Int Orthop. 2025 Jun 25. doi: 10.1007/s00264-025-06589-y. Online ahead of print.

NO ABSTRACT

PMID:40560219 | DOI:10.1007/s00264-025-06589-y

Int Orthop. 2025 Jun 25. doi: 10.1007/s00264-025-06579-0. Online ahead of print.

ABSTRACT

PURPOSE: To evaluate how changing the native posterior tibial slope (PTS) through implantation of a cemented medial unicompartmental knee arthroplasty (UKA) impacts clinical and radiographic outcomes, specifically whether it correlates with the occurrence of tibial periprosthetic radiolucency or tibial aseptic loosening (AL).

METHODS: This retrospective study analyzed 63 patients with cemented medial UKAs with a minimum follow-up of five years. Patient-reported outcomes (PROMs) included the Oxford Knee Score (OKS). Radiographic parameters assessed were: PTS, mechanical axis, prosthetic joint space height, tibial component obliquity, intraprosthetic divergence, and tibial periprosthetic radiolucency. Partial Pearson correlation and multiple linear regression analyses were used to evaluate the relationship between tibial periprosthetic radiolucency and demographic or radiographic parameters.

RESULTS: Of 63 patients (mean age 68.9 ± 7.9 years, follow-up 62.5 ± 8.8 months), 5 knees (7.9%) demonstrated tibial periprosthetic radiolucency ≥ 2 mm. The mean postoperative PTS change was 3.8 ± 2.6°, mechanical axis change: 2.5 ± 1.8°, prosthetic joint space height: 9.2 ± 3.1 mm, tibial component obliquity: 2.5° ± 3°, and intraprosthetic divergence angle: 5° ± 4°. OKS averaged 43.9 (range 22-48), with a mean knee flexion of 123.4 ± 6.8°. Statistical analysis showed no significant associations between tibial periprosthetic radiolucency and demographics, radiographic parameters, or PROMs. Changes in PTS did not correlate with a range of motion (ROM), PROMs, or radiolucency.

CONCLUSION: In our cohort, the deviation from native PTS following implantation of the cemented tibial component did not show a significant correlation with tibial periprosthetic radiolucency, PROMs, or ROM at mid-term follow-up.

PMID:40560218 | DOI:10.1007/s00264-025-06579-0

Int Orthop. 2025 Jun 25. doi: 10.1007/s00264-025-06591-4. Online ahead of print.

ABSTRACT

PURPOSE: To explore the historical case of Saint Ignatius of Loyola's leg injury and subsequent surgical interventions as a potential early instance of limb lengthening and reconstruction surgery.

METHODS: A detailed analysis of "A Pilgrim's Journey" (Ignatius of Loyola's autobiography) was conducted, focusing on orthopaedic descriptions of his injury and treatments.

RESULTS: In 1521, Íñigo López de Loyola sustained a severe, comminuted open fracture of the tibia due to a cannonball wound during the siege of Pamplona. Initial attempts at reduction were unsuccessful, leading to a non-union with significant deformity and shortening. He underwent a revision surgery, a procedure described as "carnage" and endured without a single lament. Although the fracture eventually united, residual shortening and a prominent bone deformity persisted. Unwilling to accept this disfigurement for social reasons, Ignatius requested a second, highly painful osteotomy to remove the protruding bone followed by continuous traction for "days and days of martyrdom" for progressive lengthening. Crucially, after these arduous treatments, Ignatius was able to walk and even ride a horse again. The only significant residual symptom was swelling in his leg by evening.

CONCLUSION: St. Ignatius of Loyola's case provides a compelling historical account of complex orthopaedic challenges in the early 16th century. The documented surgeries represent remarkably early attempts at managing non-union, deformity, and potentially achieving limb lengthening, predating modern reconstructive techniques by centuries. This historical narrative offers valuable insights into the nascent stages of orthopaedic surgery and highlights how a physical ordeal can profoundly shape one's life path.

PMID:40560217 | DOI:10.1007/s00264-025-06591-4

Injury. 2025 Jun 17:112532. doi: 10.1016/j.injury.2025.112532. Online ahead of print.

