共找到 20 条结果
暂无摘要（点击查看详情）
Unicompartmental knee arthroplasty (UKA) is an effective treatment for unicompartmental end-stage knee arthritis. Simultaneous bilateral UKAs for patients with bilateral knee arthritis can reduce costs, number of anesthetics, and overall rehabilitation time. It is unknown how the long-term outcomes of unilateral and simultaneous bilateral UKAs compare. In total, 1,939 unilateral and 1,939 simultaneous bilateral medial mobile-bearing UKAs (n = 3,878) from the National Joint Registry were propensity score matched. Kaplan-Meier and Cox regression were used to compare implant survival, revision indications, and mortality. The 10-year implant survival in the simultaneous bilateral group was 92% (95% confidence interval [CI] 90-94) and in the unilateral group was 90% (95% CI 88-92). The simultaneous bilateral group had a lower revision risk (hazard ratio [HR] 0.73, p = 0.01). Revisions for pain were lower in the bilateral group (0.5% vs. 1.2%, p = 0.01). There were no differences in patient mortality. Subgroup analyses found similar trends in 10-year implant survival and revision risk with both cementless (simultaneous bilateral 98% CI 95-99; unilateral 95% CI 91-98; HR 0.66, p = 0.27) and cemented fixation (simultaneous bilateral 91% CI 89-93; unilateral 90% CI 88%-92%; HR 0.85, p = 0.28). Simultaneous bilateral UKAs had better 10-year implant survival and similar mortality to compared with single-unilateral UKAs. For patients with severe symptomatic bilateral unicompartmental knee osteoarthritis, simultaneous bilateral UKAs could be considered to be a safe and effective procedure, particularly as only one operation and postoperative recovery is required. Level IV. See Instructions for Authors for a complete description of levels of evidence.
[This corrects the article DOI: 10.2106/JBJS.OA.25.00278.].
[This corrects the article DOI: 10.2106/JBJS.OA.25.00200.].
Large Language Models (LLMs) are increasingly used for health information, but concerns exist regarding performance disparities for non-English speakers, potentially exacerbating health inequities. Appropriate information is critical for patients with limited English proficiency undergoing orthopedic procedures such as total hip arthroplasty (THA). This pilot study evaluated differences in the clinical reliability of English and Spanish responses to common THA questions generated by leading LLMs. Three widely accessible LLMs (ChatGPT-4o, Gemini 2.0 Flash, and Microsoft Copilot) were evaluated using 10 standardized frequently asked questions on THA, posed in English and Spanish. Responses were independently graded by language-fluent medical experts using a 4-point rubric (1 = Unsatisfactory to 4 = Excellent) assessing clinical reliability and appropriateness. Nonparametric statistics, including Wilcoxon signed-rank, Kruskal-Wallis, and effect sizes (Cliff's Delta, η2), were used for comparisons. A statistically significant main effect of language was found (p = 0.014, η2 = 0.151), indicating significantly lower clinical reliability scores for Spanish responses in all LLMs. A nonsignificant within-model score decline was observed across all 3 LLMs. Leading LLMs exhibit significant difference in clinical reliability when providing THA information, performing less reliably in Spanish compared with English. This linguistic gap suggests a potential risk for difference in response interpretation and could potentially worsen health inequities for Spanish-speaking populations. Efforts are needed to improve multilingual capabilities and manage biases in medical artificial intelligence (AI). Clinicians and patients should exercise caution when using LLMs for health information in languages other than English until cross-lingual reliability is demonstrably improved. This study highlights a significant linguistic disparity in AI-generated health information for THA. Improving LLMs' multilingual capabilities is essential to promote equitable access to reliable medical education and prevent the exacerbation of health inequities for non-English speaking patients. Level IV. See Instructions for Authors for a complete description of levels of evidence. This study evaluates LLMs in providing THA information in English and Spanish, revealing that Spanish responses are clinically less reliable. The findings highlight linguistic gap in AI healthcare tools, raising potential concerns for patient safety, and widening health inequities for non-English speakers.
