee arthroplasty (TKA). Traditional techniques rely on anatomical landmarks, which exhibit substantial inter-patient variability and may not reliably optimize tibiofemoral load distribution. This study introduces a geometric, anatomy-independent framework using minimal surface theory (MST) to identify an energy-minimizing femoral rotational alignment based on curvature equilibrium rather than fixed bony reference axes.</div></div><div><h3>Methods</h3><div>A three-dimensional finite element model of the tibiofemoral articulation was constructed from computed tomography–derived anatomy. Posterior-stabilized TKA components were virtually implanted, and femoral rotation was varied from 5° internal to 5° external relative to the surgical transepicondylar axis. Simulations were performed at 0°, 45°, and 90° of flexion under a 700-N axial load. Willmore surface energy, mean contact pressure, peak shear stress, and contact area were quantified for each alignment. Sensitivity analyses evaluated robustness to posterior tibial slope (±3°) and insert conformity.</div></div><div><h3>Results</h3><div>Across all flexion angles and model conditions, the MST-derived minimum energy state occurred consistently at <strong>2°–3° of external rotation</strong>. Compared with neutral alignment, this optimized orientation reduced Willmore energy by <strong>38.6 %</strong>, mean contact pressure by <strong>18.7 %</strong>, and peak shear stress by <strong>30.8 %</strong>, while increasing contact area by <strong>13.1 %</strong>. Internal malrotation resulted in abrupt curvature transitions, elevated stress concentrations, and reduced load-sharing capacity. Findings remained stable across sensitivity analyses, indicating that the energy-optimal configuration is reproducible and not dependent on specific anatomical landmarks.</div></div><div><h3>Conclusion</h3><div>Minimal surface theory identifies a narrow and consistent external rotational target that optimizes congruence and reduces mechanical stress in TKA. This framework provides a mathematically grounded, anatomy-independent alternative to conventional landmark-based alignment strategies and may support future computational or robotic applications for patient-specific rotational planning.</div></div><div><h3>Level of evidence</h3><div>Computational simulation study (Level V).</div></div>","PeriodicalId":53594,"journal":{"name":"Journal of Clinical Orthopaedics and Trauma","volume":"72 ","pages":"Article 103309"},"PeriodicalIF":0.0,"publicationDate":"2025-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145839734","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of preoperative chronic pain diagnosis on unicompartmental knee arthroplasty surgery: Analysis of healthcare utilization and patient reported outcomes","authors":"Shujaa T. Khan,&nbsp;Dimitri Mabarak,&nbsp;Yuxuan Jin,&nbsp;Khaled A. Elmenawi,&nbsp;Nicolas S. Piuzzi","doi":"10.1016/j.jcot.2025.103305","DOIUrl":"10.1016/j.jcot.2025.103305","url":null,"abstract":"<div><h3>Background</h3><div>This study investigates (i) clinically relevant improvements in patient-reported outcome measures (PROMs), (ii) satisfaction rates at one-year post-unicompartmental knee arthroplasty (UKA), and (iii) patterns of healthcare utilization (HCU) in patients with and without preoperative chronic pain.</div></div><div><h3>Methods</h3><div>A total of 1275 patients who underwent primary elective unilateral UKAs at a large tertiary academic center in the United States between 2016 and 2022 were included in the cohort. Electronic medical record (EMR) was used to identify a preoperative diagnosis of chronic pain using ICD coding. The included PROMs were the KOOS Pain, PS, JR. Clinically relevant improvements were evaluated using established minimal clinically important difference (MCID) and patient acceptable symptom state (PASS) threshold achievement.</div></div><div><h3>Results</h3><div>There were 234 (18.4 %) with a chronic pain diagnosis before their UKA. Chronic pain was not associated with failure to reach MCID improvement in any of the KOOS subscales. However, it was associated with failure to reach PASS in KOOS Pain, but not KOOS PS or KOOS JR. Chronic pain was not associated with dissatisfaction at 1-year after UKA (p = 0.112). There was no difference in discharge to home/home healthcare between chronic pain and non-chronic pain patients (p = 0.706). Similarly, there was no statistically significant difference in 90-day readmissions between the two groups (p = 0.38). After adjusting for possible confounding variables, patients with a preoperative chronic pain diagnosis were not associated with a prolonged LOS (p = 0.298).</div></div><div><h3>Conclusion</h3><div>Chronic pain patients reported similar 1-year satisfaction and self-perceived improvement in knee function and pain relief to their non-chronic pain counterparts. Surgeons may use these results to reassure and set optimistic expectations in these patients.</div></div>","PeriodicalId":53594,"journal":{"name":"Journal of Clinical Orthopaedics and Trauma","volume":"73 ","pages":"Article 103305"},"PeriodicalIF":0.0,"publicationDate":"2025-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145928359","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}