ABSTRACT

BACKGROUND: The frequent use of computed tomography (CT) scan in the evaluation of trauma patients has led to an increase in the diagnosis of hemothorax. This study aimed to assess whether a hemothorax volume of <300 ml, as determined by CT imaging, can be managed without tube thoracostomy and to identify the factors that recommend its use.

METHODS: A retrospective observational study was conducted at XXX Trauma Center, including all patients with traumatic hemothorax from June 2014 to January 2020. Patient demographics, injury mechanism, severity, associated chest injuries, indications for tube thoracostomy, mechanical ventilation, hospital length of stay, complications, and outcomes were reviewed. The study compared patients with hemothorax volumes < 300 ml and ≥300 ml and assessed the outcomes of conservative management without tube thoracostomy (conservative management) vs therapeutic management with tube thoracostomy placement (failed observation).

RESULTS: A total of 254 patients with hemothorax were included. Most patients (79 %) were successfully managed without tube thoracostomy insertion, while 53 patients (21 %) required tube thoracostomy after failure of conservative management. Patients with larger hemothorax volumes were significantly more likely to require tube thoracostomy (p = 0.001) and had significantly longer hospital stays (p = 0.021). Those with failed observation had higher injury severity scores (p = 0.001), more associated lung contusions (p = 0.015), pneumothorax (p = 0.024), and rib fractures (p = 0.001). They also had larger hemothorax volumes (p = 0.001), a greater need for mechanical ventilation (p = 0.001), and prolonged hospitalization (p = 0.001). Predictors of failed observation included high hemothorax volume (≥300 ml), ISS, and greater number of fractured ribs.

CONCLUSION: Conservative management (without tube thoracostomy) was adequate for most patients with <300 ml of hemothorax volumes. Quantitative assessment of hemothorax volume should be considered part of the clinical decision-making algorithm. Further research is needed to refine management strategies and improve outcomes for traumatic hemothorax.

PMID:40555636 | DOI:10.1016/j.injury.2025.112532

Injury. 2025 Jun 17;56(8):112529. doi: 10.1016/j.injury.2025.112529. Online ahead of print.

ABSTRACT

INTRODUCTION: Sternal fractures are uncommon but may result in significant morbidity when associated with respiratory compromise or severe pain. Conventional methods such as plate fixation are often invasive and technically challenging.

METHODS: We retrospectively reviewed eight cases of transverse sternal fractures treated using an intramedullary fixation technique with cannulated cancellous screws (CCS). Preoperative computed tomography with 3D reconstruction was used for surgical planning. Reduction was achieved percutaneously or through a limited incision, followed by guidewire insertion and screw fixation.

RESULTS: The minimally invasive procedure was completed in 18-35 min (mean, 22 min) with little blood loss (mean, 23 mL). Among six patients with ventilatory compromise, four were successfully extubated within three days postoperatively. There were no complications related to screw insertion, and bone union was confirmed in all cases.

CONCLUSION: Intramedullary screw fixation represents a safe, minimally invasive, and mechanically robust alternative for the management of sternal fractures, particularly in patients with flail chest or severe pain.

PMID:40554841 | DOI:10.1016/j.injury.2025.112529

Injury. 2025 Jun 18;56(8):112522. doi: 10.1016/j.injury.2025.112522. Online ahead of print.

ABSTRACT

OBJECTIVES: To determine (1) if early routine radiographic follow-up at 2-3 weeks for patients with operatively treated tibia, fibula or ankle fractures identified complications (i.e., complications only visible on radiographs and not associated with symptoms on history taking or clinical examination) and (2) if these complications were clinically relevant (i.e., led to treatment change).

METHODS: All adult patients who underwent operative treatment for a tibia, fibula or ankle fracture between January 2021 and January 2023 and who received early routine radiographic follow-up between 10 and 30 days postoperatively were included in this retrospective case series. Routine radiographs were defined as radiographs that were scheduled and obtained as part of the institution's standardized follow-up protocol. The primary outcome was the rate of complications detected on early routine radiographs, stratified by the presence of associated symptoms based on history taking or findings on physical examination. The secondary outcome was any documented treatment change for complications.

