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Borderline Dysplasia After Primary Hip Arthroscopy with Capsular Plication and Labral Preservation: Ten-Year Survivorship and Patient-Reported Outcomes J. Bone Joint. Surg. (IF 5.3) Pub Date : 2023-05-03 Benjamin G. Domb, Jade S. Owens, Rachel M. Glein, Andrew E. Jimenez, David R. Maldonado
Background: The arthroscopic management of borderline hip dysplasia (BHD) is controversial, and long-term follow-up data are scarce. The purpose of this study was to report prospectively collected survivorship and patient-reported outcome measures (PROMs) at a minimum 10-year follow-up following primary hip arthroscopy with capsular plication and labral preservation in patients with BHD. Methods:
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AOA Critical Issues: Patient-Reported Outcome Measures: Why Every Orthopaedic Practice Should Be Collecting Them J. Bone Joint. Surg. (IF 5.3) Pub Date : 2023-04-19 Eric C. Makhni, Mary E. Hennekes, Judith F. Baumhauer, Stephanie J. Muh, Kurt Spindler
Patient-centered care is essential to providing high-quality value-based care. Patient-reported outcome measures (PROMs) are arguably the best tools available to orthopaedic providers for providing patient-centered care. Many clinical opportunities exist for the implementation of PROMs into routine practice, such as shared decision-making, mental health screening, and prediction of postoperative disposition
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Plasma D-Dimer Is Noninferior to Serum C-Reactive Protein in the Diagnosis of Periprosthetic Joint Infection J. Bone Joint. Surg. (IF 5.3) Pub Date : 2023-04-05 Saad Tarabichi, Graham S. Goh, Colin M. Baker, Emanuele Chisari, Alisina Shahi, Javad Parvizi
Background: No single test has demonstrated absolute accuracy in the diagnosis of periprosthetic joint infection (PJI). Serological markers are often used as screening tools in the workup of patients with suspected PJI. This study aimed to determine the diagnostic utility of plasma D-dimer for PJI in a variety of clinical scenarios. Methods: This prospective study enrolled 502 patients undergoing
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Comparison of Humeral-Head Replacement with Glenoid-Reaming Arthroplasty (Ream and Run) Versus Anatomic Total Shoulder Arthroplasty: A Matched-Cohort Study J. Bone Joint. Surg. (IF 5.3) Pub Date : 2023-04-05 James Levins, Vadim Molla, Jacob Adkins, Janine Molino, Emily Pasarelli, E. Scott Paxton, Andrew Green
Background: Glenoid component failure is a major concern after anatomic total shoulder arthroplasty (aTSA). Ream and run (RnR) is an alternative procedure that may avoid glenoid-related complications. The purpose of this study was to compare outcomes of RnR versus aTSA in younger patients with advanced glenohumeral osteoarthritis. Methods: This was a retrospective matched-cohort study of 110 patients
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Return to Work Following Intramedullary Nailing of Lower-Limb Long-Bone Fractures in South Africa J. Bone Joint. Surg. (IF 5.3) Pub Date : 2023-04-05 Samuel Masterson, Maritz Laubscher, Sithombo Maqungo, Nando Ferreira, Michael Held, William J. Harrison, Simon Matthew Graham
Background: Injuries are one of the leading causes of global death and disability and commonly have substantial economic implications. The economic impact of injuries is particularly pronounced in low- and middle-income countries, where 90% of injuries occur. In this study, we aimed to assess return-to-work rates of individuals who sustained a lower-limb long-bone fracture in South Africa and to identify
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The Effect of Body Mass Index on the Relative Revision Rates of Cemented and Cementless Unicompartmental Knee Replacements: An Analysis of Over 10,000 Knee Replacements from National Databases J. Bone Joint. Surg. (IF 5.3) Pub Date : 2023-04-05 Hasan R. Mohammad, Andrew Judge, David W. Murray
Background: Unicompartmental knee replacements (UKRs) are being performed in an increasingly overweight population. There are concerns that cemented fixation will not last. Cementless fixation may offer a solution, but the relative performance in different body mass index (BMI) groups remains unknown. Methods: Ten thousand, four hundred and forty cemented and cementless UKRs were propensity matched
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Retrospective Analysis of Associated Anomalies in 636 Patients with Operatively Treated Congenital Scoliosis J. Bone Joint. Surg. (IF 5.3) Pub Date : 2023-04-05 Nan Wu, Lian Liu, Yuanqiang Zhang, Lianlei Wang, Shengru Wang, Sen Zhao, Guozhuang Li, Yang Yang, Guanfeng Lin, Jianxiong Shen, Zhihong Wu, Guixing Qiu, Terry Jianguo Zhang
Background: Congenital scoliosis is frequently associated with anomalies in multiple organ systems. However, the prevalence and distribution of associated anomalies remain unclear, and there is a large amount of variation in data among different studies. Methods: Six hundred and thirty-six Chinese patients who had undergone scoliosis correction surgery at Peking Union Medical College Hospital from
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No Increased Risk of Nonunion with Bisphosphonate Use in a Medicare Claims Cohort Following Operatively Treated Long-Bone Fractures J. Bone Joint. Surg. (IF 5.3) Pub Date : 2023-04-05 Tyler J. Thorne, Lillia Steffenson, Dillon C. O’Neill, Lucas S. Marchand, Brook I. Martin, Justin M. Haller
