JBJS

Long-Term Trajectories of Patient-Reported Outcomes Following Total Knee Arthroplasty: A Longitudinal Study of 1,264 Patients

J Bone Joint Surg Am. 2025 Nov 20. doi: 10.2106/JBJS.25.00770. Online ahead of print.

ABSTRACT

BACKGROUND: Although total knee arthroplasty (TKA) is known to improve patient-reported outcome measure (PROM) scores in the short term to midterm, the long-term trajectories of both disease-specific and generic PROM scores remain unclear.

METHODS: We retrospectively analyzed the prospectively collected registry data of 1,264 patients (mean age, 68.5 years; 93.7% female) who underwent primary TKA for osteoarthritis between 2005 and 2013 and completed PROM assessments at baseline and 10 years postoperatively. Disease-specific PROMs were assessed using the Knee Society Knee Score (KSKS), Knee Society Function Score (KSFS), and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Generic PROMs were assessed using the Short Form-36 Health Survey (SF-36). Assessments were performed preoperatively and at 6 months and 1, 2, 5, 10, and 15 years postoperatively. Generalized linear models and linear mixed-effects models were used to evaluate temporal changes and subgroup differences by age and sex.

RESULTS: All PROM scores improved significantly within 6 months after TKA. Thereafter, disease-specific PROMs showed modest changes up to 1 year, with relative stability until 5 years, whereas generic PROMs demonstrated heterogeneous patterns across different domains. Between 5 and 10 years postoperatively, WOMAC pain and stiffness scores did not show significant changes, the KSKS decreased but not significantly so, and WOMAC physical function scores exhibited small but significant deterioration that was not clinically meaningful. SF-36 domains demonstrated varied trajectories: physical and mental component scores declined by more than the minimal clinically important difference after 5 years, whereas the social functioning score showed continuous improvement, although not all changes were significant. Octogenarians demonstrated lower physical functioning scores but higher social functioning scores in the long term compared with younger patients, and female patients demonstrated inferior functional and vitality scores compared with male patients.

CONCLUSIONS: Both disease-specific and generic PROM scores after TKA improved significantly and remained superior to baseline scores over a 15-year period, although physical function scores tended to decline in the long term. In this large, predominantly female Korean cohort, the distinct age- and sex-specific trajectories highlight the importance of implementing individualized, time-adapted long-term management strategies to optimize patient outcomes.

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

PMID:41490420 | DOI:10.2106/JBJS.25.00770

The Application of Agentic Artificial Intelligence in Orthopaedics

J Bone Joint Surg Am. 2026 Jan 5. doi: 10.2106/JBJS.25.01497. Online ahead of print.

ABSTRACT

BACKGROUND: Artificial intelligence (AI) in orthopaedics is shifting from passive interfaces in which a surgeon queries a large language model to an era of active participation in which a surgeon empowers a software platform to automate certain tasks on their behalf. The emerging new paradigm called agentic AI involves agents that move beyond decision support tools to becoming semi-autonomous collaborators in research, clinical, and rehabilitation tasks.

PURPOSE: The purpose of this review is to summarize how recent advances (April 2022 to October 2025) in automation, prediction, and augmentation agents are poised to transform the practice of orthopaedics; and to outline the conceptual, technical, and ethical foundations of this transition.

RECENT FINDINGS: An agent is software that can process information and act independently to execute a set of defined tasks. It can seek knowledge, ask for help, deploy other software, and learn from its actions. Automation, prediction and augmentation agents can be leveraged in multi-agent and federated-learning architectures, working together to create coordinated ecosystems that can manage complex tasks and that improve with clinical use. Collectively, the output of such ecosystems is referred to as agentic AI. However, regulatory and ethical concerns underscore the need for transparency, equity, and the preservation of human agency within these frameworks.

SUMMARY: Agentic AI marks a transition from passive tools that merely assist clinicians to autonomous systems that act alongside them. The success of this technology in orthopaedics will depend on the depth of human-machine collaboration they enable and how well they align computational precision with the enduring human art of restoring motion and health.

