JBJS

Is It Enough? Disclosure of Medical Industry Payments to Orthopaedic Surgery Journal Editors and the Need for Transparency

J Bone Joint Surg Am. 2025 Nov 13. doi: 10.2106/JBJS.24.01623. Online ahead of print.

ABSTRACT

BACKGROUND: Financial conflicts of interest (COIs) are arguably a powerful form of COI in scientific journal publishing. The purposes of this paper were to explore the financial COIs of the 6 most highly ranked U.S.-based orthopaedic surgery journals, to more thoroughly examine financial COIs in the journal with the highest industry payments, and to discuss possible approaches to mitigating the potential negative impact of financial COIs.

METHODS: Two publicly available sources of data were used to characterize editor industry funding: the websites or mastheads of high-impact U.S.-based journals and the Open Payments database from the Centers for Medicare & Medicaid Services.

RESULTS: From 2021 to 2023, the median General and Research Payments per editor varied substantially, from a low of $0 to Clinical Orthopaedics and Related Research editors to $2,735,566 to The Journal of Arthroplasty editors.

CONCLUSIONS: Financial COIs existed for some editors at each of the 6 most highly ranked U.S.-based orthopaedic surgery journals. For The Journal of Arthroplasty, the sixth-highest-ranking journal, the majority of the editors and editorial board members had financial COIs. Adverse journal consequences related to financial COIs could be mitigated by enhancing the transparency of disclosures and prominently displaying journal policies for handling COIs on journal websites.

PMID:41231923 | DOI:10.2106/JBJS.24.01623

A Randomized Controlled Trial of a Conventional Versus Modular Dual-Mobility Bearing: Are Serum Metal Levels a Concern?

J Bone Joint Surg Am. 2025 Nov 13. doi: 10.2106/JBJS.24.01479. Online ahead of print.

ABSTRACT

BACKGROUND: The primary purpose of this randomized controlled trial was to evaluate serum metal levels in patients after total hip arthroplasty (THA) with a conventional compared with a modular dual-mobility bearing. The secondary aim was to compare patient-reported outcome measure (PROM) scores between the 2 cohorts.

METHODS: Patients undergoing primary THA for osteoarthritis were randomized to receive either a modular dual-mobility or conventional polyethylene bearing. All patients received the same titanium acetabular and femoral components and a ceramic femoral head. Serum cobalt and chromium levels were measured preoperatively and annually at 1 through 5 years postoperatively. A total of 53 patients were enrolled. The 2 cohorts did not differ significantly in terms of demographics. In the conventional-bearing cohort, 76% of the patients were White and 24% were Black, African American; 48% of the patients were male and 52% were female. In the dual-mobility cohort, 86% of the patients were White and 14% were Black, African American; 79% of the patients were male and 21% were female.

RESULTS: Forty-one patients who were randomized to a modular dual-mobility (n = 24) or conventional (n = 17) bearing and had a minimum follow-up of 2 years underwent serum metal analysis. No differences in serum cobalt levels (mean, 0.14 ng/mL [range, 0.075 to 0.29 ng/mL] versus 0.21 ng/mL [range, 0.075 to 0.57 ng/mL]; p = 0.22) or chromium levels (mean, 0.14 ng/mL [range, 0.05 to 0.50 ng/mL] versus 0.12 ng/mL [range, 0.05 to 0.35 ng/mL]; p = 0.65) were identified between the modular dual-mobility and conventional cohorts, respectively, at the 2-year postoperative time point.

CONCLUSIONS: There were no significant differences in serum cobalt or chromium levels at 1 and 2 years postoperatively in patients who received a ceramic femoral head and this specific dual-mobility bearing compared with a ceramic head and a conventional acetabular component. While modest expected elevations in postoperative relative to preoperative serum cobalt and chromium levels were observed in the dual-mobility group, in no case did the cobalt level exceed the laboratory reference range or the threshold of 1 ng/mL that has been associated with adverse local tissue reactions due to mechanically assisted crevice corrosion.

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

PMID:41231919 | DOI:10.2106/JBJS.24.01479

Postoperative Abstinence Restores Osseointegration Impaired by Ethanol Consumption in a Murine Tibial Implant Model

J Bone Joint Surg Am. 2025 Nov 13. doi: 10.2106/JBJS.25.00517. Online ahead of print.

ABSTRACT

BACKGROUND: Alcohol negatively affects bone health and fracture repair, yet its effects on implant osseointegration remain poorly understood. This in vivo study utilized a previously developed murine model to evaluate implant osseointegration before and after continuous ethanol consumption.