Background: The diagnosis of a fragility fracture represents an important intervention event for the initiation of medical osteoporosis treatments. However, it is unclear if osteoporosis medications increase the risk of nonunion if administered in the setting of acute fracture. The purpose of the present study was to investigate whether bisphosphonates or selective estrogen receptor modulators/hormone
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Application of Nucleic Acid-Based Strategies to Detect Infectious Pathogens in Orthopaedic Implant-Related Infection J. Bone Joint. Surg. (IF 5.3) Pub Date : 2023-04-05 Emily Ann McClure, Paul Werth, Benjamin Ross, Ida Leah Gitajn
➤ Implant-associated infection in orthopaedic surgery remains an enormous and largely unsolved clinical problem with a high rate of persistent or recurrent infection. This may be due, at least in part, to the potential for underdiagnosis by traditional microbial culture or the potential for culture to incompletely identify the microbial species present. ➤ Nucleic acid-based diagnostic techniques, focused
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Opportunities for International Orthopaedic Volunteerism: An Exploration of United States and Canada-Based Nonprofit Organizations J. Bone Joint. Surg. (IF 5.3) Pub Date : 2023-04-05 Kelsey E. Brown, Rafat H. Solaiman, Michael J. Flores, Haley Nadone, Madeline C. MacKechnie, David W. Shearer, Theodore Miclau
Background: In low and middle-income countries (LMICs), there are often not enough orthopaedic surgeons to treat musculoskeletal conditions. International volunteerism is 1 way that the orthopaedic community seeks to meet this need. This study explored the opportunities available for orthopaedic surgeons to volunteer overseas as offered by nonprofit organizations in the United States and Canada. Methods:
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Short-Term Neck Pain After Posterior Foraminotomy Compared with Anterior Discectomy with Fusion for Cervical Foraminal Radiculopathy: A Secondary Analysis of the FACET Randomized Controlled Trial J. Bone Joint. Surg. (IF 5.3) Pub Date : 2023-03-23 Nádia F. Simões de Souza, Anne E.H. Broekema, Remko Soer, Michiel F. Reneman, Rob J.M. Groen, J. Marc C. van Dijk, Katalin Tamási, Jos M.A. Kuijlen, on behalf of the FACET Investigators*
Background: Short-term neck pain after posterior cervical foraminotomy (posterior surgery) compared with anterior cervical discectomy with fusion (anterior surgery) treating cervical radiculopathy has only been assessed once, retrospectively, to our knowledge. The aim of this study was to prospectively evaluate the course of neck pain for 6 weeks after both treatments. Methods: This is a secondary
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Automatic Assessment of Lower-Limb Alignment from Computed Tomography J. Bone Joint. Surg. (IF 5.3) Pub Date : 2023-03-22 Ruurd J.A. Kuiper, Peter R. Seevinck, Max A. Viergever, Harrie Weinans, Ralph J.B. Sakkers
Background: Preoperative planning of lower-limb realignment surgical procedures necessitates the quantification of alignment parameters by using landmarks placed on medical scans. Conventionally, alignment measurements are performed on 2-dimensional (2D) standing radiographs. To enable fast and accurate 3-dimensional (3D) planning of orthopaedic surgery, automatic calculation of the lower-limb alignment
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Spinal Sagittal Alignment Changes During Childhood: Results of a National Cohort Analysis of 1,059 Healthy Children J. Bone Joint. Surg. (IF 5.3) Pub Date : 2023-03-22 Sébastien Pesenti, Yann Philippe Charles, Solène Prost, Federico Solla, Benjamin Blondel, Brice Ilharreborde, on behalf of the French Spine Surgery Society (SFCR)
Background: In the past decades, it has been recognized that sagittal alignment of the spine is crucial. Although the evolution of spinal alignment with growth has previously been described, there are no data for key parameters such as the exact shapes (extent and magnitude) of spinal curvatures. The goals of this study were therefore to determine normative values of spinopelvic sagittal parameters
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Risk Factors for a Failed Transmetatarsal Amputation in Patients with Diabetes J. Bone Joint. Surg. (IF 5.3) Pub Date : 2023-03-21 Itay Ron, Cynthia Kyin, Bezalel Peskin, Nabil Ghrayeb, Doron Norman, Tal Ben-Kiki, Jacob Shapira
Background: Transmetatarsal amputation (TMA) is a well-recognized limb-salvage procedure, often indicated for the treatment of diabetic foot infections. Currently, there is no widespread agreement in the literature with regard to the factors associated with failure of TMA. This study aimed to define risk factors for the failure of TMA, defined as below-the-knee or above-the-knee amputation, in patients
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A Call to Action for Musculoskeletal Research Funding: The Growing Economic and Disease Burden of Musculoskeletal Conditions in the United States Is Not Reflected in Musculoskeletal Research Funding J. Bone Joint. Surg. (IF 5.3) Pub Date : 2023-03-15 Kara McConaghy, Alison K. Klika, Suneel S. Apte, Ahmet Erdemir, Kathleen Derwin, Nicolas S. Piuzzi
As a result of an aging population, musculoskeletal disease is a growing source of health and economic burden in the United States. In 2019, musculoskeletal conditions affected approximately 127.4 million people (more than a third of the U.S. population); they were the top driver of health-care spending in 2016, with an estimated direct annual cost of $380.9 billion. While musculoskeletal conditions