PMID:41490410 | DOI:10.2106/JBJS.25.01497

The Transformative Potential of Artificial Intelligence in Latin American Research

J Bone Joint Surg Am. 2026 Jan 5. doi: 10.2106/JBJS.25.01431. Online ahead of print.

ABSTRACT

➢ Substantial disparities exist between Latin America and high-income countries in research capacity, and artificial intelligence (AI) has emerged as a powerful tool to accelerate scientific development and reduce this gap.➢ Orthopaedic research in Latin America faces persistent barriers, including limited funding, lack of trained investigators, and insufficient data infrastructure, that restrict innovation and international collaboration.➢ By automating complex and time-consuming tasks, AI can lower research costs, improve efficiency, and enhance project quality across all stages, from data analysis to manuscript preparation.➢ The growing adoption of AI in the region is already strengthening academic productivity, fostering collaboration, and supporting Latin America's transition to a more equitable and innovative research environment.

PMID:41490408 | DOI:10.2106/JBJS.25.01431

Impact of the Femoral Pin Tracker on Soft-Tissue Tension in Robotic-Assisted Total Knee Arthroplasty: A Prospective Randomized Controlled Trial

J Bone Joint Surg Am. 2026 Jan 5. doi: 10.2106/JBJS.25.00705. Online ahead of print.

ABSTRACT

BACKGROUND: The femoral pin tracker in robotic-assisted total knee arthroplasty (TKA) can be placed intraincisionally or extraincisionally. The purpose of our study was to determine the impact of these placement methods on soft-tissue tension in the knee joint.

METHODS: A total of 132 patients undergoing robotic-assisted TKA were prospectively enrolled; of those, 80 were randomized to receive an intraincisional or extraincisional femoral pin tracker during surgery. Soft-tissue tension in the medial and lateral compartments of the knee joint was measured using a sensor before and after the removal of the pin tracker. Measurements were performed at 10°, 45°, 90°, and 120° of knee flexion. Changes in knee joint soft-tissue tension from before to after the removal of the pin tracker were compared between the 2 groups.

RESULTS: Our trial included 80 patients (mean age, 66.98 ± 38.48 years; 24% male; 100% Han Chinese). The intraincisional group demonstrated significantly greater changes in soft-tissue tension in the medial compartment of the knee at 10° (p < 0.001), 45° (p = 0.028), and 90° (p = 0.046) of knee flexion compared with the extraincisional group. No significant between-group differences were found in the changes in tension in the medial compartment at 120° of knee flexion (p > 0.05) or in the lateral compartment at any angle (p > 0.05).

CONCLUSIONS: Intraincisional placement of the femoral pin tracker may influence soft-tissue tension in the medial compartment of the knee. Surgeons should be aware of these differences when performing soft-tissue balancing before the removal of the femoral pin tracker.

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

PMID:41490306 | DOI:10.2106/JBJS.25.00705

Microbial Resistance Patterns in Periprosthetic Joint Infection of the Knee: A 24-Year Longitudinal Study

J Bone Joint Surg Am. 2026 Jan 5. doi: 10.2106/JBJS.25.00541. Online ahead of print.

ABSTRACT

BACKGROUND: Understanding the causative microorganisms and initiating appropriate empirical antibiotics early are important in the management of knee periprosthetic joint infections (PJIs). The aim of this study was to identify trends in PJI microorganisms and antibiotic resistance profiles over 24 years to guide empirical antibiotic selection.

METHODS: This study included 487 first-episode PJIs identified between 2000 and 2023 following primary total knee arthroplasty (TKA) at 3 large tertiary hospitals. PJIs were classified using the Tsukayama classification, which is based on the timing from the primary TKA and the source of infection. Multivariable logistic regression was used to analyze risk factors for polymicrobial and resistant infections.