RESULTS: Six hundred and twenty-eight patients (median age of 47 years, 42 % male) were included. A total of 5 complications in 628 patients (0.8 %) were seen on early routine radiographs, of which 3 complications (0.5 %) were exclusively identified on radiographs (i.e., not associated with symptoms). None of these 3 complications led to a change in treatment strategy. The remaining 2 complications were visible on radiographs but were accompanied by symptoms on history taking or physical examination.

CONCLUSION: The results of the current study suggest that radiographs at 2-3 weeks following operative treatment of tibia, fibula or ankle fractures may not need to be ordered routinely. Obtaining radiographs should be guided by clinical indication or by patient and surgeon preference (e.g., for reasons beyond complications). These findings should be considered in light of increasing healthcare expenditures and the time investment required of patients and healthcare professionals.

PMID:40554111 | DOI:10.1016/j.injury.2025.112522

J Bone Joint Surg Am. 2025 Jun 24. doi: 10.2106/JBJS.24.01373. Online ahead of print.

ABSTRACT

Medical slang is commonly used in the orthopaedic community to improve communication, enhance team cohesion, and provide humor in intense work environments. However, when used carelessly, inappropriate terminology can alienate certain groups of physicians. When encountered in clinical settings, these terms can create uncomfortable environments, reduce trust, and discourage trainees from pursuing orthopaedics. To create more inclusive and effective clinical teams, it is important to regularly reassess medical slang and develop alternative terms that are respectful, practical, and consistent. This contemporary article highlights 8 examples of inappropriate terminology that are used in the orthopaedic community, explores their history of use, and suggests more appropriate alternatives.

PMID:40554618 | DOI:10.2106/JBJS.24.01373

J Bone Joint Surg Am. 2025 Jun 24. doi: 10.2106/JBJS.24.01538. Online ahead of print.

ABSTRACT

BACKGROUND: The usage of medial unicompartmental knee arthroplasty (mUKA) is increasing, but concerns remain regarding the risk of early periprosthetic tibial fracture (PPTF), particularly following cementless mUKA. The aims of this study were to compare the risk of PPTF between cemented and cementless mUKAs and to analyze risk factors for early PPTF.

METHODS: Using data from the Danish Knee Arthroplasty Register and the Danish National Patient Registry, all mUKAs from 1997 to 2022 were identified and stratified as cemented or cementless mUKAs. Subsequent fractures were identified through the reason for revision, diagnosis codes, and fracture-specific procedure codes.

RESULTS: This study included 9,700 cemented mUKAs (mean follow-up of 9 years) and 12,380 cementless mUKAs (mean follow-up of 3 years). The 4-month cumulative proportions of PPTF were 0.2% (95% confidence interval [CI], 0.2% to 0.4%) after cemented mUKA and 0.7% (95% CI, 0.6% to 0.9%) after cementless mUKA. Risk factors for early PPTF (≤4 months) were cementless mUKA (hazard ratio [HR], 2.9; 95% CI, 1.6 to 5.5), female sex (HR, 2.6; 95% CI, 1.6 to 4.2), an age of ≥70 years (HR, 4.0; 2.5 to 6.4), body mass index (BMI) of ≥40 kg/m2 (HR, 2.4; 95% CI, 1.0 to 5.8), and a height of <160 cm (HR, 2.2; 95% CI, 1.3 to 3.6). Female patients ≥70 years of age with a BMI of ≥40 kg/m2 and/or a height of <160 cm represented 3% of all mUKAs. In this group, patients with cementless mUKA had a 4-month cumulative proportion of PPTF of 4.5% (95% CI, 2.9% to 6.9%).

