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

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

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

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

J Bone Joint Surg Am. 2026 Jan 5. doi: 10.2106/JBJS.25.01373. Online ahead of print.

NO ABSTRACT

PMID:41490245 | DOI:10.2106/JBJS.25.01373

J Bone Joint Surg Am. 2026 Jan 5. doi: 10.2106/JBJS.25.01200. Online ahead of print.

NO ABSTRACT

PMID:41490243 | DOI:10.2106/JBJS.25.01200

J Bone Joint Surg Am. 2026 Jan 5. doi: 10.2106/JBJS.25.00868. Online ahead of print.

NO ABSTRACT

PMID:41490085 | DOI:10.2106/JBJS.25.00868

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

Int Orthop. 2026 Jan 5. doi: 10.1007/s00264-025-06731-w. Online ahead of print.

ABSTRACT

BACKGROUND: Modular dual mobility (MDM) cups are widely used in primary total hip arthroplasty (THA) to reduce dislocation, but their impact on range of motion (ROM) to impingement versus single-mobility (SM) cups remains uncertain.

METHODS: In this paired robotic-simulation study, 108 primary robotic-assisted THAs were virtually planned twice with CT-based software, once with an SM cup and once with an MDM cup. Cup and stem orientation were optimised to restore intra-articular length and global offset within 5 mm of the contralateral hip and to avoid impingement. ROM to first impingement was measured in extension/external rotation (ER), flexion/internal rotation (IR) with physiological pelvic tilt, and flexion/IR with 20° adduction. The mode of first impingement (intra-articular, extra-articular, or mixed) was recorded.

RESULTS: Compared with SM, MDM cups increased ROM to impingement in extension and ER but slightly reduced ROM in flexion and IR at several test positions. Maximal extension to impingement and ER in extension were higher with MDM, whereas flexion with pelvic anteversion and IR at 100° flexion were lower. ROM to impingement was not uniformly greater with MDM, and first contact often shifted from intra-articular implant-on-implant impingement toward extra-articular impingement.

CONCLUSION: In robotic THA, MDM cups provide selective gains in ROM to impingement and shift the impingement towards extra-articular structures rather than providing a global increase in safe ROM. Clinically, MDM may suit patients needing extension/ER reserve or with anterior instability risk, and planning should consider osteophytes and bony constraints. Further prospective clinical validation is warranted.

PMID:41491305 | DOI:10.1007/s00264-025-06731-w

Int Orthop. 2026 Jan 5. doi: 10.1007/s00264-025-06722-x. Online ahead of print.

ABSTRACT

INTRODUCTION: Nonoperative treatment is the preferred initial intervention for plantar fasciitis. However, some patients fail to respond and present with continued pain. This study investigated the effectiveness of concentrated bone marrow aspirate concentrate (BMAC) injections in the treatment of recalcitrant plantar fasciitis.

METHODS: Retrospective chart review was performed to identify patients diagnosed with chronic plantar fasciitis that underwent treatment with BMAC injection. Bone marrow aspirate was harvested from the iliac crest, concentrated, and injected into the site of maximal tenderness in the plantar fascia. Visual analogue scale (VAS) pain scores were collected before and after the BMAC injection at six, ten, 24, and 48 weeks. Postoperative complications were recorded.

RESULTS: A total of 19 patients (19 feet) with chronic plantar fasciitis were treated with BMAC injection. Average age was 52.6 (SD, ± 7.5) years with an average BMI of 26.4 (SD, ± 4.6) kg/m2. The average duration of pain prior to the BMAC injection was 2.5 (SD, ± 1.3) years. Preoperatively, average VAS was 7.5 (SD, ± 2.3), with significant improvement at six weeks (mean, 2.3; SD, ± 1.2), ten weeks (mean, 2.2; SD, ± 1.2), 24 weeks (mean 1.7; SD, ± 1.1), and at 48 weeks (mean, 1.1; SD, ± 0.7) postoperatively (all p < 0.05). No complications were observed at the surgical or donor site.

CONCLUSION: Patients with recalcitrant plantar fasciitis treated with BMAC injection demonstrated and maintained a statistically significant decrease in VAS pain score upon assessment at each postoperative follow-up up to 48 weeks, with no adverse effects at the donor or injection site. These findings suggest that BMAC injection may be a safe treatment option offering early pain relief.

PMID:41489648 | DOI:10.1007/s00264-025-06722-x

Injury. 2025 Dec 17;57(2):112974. doi: 10.1016/j.injury.2025.112974. Online ahead of print.

ABSTRACT

HYPOTHESIS: The 22 Winchester Magnum caliber will not have enough momentum and kinetic energy to penetrate through a near-human porcine model in three constructs; a chest model, a bone model, and an extended muscle model.

METHODS: Two types of projectiles were evaluated, i.e. a jacketed hollow point in (JHP) and a full metal jacket (FMJ). These were fired through a hand-held pistol into the three models. The models were similar in size, weight, and dimensions. Velocity, depth of penetration, and residual projectile construction were measured.

RESULTS: The JHP penetrated through all layers in the muscle chest model, it fractured long bone but failed to exit the bone model and it did not penetrate the chest cavity in the extended muscle model. The FMJ, on the other hand, penetrated and exited all three constructs into a backstop. The JHP expanded well in the muscle models but fragmented completely in the bone model. The FMJ deformed and could be retrieved after exiting all three models.