RESULTS: A total of 487 PJI cases with 608 culture specimens were identified. The mean patient age (and standard deviation) was 70 ± 11 years, with 65% male patients and 35% female patients. All ethnicity data were self-reported. Of the patients in this study, 57% were New Zealand European, 14% were other European, 14% were Pacific Islander, 10% were New Zealand Māori, and 6% were Asian. The most common pathogen for PJIs was Staphylococcus aureus. The proportion of resistant cases (19% to 24%) was consistent across the 24-year period. A prosthesis in situ for <1 year was found to be the most important risk factor for polymicrobial infections (11 times more likely) and resistant infections (3 times more likely). Flucloxacillin monotherapy covered 45% of early PJI cases, 57% of chronic PJI cases, and 79% of late hematogenous cases. In comparison, vancomycin monotherapy provided coverage of ≥78% across all 3 PJI classes, and adding a gram-negative antibiotic such as gentamicin or cotrimoxazole increased coverage to >90%.

CONCLUSIONS: Despite the known emergence of resistant organisms in health-care settings, the primary causative microorganisms remained the same in knee PJIs, with no notable increase in resistant cases, over 24 years. Based on the findings of this study, vancomycin with gram-negative coverage is recommended as the empirical treatment of choice in early PJIs, and beta-lactams, such as flucloxacillin and a first-generation cephalosporin (e.g., cefazolin), were found to still be effective for late hematogenous PJIs. For septic PJI, dual therapy with vancomycin and a gram-negative agent is recommended, regardless of infection timing.

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

PMID:41490082 | DOI:10.2106/JBJS.25.00541

Satisfied but Failed: Patient Satisfaction Compared with Total Knee Arthroplasty Success Defined by the U.S. Centers for Medicare &amp; Medicaid Services

J Bone Joint Surg Am. 2025 Dec 29. doi: 10.2106/JBJS.25.00896. Online ahead of print.

ABSTRACT

BACKGROUND: More than 1 million total knee arthroplasties (TKAs) are performed annually in the United States to reduce knee pain, restore physical function, and enhance quality of life. However, nearly 1 in 5 patients are not satisfied after 1 year. We aimed to compare patient satisfaction with the U.S. Centers for Medicare & Medicaid Services (CMS) definition of success in TKA.

METHODS: We studied a multicenter cohort of patients undergoing primary unilateral TKA, comparing patient satisfaction with CMS-defined surgery success, which is a minimum 20-point improvement in the Knee Injury and Osteoarthritis Outcome Score for Joint Replacement (KOOS JR, scored 0 to 100) at 1 year. We cross-classified surgeries by satisfaction and success and used multivariable logistic regression to identify factors associated with satisfied patients being deemed as having undergone surgeries that failed.

RESULTS: We studied 8,444 patients with a mean age of 68 years (with patients grouped by age: 30 to 64 years and 65 to 95 years). Of the patients, 67% were women and 60% were obese. With regard to the patients' race and/or ethnicity, 81% were White, 17% were Black, 1% were Asian, 0.6% were Native American or Alaskan Native, and 0.3% were native Hawaiian or other Pacific Islander. Although 84% of all patients reported satisfaction with the surgery, only 64% of surgeries were deemed successful. Among satisfied patients, only 71% underwent a surgery that was deemed to be successful, and discordance depended strongly on their baseline score. For satisfied patients with the worst baseline status (KOOS JR of <40), the CMS deemed the surgeries to be successful 91% of the time. In contrast, for satisfied patients with better baseline status (KOOS JR of ≥60), the CMS determined that only 39% of the surgeries were successful. Surgical failure in satisfied patients was also associated with younger age, back pain, contralateral knee pain, lower health literacy, diabetes, and poorer mental health. Including the baseline KOOS JR in the model significantly increased predictive accuracy (the area under the receiver operating characteristic curve rose from 0.58 to 0.79).

CONCLUSIONS: We found substantial discordance between patients' satisfaction with the procedure and how the CMS currently assesses TKA success. A graded success metric, risk-adjusted for patients' baseline status, would align better with satisfaction. It is also worth exploring whether adding a few questions on joint-specific pain and function could better capture meaningful changes in patients whose high baseline status leaves little room for improvement on the KOOS JR.

