Orthopaedic Surgeons Research Articles

Survey of postoperative practices for lumbar spinal stenosis surgery among canadian spinal surgeons and rehabilitation professionals.

Survey of postoperative practices for lumbar spinal stenosis surgery among canadian spinal surgeons and rehabilitation professionals.

Nationwide analysis of pelvic and acetabular fracture surgeries in Japan: The impact of aging and healthcare resources.

Nationwide analysis of pelvic and acetabular fracture surgeries in Japan: The impact of aging and healthcare resources.

Registration of carpometacarpal arthroplasty in the Dutch arthroplasty register: Impacting factors and participation.

Registration of carpometacarpal arthroplasty in the Dutch arthroplasty register: Impacting factors and participation.

Classification of endoscopic spine procedures.

Classification of endoscopic spine procedures.

Recommendations for Culturally Competent Orthopaedic Care of Muslim Patients.

The growing cultural diversity in the patient populations in the United States highlights the necessity for improved cultural competence in healthcare, specifically for the estimated 3.45 million Muslims living in the country. Islam is one of the fastest-growing religions in the world, and the Muslim population in the United States is predicted to grow markedly. Such a demographic trend provides a compelling rationale to address this community's cultural and orthopaedic treatment peculiarities. Based on these estimates, US orthopaedic surgeons will highly likely care for Muslim patients during their careers. Islamic traditions can influence various aspects of daily life for Muslim patients, including health-related practices, with the degree of adherence varying widely among individuals. For a healthcare professional, it is vital to apprehend fundamental Islamic beliefs because this will help attend to patients' needs individually and respectfully and avoid possible harm in some cases. This article seeks to spread awareness among orthopaedic providers regarding fundamental Islamic beliefs and practices that may affect patient care, providing practical recommendations for accommodating Muslim patients across various healthcare settings.

Anti-Osteoporotic Treatment Reduces Risk of Revision Following Total Shoulder Arthroplasty in Patients with Osteoporosis

Anti-Osteoporotic Treatment Reduces Risk of Revision Following Total Shoulder Arthroplasty in Patients with Osteoporosis

Pediatric patients with tenosynovial giant cell tumor: Real-world results from an observational registry.