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Tissue Integration and Chondroprotective Potential of Acetabular Labral Augmentation with Autograft Tendon: Study of a Porcine Model J. Bone Joint. Surg. (IF 5.3) Pub Date : 2023-03-15 Tiao Su, Yunong Ao, Liu Yang, Guang-xing Chen
Background: The aim of this study was to explore the tissue healing process and changes in articular cartilage following acetabular labral augmentation in a porcine model. Methods: The labrum was resected unilaterally from 10 o’clock to 1 o’clock on the capsular side in 36 pigs. Eighteen pigs underwent labral augmentation (AUG group) using autologous Achilles tendon. No additional procedures were
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Nationwide Results of Microorganism Antigen Testing as a Component of Preoperative Synovial Fluid Analysis J. Bone Joint. Surg. (IF 5.3) Pub Date : 2023-03-15 Krista O’Shaughnessey Toler, Pearl Ravindra Paranjape, Alex McLaren, Brett Levine, Alvin Ong, Carl Deirmengian
Background: Antigen immunoassays to detect synovial fluid (SF) microorganisms have recently been made available for clinical use. The purpose of this study was to determine the sensitivity and specificity of an SF microorganism antigen immunoassay detection (MID) panel, evaluate the panel’s capability to detect microorganisms in the setting of culture-negative periprosthetic joint infection (PJI)
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Quadriceps Strain and TKA: Contribution of the Tourniquet and Intramedullary Rod to Postoperative Thigh Pain: A Randomized Controlled Trial J. Bone Joint. Surg. (IF 5.3) Pub Date : 2023-03-15 Gregory W. Stocks, Melissa Odoemene, Julia Gex, Emily A. Vidal, Kathryn Sawyer, Stephen L. Jones, Brandon Thompson, Mitzi S. Laughlin
Background: Thigh pain is relatively common after total knee arthroplasty (TKA) and has been attributed to compression of the thigh muscles by the tourniquet used during surgery. Thigh pain that occurs after a TKA that was performed without a tourniquet may be due to a strain of the quadriceps muscle or insertion of the intramedullary (IM) rod. The purpose of the present study was to determine the
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Cost Analysis of Conversion Total Knee Arthroplasty: A Multi-Institutional Database Study J. Bone Joint. Surg. (IF 5.3) Pub Date : 2023-03-15 Steven Denyer, Carlo Eikani, Daniel Bujnowski, Hassan Farooq, Nicholas Brown
Background: Total knee arthroplasty (TKA) after prior knee surgery, also known as conversion TKA (convTKA), has been associated with higher complications, resource utilization, time, and effort. The increased surgical complexity of convTKA may not be reflected by the relative value units (RVUs) assigned under the current U.S. coding guidelines. The purpose of this study was to compare the RVUs of
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Normative Femoral and Tibial Lengths in a Modern Population of Twenty-First-Century U.S. Children J. Bone Joint. Surg. (IF 5.3) Pub Date : 2023-03-15 Chunho Chen, Todd A. Milbrandt, Elham Babadi, Stephanie Q. Duong, Dirk R. Larson, William J. Shaughnessy, Anthony A. Stans, Nathan C. Hull, Hamlet A. Peterson, A. Noelle Larson
Background: The Green-Anderson (GA) leg-length data remain the gold standard for the age-based assessment of leg lengths in children despite their methodologic weaknesses. We aimed to summarize current growth trends among a cross-sectional cohort of modern U.S. children using quantile regression methods and to compare the median femoral and tibial lengths of the modern U.S. children with those of
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Emerging Minimally Invasive Percutaneous Procedures for Periacetabular Osteolytic Metastases J. Bone Joint. Surg. (IF 5.3) Pub Date : 2023-03-15 Izuchukwu Ibe, Christopher M. Dussik, Alexandra K. Callan, Jennifer Barr, Francis Y. Lee
➤ Periacetabular osteolytic skeletal metastases are frequently associated with pain and impaired ambulatory function. Minimally invasive techniques allow for the restoration of ambulation without interrupting critical systemic cancer therapy. ➤ The open surgical management of massive periacetabular osteolytic lesions, such as by curettage, internal fixation, or complex total hip reconstruction, is
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Perioperative Essential Amino Acid Supplementation Facilitates Quadriceps Muscle Strength and Volume Recovery After TKA: A Double-Blinded Randomized Controlled Trial J. Bone Joint. Surg. (IF 5.3) Pub Date : 2023-03-01 Hideki Ueyama, Narihiro Kanemoto, Yukihide Minoda, Yoshiki Taniguchi, Hiroaki Nakamura
Background: Perioperative essential amino acid (EAA) supplementation suppresses lower-limb muscle atrophy and promotes functional improvement in the first 4 weeks after total knee arthroplasty (TKA). However, its effect on the recovery of muscle volume and strength in the intermediate term is unclear. The aim of this study was to evaluate the effect of perioperative EAA supplementation on the recovery
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Efficacy of a Modified Cocktail for Periarticular Local Infiltration Analgesia in Total Knee Arthroplasty: A Prospective, Double-Blinded, Randomized Controlled Trial J. Bone Joint. Surg. (IF 5.3) Pub Date : 2023-03-01 Qiuru Wang, Chengcheng Zhao, Jian Hu, Ting Ma, Jing Yang, Pengde Kang