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

PMID:41460960 | DOI:10.2106/JBJS.25.00896

Comparison of Highly Cross-Linked and Conventional Polyethylene During Simultaneous Bilateral Cruciate-Retaining Total Knee Arthroplasties: Results at a Minimum Follow-up of 15 Years

J Bone Joint Surg Am. 2025 Dec 29. doi: 10.2106/JBJS.25.00621. Online ahead of print.

ABSTRACT

BACKGROUND: There have been no long-term studies comparing the revision rates of a highly cross-linked polyethylene (HXLPE) bearing with those of a conventional polyethylene (CP) bearing among cruciate-retaining (CR) total knee arthroplasties (TKAs). The aim of the current long-term study was to compare CR TKAs with HXLPE and CP bearings in terms of clinical, radiographic, and computed tomographic (CT) scan results; prevalence of osteolysis; revision rate; and implant survivorship.

METHODS: This study enrolled a consecutive series of 410 Korean patients (mean age, 62.6 ± 8 years) who underwent simultaneous bilateral TKAs during the same anesthetic session. This study included 164 men and 246 women. Each patient underwent a posterior CR high-flexion TKA (NexGen CR-Flex TKA; Zimmer Biomet) with an HXLPE bearing on 1 side and a NexGen CR-Flex TKA with a CP bearing on the opposite side. The mean follow-up period was 17.5 years (range, 15 to 19 years).

RESULTS: At the latest follow-up, there were no significant differences between the HXLPE and CP groups with regard to the Knee Society score (94 compared with 93 points), Western Ontario and McMaster Universities Osteoarthritis Index (19.2 points for both groups), range of motion (125° compared with 126°), radiographic and CT results, or revision rate (2.0% compared with 2.2%). No knee showed osteolysis in either group. The estimated survival rate at 17.5 years, using revision or aseptic loosening as the end point, was 98.0% (95% confidence interval, 92% to 100%) for the group with the CR-Flex TKA with an HXLPE bearing and 97.8% (95% confidence interval, 92% to 100%) for the group with the CR-Flex TKA with a CP bearing.

CONCLUSIONS: The findings of this long-term study (minimum follow-up of 15 years) indicate that CR-Flex TKAs with HXLPE and CP bearings both yielded excellent clinical outcomes and implant survivorship. However, no significant clinical advantage was observed for HXLPE over CP bearings in this patient population.

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

PMID:41460951 | DOI:10.2106/JBJS.25.00621

A Fully Automated Multistage Deep Learning System for Lenke Classification: Enhanced Diagnostic Precision in Adolescent Idiopathic Scoliosis

J Bone Joint Surg Am. 2025 Dec 29. doi: 10.2106/JBJS.25.01015. Online ahead of print.

ABSTRACT

BACKGROUND: The Lenke classification for adolescent idiopathic scoliosis (AIS) has interobserver variability due to subjective clinical assessment. We developed and validated a fully automated deep learning system for precise Lenke classification using spinal radiographs.

METHODS: This retrospective study included 650 individuals (mean age, 13.75 ± 2.23 years; 433 female, 217 male; 618 Han Chinese, 32 Tibetan), comprising 183 healthy controls and 467 patients with AIS (aged 10 to 18 years; 25° ≤ Cobb angle < 90°) with full-spine radiographs. A multistage deep learning system consisting of (1) Swin-Unet segmentation of vertebrae (C7-S1) for automated Cobb angle measurement, (2) DeepLabv3+ localization of lumbar pedicles (L1-L5) to determine modifiers via the centroid-to-CSVL (central sacral vertebral line) distance, and (3) a fusion module integrating features to curve types and lumbar (A/B/C) and sagittal thoracic (-/N/+) modifiers was designed to perform end-to-end Lenke classification automatically. Validation used an independent test set.