11544 Background: Tenosynovial giant cell tumor (TGCT) is a rare, locally aggressive tumor originating in the synovial lining of the joint, bursa, and tendon sheath. Since TGCT typically impacts individuals 20-50 years of age, pediatric TGCT is ultra-rare. However, pediatric patients are often not included in clinical trials or prospective data. Real-world data are needed to understand the impact of TGCT on pediatric patients’ quality of life and any differences between adults with TGCT. Methods: The TGCT Support Registry is an international, prospective registry initiated in 2022 by TGCT Support, a program of The Life Raft Group. The registry is the largest registry of patients with TGCT and records patient-reported demographic, pathologic, clinical information. This cross-sectional analysis presents data of patients ≤ 18 years of age at time of enrollment with Diffuse (D)-TGCT, Localized (L)-TGCT, or unknown subtype. Results: A total of 122 pediatric patients (9.5%) were included from a 1,278-patient registry (Table). Most patients were female (67.2%), had D-TGCT (73.0%), in the knee (83.6%), and a median age at diagnosis of 14.5 years. Symptoms reported were pain (94.3%), limited joint range of motion (89.3%), and swelling (84.4%). >50% of pediatric patients were initially misdiagnosed and were more likely to be misdiagnosed than adults (62.3% vs 49.9%, p < 0.01). 64.8% of pediatric patients were diagnosed by orthopedic surgeons, and 52.5% were diagnosed ≥1 years after symptom onset. Half of pediatric patients had joint aspirations to manage symptoms (47.5%) and non-steroidal anti-inflammatories were common (76.2%). Surgery was the predominant treatment modality and 61.5% reported that surgery occurred ≤ 3 months of diagnosis. Pediatric patients with D-TGCT underwent an average of 3.4 surgeries, compared to 1.8 surgeries for those with L-TGCT. 66.3% of pediatric patients with D-TGCT had ≥1 post-operative recurrence compared to 15.0% of L-TGCT pediatric patients. Most pediatric patients were referred to general orthopedic surgeons (80.3%), only a third consulted an oncology specialist, and 35.3% were also treated by pediatricians. Systemic therapies (i.e., imatinib, nilotinib, pexidartinib) were prescribed infrequently to pediatric patients with D-TGCT (17.2%). Pediatric patients reported that pain often interfered with daily activities and enjoyment of life. Conclusions: This real-world analysis highlights the significant disease burden of pediatric TGCT, as compared to adults, which severely affecting their quality of life. The reliance on surgical treatment and underuse of multidisciplinary care emphasizes the unmet need for provider education and treatment advancements tailored to this population. Greater efforts to develop systemic therapies specific to pediatrics are warranted to reduce recurrence rates and improve quality of life. Characteristics of patients stratified by subtype (localized, diffuse, or unknown), including sex, age, region, location of disease, misdiagnosis, duration from symptom onset to diagnosis, average surgeries, recurrences, and use of systemic therapies. Diffuse(n=89, 73.0%) Localized(n=20, 16.4%) Unknown(n=13, 10.6%) Total(N=122) Female sex, n (%) 59 (66.3) 14 (70.0) 9 (69.2) 82 (67.2) Median age at Diagnosis, years (range) 14 (3 - 17) 15 (4 - 17) 14.5 (7 - 15) 14.5 (3 - 17) Median age at Enrollment, years (range) 16 (4-18) 17 (6-18) 15 (10-18) 16 (4-18) Located in the US, n (%) 47 (52.8) 11 (55.0) 4 (30.8) 62 (50.8) Location of disease, n (%) Knee 76 (85.4) 16 (80.0) 10 (76.9) 102 (83.6) Hip 8 (9.0) 4 (20.0) 1 (7.7) 13 (10.7) Ankle 5 (5.6) 0 (0.0) 0 (0.0) 5 (4.1) Other a 0 (0.0) 0 (0.0) 2 (15.4) 2 (1.6) Misdiagnosis, n (%) 56 (62.9) 10 (50.0) 10 (76.9) 76 (62.3) Time from Symptom Onset to Diagnosis, n (%) <12 months 42 (47.1) 8 (40.0) 4 (30.8) 54 (44.3) 12–24 months 24 (27.0) 5 (25.0) 3 (23.1) 32 (26.2) 25–60 months 14 (15.7) 4 (20.0) 3 (23.1) 21 (17.2) >60 months 6 (6.7) 3 (15.0) 2 (15.4) 11 (9.0) Diagnosed during Surgery 3 (3.4) 0 (0.0) 1 (7.7) 4 (3.3) Average surgeries, (SD) Median 3.4 (2.8)2 1.8 (1.5)1 1 (1.2)1 2.9 (2.5)2 Systemic Therapy, Check all that apply Pexidartinib Imatinib Nilotinib 20 (22.5)7 (7.9)12 (13.5)1 (1.1) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 1 (7.7)1 (7.7)0 (0.0)0 (0.0) 21 (17.2)8 (7.4)12 (9.8)1 (0.8) Local Recurrences, n (%) Yes 1 Recurrence ≥ 2 Recurrences 59 (66.3)19 (21.3)40 (44.9) 3 (15.0)2 (10.0)1 (5.0) 4 (3.8)1 (7.7)3 (23.1) 66 (54.1)22 (18.0)44 (36.1) No I have not had surgery I am unsure 30 (33.7)12 (13.5)8 (9.0) 17 (85.0)2 (10.0)4 (20.0) 9 (69.2)5 (38.5)1 (7.7) 56 (45.9)19 (15.6)13 (10.7)

Kellgren-Lawrence grading of knee osteoarthritis using deep learning: Diagnostic performance with external dataset and comparison with four readers.

Kellgren-Lawrence grading of knee osteoarthritis using deep learning: Diagnostic performance with external dataset and comparison with four readers.