Background: Periarticular local infiltration analgesia (LIA) is largely utilized for controlling pain after total knee arthroplasty (TKA). The present work aimed to assess the efficacy of a modified LIA cocktail for patients undergoing TKA. Methods: Magnesium sulfate (MgSO4) and sodium bicarbonate (NaHCO3) were added to a conventional LIA cocktail comprising ropivacaine, epinephrine, and dexamethasone
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Catastrophic Health Expenditure in Patients with Lower-Extremity Orthopaedic Trauma J. Bone Joint. Surg. (IF 5.3) Pub Date : 2023-03-01 Jody M. Law, Madison Brody, Katherine E. Cavanaugh, Christopher J. Dy
Background: Health-care expenditures are a leading contributor to financial hardship in the United States. Traumatic orthopaedic injuries are unpredictable and result in substantial expense. Our objectives were to quantify the catastrophic health expenditure (CHE) risk of patients with orthopaedic trauma and to examine the impact of insurance status, socioeconomic status, sex, and race on CHE. Methods:
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Lactate Mediates the Bone Anabolic Effect of High-Intensity Interval Training by Inducing Osteoblast Differentiation J. Bone Joint. Surg. (IF 5.3) Pub Date : 2023-03-01 Zhenglin Zhu, Yi Chen, Jing Zou, Shengqiang Gao, Dandong Wu, Xuelun Li, Ning Hu, Jinzhong Zhao, Wei Huang, Hong Chen
Background: High-intensity interval training (HIIT) reportedly improves bone metabolism and increases bone mineral density (BMD). The purpose of the present study was to investigate whether lactate mediates the beneficial effects of exercise on BMD, bone microarchitecture, and biomechanical properties in an established osteoporotic animal model. In addition, we hypothesized that lactate-induced bone
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Conversion to Arthroplasty After Internal Fixation of Nondisplaced Femoral Neck Fractures: Results from a Swedish Register Cohort of 5,428 Individuals 60 Years of Age or Older J. Bone Joint. Surg. (IF 5.3) Pub Date : 2023-03-01 Johan Lagergren, Sebastian Mukka, Olof Wolf, Emma Nauclér, Michael Möller, Cecilia Rogmark
Background: Although most nondisplaced or minimally displaced femoral neck fractures are routinely treated with internal fixation, high rates of secondary surgical procedures are common, especially in the elderly population. Primary arthroplasty in elderly patients has been proposed as an alternative treatment to reduce the need for a secondary surgical procedure. The objective of this study was to
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Lateral Patellar Instability J. Bone Joint. Surg. (IF 5.3) Pub Date : 2023-03-01 Véronique Drapeau-Zgoralski, Brendan Swift, Andrew Caines, Alicia Kerrigan, Sasha Carsen, Michael Pickell
➤ Patellar instability represents a common problem with an evolving understanding and multifactorial pathoetiology. Treatment plans should be based on the identification of contributing anatomical factors and tailored to each individual patient. ➤ Risks for recurrent instability are dependent on several patient-specific factors including patella alta, increased tibial tubercle-to-trochlear groove (TT-TG)
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What’s Important (Arts & Humanities): The Gothic and the Grotesque—Romanticizing Deformity in Verdi’s Rigoletto J. Bone Joint. Surg. (IF 5.3) Pub Date : 2023-03-01 Michael J. Moses, Themistocles S. Protopsaltis
Rigoletto, composed by Giuseppe Verdi, is one of the most commonly performed operas around the world. At the time of its 1851 premiere in Venice, the work was remarkable for its portrayal of a main character with a spinal deformity. Through the music of Rigoletto, Verdi explored the societal tensions surrounding physical deformity in the 19th century, providing valuable lessons about the importance
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Influence of Scan Parameters of Single and Dual-Energy CT Protocols in Combination with Metal Artifact Suppression Algorithms for THA: An ex Vivo Study J. Bone Joint. Surg. (IF 5.3) Pub Date : 2023-02-27 Gilbert M. Schwarz, Stephanie Huber, Christian Wassipaul, Maximilian Kasparek, Lena Hirtler, Jochen G. Hofstaetter, Till Bader, Helmut Ringl
Background: Metal artifacts caused by hip arthroplasty stems limit the diagnostic value of computed tomography (CT) in the evaluation of periprosthetic fractures or implant loosening. The aim of this ex vivo study was to evaluate the influence of different scan parameters and metal artifact algorithms on image quality in the presence of hip stems. Methods: Nine femoral stems, 6 uncemented and 3 cemented
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Presentation and Surgical Management of Multiple Ligament Knee Injuries: A Multicenter Study from the Surgical Timing and Rehabilitation (STaR) Trial for MLKIs Network J. Bone Joint. Surg. (IF 5.3) Pub Date : 2023-02-24 Kathleen M. Poploski, Andrew D. Lynch, Travis C. Burns, Christopher D. Harner, Bruce A. Levy, Brett D. Owens, Dustin L. Richter, Robert C. Jr. Schenck, Volker Musahl, James J. Irrgang, the STaR Trial for Multiple Ligament Knee Injuries Network
Background: Multiple ligament knee injuries (MLKIs) represent a spectrum of injury patterns that are often associated with concomitant musculoskeletal and neurovascular injuries, complex treatment, and postoperative complications. However, there has not been high-level evidence describing the presentation and treatment of MLKIs. The purpose of this multicenter retrospective study was to describe characteristics