CONCLUSIONS: The risk of early, surgery-related PPTF was higher after cementless mUKA compared with cemented mUKA. Risk factors for early PPTF include cementless mUKA, female sex, an age of ≥70 years, a BMI of ≥40 kg/m2, and a height of <160 cm. Our data highlight the need for careful, bone-conserving tibial preparation and consideration of cemented tibial fixation for female patients ≥70 years of age with a height of <160 cm and/or a BMI of ≥40 kg/m2.

LEVEL OF EVIDENCE: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

PMID:40554616 | DOI:10.2106/JBJS.24.01538

Int Orthop. 2025 Jun 23. doi: 10.1007/s00264-025-06590-5. Online ahead of print.

NO ABSTRACT

PMID:40549194 | DOI:10.1007/s00264-025-06590-5

Int Orthop. 2025 Jun 23. doi: 10.1007/s00264-025-06586-1. Online ahead of print.

NO ABSTRACT

PMID:40549193 | DOI:10.1007/s00264-025-06586-1

Injury. 2025 May 22;56(8):112449. doi: 10.1016/j.injury.2025.112449. Online ahead of print.

NO ABSTRACT

PMID:40544747 | DOI:10.1016/j.injury.2025.112449

Injury. 2025 Jun 12:112524. doi: 10.1016/j.injury.2025.112524. Online ahead of print.

ABSTRACT

BACKGROUND: Patients with blunt solid organ injury (BSOI) face heightened thromboembolic risks, prompting scrutiny of early versus late venous thromboembolic (VTE) prophylaxis effects.

METHODS: Analyzing TQIP data (2017-2019) for adults (≥18 years) with severe BSOI under non-operative management and VTE prophylaxis, we classified patients into early (≤48 h) and late (>48 h) prophylaxis groups. We conducted a propensity score matching (PSM) to balance the population based on demographics, organ injury severity, vital signs and need for blood transfusion. Data were compared post-PSM.

RESULTS: Among 23,668 patients, mortality was 3.1 %, with 42.2 % receiving early and 57.8 % late VTE prophylaxis. Early prophylaxis correlated with lower mortality (2.1 % vs. 3.9 %), lower rates of failure of non-operative management (12.4 % vs. 16.6 %), stroke (0.7 % vs. 1.2 %), DVT (2.1 % vs. 4.9 %) and PE (1.4 % vs. 2.3 %) (p < 0.001 for all). Late prophylaxis associated with longer hospitalization and ICU stays (p < 0.001 for both). Post-match data showed that compared to early VTE prophylaxis, patients that received late VTE prophylaxis had higher mortality rates (2.5 % vs. 1.9 %), failure of non-operative management (14.6 % vs. 11.8 %), longer hospital (15.8 (8.7) vs. 12.4 (6.7) days) and ICU (8.9 (4.7) vs. 6.8 (3.4) days) LOS, and higher rates of developing thrombotic complications during hospital stay (p < 0.05, for all).

CONCLUSION: Early VTE prophylaxis not only proves safe for isolated solid organ injury patients but also is associated with lower mortality, mitigating thromboembolic risks and shortening hospital and ICU stays.

LEVEL OF EVIDENCE: Level III retrospective study.

PMID:40544037 | DOI:10.1016/j.injury.2025.112524

Int Orthop. 2025 Jun 20. doi: 10.1007/s00264-025-06585-2. Online ahead of print.

ABSTRACT

BACKGROUND: Shoulder pain is a common reason for patients to seek care from general practitioners or orthopaedic specialists. Prior studies suggest a correlation between acromial morphology and shoulder pathologies. This study aimed to determine acromion characteristics in the Indonesian population and evaluate associations between acromion type, radiographic parameters, sex, and shoulder disorders.

METHODS: A cross-sectional study was conducted on 487 patients with shoulder disorders, using consecutive sampling and data from our institution's radiology database (2020-2021). Acromion morphology was classified using the Bigliani system. Diagnoses were based on clinical and radiological records. Radiographic parameters assessed included critical shoulder angle (CSA), acromion index (AI), lateral acromial angle (LAA), acromioclavicular (AC) joint distance, acromiohumeral (AH) joint distance, and acromial tilt.