RESULTS: The system achieved 95.6% overall accuracy in Lenke classification and had a macro-averaged F1 score of 0.862. Vertebral segmentation attained Dice coefficients of 0.917 (anteroposterior) and 0.942 (lateral). Cobb angle measurements showed excellent agreement with those of experts (intraclass correlation coefficient, 0.969 to 0.976 for thoracic or thoracolumbar/lumbar curves). Modifier assignment achieved F1 scores of 0.912 (lumbar A/B/C) and 0.928 (sagittal -/N/+), exceeding clinical acceptability thresholds.

CONCLUSIONS: The fully automated system was able to perform rapid, objective, interpretable, and clinically reliable classification of the Lenke type directly from radiographs, with performance comparable with that of expert assessment. It demonstrates potential for standardizing AIS surgical planning, reducing diagnostic variability, and improving surgical workflow efficiency.

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

PMID:41460944 | DOI:10.2106/JBJS.25.01015

The Trapezius Aponeurosis Insertion on the Acromion: An Anatomical Study with a Possible Implication for Dynamic Stabilization of the Acromioclavicular Joint

J Bone Joint Surg Am. 2025 Dec 29. doi: 10.2106/JBJS.25.01007. Online ahead of print.

ABSTRACT

BACKGROUND: The trapezius is recognized as a dynamic stabilizer of the acromioclavicular (AC) joint. This function has drawn attention in the treatment of AC joint dislocation. We aimed to clarify the anatomy of the aponeurosis of the trapezius insertion about the AC joint. We hypothesized that the trapezius aponeurosis would exhibit distinctive characteristics in 3 regions: the acromial, AC-joint, and clavicular insertions.

METHODS: We analyzed 21 cadaveric shoulder girdle specimens from 13 donors of Japanese ethnicity (4 male and 9 female; mean age [and standard deviation], 86 ± 7.9 years [range, 72 to 97 years]). Fifteen specimens were analyzed macroscopically and 5 histologically. One specimen was excluded because of osteoarthritis. Macroscopic examination included aponeurosis length measurement and fiber orientation analysis.

RESULTS: The trapezius aponeurosis inserted on the medial edge of the acromion, the posterior end of the AC joint, and the posterior edge of the lateral clavicle. The mean aponeurosis length was longest at the acromial insertion (mean, 28.9 ± 5.4 mm), followed by the AC-joint insertion (20.3 ± 7.7 mm), and shortest at the clavicular insertion (7.2 ± 3.2 mm) (p < 0.001). The trapezius aponeurosis was found to extend to the surface of the acromion and AC joint, connecting these structures to the deltoid origin. The coherency value, which reflects the regularity of fiber orientation, was higher on the osseous surface of the acromial insertion (median [interquartile range], 0.36 [0.26 to 0.55]) and the AC-joint insertion (0.37 [0.23 to 0.44]) than at the clavicular insertion (0.22 [0.18 to 0.30]). Histological observation showed that the aponeurosis was inserted via fibrocartilage only at the acromial insertion, just posterior to the AC joint. The aponeurosis at the AC-joint insertion was thicker than that at the clavicular insertion.

CONCLUSIONS: The trapezius aponeurosis at the acromial and AC-joint insertions formed a contiguous complex with the origin of the deltoid tendon and with the superior AC-joint capsule.

CLINICAL RELEVANCE: The trapezius aponeurosis at the acromial insertion, just posterior to the AC joint, may be critical for the dynamic stability of the joint.

PMID:41460933 | DOI:10.2106/JBJS.25.01007

Postoperative Clopidogrel Thromboprophylaxis in TJA: Increased Risk of Transfusion but Similar Venous Thromboembolic Risk Compared with Aspirin

J Bone Joint Surg Am. 2025 Dec 29. doi: 10.2106/JBJS.25.00930. Online ahead of print.

ABSTRACT

BACKGROUND: Patients undergoing total joint arthroplasty (TJA) who are on long-term use of clopidogrel for atherothrombotic prophylaxis often continue this drug as venous thromboembolism (VTE) chemoprophylaxis following primary total knee (TKA) and total hip arthroplasty (THA). We sought to assess the 90-day bleeding and thromboembolic risk profiles of patients receiving clopidogrel monotherapy for postoperative VTE chemoprophylaxis compared with those receiving aspirin following TJA.