Total knee arthroplasty (TKA) is the treatment of choice for end-stage knee osteoarthritis in many patients. In younger patients with predominantly medial compartment disease, high tibial osteotomy (HTO) is performed as a joint-preserving treatment. However, concerns remain regarding potentially compromised outcomes of TKA after previous HTO given the axial deviation, osteotomy site, secondary surgery, previous hardware, and instrumentation. Therefore, this study compared long-term implant survival, revision, and infection rates, and patient-reported outcomes between patients undergoing TKA after HTO and matched TKA-only controls. Postoperative complications and revision surgeries were prospectively recorded in patients who underwent TKA from 2000 to 2023 at a single academic center. Patients with previous ipsilateral HTO formed the study group and were propensity matched 1:2 to TKA-only patients without a previous osteotomy based on age, sex, and body mass index. Knee Society Scores (KSS) were collected prospectively. Implant survivorship was analyzed using Kaplan-Meier survival curves and Cox proportional hazards models. The study included 134 HTO-TKA and 268 matched TKA-only patients, with a mean follow-up of 10.5 ± 6.4 years (range: 0-24 years) after TKA. Both groups showed significant postoperative improvements in KSS (p < 0.02) with comparable clinical outcomes (HTO-TKA: 79.0 (6.0), TKA-only: 79.0 (11.8)). Revision arthroplasty rates were 5.2% for HTO-TKA and 4.5% for TKA-only (p = 0.69); the mean time to revision was 8.1 ± 8.7 years vs. 4.4 ± 3.5 years, respectively (p = 0.30). Infection rates were 2.2% and 1.1%, respectively (p = 0.74). Revision and infection rates were comparable between HTO-TKA and matched TKA-only patients, with no statistically significant differences. Our findings demonstrate comparable patient-reported outcomes in both groups. These findings indicate that a previous HTO does not adversely affect TKA implant longevity or clinical outcomes when compared with matched primary TKA patients within the US population. Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
Conversion total hip arthroplasty (THA) is performed as a salvage operation for patients who develop symptomatic posttraumatic arthritis following open reduction internal fixation (ORIF) of displaced acetabular fractures. Historically, high failure rates in this patient population were related to acetabular loosening. Recent studies, however, have demonstrated improved outcomes with modern techniques. This study aims to evaluate the outcomes and survivorship of early conversion THA after high-energy acetabular fractures at our institution. A retrospective review was performed of all patients who underwent acetabular ORIF and subsequent conversion THA at a Level I trauma center between 2002 and 2022. Patients with less than 1 year follow-up after conversion THA without complication were excluded. Patient demographics, injury characteristics, perioperative details of ORIF and THA, complications, and subsequent reoperations and revisions were recorded. A total of 144 cases were included. The average age was 51.3 years at the time of ORIF with transverse posterior wall (46.5%) and posterior wall (30.6%) fracture patterns predominating. The median time from ORIF to conversion THA was 1.1 years (interquartile range [IQR], 0.7-1.8). Complications occurred in 47 THAs (32.6%), with dislocation (n = 19, 13.2%) and periprosthetic joint infection (n = 17, 11.8%) being the most common. The reoperation and revision rate following conversion THA was 21.5% and 18.1%, respectively. The median time from conversion THA to revision THA was 0.5 years (IQR, 0.1-1.3), with 69.2% of revisions occurring within the first year. Early conversion THA following acetabular ORIF in our cohort was associated with a marked rate of complication and revision surgery. Although aseptic loosening was less prevalent, instability and infection rates were significant concerns. These findings underscore the need for continued improvements in managing this challenging patient population. Level III. See Instructions for Authors for a complete description of levels of evidence.
Slipped capital femoral epiphysis (SCFE) is a common pediatric hip disorder primarily managed with transphyseal screw fixation. Opioid pain medication is often used postoperatively, but there is little evidence to guide prescribing practices. The purpose of this study was to describe opioid utilization and prescribing practices for patients after screw fixation of SCFE. This was a prospective observational study of patients with SCFE who underwent transphyseal screw fixation. Patients and guardians were contacted on postoperative days 1, 3, and 5 for data collection. Postdischarge analgesic use, pain severity using a parental proxy, and pain control satisfaction were recorded. Patients who underwent surgical osteotomy or open reduction, patients with cognitive disability, or patients who had other injuries impeding accurate pain assessments were excluded. Of the 34 patients recruited for the study, 91.2% (31/34) of patients were prescribed opioid medications. Of these 31 patients, 4 were lost to follow-up (87% follow-up). In total, 266 opioid doses were prescribed and 28 were used (p < 0.0001). On average, patients were prescribed 9.85 ± 3.8 opioid doses but used an average of 0.77 ± 1.27 opioid doses (p < 0.0001). Sixty percent of patients did not use any of their prescribed opioid medication, and 90% were satisfied with their pain postoperatively. In addition, 90% of prescribed opioid doses went unused. There was no significant difference in pain control between patients who took opioids and those who did not for each postoperative day. Analysis of opioid use distribution demonstrated that a prescription of 3 doses postoperatively would be sufficient for greater than 95% of all patients. Overprescription of opioids occurs following screw fixation of SCFE, introducing oversupply into the population. Most patients do excellently with minimal opioid use and have low levels of pain. With adequate nonopioid analgesia counseling and use, outpatient opioid prescriptions following screw fixation of SCFE should be limited. If providers elect to prescribe opioids, we recommend prescribing no more than 3 doses following screw fixation of SCFE. Level II. See Instructions for Authors for a complete description of levels of evidence.