METHODS: Adult mice were given regular drinking water (control group) or 10% to 15% ethanol in their drinking water for 3 months before undergoing surgical implantation of a load-bearing, porous titanium implant in the proximal tibia. Ethanol consumption was continued until euthanasia at 4 weeks post-implantation (ethanol group) or stopped immediately post-implantation (abstinence group) to mimic postoperative ethanol cessation. Osseointegration was assessed using micro-computed tomography (micro-CT), biomechanical pullout testing, and histological analysis.

RESULTS: Mice with continuous ethanol consumption exhibited significantly reduced peri-implant bone formation, as measured with histology and micro-CT, compared with controls. Biomechanical testing demonstrated a weaker bone-implant interface in the ethanol group compared with controls. In contrast, postoperative abstinence restored the peri-implant bone formation and bone-implant interface strength to levels similar to those in the control group.

CONCLUSIONS: Ethanol consumption compromised implant osseointegration in mice, while postoperative abstinence promoted the recovery of peri-implant bone formation and interface strength.

CLINICAL RELEVANCE: Future clinical studies are needed to assess the impact of preoperative and postoperative abstinence of ethanol on osseointegration of orthopaedic implants.

PMID:41231916 | DOI:10.2106/JBJS.25.00517

Five-Year Radiographic and Clinical Outcomes of Pyrocarbon Hemiarthroplasty for Glenohumeral Arthritis and Osteonecrosis

J Bone Joint Surg Am. 2025 Nov 13. doi: 10.2106/JBJS.25.00163. Online ahead of print.

ABSTRACT

BACKGROUND: This study evaluated the progression of humeral head medialization in patients who underwent pyrocarbon hemiarthroplasty (PyC-HA). The authors hypothesized that glenoid erosion would not dramatically progress between the short-term and final imaging evaluations, and that there would be excellent clinical outcomes at ≥5-year follow-up.

METHODS: Patients who underwent PyC-HA with ≥60 months of follow-up were included in this prospective study. Relevant data included preoperative demographic characteristics, Walch glenoid classification, changes in clinical outcomes, and revision-free and failure-free survival rates. An investigator, who was blinded to patient outcomes, assessed the glenoid morphology, changes in medialization, joint space, acromiohumeral distance (AHD), critical shoulder and β angles, and posterior subluxation in decentered glenoids at the 2-year and final follow-up visits.

RESULTS: Forty-five patients with a mean age of 52 years and a mean follow-up of 73 months met the inclusion criteria. Significant improvements were observed across all outcome measures. The 7-year revision-free survival rate was 95.7%. Posterior subluxation in decentered shoulders decreased from 27.1% preoperatively to 19.8% postoperatively (p = 0.008). The mean medialization of the humeral head was 2.9 ± 2.8 mm at the 2-year follow-up and increased to 4.0 ± 3.3 mm at the time of the final follow-up (p = 0.096). A >2-mm decrease in AHD from early postoperative to final imaging was observed in 82.2% of patients (p < 0.001). All other radiographic changes were not significant.

CONCLUSIONS: PyC-HA is a reliable procedure for treating glenohumeral joint disease, demonstrating excellent clinical outcomes and stabilized glenoid morphology in the majority of patients between the 2-year and intermediate-term follow-up.

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

PMID:41231915 | DOI:10.2106/JBJS.25.00163

The Latarjet Procedure May Induce Pathokinematics with Posterior Humeral Head Subluxation: An Experimental Dynamic Radiostereometric Study

J Bone Joint Surg Am. 2025 Nov 3. doi: 10.2106/JBJS.25.00120. Online ahead of print.

ABSTRACT

BACKGROUND: The effectiveness of the Latarjet procedure in stabilizing the glenohumeral joint (GHJ) in the abducted and externally rotated position is well documented. However, evidence of its ability to restore the GHJ kinematics in other positions and without anterior-directed load is sparse. The purpose of this study was to evaluate the GHJ kinematics, throughout external rotation, following the Latarjet procedure in shoulders with 15% anterior glenoid bone loss.

METHODS: Eight human donor arms were examined using dynamic radiostereometry during GHJ external rotation with anterior-directed loads of 0 to 30 N. Kinematics, measured on the basis of the humeral head center and the contact point relative to the glenoid, were assessed at 30° and 60° of GHJ abduction for 3 conditions: the native GHJ, 15% glenoid bone loss, and following the Latarjet procedure.