RESULTS: Among 487 patients, type II acromion was most common (59.5%), followed by type I (33.3%), type IV (4.5%), and type III (2.7%). Mean CSA was 38.36 ± 5.13, AI 0.72 ± 0.09, LAA 72.52 ± 6.01, AC joint distance 3.18 ± 0.89, AH distance 8.61 ± 1.86, and acromial tilt 28.84 ± 4.52. No significant association was found between acromion type and shoulder disorders (p = 0.34), or between sex and acromion type (p = 0.516). Radiographic parameters also showed no significant correlation with shoulder disorders.

CONCLUSION: Type II acromion was the most prevalent in this Indonesian population. No significant associations were observed between acromion type, sex, or radiographic parameters and shoulder pathologies. Acromial morphology may represent normal anatomical variation rather than a pathological finding.

PMID:40540035 | DOI:10.1007/s00264-025-06585-2

Int Orthop. 2025 Jun 20. doi: 10.1007/s00264-025-06571-8. Online ahead of print.

ABSTRACT

PURPOSES: To compare radiological and clinical outcomes of TiRobot-assisted versus traditional freehand percutaneous anterior column screw fixation for transverse with or without posterior wall fractures of acetabulum based on the Kocher‑Langenbeck (K‑L) approach.

METHODS: Patients suffering transverse with or without posterior wall fractures of acetabulum that were fixed by TiRobot-assisted or traditional freehand percutaneous anterior column screw fixation via the K-L approach were divided into two groups:group A (TiRobot-assisted fixation) and group B (traditional freehand fixation). Surgical time, blood loss, postoperative complications, follow-up length, hospital stay and fracture healing time were recorded. Fracture reduction quality was estimated via criteria described by Matta.Fracture healing was evaluated on the pelvic radiographs at each follow-up. Functional outcomes were examined using the Postel Merle D'Aubigné score system at the final follow-up.

RESULTS: A total of 29 patients who met the inclusion and exclusion criteria were evaluated for eligibility in this study, with 16 patients assigned to group A and 13 to group B.The mean intraoperative blood loss was 581.3 ± 242.8 ml in group A and 761.5 ± 193.8 ml in group B(P < 0.05). The average intraoperative fluoroscopy in group A was 8.3 ± 1.5 times, while that in group B was 12.7 ± 2.0 times(P < 0.001). The mean number of needle adjustments was 0.6 ± 0.6 in group A and 2.0 ± 0.7 in group B(P < 0.001). No signifcant differences in surgical time of the anterior column screw fixation,hospital stay,reduction quality, fracture healing time, complications and functional outcomes were noted between the two groups. It is worth noting that, in TiRobotic-assistance early-stage group the mean surgical time of anterior fracture fixation was 29.3 ± 2.5 min, while it was 19.3 ± 2.2 and 26.7 ± 4.2 min in Tirobotic-assistance late-stage group and freehand group respectively, with a statistically significant inter-group difference (P < 0.001).

CONCLUSIONS: The K‑L approach combined with TiRobot‑aided anterior column screw fixation is a safe and effective option for transverse with or without posterior wall fractures of acetabulum. Compared with traditional freehand percutaneous anterior column screw fixation, TiRobot‑aided screw fixation has obvious advantages on blood loss, invasiveness, screw placement accuracy, patient and physician radiation exposure. Tirobot‑aided screw fixation involves a learning curve. During the initial phase, the surgical time is prolonged due to unfamiliarity with the technology; however, as proficiency improves, the surgical time is significantly reduced compared to traditional freehand technique. The K‑L approach combined with traditional freehand percutaneous anterior column screw fixation can also be a reliable alternative for transverse with or without posterior wall fractures of acetabulum, with the similar reduction quality, complications and functional outcomes.

PMID:40540034 | DOI:10.1007/s00264-025-06571-8

Injury. 2025 Jun 11:112523. doi: 10.1016/j.injury.2025.112523. Online ahead of print.