Plate fixation in skeletally immature children can cause angular deformity with longitudinal growth even when the plate does not overlie the adjacent physis. While this phenomenon has been described for the distal femur, angular deformity has not been reported following plating in other long bones. The aim of the study was to characterize whether sagittal-plane deformity occurs following volar plating of radius fractures in skeletally immature children and to determine associated risk factors. A retrospective review of volar plating of acute radius fractures in children with an open distal radius physis at a single institution was completed. In patients with at least 4 months of follow-up, the first radiograph and the last follow-up radiograph were evaluated for any change in sagittal angulation distal to the plate. Demographic information was obtained from the electronic medical record. Linear regression analysis was used to determine if distance from the plate to the physis, follow-up time, age, or coexisting ulnar fracture was predictive of any observed changes in angulation. Sixty-one acute radius fractures treated with volar plating at a mean age of 12.1 years (67% male, 70.5% White, 90.2% non-Hispanic) were included. When analyzing by fracture location, 78% (21/27) of the distal-third radius fractures with appropriate follow-up developed at least 10° of apex volar angular deformity, with 44% (12/27) exhibiting greater than 20°. Middle-third and proximal-third fractures did not exhibit similar degrees of angulation (only 13% [4/30] and 0% [0/4] of included patients developed more than 10° of deformity, respectively). Linear regression analysis revealed distance of the plate to the physis and follow-up time to be strong predictors of angulation (both p < 0.0001). Children with radius fractures, particularly those in the distal-third, treated with a volar plate may develop apex volar angular deformity. While the exact rate of this phenomenon is unclear, these findings underscore the importance of strict surgical indications and vigilant postoperative monitoring beyond fracture healing, and represent a paradigm shift in understanding growth modulation following plating. Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
Antidepressants are commonly prescribed in patients undergoing total joint arthroplasty. While depression influences recovery, the association between perioperative antidepressant use and opioid-related outcomes remains unclear. Given the opioid crisis, we examined whether antidepressant exposure around surgery is independently associated with postoperative opioid abuse after total knee (TKA) and hip arthroplasty (THA), along with systemic and prosthetic complications over short-term and long-term follow-up. We conducted a retrospective cohort study using the TriNetX Research Network (2005-2025). Adults undergoing elective primary TKA or THA were identified using International Classification of Diseases-10/current procedural terminology codes. Patients with antidepressant prescriptions within 3 months before or after surgery were compared with nonusers. Propensity score matching (1:1) balanced demographics, comorbidities, and concurrent medications. Outcomes included opioid abuse diagnoses, opioid prescribing, systemic complications, and prosthetic failures at 90 days and 5 years. Odds ratios (ORs) with 95% CIs were calculated. After matching, 90-day cohorts included 106,516 TKA patients and 46,227 THA patients per group; 5-year cohorts included 44,251 TKA and 16,019 THA patients per group. Despite modest prescribing differences, antidepressant use was associated with higher opioid-abuse diagnoses. At 90 days: TKA 0.10% vs. 0.02% (OR 4.3) and THA 0.12% vs. 0.02% (OR 5.7). At 5 years: TKA 0.74% vs. 0.12% (OR 6.0) and THA 0.42% vs. 0.09% (OR 4.5). Antidepressant users also had increased systemic and prosthetic complications, including prosthetic joint infection, periprosthetic fracture, and revision. Perioperative antidepressant use is independently associated with increased postoperative opioid abuse and higher complication rates after TKA and THA. These findings support preoperative psychiatric screening, medication review, multimodal pain strategies, and closer monitoring to mitigate opioid-related harm in vulnerable arthroplasty patients. Level III. See Instructions for Authors for a complete description of levels of evidence.