METHODS: Utilizing a national, all-payer health-care database that captures approximately 25% of all inpatient procedures in the U.S., we identified all adult patients who underwent primary elective TKA or THA between 2016 and 2021. Patients who received clopidogrel monotherapy for postoperative VTE chemoprophylaxis were propensity-score matched in an approximately 1:7 ratio to patients who received aspirin monotherapy on the basis of age, sex, procedure type, perioperative tranexamic acid administration, and known indications for clopidogrel administration. Primary outcomes included the 90-day risks of bleeding and thromboembolic complications.

RESULTS: A total of 21,273 patients who received aspirin were matched to 3,078 patients who received clopidogrel. After matching, there were no significant differences between the 2 cohorts with respect to patient demographics, comorbidities, rates of tranexamic acid administration, and hospital characteristics. After accounting for potential confounding variables, patients who received clopidogrel were at an increased risk for postoperative blood transfusion (adjusted odds ratio [aOR]: 1.69; 95% confidence interval [CI]: 1.30 to 2.21; p < 0.001) and acute anemia (aOR: 1.13; 95% CI: 1.03 to 1.26; p = 0.015) relative to patients receiving aspirin. No significant differences between the cohorts in the risk of deep vein thrombosis, pulmonary embolism, stroke, myocardial infarction, hematoma, or hemorrhage were found.

CONCLUSIONS: Patients who received clopidogrel monotherapy for postoperative VTE chemoprophylaxis had an increased risk of postoperative bleeding complications but a similar risk of thromboembolic complications following TJA compared with patients who received aspirin. These findings suggest that the decision to resume clopidogrel for postoperative thromboprophylaxis should balance the potent antiplatelet activity with the risk of bleeding complications in high-risk cardiovascular patients.

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

PMID:41460931 | DOI:10.2106/JBJS.25.00930

A Dedicated Trauma Operating Room for Hand Surgery Reduces After-Hours Cases and Costs without Affecting Wait Times: A Retrospective Single-Center Cohort Study

J Bone Joint Surg Am. 2025 Dec 29. doi: 10.2106/JBJS.25.00025. Online ahead of print.

ABSTRACT

BACKGROUND: After-hours hand trauma care is associated with surgeon fatigue, a higher risk of complications, and increased staffing costs. Dedicated trauma operating rooms (DTORs) have been established in orthopaedic and trauma surgery to improve access to care and patient outcomes. The purpose of this study was to measure the impact of a DTOR for hand surgery on the proportion of after-hours cases and wait times from consultation to surgery at a Canadian urban tertiary-care center.

METHODS: This retrospective cohort study included adult patients undergoing hand trauma surgery during 2 periods: before DTOR implementation, from August 1, 2018, to January 31, 2020 (n = 599), and after DTOR implementation, from August 1, 2022, to January 31, 2024 (n = 541). The main outcomes were the proportion of emergency cases performed after hours and the wait times from consultation to surgery. A post hoc analysis examined total hospital costs. Multivariable logistic regression was used to estimate associations with binary outcomes, and multivariable negative binomial regression was used to estimate associations with continuous outcomes. Other outcomes, including caseload, surgical complications, and revision surgeries, were assessed using univariate analysis.

RESULTS: After DTOR implementation, after-hours cases decreased from 18% (109 of 599) to 8% (45 of 541). Adjusting for covariates, DTOR implementation was associated with fewer emergency hand surgeries being performed after hours (odds ratio, 0.47 [95% confidence interval (CI), 0.23 to 0.95]; p = 0.03). The median wait times were similar before and after DTOR implementation: 6 days before implementation and 8 days after it (rate ratio, 1.03 [95% CI, 0.91 to 1.16]; p = 0.64). DTOR implementation was associated with a 19% adjusted reduction in total hospital costs: in Canadian dollars, $2,578.66 before DTOR implementation and $2,220.98 after it (rate ratio, 0.81 [95% CI, 0.78 to 0.84]; p < 0.001). The hand trauma caseload was similar (p = 0.09) before and after DTOR implementation. Complications became less frequent after DTOR implementation (reduced from 5% to 2%; p = 0.03), whereas revision rates did not change (10% and 11%; p = 0.70).