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An Interrupted Time Series Analysis Measuring the Impact of Research and Education on Clinical Practice: Decreasing Allograft Use in Young Patients Using a Registry to Track Outcomes J. Bone Joint. Surg. (IF 5.3) Pub Date : 2023-02-22 Gregory B. Maletis, Heather A. Prentice, Ronald W.B. Wyatt, Elizabeth W. Paxton, Tadashi T. Funahashi
Background: We sought to evaluate whether allograft utilization for primary anterior cruciate ligament reconstruction (ACLR) within our health-care system changed following the implementation of an allograft reduction intervention and whether revision rates within the health-care system changed following the initiation of the intervention. Methods: We conducted an interrupted time series study using
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Oxidation in Retrieved, Never-Irradiated UHMWPE Bearings: What Can We Learn About in Vivo Oxidation? J. Bone Joint. Surg. (IF 5.3) Pub Date : 2023-02-15 Barbara H. Currier, Kori C. Jevsevar, Douglas W. Van Citters
Background: Published analyses of never-irradiated, ethylene oxide (EtO)-sterilized tibial inserts and EtO- and gas plasma (GP)-sterilized acetabular ultra-high molecular weight polyethylene (UHMWPE) retrievals demonstrated minimal UHMWPE in vivo oxidation, whereas another analysis of EtO-sterilized acetabular liners found elevated oxidation linked with in vivo stresses. This study explored whether
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Expectant Management, Tendon Transfer, or Nerve Transfer Surgery for Radial Nerve Injury: A Qualitative Study Exploring Patient Expectations, Goals, and Treatment Experiences J. Bone Joint. Surg. (IF 5.3) Pub Date : 2023-02-16 Adam Lieberdorfer, Nirmala Shivakumar, Macyn M. Stonner, David M. Brogan, Wilson Z. Ray, Susan E. Mackinnon, Christopher J. Dy
Background: After a radial nerve injury, patients must weigh a complicated set of advantages and disadvantages to observation or surgery. We conducted semistructured interviews to characterize the decision-making process that these patients undertake. Methods: We recruited participants who were treated with expectant management (nonoperatively), received only a tendon transfer, or received a nerve
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Post-Maturity Progression in Adolescent Idiopathic Scoliosis Curves of 40° to 50° J. Bone Joint. Surg. (IF 5.3) Pub Date : 2023-02-15 Sze-Hon Yu, Cheuk-Man Ng, Jason Pui-Yin Cheung, Graham Ka-Hon Shea
Background: Adolescent idiopathic scoliosis (AIS) curves of 50° to 75° are inclined to progress and are thus indicated for surgery. Nevertheless, the natural history of curves of 40° to 50° following skeletal maturity remains uncertain and presents a clinical dilemma. The aim of this study was to determine the prevalence, rate, and prognostic indicators of curve progression within this patient group
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Demographic and Socioeconomic Determinants Are Associated with Poor Preoperative Patient-Reported Pain and Function in Primary TKA: A Cohort Study of 14,079 Patients J. Bone Joint. Surg. (IF 5.3) Pub Date : 2023-02-15 Jose Vega, Ahmed K. Emara, Melissa Orr, Alison K. Klika, Nicolas S. Piuzzi, the Cleveland Clinic Arthroplasty Group*
Background: Pain and function, as reflected by patient-reported outcome measures (PROMs), can influence improvement after total knee arthroplasty (TKA) and can reflect the extent of patient access to orthopaedic surgical care. We aimed to (1) categorize patients according to pain and function PROM phenotypes, (2) identify patient characteristics associated with poor preoperative pain and function
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Effect of Fibular Allograft Augmentation in Medial Column Comminuted Proximal Humeral Fractures: A Randomized Controlled Trial J. Bone Joint. Surg. (IF 5.3) Pub Date : 2023-02-15 Qiuke Wang, Ning Sheng, Jen-Tai Huang, Hongyi Zhu, Maimaitiaili Tuerxun, Zesong Ruan, Tingwang Shi, Yu Zhu, Yunlong Zhang, Biyu Rui, Lei Wang, Yunfeng Chen
Background: Previous observational studies and meta-analyses have recommended augmentation with a fibular allograft (FA) during the treatment of proximal humeral fractures with locking plates (LPs). However, to our knowledge, randomized controlled trials comparing open reduction and internal fixation (ORIF) with and without FA have not been performed to date. Methods: This was a randomized controlled
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Short-Term Indwelling Foley Catheters Do Not Reduce the Risk of Postoperative Urinary Retention in Uncomplicated Primary THA and TKA: A Randomized Controlled Trial J. Bone Joint. Surg. (IF 5.3) Pub Date : 2023-02-15 Matthew T. Weintraub, JaeWon Yang, Denis Nam, Joshua A. Greenspoon, Anne DeBenedetti, Vasili Karas, Neal Mehta, Craig J. Della Valle
Background: The purpose of this randomized controlled trial was to determine whether a short-term Foley catheter (inserted in the operating room and removed upon arrival to the orthopaedic floor) would reduce the risk of postoperative urinary retention (POUR) in patients undergoing primary total hip (THA) and total knee arthroplasty (TKA). Methods: Three hundred and eighty-eight patients undergoing
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The Markup on Orthopaedic Services: An Analysis of 2014-2019 Medicare Data and the Potential for Surprise Billing J. Bone Joint. Surg. (IF 5.3) Pub Date : 2023-02-15 Robert J. Burkhart, Alexander J. Acuña, Kevin Y. Zhu, Atul F. Kamath