Gender-based reimbursement disparities in orthopedic surgery remain poorly understood, particularly when accounting for practice composition and setting. The purpose of this study was to compare and evaluate gender-based differences in Medicare reimbursement and practice patterns among female and male orthopedic surgeons. A cross sectional analysis of public Medicare data from 2013 to 2021 was performed. Outcomes included annual Medicare payments, submitted charges, total services, service categories, and beneficiaries treated by orthopedic surgeons who bill Medicare. Univariate and multivariable analyses quantified differences in payment, practice volume and composition, geographic adjustment, and Current Procedural Terminology (CPT)-matched reimbursements. A total of 29,357 orthopedic surgeons (27,442 men and 1,919 women) billed Medicare fee-for-service during the study period. Female surgeons, on average, submitted 48.3% fewer total charges and received 44.1% lower annual Medicare payments per surgeon compared with male surgeons. These differences persisted after multivariable regression adjusted for practice metrics and excluded top and bottom earners. Female surgeons also billed fewer services, treated fewer beneficiaries, and submitted fewer unique CPT codes. However, payment disparities persisted even after matching surgeons by volume of services, beneficiaries, and years in practice. Male surgeons performed higher volumes of all 10 highest-paying orthopedic CPT codes. In CPT matched analyses, female surgeons received lower reimbursement per service than male surgeons performing identical procedures. These findings suggest that the observed gender-based disparities in orthopedic surgery Medicare reimbursement cannot be explained by differences in volume, procedural mix, or geographic practice cost. Instead, they likely reflect a combination of structural and behavioral mechanisms described in prior literature that may influence how access to clinical opportunities, referrals, and reimbursement practices unfold in surgical practices. Variations in coding practices may represent an important focus for future investigation and targeted educational initiatives. Level III, Retrospective Cohort Study. See Instructions for Authors for a complete description of levels of evidence.
Orthopaedic Surgery remains one of the most competitive medical specialties to successfully match into. Historically, the United States Medical Licensing Examination Step 1 score was a major determinant of match success. Since its conversion to pass/fail status in January 2022, uncertainty has emerged regarding how programs mentor and advise applicants. The purpose of this study was to examine the changes in Orthopaedic Surgery applicant characteristics before the transition from a scored examination (2017-2022) to a pass/fail examination (2023-2025). The authors accessed the Texas Seeking Transparency in Application to Residency survey database, which contains survey information from graduating medical students nationwide regarding residency application characteristics. Characteristics of matched versus unmatched applicants between 2017 to 2022 and 2023 to 2025 were compared. A total of 1,652 Orthopaedic Surgery applicants responded to the survey from 2017 to 2025 (data collected in May 2025). Since the incorporation of a pass/fail Step 1, Step 2 scores and research productivity has increased, volunteerism has decreased, and other academic metrics have remained unchanged. Applicants demonstrated shifts in characteristics without a corresponding change in match rates. From 2023 to 2025, applicants bolstered Step 2 performance and research output as primary differentiators in the absence of a numerical Step 1 score. Traditional academic markers such as class rank, clerkship performance, and Alpha Omega Alpha membership remained stable, while volunteer and leadership involvement declined moderately over the same period. These findings provide evidence-based guidance for navigating the Orthopaedic Surgery selection process in the postnumerical Step 1 era.