RESULTS: Following the Latarjet procedure, the humeral head center and contact point were up to 9.7 mm (95% confidence interval [CI], 0.5 to 18.8 mm) more posterior and 7.4 mm (95% CI, 0.3 to 14.4 mm) more superior compared with 15% glenoid bone loss. With a 30 N anterior-directed load, the contact point was up to 4.4 mm (95% CI, 2.4 to 6.4 mm) more anterior compared with 15% glenoid bone loss. No significant differences in kinematics between the native GHJ and following the Latarjet procedure were observed with anterior-directed load application. However, without an anterior-directed load, the humeral head center and contact point were up to 7.9 mm (95% CI, 2.3 to 13.5 mm) more posterior and 6.1 mm (95% CI, 0.0 to 12.2 mm) more inferior following the Latarjet procedure compared with the native GHJ.

CONCLUSIONS: With anterior-directed loading, the Latarjet procedure to treat 15% glenoid bone loss restored the native GHJ kinematics, with the largest stabilizing effect at the end-range external rotation. However, without anterior-directed loading, the humeral head center and contact point were more posterior and inferior following the Latarjet procedure than in the native GHJ, suggesting potential excessive posterior humeral head translation.

CLINICAL RELEVANCE: Posterior subluxation of the humeral head during resting and non-loaded activities following the Latarjet procedure may be a concern in terms of future posterior glenoid cartilage wear and GHJ osteoarthritis. However, these results need to be confirmed in a clinical setting.

PMID:41183158 | DOI:10.2106/JBJS.25.00120

Demystifying Traditional Bonesetting: Lessons from Mbarara Regional Hospital

J Bone Joint Surg Am. 2025 Nov 3. doi: 10.2106/JBJS.24.00387. Online ahead of print.

ABSTRACT

BACKGROUND: Globally, traditional bonesetters (TBSs) often provide patients with care for their orthopaedic concerns, from musculoskeletal injuries to oncological pathologies, often using techniques that may differ from Western methods. The aim of this study was to investigate the motivations for seeking care from a TBS, the types of treatments received, and the attitudes toward traditional bonesetting, and to determine any differences between patients with traumatic versus nontraumatic musculoskeletal pathologies.

METHODS: We surveyed patients who presented to the Orthopaedic Outpatient Clinic at Mbarara Regional Referral Hospital (MRRH) in Mbarara, Uganda, who had previously seen a TBS for their orthopaedic concern, in order to determine their reasons for seeking care from a TBS and the impressions of their care.

RESULTS: This study included 168 patients: 109 presented with traumatic injury, and 59 presented with another orthopaedic concern. The trauma group had a higher monthly family income (p < 0.001) and a higher level of education (p = 0.006) than the nontrauma cohort. Treatments provided by the TBS included cutting or puncturing of the skin, locally applied herbs, casting, and other traditional methods. The greatest motivation for seeking traditional bonesetting among trauma patients was belief in its efficacy; the patients in the nontrauma cohort believed that a TBS could reverse the witchcraft or curse that had caused their ailment. Failure of management was the reason that was cited most by both the trauma and nontrauma groups for discontinuing treatment with a TBS.

CONCLUSIONS: Orthopaedic pathology influences the way that individuals seek traditional bonesetting and their motivations for doing so. For nontraumatic pathologies, superstitious beliefs and a belief in its efficacy play a role in the selection of traditional bonesetting. Additional surveys of individuals may further elucidate the outcomes of seeking care from a TBS.

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

PMID:41183157 | DOI:10.2106/JBJS.24.00387

Posterior Cruciate Ligament (PCL) Versus Combined PCL and Posterolateral Corner Reconstruction in Isolated PCL Grade-III Injuries

J Bone Joint Surg Am. 2025 Nov 3. doi: 10.2106/JBJS.24.01051. Online ahead of print.

ABSTRACT

BACKGROUND: Isolated grade-III posterior cruciate ligament (PCL) injuries are defined as PCL injuries without any other ligamentous pathology that have a posterior translation of ≥12 mm compared with the contralateral knee. The aims of this study were to investigate isolated grade-III PCL injuries and to compare the clinical outcomes of 2 surgical methods.

METHODS: Patients with a PCL injury between 2008 and 2020 were retrospectively reviewed. Patients with an isolated grade-III PCL injury underwent either PCL reconstruction or combined PCL and posterolateral corner (PLC) reconstruction. Stress radiographs (Telos) and International Knee Documentation Committee (IKDC) subjective score, Lysholm knee score, and Tegner activity scale values were obtained preoperatively and at each follow-up.