Background: Markups on charges for medical services have the potential to result in “surprise billing,” especially for out-of-network and uninsured patients. Although previously analyzed in other surgical subspecialties, the distribution and level of cost-to-charge ratios (CCRs) for orthopaedic services have yet to be studied. Therefore, our analysis sought to evaluate the CCRs for orthopaedic surgery
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Comparative Effectiveness of Total Hip Arthroplasty and Hemiarthroplasty for Femoral Neck Fracture: A Propensity-Score-Matched Cohort Study J. Bone Joint. Surg. (IF 5.3) Pub Date : 2023-02-09 Mina Tohidi, Stephen M. Mann, Michael A. McIsaac, Patti A. Groome
Background: The optimal treatment of older patients with a displaced femoral neck fracture remains a controversial topic. This study aimed to compare clinical outcomes across a matched group of patients with a femoral neck fracture treated with either hemiarthroplasty or total hip arthroplasty (THA). Methods: Routinely collected health-care databases were linked to create a population-based cohort
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Clavicular Fractures in the Adolescent J. Bone Joint. Surg. (IF 5.3) Pub Date : 2023-02-08 Midhat Patel, Benton E. Heyworth, Niloofar Dehghan, Charles T. Mehlman, Michael D. McKee
➤ Current evidence suggests that the majority of clavicular fractures in adolescents can and should be treated nonoperatively. ➤ Although rare, in certain patients or fracture patterns, nonoperative management may be associated with delayed healing, prolonged disability, and/or poor functional outcome requiring secondary reconstruction. ➤ When warranted, primary open reduction and internal fixation
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Comparison of Functional Recovery Between Unicompartmental and Total Knee Arthroplasty: A Randomized Controlled Trial J. Bone Joint. Surg. (IF 5.3) Pub Date : 2023-02-01 Boonchana Pongcharoen, Pongsathorn Liengwattanakol, Krit Boontanapibul
Background: Comparisons of functional recovery between unicompartmental knee arthroplasty (UKA) and total knee arthroplasty (TKA) using performance-based tests are lacking. Therefore, this study aimed to compare 2-minute walk test (2MWT) and Timed Up-and-Go test (TUG) results between UKA and TKA for isolated medial knee osteoarthritis (OA). We hypothesized that UKA yields faster functional recovery
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Primary Closure or Secondary Wound Healing of Pin Sites After External Fixator Removal: A Single-Center Blinded Randomized Controlled Trial J. Bone Joint. Surg. (IF 5.3) Pub Date : 2023-02-01 Franz Tillmann, Ruben J. Hoepelman, Flavio Cagienard, Björn-Christian Link, Reto Babst, Bryan J.M. van de Wall, Frank J.P. Beeres
Background: The aim of this single-center randomized controlled trial was to compare primary wound closure using a suture with secondary wound healing of pin sites after removal of temporary external fixation. Methods: This noninferiority trial included all patients who were treated with a temporary external fixator on an upper or lower extremity at 1 institution. The primary outcome was pin-site
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Surgical Treatment of Single-Level Lumbar Stenosis Is Associated with Lower 2-Year Mortality and Total Cost Compared with Nonsurgical Treatment: A Risk-Adjusted, Paired Analysis J. Bone Joint. Surg. (IF 5.3) Pub Date : 2023-02-01 Raymond W. Hwang, Catherine M. Briggs, Scott D. Greenwald, Paul J. Manberg, Nassib G. Chamoun, Scott G. Tromanhauser
Background: Spine surgery has demonstrated cost-effectiveness in reducing pain and restoring function, but the impact of spine surgery relative to nonsurgical care on longer-term outcomes has been less well described. Our objective was to compare single-level surgical treatment for lumbar stenosis, with or without spondylolisthesis, and nonsurgical treatment with respect to patient mortality, resource
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Neurological Survivorship Following Surgery for Degenerative Cervical Myelopathy: A Longitudinal Study on 195 Patients J. Bone Joint. Surg. (IF 5.3) Pub Date : 2023-02-01 Victor Hin Ting Yick, Changmeng Zhang, Janus Siu Him Wong, Samuel Yan Lik Ng, Nicholas San Tung Wong, Hongfei Wang, Paul Aarne Koljonen, Graham Ka Hon Shea
Background: Long-term data on postoperative neurological survivorship for patients with degenerative cervical myelopathy (DCM) undergoing decompressive surgery are limited. The purposes of this study were to assess neurological survivorship after primary decompressive surgery for DCM and to identify predictors for postoperative deterioration. Methods: A longitudinal clinical data set containing surgical
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Comparison of “Human” and Artificial Intelligence Hand-and-Wrist Skeletal Age Estimation in an Epiphysiodesis Cohort J. Bone Joint. Surg. (IF 5.3) Pub Date : 2023-02-01 Dylan G. Kluck, Marina R. Makarov, Yassine Kanaan, Chan-Hee Jo, John G. Birch
Background: We previously demonstrated that the White-Menelaus arithmetic formula combined with skeletal age as estimated with the Greulich and Pyle (GP) atlas was the most accurate method for predicting leg lengths and residual leg-length discrepancy (LLD) at maturity in a cohort of patients treated with epiphysiodesis. We sought to determine if an online artificial intelligence (AI)-based hand-and-wrist