ABSTRACT

INTRODUCTION: Traumatic brain injury (TBI) is a major contributor to emergency department (ED) visits worldwide, with older adults being particularly susceptible due to fall-related injuries. The widespread use of anticoagulants, including direct oral anticoagulants (DOACs) and vitamin K antagonists (VKAs), raises concerns about the risk of delayed intracranial haemorrhage (dICH), even in cases where the initial head computed tomography (CT) scan shows no abnormalities. The optimal strategies for managing and monitoring these patients remain a subject of ongoing debate.

MATERIALS AND METHODS: We conducted a monocentric retrospective observational study at Santa Croce e Carle Hospital, Cuneo, Italy, from January 2019 to August 2024. We included patients aged ≥18 years, on chronic anticoagulant therapy, presenting with mild TBI (GCS ≥13) and a negative initial CT scan. All patients underwent a second CT after 24 h of observation, regardless of clinical changes. The primary outcome was the incidence of dICH. Secondary outcomes included neurosurgical interventions and 30-day mortality.

RESULTS: The study included 596 patients (median age 83 years; 46.5 % male). Most patients were on DOACs (74.5 %), and falls were the most common trauma mechanism (90.4 %). dICH was diagnosed in 2 % of patients (n = 12), with subarachnoid haemorrhage and subdural hematoma being the most frequent findings (5 patients each). None of the dICH cases required neurosurgical intervention or resulted in mortality at 30 days. Patients with dICH were more likely to have a GCS <15 upon arrival (16.7 % vs. 3.9 %; p = 0.17) and experienced high-energy trauma mechanism, (16.7 % vs. 1.7 %; p = 0.044); among patients with dICH, 41.7 % were on VKA therapy, compared to 25.2 % of patients without dICH (p = 0,33). Complications during hospitalization, primarily nosocomial infections and delirium, occurred in 66 % of patients hospitalized for dICH.

CONCLUSION: Our findings confirm that dICH after TBI in anticoagulated patients with a negative initial CT is rare and typically benign. Routine prolonged observation and repeat CTs may not be necessary for all patients, particularly those without high-risk factors; individualized management based on clinical risk factors could minimize unnecessary hospitalizations, reduce complications, and optimize healthcare resources.

PMID:40537351 | DOI:10.1016/j.injury.2025.112523

J Bone Joint Surg Am. 2025 Jun 19. doi: 10.2106/JBJS.24.01225. Online ahead of print.

ABSTRACT

BACKGROUND: Implant-associated infections (IAIs) require aggressive debridement to eliminate microbial bioburden. The use of irrigants may improve microbial killing during debridement. This study compared the efficacy of surgical irrigants in vitro against Staphylococcus aureus alone and in combination with Candida albicans, in both planktonic and biofilm states.

METHODS: Full-strength Dakin's solution, 0.35% povidone-iodine (PI), 10% PI, 3% hydrogen peroxide (HP), a 1:1 combination of 10% PI and 3% HP (PI + HP), Irrisept, XPERIENCE, Bactisure, and normal saline solution were tested. For planktonic testing, 1 × 106 colony-forming units (CFUs) of S. aureus and C. albicans were utilized, and biofilms were grown in these conditions on 0.8 × 10-mm titanium alloy Kirschner wires for 48 hours. Killing assays were performed using 5-minute dwell times. Success was defined by complete eradication of planktonic or biofilm CFUs.

RESULTS: PI + HP and Bactisure were the only irrigants to eradicate S. aureus in both planktonic and biofilm states. PI + HP was the only irrigant to eradicate polymicrobial S. aureus + C. albicans bioburden in both states.

CONCLUSIONS: PI + HP and Bactisure were superior irrigants against S. aureus, eliminating it in planktonic and biofilm states. PI + HP was the only irrigant to eradicate polymicrobial S. aureus + C. albicans bioburden in both states. In vivo studies are needed to evaluate the clinical effectiveness.

CLINICAL RELEVANCE: Surgical irrigants have variable efficacy in eradicating microbes depending on their state of existence (planktonic versus biofilm). In this study, the most effective eradication of polymicrobial S. aureus + C. albicans bioburden was a 1:1 combination of 10% PI and 3% HP, which is of nominal cost.