This randomized controlled trial evaluates low-dose oral corticosteroids for improving pain and function after total knee arthroplasty (TKA), leveraging their potent anti-inflammatory effects. A total of 102 patients who underwent primary unilateral TKA were randomized to receive either 400 mg of celecoxib plus 10 mg of oral prednisolone daily or 400 mg of celecoxib alone. Oral medications started after discharge (24-48 hours after surgery) and continuing for 2 weeks. Follow-up visits were conducted at 1, 2, 4, 12, and 24 weeks postsurgery. The Visual Analog Scale, range of motion (ROM), Knee Society Score, Oxford Knee Score, and sleep quality were evaluated. Demographic data were similar, except for age, with celecoxib alone group being older (p = 0.005). The celecoxib + prednisolone group experienced significantly lower Visual Analog Scale pain scores at 1 week (mean difference [MD]: -0.81; 95% confidence interval [CI]: -1.59 to -0.03) and 2 weeks (MD: -0.99; 95% CI: -1.87 to -0.09) postoperatively. Age-adjusted results confirmed the reduction in pain with a slight difference, although it was not statistically significant. Knee function scores showed statistically significant improvement in the celecoxib + prednisolone group at 2 weeks (MD: 12.96; 95% CI: 0.21-26.13). Improvement in knee function scores was reduced by about half in age-adjusted analysis and was not statistically significant (MD: 6.25, p = 0.35). ROM demonstrated significant difference at 4 weeks (MD: 6.66; 95% CI: 0.44-12.86). Sleep quality showed significant improvement in the celecoxib + prednisolone group at 2 weeks (MD: 0.84; 95% CI: 0.05-1.64). Improvement was clinically confirmed by controlling for the effect of age with borderline significance. Uncertainty was observed due to wide CIs in some results. Oral low-dose prednisolone administered early after TKA resulted in significant reductions in pain and improvements in sleep quality, ROM, and Knee Society Score during the early postoperative period. However, these improvements did not consistently reach the minimal clinically important difference. Adjusted analyses accounting for age suggested modest benefits, but wide CIs and small effect sizes warrant cautious interpretation. To optimize dosing regimens and assess the long-term effects of oral corticosteroids in TKA recovery protocols, large-scale randomized controlled trials are necessary. Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.
Postoperative hyponatremia (sodium level <135 mEq/L) is common among total joint arthroplasty (TJA) patients. However, its impact on TJA outcomes remains unclear. Our study aimed to evaluate the relationship between postoperative hyponatremia and adverse outcomes following TJA. A retrospective review was conducted of patients undergoing inpatient primary and revision TJA between 2010 and 2023 at a large tertiary care center. Patients were segregated based on their preoperative and postoperative sodium (pre/post) status: normonatremic/normonatremic (Group 1; n = 3,441), normonatremic/hyponatremic (Group 2; n = 830), and hyponatremic/hyponatremic (Group 3; n = 110). Multivariate regression analyses controlling for age, sex, body mass index, Charlson Comorbidity Index score, operative time, and procedure type were performed to evaluate the risk of 90-day adverse medical and surgical outcomes. Compared with Group 1, Group 2 had a significantly higher risk of any medical complication (odds ratio [OR]: 1.750, 95% confidence interval [CI]: 1.313-2.334; p < 0.001) as well as any other complication (OR: 1.629, 95% CI: 1.248-2.128; p < 0.001). This was largely driven by an increased risk of acute kidney injury (AKI; OR: 1.982; 95% CI: 1.451-2.709; p < 0.001), with no differences seen for the remaining complications. When excluding AKI, there were no differences in any evaluated complications between Group 1 and Group 2. There were no differences in rates of any surgical complications between evaluated groups (OR: 1.018; 95% CI: 0.552-1.877; p = 0.955). Mild postoperative hyponatremia was associated with a higher risk of AKI as well as medical and overall complications. In the largest series to date, patients with postoperative hyponatremia largely had comparable 90-day outcomes to patients who were normonatremic postoperatively. These findings suggest that asymptomatic mild postoperative hyponatremia may unnecessarily increase resource utilization. These patients may be safely discharged without the additional costs associated with aggressive hyponatremia management. Level III. See Instructions for Authors for a complete description of levels of evidence.
» Arthroplasty outcomes are fundamentally tied to the accuracy of bone preparation and subsequent implant positioning. » Laser bone shaping represents a paradigm shift from mechanical cutting to controlled thermomechanical ablation. » Integration with real-time optical sensing and robotic targeting enables execution of patient-specific surgical plans with unprecedented accuracy and a pathway to autonomous procedures. » Clinical adoption is dependent on achieving clinically relevant bone removal rates and seamless surgical workflow integration. » These capabilities enable bone-preserving resurfacing procedures that move beyond conventional planar reconstruction.