A systematic review of the association between early comprehensive geriatric assessment and outcomes in hip fracture care for older people

AimsPerformance indicators are increasingly used to improve the quality of healthcare provided to hip fracture patients. Joint care, under orthopaedic surgeons and physicians with an interest in older patients, is one of the more common indicators of high-quality care. In this systematic review, we investigated the association between ‘comprehensive geriatric assessment’ and patient outcomes following hip fracture injury.MethodsIn total, 12 electronic databases and other sources were searched for evidence, and the methodological quality of studies meeting the inclusion criteria was assessed. The protocol for this suite of related systematic reviews was registered with PROSPERO (ID: CRD42023417515).ResultsA total of 24,591 articles were reviewed, and 39 studies met the inclusion criteria for the review, involving a total of 25,363 patients aged over 60 years with a hip fracture. There were five randomized clinical trials, three quasi-experimental studies, two non-randomized parallel group control trials, 22 pre-/post-intervention studies, and seven retrospective cohort studies, conducted between January 1992 and December 2021. The timing and content of a comprehensive geriatric assessment was ill-defined in many studies and care pathways were heterogeneous, which precluded meta-analysis of the data. Early comprehensive geriatric assessment was associated with improved outcomes in 31 of the 36 (86%) patient-reported outcomes, including improved mobility (acute/long-term), functional status, and better quality of life. In total, 155 out of 219 (70.78%) clinical outcomes derived from hospital records showed a positive association with early comprehensive geriatric review, including reduced preoperative time and length of hospital stay, reduced incidence of postoperative complications, fewer hospital readmissions, and lower mortality.ConclusionEarly comprehensive geriatric assessments after hip fracture in older people is associated with improved patient-reported outcomes and better clinical outcomes such as reduced incidence of complications, length of hospital stay, preoperative waiting time, and mortality. Standardization of the definitions of ‘early’ and ‘comprehensive’ geriatric assessments and consistent reporting of care pathway models would improve future evidence synthesis.Cite this article: Bone Joint J 2025;107-B(6):595–603.

An AI-based system for fully automated knee alignment assessment in standard AP knee radiographs.

Accurate assessment of knee alignment in pre- and post-operative radiographs is crucial for knee arthroplasty planning and evaluation. Current methods rely on manual alignment assessment, which is time-consuming and error-prone. This study proposes a machine learning-based approach to fully automatically measure anatomical varus/valgus alignment in standard anteroposterior (AP) knee radiographs. We collected a training dataset of 566 pre-operative and 457 one-year post-operative AP knee radiographs from total knee arthroplasty patients, along with a separate test set of 376 patients. The distal femur and proximal tibia/fibula were manually outlined using points to capture the knee joint. The outlines were used to develop an automatic system to locate the points. The anatomical femorotibial angle was calculated using the points, with varus/valgus defined as negative/positive deviations from zero. Fifty test images were clinically measured on two occasions by an orthopaedic surgeon. Agreement between points-based manual, automatic, and clinical measurements was assessed using intra-class correlation coefficient (ICC), mean absolute difference (MAD) and Bland-Altman analysis. The agreement between automatic and manual measurements was excellent pre-/post-operatively with ICC 0.98/0.96 and MAD 0.8°/0.7°. The agreement between automatic and clinical measurements was excellent pre-operatively (ICC: 0.97; MAD: 1.2°) but lacked performance post-operatively (ICC: 0.78; MAD: 1.5°). The clinical intra-observer agreement was excellent pre-/post-operatively with ICC 0.99/0.95 and MAD 0.9°/0.8°. The developed system demonstrates high reliability in automatically measuring varus/valgus alignment pre- and post-operatively, and shows excellent agreement with clinical measurements pre-operatively. It provides a promising approach for automating the measurement of anatomical alignment.

The Impact of Obesity on Postoperative and Perioperative Outcomes in Lumbar Spine Surgery, a Systematic Review and Meta Analysis.

The Impact of Obesity on Postoperative and Perioperative Outcomes in Lumbar Spine Surgery, a Systematic Review and Meta Analysis.

Plate vs. Nail: Is there a more effective implant for extreme tibia fractures?

Plate vs. Nail: Is there a more effective implant for extreme tibia fractures?