PMID:40536949 | DOI:10.2106/JBJS.24.01225

J Bone Joint Surg Am. 2025 Jun 19. doi: 10.2106/JBJS.24.01485. Online ahead of print.

ABSTRACT

BACKGROUND: Patient-level value analysis (PLVA) has been applied to several orthopaedic procedures but has not yet been utilized to assess the value of total knee arthroplasty (TKA). The purpose of this study was to evaluate the 1-year episode of care for TKA with use of PLVA to identify characteristics that influence value at both the patient and surgeon level.

METHODS: The institutional patient-reported outcome (PRO) database was queried for all patients who underwent TKA from 2020 to 2022. Patients were excluded on the basis of an index revision procedure, a pathology other than primary osteoarthritis, unicompartmental knee arthroplasty, robotic-assisted TKA, incomplete baseline or 1-year PROs, concomitant procedures (i.e., bilateral TKA or hardware removal), complications requiring readmission or reoperation, TKA without patellar resurfacing, the use of constrained implants, incomplete cost information, or other hip or knee arthroplasty procedure during the 1-year episode of care. PROs of interest included preoperative and 1-year postoperative Knee injury and Osteoarthritis Outcome Score-Joint Replacement (KOOS-JR) scores. Episode-of-care costs were calculated using time-driven activity-based costing. The 1-year value quotient (VKOOS) was calculated for each patient as the ratio of the 1-year change in KOOS-JR score to the total episode-of-care cost.

RESULTS: A total of 684 patients (62% female; mean age, 68 ± 8 years) met the inclusion criteria. The mean KOOS-JR score significantly increased from baseline (53 ± 11) to 1 year (79 ± 14; p < 0.001), with a mean improvement of 26 ± 16. The mean total episode-of-care cost was $9,563 ± $2,370. There was no significant correlation between episode-of-care costs and the change in KOOS-JR score (r = 0.02; p = 0.581). Surgery performed at an ambulatory surgery center (p < 0.001) and as an outpatient procedure (p = 0.036) were predictive of lower costs. Patient-specific instrumentation (p < 0.001) and a tibial stem extension (p < 0.001) were predictive of higher costs. Older age (p = 0.023) and male sex (p = 0.007) were predictive of less improvement in KOOS-JR scores from baseline to 1 year.

CONCLUSIONS: Our study identified patient and surgical characteristics that drive costs and PROs in TKA. PLVA can be used to identify "bright spots" in orthopaedic procedures to optimize care delivery.

LEVEL OF EVIDENCE: Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.

PMID:40536933 | DOI:10.2106/JBJS.24.01485

J Bone Joint Surg Am. 2025 Jun 19. doi: 10.2106/JBJS.24.01484. Online ahead of print.

ABSTRACT

BACKGROUND: Patient-education materials (PEMs) are essential to improve health literacy, engagement, and treatment adherence, yet many exceed the recommended readability levels. Therefore, individuals with limited health literacy are at a disadvantage. This study evaluated the readability of spine-related PEMs from the American Academy of Orthopaedic Surgeons (AAOS), the North American Spine Society (NASS), and the American Association of Neurological Surgeons (AANS), and examined the potential of artificial intelligence (AI) in optimizing PEMs for improved patient comprehension.

METHODS: A total of 146 spine-related PEMs from the AAOS, NASS, and AANS websites were analyzed. Readability was assessed using the Flesch-Kincaid Grade Level (FKGL) and Simple Measure of Gobbledygook (SMOG) Index scores, as well as other metrics, including language complexity and use of the passive voice. ChatGPT-4o was used to revise the PEMs to a sixth-grade reading level, and post-revision readability was assessed. Test-retest reliability was evaluated, and paired t tests were used to compare the readability scores of the original and AI-modified PEMs.