Musculoskeletal (MSK) complaints represent one of the most common reasons for outpatient visits in the United States, yet MSK education within medical school curricula remains variable and often limited. Although institutional factors such as orthopaedic residency affiliation, geographic region, school ranking, and public vs. private status may shape curricular development, their specific influence on MSK instruction is not well understood. This study characterizes the duration and publicly reported features of MSK education across US allopathic medical schools, providing a descriptive overview of the current national landscape. Curricular data were collected from all US allopathic medical schools when publicly available. Additional data collected were (1) presence of affiliated orthopaedic residency, (2) US News & World Report ranking tier, (3) Association of American Medical Colleges (AAMC) four-region and nine-region classifications, and (4) institution type (public vs. private). A total of 157 US allopathic medical schools were reviewed. Of these, 78 schools reported an extractable numerical MSK curriculum duration, while 39 schools listed MSK content without providing a discrete curriculum length ("No Length Listed") and 40 did not report MSK curriculum length in an extractable format ("Not Listed"). Among all schools analyzed, 127 had an affiliated orthopaedic surgery residency program with an average duration of 6.2 weeks for those with extractable data and 30 had no orthopaedic residency affiliation with an average duration of 5.5 weeks. MSK curriculum duration data were represented across all US News & World Report ranking tiers and spanned all 4 major US regions as well as all 9 AAMC geographic divisions. Institution type was reported for schools with available data, including both public (mean 5.9 weeks) and private (mean 6.1 weeks) medical schools. Across the institutions reviewed, MSK curriculum duration appeared consistently limited regardless of institutional or regional characteristics. This overall pattern reflects a widespread shortfall in MSK educational exposure and underscores the broader need for clearer expectations and standardized guidance to ensure adequate MSK preparedness among medical students.
The literature comparing patient-reported outcomes of the same patient's primary and revision total knee arthroplasty (TKA) is nonexistent, and comparisons between revision and primary TKA are sparse. We aimed to fill this gap by comparing the Oxford Knee Score (OKS) and satisfaction for the same patient between their primary and revision TKA and assess these by different reasons for revision. We identified an 11,584-patient single-center TKA cohort of whom 382 patients went on to revision during 2005 to 2024. Patients answered OKS and satisfaction questionnaires as part of routine clinic visits, which we assessed preoperatively and postoperatively at years 1, 5, and 10 for both primary and revision TKA. We performed descriptive analyses and used logistic regression to estimate the association between patient characteristics and dichotomous outcomes. Infection was the most common reason for first revision (N = 127) followed by instability, loosening, and stiffness. Patients revised for aseptic loosening/osteolysis reported the highest rates of satisfaction. OKS is lowest for patients revised for stiffness both before and after their revision (mean OKS 18.5 preop, 21.6 at 1 year). Furthermore, most of the patients who were not satisfied after their primary were not satisfied after their revision. Despite the low postrevision OKS, exactly half (50%) of patients revised for stiffness who were not satisfied after their primary TKA, reported being satisfied with their revision. Patients revised after 10 years were more likely to be satisfied a year after their revision than those revised in the first 2 years, odds ratio 9.7 (95% confidence interval 1.2-80.2). Patients who initially had good results and had a late failure of their primary TKA generally fared well after revision, especially when revised for mechanical issues such as aseptic loosening. Patients revised earlier, especially those with stiff knees or who had worse early satisfaction scores, were less likely to see benefits from revision. Level III retrospective cohort study. See Instructions for Authors for a complete description of levels of evidence.
A strong association exists between outcomes of orthopaedic surgery and patients' preoperative mental health. Therefore, population-wide trends and changes in well-being are of great interest to providers. We sought to describe the well-being among patients undergoing orthopaedic surgery before, during, and after the pandemic. Patients who underwent an orthopaedic surgical procedure at 1 specialty hospital in New York City between 2019 and August 2024 were split into prepandemic, pandemic, and postpandemic groups (n = 129,677). Preoperative Patient-Reported Outcome Measurement Information System Scale v1.2-Global Health (PROMIS-GH) mental health (MH) and physical health (PH) scores were analyzed in addition to the proportion of patients with low MH and PH. Demographic and clinical factors associated with low MH/PH were identified. Median PROMIS MH and PH scores declined in the pandemic cohort and remained decreased in the postpandemic cohort. Compared with the prepandemic cohort, the proportion of patients with low MH increased in the pandemic cohort (11% vs. 5%) and increased further in the postpandemic cohort (14%). Compared with the prepandemic cohort, the proportion of patients with low PH increased in the pandemic cohort (37% vs. 25%) and increased further in the postpandemic cohort (40%). Relative to the prepandemic period, the odds of low MH adjusted for demographic, clinical, and social factors were 2.70 for the pandemic period and 3.46 for the postpandemic period; for low PH 1.95 and 2.21, respectively. Factors associated with low MH/PH included preoperative comorbidities, age, sex, ethnicity, insurance type, socioeconomic status, and surgery within the spine service. Our results suggest that mental and physical health among patients undergoing orthopaedic surgery in New York City worsened during the pandemic. In the postpandemic period, mental and physical health has continued to decline with a higher proportion of low MH and low PH compared with prepandemic and pandemic levels. The persistent decline observed past the pandemic period indicates that long-term social and societal factors may be associated with population-wide changes in psychosocial functioning rather than exclusively pandemic-specific determinants. In response to this negative trend, surgeons and institutions should consider additional preoperative supports for patients with diminished well-being. Level III-Retrospective cohort study. See Instructions for Authors for a complete description of levels of evidence.