Outpatient Total Joint Arthroplasty at an Ambulatory Surgical Center: An Analysis of Failure to Launch

Outpatient Total Joint Arthroplasty at an Ambulatory Surgical Center: An Analysis of Failure to Launch

Patient-Physician Racial Concordance Increases Likelihood of Total Knee Arthroplasty Recommendation

Patient-Physician Racial Concordance Increases Likelihood of Total Knee Arthroplasty Recommendation

Proposal for a New Treatment Algorithm for Proximal Humerus Fractures based on a Clinical Survey among 340 Surgeons

Proposal for a New Treatment Algorithm for Proximal Humerus Fractures based on a Clinical Survey among 340 Surgeons

Comparative effectiveness of bone, cartilage and osteochondral xenograft (calf fetal) on healing of the critical bone defect in a rabbit model.

Comparative effectiveness of bone, cartilage and osteochondral xenograft (calf fetal) on healing of the critical bone defect in a rabbit model.

Antegrade ESIN technique via the Kocher interval reduces radiation exposure and accelerates recovery in pediatric DRDMJ fractures: A comparative study with cadaveric validation.

Antegrade ESIN technique via the Kocher interval reduces radiation exposure and accelerates recovery in pediatric DRDMJ fractures: A comparative study with cadaveric validation.

Spine surgeon conflict of interest disclosure discrepancies between a national conference and the open payments database.

Spine surgeon conflict of interest disclosure discrepancies between a national conference and the open payments database.

Risk Analysis Index for Estimation of 30-Day Postoperative Mortality in Hip Fractures

Hip fractures present a substantial public health challenge, with projections of more than 500 000 per year by 2040. As such, frailty indices such as the Revised Risk Analysis Index (RAI) and the Modified Five-Item Frailty Index (mFI-5) have been recently investigated as metrics for preoperative risk stratification for these patients. To understand the accuracy of frailty, as measured by the RAI and the mFI-5, for estimating 30-day mortality following surgically managed hip fractures. This retrospective cross-sectional analysis used the American College of Surgeons' National Surgical Quality Improvement database. Patients aged 65 years old with surgically managed traumatic hip fracture from 2015 to 2019 were included. Frailty was evaluated using the RAI, a 5-domain scale with 14 weighted variables graded from 0 to 81, and the mFI-5, a 2-domain scale with 5 unweighted variables graded from 0 to 5; for both, a higher score denotes worse frailty. Data collection occurred from May to June 2024. Diagnosis of hip fracture and undergoing surgical fixation, hemiarthroplasty, or total hip arthroplasty. The primary outcome was 30-day mortality. Multivariable regression was conducted to assess the estimating value of frailty scales. Discriminatory accuracy was assessed using a receiver operating characteristic curve and quantified using a C-statistic. The cohort consisted of 114 359 patients (70 038 female [69.9%]; median [IQR] age, 84 [77-89] years) with 51 071 prefrail patients (44.7%) according to the mFI-5 and 31 883 very frail patients (27.9%) according to the RAI comprising the largest frailty groups. Increasing frailty status was associated with greater odds ratio (OR) for 30-day mortality for both the mFI-5 (prefrail OR, 1.35 [95% CI, 1.24-1.47]; frail OR, 2.11 [95% CI, 1.94-2.30]; severely frail OR, 3.53 [95% CI, 3.20-3.90]; P < .001 for all) and RAI (normal OR, 1.55 [95% CI, 1.35-1.79]; frail OR, 2.97 [95% CI, 2.59-3.42]; very frail OR, 6.17 [95% CI, 5.38-7.08]; P < .001 for all). The RAI demonstrated superior discriminatory accuracy for 30-day mortality compared with the mFI-5 (area under the receiver operating characteristic curve, 0.73 [95% CI, 0.72-0.73] vs 0.61 [95% CI, 0.60-0.62]; P < .001). In this cross-sectional study of 114 359 patients, the RAI demonstrated superior odds and discriminatory accuracy for estimating 30-day mortality following surgical management of hip fractures. The RAI may be considered as a risk stratification tool for orthopedic surgeons to adjunct surgical planning, thereby reducing postoperative mortality.

How Does CMS' Merit-based Incentive Payment System Penalize or Reward Orthopaedic Surgeons Caring for Socially At-risk Patients?

How Does CMS' Merit-based Incentive Payment System Penalize or Reward Orthopaedic Surgeons Caring for Socially At-risk Patients?