RESULTS: Of 448 patients with a PCL injury, 254 patients with an isolated PCL injury were identified. Sixty of the 254 patients had a grade-III posterior translation. Thirty patients were excluded due to a lack of follow-up or medical information, leaving a cohort of 30 patients. The 17 patients who underwent isolated PCL reconstruction (Group I) and the 13 patients who underwent combined PCL and PLC reconstruction (Group II) had a mean age of 36.2 years (range, 16 to 59 years) and 31.8 years (range, 16 to 58 years) (p = 0.438), respectively, with a mean follow-up of 4.9 years (range, 2 to 11.8 years) and 4.3 years (range, 2 to 10 years) (p = 0.623), respectively. In Groups I and II, posterior translation, compared with the contralateral knee, improved from 13.7 ± 1.7 mm to 7.2 ± 3.2 mm (p < 0.0001) and from 14.6 ± 2.0 to 7.1 ± 2.4 mm (p = 0.001), respectively. In Group I, the mean IKDC, Lysholm, and Tegner scores improved from 54.8 to 71.8 (p = 0.001), from 56.7 to 77.9 (p = 0.004), and from 3.8 to 5.5 (p = 0.021), respectively. In Group II, the mean IKDC, Lysholm, and Tegner scores improved from 47.1 to 69.5 (p = 0.003), from 54.2 to 77.8 (p = 0.003), and from 4.0 to 5.2 (p = 0.042), respectively. No differences were observed between the groups.

CONCLUSIONS: Patients with an isolated grade-III PCL injury who underwent isolated PCL reconstruction showed significant improvements in subjective and objective outcomes. No significant difference was observed between patients who underwent isolated PCL reconstruction and those who underwent combined PCL and PLC reconstruction.

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

PMID:41183155 | DOI:10.2106/JBJS.24.01051

Helical Blade Versus Lag Screw Fixation in the Cephalomedullary Nailing of Geriatric Hip Fractures

J Bone Joint Surg Am. 2025 Nov 3. doi: 10.2106/JBJS.25.00294. Online ahead of print.

ABSTRACT

BACKGROUND: While some prior research has shown helical blades to have higher risks of fixation failure and cut-out than lag screws in the cephalomedullary nailing of intertrochanteric femoral fractures, other studies have not demonstrated any such differences. The purpose of this study was to compare the performance of helical blade and lag screw fixation among older patients with a hip fracture treated with cephalomedullary nailing and to determine whether the relative performance of these 2 fixation methods varies on the basis of patient characteristics.

METHODS: This retrospective cohort study utilized the hip fracture registry of an integrated health-care system to identify patients ≥60 years old who underwent cephalomedullary nailing with a helical blade or lag screw from 2009 to 2023. Propensity score-weighted Cox proportional hazards regression was used to evaluate the risk of aseptic revision (the primary outcome measure) and the risks of revision for specific reasons (the secondary outcome measures), with mortality considered as a competing risk.

RESULTS: The study sample included 22,308 cases (11,877 with a helical blade and 10,431 with a lag screw; mean patient age, 81.7 years; 71.5% female; 73.3% White; 71.8% with an American Society of Anesthesiologists [ASA] classification of ≥3). The 10-year cumulative incidence of aseptic revision was 1.69% (n = 194) in the helical blade group and 1.88% (n = 182) in the lag screw group (adjusted hazard ratio [HR], 0.87; 95% confidence interval [CI], 0.69 to 1.11; p = 0.27). There was evidence of effect modification by ASA classification, with the helical blade outperforming the lag screw in patients with an ASA of 1 to 2 (aseptic revision incidence, 1.74% versus 2.56%; adjusted HR, 0.65; 95% CI, 0.43 to 0.98; p = 0.04) but not in those with an ASA of ≥3 (aseptic revision incidence, 1.72% versus 1.64%; adjusted HR, 1.03; 95% CI, 0.78 to 1.35; p = 0.85). There was no evidence of effect modification by age or sex.

CONCLUSIONS: In this study of geriatric patients with a hip fracture treated with cephalomedullary nailing, helical blade and lag screw fixation performed similarly overall. Our finding that helical blade fixation may perform better in healthier (ASA 1 to 2) geriatric patients is interesting and deserves further investigation.

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

PMID:41183152 | DOI:10.2106/JBJS.25.00294

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