CONCLUSIONS: DTOR implementation was associated with fewer after-hours surgeries, lower complication rates, and meaningful hospital cost savings, without increasing wait times or revision rates. These findings support integrating DTORs to improve operational efficiency and patient outcomes in hand trauma care.

LEVEL OF EVIDENCE: Economic and Decision Analysis Level III. See Instructions for Authors for a complete description of levels of evidence.

PMID:41460927 | DOI:10.2106/JBJS.25.00025

Diagnosis and Management of Osteoporotic Vertebral Compression Fractures

J Bone Joint Surg Am. 2025 Dec 29. doi: 10.2106/JBJS.25.00201. Online ahead of print.

ABSTRACT

➢ The incidence of vertebral compression fractures is increasing, particularly in elderly populations and postmenopausal women, in whom low bone mineral density is a key underlying factor.➢ Conservative management remains the first-line treatment option due to its high success rate and avoidance of surgical complications. When surgical intervention is necessary, cement augmentation via kyphoplasty and via vertebroplasty remain the most common options.➢ Kyphoplasty may be favored over vertebroplasty, especially in patients with severe preoperative kyphotic deformities, as kyphoplasty has a lower risk of adjacent vertebral fractures and demonstrates a greater reduction of the kyphotic deformity.➢ Consideration of restoring proper local spinal alignment is essential in preventing adjacent vertebral fractures and maintaining long-term spinal stability.

PMID:41460925 | DOI:10.2106/JBJS.25.00201

Clinical Outcomes of Pyrocarbon Hemiarthroplasty: A Short-Term, Multicenter Study

J Bone Joint Surg Am. 2025 Dec 29. doi: 10.2106/JBJS.25.00054. Online ahead of print.

ABSTRACT

BACKGROUND: Unacceptable pain relief after hemiarthroplasty (HA) has limited its utilization for shoulder replacement. The material properties of pyrolytic carbon-graphite composites may result in less abrasion compared with metal bearing surfaces, theoretically decreasing glenoid-sided pain and erosion. This prospective, single-arm, multicenter study was performed to evaluate the short-term clinical outcomes and implant survivorship of pyrocarbon HA.

METHODS: The enrollment of 157 patients occurred at 18 sites between December 2015 and April 2017 as part of an Investigational Device Exemption protocol. The Constant score, American Shoulder and Elbow Surgeons (ASES) score, Single Assessment Numeric Evaluation (SANE) score, patient satisfaction, EuroQol-5 Dimensions (EQ-5D) score, and active range of motion were evaluated. A historical control cohort treated with cobalt-chromium HA was identified through a propensity score subclassification analysis. The pyrocarbon HA and cobalt-chromium HA cohorts were compared on the basis of a Composite Clinical Success (CCS) rate, defined as a ≥17-point change in the Constant score without revision or a device-related adverse event.

RESULTS: Of the 157 patients enrolled, 144 had short-term follow-up (mean, 24.4 ± 1.2 months), 10 were lost to follow-up, and 3 underwent revision prior to 24 months due to pain or low-grade infection. The mean patient age was 52.4 ± 10.9 years (range, 19 to 73 years). There were significant improvements in all active range-of-motion and patient-reported outcomes. The outcomes of the pyrocarbon HA cohort (n = 157) were compared with those of the cobalt-chromium HA group (n = 169) eligible for a minimum 24-month follow-up, in which multiple imputation was employed to address missing data. The CCS was 82.7% for the pyrocarbon HA group and 66.8% for the cobalt-chromium HA group (p < 0.001).

CONCLUSIONS: Pyrocarbon HA demonstrated favorable results at a short-term follow-up and improved outcomes compared with the propensity score subclassification-derived cobalt-chromium HA cohort.

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

PMID:41460921 | DOI:10.2106/JBJS.25.00054

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