The growth of value-based purchasing programs has increased interest in understanding risk factors for readmission and preventing unplanned readmissions. The aim of this study was to estimate rates and risk factors for 30-day readmission following inpatient total shoulder arthroplasty (TSA) in Pennsylvania between 2010 and 2018. We examined inpatient TSA between 2010 and 2018 in Pennsylvania using a statewide administrative discharge data set. Readmissions were for any cause and to any hospital in the state, and not only to the operating hospital. Potential risk factors included patient demographics, comorbidities, and discharge destination. Logistic regression was used to identify significant risk factors. Among 14,333 patients receiving TSA, 469 (3.27%) were readmitted within 30 days. Patients admitted on an urgent or emergent basis had 65% greater odds (odds ratio [OR] = 1.65, p = 0.009) than patients treated on an elective basis. While patients covered by commercial insurance had 24% lower odds of readmission (OR = 0.76, p = 0.04), patients covered by Medicaid had twice (OR = 1.95, p = 0.002) the odds of readmission. Relative to patients with no comorbidities, patients with 1 to 2 comorbidities had 54% greater odds (OR = 1.54, p < 0.0001), and patients with 3+ comorbidities had triple the odds (OR = 3.14, p < 0.0001) of readmission within 30 days. Discharge destination was a significant predictor of readmission, with patients discharged with home health having 50% greater odds (OR = 1.49, p < 0.0001) and patients discharged to a skilled nursing facility having more than twice the odds (OR = 2.19, p < 0.0001) of readmission within 30 days. In this statewide analysis, there were several significant risk factors for 30-day readmission following inpatient admission for TSA, many of which may be useful targets for hospitals to prevent costly orthopaedic surgery readmissions. Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
Externally controlled intramedullary lengthening nails (IMNs) have reduced the soft-tissue morbidity associated with external fixation. However, these complex devices introduce specific risks related to their motorized and telescopic mechanisms. Existing literature often conflates structural fatigue fractures with internal mechanism dysfunction. This systematic review aims to analyze the incidence, etiology, and management of intrinsic mechanism failures in lengthening IMNs. A comprehensive search of PubMed, Embase, and Scopus was conducted from January 2000 to July 2025 in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines. The review included human studies reporting mechanism-related failures (e.g., jamming, backtracking, and motor failure) in externally controlled IMNs. Studies describing only structural fatigue fractures or nonexternally controlled devices were excluded (e.g., Intramedullary Skeletal Kinetic Distractor [ISKD]). Data were stratified by implant generation and material. Twenty-nine studies encompassing 2,495 nails were included. The overall reported mechanism-related failure rate was 4.3% (n = 107/2,495). Distinct failure phenotypes emerged based on the implant material. Titanium-alloy nails (PRECICE P1/P2) demonstrated a 4.2% failure rate (n = 74/1,761), predominantly characterized by mechanical jamming or gear slippage due to load-induced yield. Stainless steel nails (STRYDE) exhibited a significantly higher failure rate of 12.9% (n = 12/93), primarily driven by tribocorrosion and biological reactions at the telescopic junction. The FITBONE system had a reported failure rate of 3.3% (n = 21/641). Management required surgical intervention in 97.2% of failure cases, with exchange nailing being the primary salvage strategy (94.4%). Despite the need for reoperation, the target limb length was reportedly achieved in the majority of studies where quantitative outcomes were specified. Mechanism failure in externally controlled lengthening IMNs is a clinically significant complication with a reported incidence of approximately 1 in 24 cases. A material trade-off is evident: Titanium implants are susceptible to mechanical gear yield, whereas stainless steel implants are prone to tribocorrosion-induced failure. While these failures necessitate revision surgery, they typically do not preclude successful limb reconstruction if managed with timely nail exchange. Level III. See Instructions for Authors for a complete description of levels of evidence.