RESULTS: The original PEMs had a mean FKGL of 10.2 ± 2.6, which significantly exceeded both the recommended sixth-grade reading level and the average U.S. eighth-grade reading level (p < 0.05). ChatGPT-4o generated articles with a significantly reduced mean FKGL of 6.6 ± 1.3 (p < 0.05). ChatGPT-4o also improved other readability metrics, including the SMOG Index score, language complexity, and use of the passive voice, while maintaining accuracy and adequate detail. Excellent test-retest reliability was observed across all of the metrics (intraclass correlation coefficient [ICC] range, 0.91 to 0.98).

CONCLUSIONS: Spine-related PEMs from the AAOS, the NASS, and the AANS remain excessively complex, despite minor improvements to readability over the years. ChatGPT-4o demonstrated the potential to enhance PEM readability while maintaining content quality. Future efforts should integrate AI tools with visual aids and user-friendly platforms to create inclusive and comprehensible PEMs to address diverse patient needs and improve health-care delivery.

PMID:40536932 | DOI:10.2106/JBJS.24.01484

J Bone Joint Surg Am. 2025 Jun 19. doi: 10.2106/JBJS.24.01483. Online ahead of print.

ABSTRACT

BACKGROUND: Computer navigation and patient-specific instrumentation in unicompartmental knee replacement (UKR) improve the precision of implant positioning, but there is limited information regarding their impact on implant survival and patient-reported outcomes. We aimed to compare postoperative implant survival, Oxford Knee Score (OKS) values, health-related quality of life (measured using the EuroQol-5 Dimension 3-level version [EQ-5D-3L]), and intraoperative complications between UKRs performed using computer navigation or patient-specific instrumentation versus conventional instrumentation.

METHODS: Using National Joint Registry data, an observational study of patients who underwent primary UKR for osteoarthritis between 2003 and 2020 was performed. The primary analyses focused on all-cause revision, and the secondary analyses focused on differences in the OKS and EQ-5D-3L at 6 to 12 months postoperatively. To account for several covariates, weights based on propensity scores were generated. Cox proportional hazards models and generalized linear models were used to assess for differences in revision risk, and OKS and EQ-5D-3L change scores, respectively, between patient groups. Sensitivity analyses accounting for body mass index were performed. Effective sample sizes (ESSs) were computed, representing the statistical power comparable with that of an unweighted sample.

RESULTS: Compared with conventional instrumentation, the hazard ratio (HR) for all-cause revision was 1.126 (95% confidence interval [CI], 0.909 to 1.395; p = 0.277; ESS, 4,273) with computer navigation and 0.805 (95% CI, 0.442 to 1.467; p = 0.478; ESS, 1,199) with patient-specific instrumentation. No difference was found in the change in OKS between the groups (-1.287; 95% CI, -2.851 to 0.278; p = 0.107; ESS, 470), although improvement in the EQ-5D-3L scores was relatively lower for computer-navigated UKR compared with conventional instrumentation (-0.049, 95% CI, -0.093 to -0.005; p = 0.028; ESS, 455). However, sensitivity analyses demonstrated that computer navigation was associated with an increased risk of all-cause revision (HR, 1.446; 95% CI, 1.102 to 1.898; p = 0.008; ESS, 3,011) and relatively smaller improvements in the OKS (-2.845; 95% CI, -5.006 to -0.684; p = 0.010; ESS, 272) and EQ-5D-3L scores (-0.087; 95% CI, -0.145 to -0.030; p = 0.003; ESS, 286). There were no differences in intraoperative complications (p = 0.073).

CONCLUSIONS: This study found no clinically meaningful differences in patient-reported outcomes following computer-navigated UKR. Although likely underpowered, the primary analyses showed no difference in implant survival. While a sensitivity analysis suggested that computer navigation could worsen implant survival, this analysis had a smaller sample size. These findings highlight potential signals that warrant further investigation.

LEVEL OF EVIDENCE: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

PMID:40536918 | DOI:10.2106/JBJS.24.01483

Int Orthop. 2025 Jun 19. doi: 10.1007/s00264-025-06582-5. Online ahead of print.

NO ABSTRACT

PMID:40536561 | DOI:10.1007/s00264-025-06582-5