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Early Joint Use Following Elbow Dislocation Limits Range-of-Motion Loss and Tissue Pathology in Posttraumatic Joint Contracture J. Bone Joint. Surg. (IF 5.3) Pub Date : 2023-02-01 Alex J. Reiter, Hayden R. Schott, Ryan M. Castile, Paul C. Cannon, Necat Havlioglu, Aaron M. Chamberlain, Spencer P. Lake
Background: Simple elbow dislocation occurs at an incidence of 2.9 to 5.21 dislocations per 100,000 person-years, with as many as 62% of these patients experiencing long-term elbow joint contracture, stiffness, and/or pain. Poor outcomes and the need for secondary surgical intervention can often be prevented nonoperatively with early or immediate active mobilization and physical therapy. However,
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No Benefit of Adductor Canal Block Compared with Anterior Local Infiltration Analgesia in Primary Total Knee Arthroplasty: A Single-Blinded Randomized Controlled Clinical Trial J. Bone Joint. Surg. (IF 5.3) Pub Date : 2023-02-01 Caroline Pic, Caroline Macabeo, Emran Waissi, Philippe Lasselin, Mahé Raffin, Pierre Pradat, Laure Lalande, Sebastien Lustig, Frederic Aubrun, Mikhail Dziadzko
Background: An adductor canal block (ACB) performed by an anesthesiologist is an established component of analgesia after total knee arthroplasty. Alternatively, surgeons may perform periarticular local infiltration analgesia (LIA) intraoperatively. We hypothesized that ACB would be superior to anterior LIA in terms of morphine consumption in the first 48 hours after primary total knee arthroplasty
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Orthostatic Intolerance-Type Events Following Hip and Knee Arthroplasty: A Systematic Review and Meta-Analysis J. Bone Joint. Surg. (IF 5.3) Pub Date : 2023-02-01 Tarcisio F. de Campos, Nick Vertzyas, Mitch Wolden, Deshitha Hewawasam, Ben Douglas, Christopher McIllhatton, Jessica Hili, Chloe Molnar, Michael I. Solomon, Gregory C. Gass, Sean F. Mungovan
Background: Orthostatic intolerance (OI)-type events following hip and knee arthroplasty increase the risk of falls, hospital length of stay, and health-care costs. There is a limited understanding of the incidence of and risk factors for OI-type events in patients during the acute hospital stay. Our aim was to systematically review the incidence of and risk factors for OI-type events during the acute
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The Role of Dual-Mobility Components in Total Hip Arthroplasty J. Bone Joint. Surg. (IF 5.3) Pub Date : 2023-02-01 Theodore T. Manson, Murillo Adrados, Jeremy M. Gililland, Bilal M. Mahmood, Linsen T. Samuel, Joseph T. Moskal
➤ Dual mobility (DM) refers to a now widely available option for total hip articulation. DM implants feature a small inner head, a hard bearing, that connects via a taper fit onto the femoral trunnion. This head freely rotates but is encased inside a larger, outer polyethylene head that articulates with a smooth acetabular component. ➤ DM acetabular components are available in the form of a monoblock
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A Framework and Blueprint for Building Capacity in Global Orthopaedic Surgical Outreach J. Bone Joint. Surg. (IF 5.3) Pub Date : 2023-02-01 Lauren M. Shapiro, Jessica M. Welch, Maya Chatterjee, Julie A. Katarincic, Fraser J. Leversedge, George S.M. Dyer, Duretti T. Fufa, Scott H. Kozin, Kevin C. Chung, Paige M. Fox, James Chang, Robin N. Kamal
Background: Nongovernmental organizations (NGOs) from high-income countries provide surgical outreach for patients in low and middle-income countries (LMICs); however, these efforts lack a coordinated measurement of their ability to build capacity. While the World Health Organization and others recommend outreach trips that aim to build the capacity of the local health-care system, no guidance exists
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A Novel Surgical Classification for Extremity and Pelvic Hemophilic Pseudotumors: The PUMCH Classification J. Bone Joint. Surg. (IF 5.3) Pub Date : 2023-01-27 Ziquan Li, Ke Xiao, Xiao Chang, Xi Zhou, Yanyan Bian, Baozhong Zhang, Yong Liu, Peng Gao, Bin Feng, Xisheng Weng
Background: A hemophilic pseudotumor (HPT) is a rare and challenging complication of hemophilia for which there is no classification system that provides uniformity of descriptions or that can be used to guide management. We have developed such a classification based on anatomical site, HPT severity, and corresponding surgical treatment. Methods: The PUMCH (Peking Union Medical College Hospital)
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Outcomes of Periacetabular Osteotomy for Borderline Acetabular Dysplasia J. Bone Joint. Surg. (IF 5.3) Pub Date : 2023-01-18 Jeffrey J. Nepple, Frank W. Parilla, Gail E. Pashos, John C. Clohisy
Background: The optimal surgical treatment (hip arthroscopy compared with periacetabular osteotomy [PAO]) for borderline acetabular dysplasia (lateral center-edge angle [LCEA], 18° to 25°) remains a topic of debate. To date, the literature has focused primarily on arthroscopy outcomes, with only a few small reports on PAO outcomes. The purpose of this study was to define PAO outcomes in a large cohort
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Allograft Versus Bioactive Glass (BG-S53P4) in Pediatric Benign Bone Lesions: A Randomized Clinical Trial J. Bone Joint. Surg. (IF 5.3) Pub Date : 2023-01-19 Johanna Syvänen, Willy Serlo, Jenni Jalkanen, Ia Kohonen, Arimatias Raitio, Yrjänä Nietosvaara, Ilkka Helenius
Background: Benign bone cysts in children have a high risk of recurrence after bone grafting. The optimal treatment and filling material for these lesions are currently unknown. Methods: We compared cyst recurrence after intralesional curettage and filling with allograft versus bioactive glass (BG-S53P4; Bonalive) in a randomized clinical trial. The volume of recurrent cyst at 2-year follow-up was
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Nonoperative Versus Operative Treatment for Displaced Finger Metacarpal Shaft Fractures: A Prospective, Noninferiority, Randomized Controlled Trial J. Bone Joint. Surg. (IF 5.3) Pub Date : 2023-01-18 Fredrik Peyronson, Cecilia Stalberg Ostwald, Nils P. Hailer, Grey Giddins, Torbjörn Vedung, Daniel Muder
Update This article was updated on January 18, 2023, because of a previous error, which was discovered after the preliminary version of the article was posted online. On page 103, in the first column of Table III, the continuous outcomes, which had been given as “Median” and “(range)”, are now given as “Mean” and “(95% CI)”, respectively. Background: Finger metacarpal fractures represent up to 31%
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Time to Positivity of Cultures Obtained for Periprosthetic Joint Infection J. Bone Joint. Surg. (IF 5.3) Pub Date : 2023-01-18 Saad Tarabichi, Graham S. Goh, Luigi Zanna, Qudratullah S. Qadiri, Colin M. Baker, Thorsten Gehrke, Mustafa Citak, Javad Parvizi
Background: Despite its well-established limitations, culture remains the gold standard for microbial identification in periprosthetic joint infection (PJI). However, there are no benchmarks for the time to positivity (TTP) on culture for specific microorganisms. This study aimed to determine the TTP for pathogens commonly encountered in PJI. Methods: This retrospective, multicenter study reviewed
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Mechanical Failures in Magnetic Intramedullary Lengthening Nails J. Bone Joint. Surg. (IF 5.3) Pub Date : 2023-01-18 Larysa P. Hlukha, Hamza M. Alrabai, Oliver C. Sax, Ahmed I. Hammouda, Philip K. McClure, John E. Herzenberg
Background: Magnetic intramedullary lengthening nails (MILNs) have gained popularity in recent years for the treatment of limb-lengthening discrepancies. We sought to catalog mechanical failures and their prevention and management in a large, single-institution series. We specifically assessed the rate of mechanical failures, the types of failures observed, and management strategies. Methods: We
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Fracture in Patients with Normal Bone Mineral Density: An Evaluation of the American Orthopaedic Association’s Own the Bone Registry J. Bone Joint. Surg. (IF 5.3) Pub Date : 2023-01-18 Aamir Kadri, Neil Binkley, Scott D. Daffner, Paul A. Anderson
Background: Fractures often occur in patients with normal dual x-ray absorptiometry (DXA)-measured bone mineral density (BMD). DXA does not consider clinical fracture risk factors or bone quality. We hypothesized that patients with normal BMD who sustain a fracture have other characteristics suggesting abnormal bone and an elevated fracture risk requiring additional bone health evaluation and potential
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Does Choice of Patellar Implant in Total Knee Arthroplasty Matter?: A Randomized Comparative Trial of 3 Commonly Used Designs J. Bone Joint. Surg. (IF 5.3) Pub Date : 2023-01-18 Monther A. Gharaibeh, Payam Tarassoli, Darren B. Chen, Jil A. Wood, Scott Beuzeville, Richard Quinn, Ian A. Harris, Samuel J. MacDessi
Background: There is currently a lack of evidence to identify the optimal patellar implant design in total knee arthroplasty (TKA). The aim of this study was to assess clinical, intraoperative, radiographic, and scintigraphic differences between inlay (IN), onlay round (OR), and onlay oval (OO) patellar implants. Methods: A parallel-group, double-blinded, randomized trial compared IN, OR, and OO
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The Reverse Fragility Index: Interpreting the Current Literature on Long-Term Survivorship of Computer-Navigated Versus Conventional TKA: A Systematic Review and Cross-Sectional Study of Randomized Controlled Trials J. Bone Joint. Surg. (IF 5.3) Pub Date : 2023-01-18 Jeffrey L. Shi, Edward S. Mojica, Michael A. Moverman, Nicholas R. Pagani, Richard N. Puzzitiello, Mariano E. Menendez, Matthew J. Salzler, Matthew Gordon, James V. Bono
Background: Despite the most recent American Academy of Orthopaedic Surgeons clinical practice guideline making a “strong” recommendation against the use of intraoperative navigation in total knee arthroplasty (TKA), its use is increasing. We utilized the concept of the reverse fragility index (RFI) to assess the strength of neutrality of the randomized controlled trials (RCTs) comparing the long-term
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AOA Critical Issues Symposium: Deficit Recovery for the Orthopaedic Service Line J. Bone Joint. Surg. (IF 5.3) Pub Date : 2023-01-18 Charles S. Day, Charles A. Goldfarb, Lisa L. Lattanza, Maxwell T. Yoshida, L. Scott Levin
The COVID-19 pandemic and the mandated cessation of surgical procedures for a substantial portion of the 2020 year placed tremendous strain, both clinically and financially, on the health-care system in the United States. As a surgical specialty that accounts for nearly a quarter of all hospital net income, the revenue recovery of orthopaedic service lines (OSLs) is of particular importance to the