CONCLUSION: The JHP is an effective self-defense round in a standard chest model but functioned inadequately after contacting a long bone or an extended muscle barrier. The FMJ is effective in penetrating the vitals even after piercing a long bone or extended soft tissue. These constructs represent real-life self-defense scenarios, better than any artificial model and should be used by manufacturers and enthusiasts as their final testing module evaluating a specific projectile.

PMID:41485320 | DOI:10.1016/j.injury.2025.112974

Injury. 2025 Dec 25;57(2):113013. doi: 10.1016/j.injury.2025.113013. Online ahead of print.

ABSTRACT

OBJECTIVE: Management of Gustilo 3B tibias remains problematic with high complication rate. Controversy persists about coverage timing, and whether the clock starts at time of injury or definitive fixation. Postoperative outcomes of 3B open tibia fractures and the effect of fixation and flap timing were reviewed retrospectively.

METHODS: Design: Retrospective observational study.

SETTING: Data derived from Bellwether PearlDiver, a multicenter insurance claims database. Patient Selection Criteria: 1066 Gustilo 3B tibia fractures were identified with flap coverage within 45 days of fixation (2009 ... 2021). Fixation within 3days of injury was classified as prompt. The remaining fixations were designated as delayed. Flap coverage within 3 days of fixation was considered prompt. Coverage after this was considered delayed. Outcome Measures and Comparisons: Complications and return to OR were analyzed. Separately, patients were divided by days to definitive fixation or days to flap coverage, irrespective to the other. One-year complication incidence was compared using linear regression analysis.

RESULTS: 252 (23.6 %) patients received prompt fixation and prompt flap. 519 (48.7 %) received prompt fixation and delayed flap. 271 (25.4 %) underwent both delayed fixation and flap while only 24 (2.3 %) received prompt flap following a delay in fixation. By linear regression analysis, surgical site infection (SSI), wound disruption (WD), and reoperation incidence increased by 0.53 % (p < 0.001), 0.84 % (p < 0.001), and 0.63 % (p < 0.001), respectively, with each day between fixation and flap coverage. Days from injury to fixation was significant for increased WD incidence (0.38 %, p = 0.03).

CONCLUSIONS: Early flaps demonstrated fewer complications. Very few patients with delayed fixation received prompt flap coverage. Prior research suggested that delayed fixation had few consequences when followed by prompt flap coverage. This appears to be rare in practice. Prompt multidisciplinary orthopaedic and plastics management of Gustilo 3B tibia fractures is important for optimal outcomes in these injuries.

LEVEL OF EVIDENCE: Level 3.

PMID:41483688 | DOI:10.1016/j.injury.2025.113013

Injury. 2025 Dec 25;57(2):113012. doi: 10.1016/j.injury.2025.113012. Online ahead of print.

ABSTRACT

BACKGROUND: Trauma care in Scotland is organised into four networks and the North of Scotland Trauma Network, covering 60 % of Scotland's landmass, was the first of the four regions to go live in October 2018. The trauma demographics, journeys and outcomes over the decade of 2013-2023, five years and nine months prior to and five years post implementation were examined.

METHODS: Data prospectively collected by Scottish Trauma Audit Group (STAG) during the time period was analysed. Patients of all ages, Injury Severity Score (ISS) > 8 and head injury Abbreviated Injury Scale (AIS) > 1 were included. The primary outcome was mortality. Multivariate logistic regression compared factors associated with mortality pre- and post - network.

RESULTS: Post-network, 47.8 % of ISS>15 presented at non-Major Trauma Centre (MTC) hospitals, of which 47.4 % underwent secondary transfer. Half (50.5 %) of serious head injuries (AIS>2) presented to the Trauma Unit (TU) / Local Emergency Hospitals (LEH), of which 34.4 % were transferred to the MTC. Of those transferred to the MTC, moving vehicle was the commonest mechanism (44.7 %) and median ISS was 22 (IQR 17 - 29). Ultimately, the majority (75 %) of major trauma patients were treated at the MTC post network. Whilst overall mortality was 7.8 %; this rose to 18.3 % for ISS > 15, and 20.6 % for serious head injury. Mortality for ISS > 15 first presenting outside of the MTC and then subsequently transferred was 8.3 %. There was significant difference in 30-day mortality in those presenting after network implementation (OR 0.76 [0.6 - 0.97], p = 0.03) adjusting for age, ISS, head injury severity and mechanism of injury. A sensitivity analysis of the two consistently contributing hospitals (TU and MTC) was performed and mortality improvement was maintained (OR 0.71, 95 % CI 0.55 - 0.93, p = 0.011) although this could have been due to improved data capture of lower acuity trauma, or other confounding variables.

CONCLUSION: In a geographically dispersed network, the contributions of TUs and LEHs and subsequent secondary transfers are substantial. Network investment in training, communication pathways and transfer governance is essential.

PMID:41483687 | DOI:10.1016/j.injury.2025.113012

Int Orthop. 2026 Jan 2. doi: 10.1007/s00264-025-06724-9. Online ahead of print.

ABSTRACT

PURPOSE: The cumulative probability of a first-time dislocation (CPD) after total hip arthroplasties (THAs) with a 22-mm head was reported in 2004 to rise steadily to 7% at 25 years. Later reports employing larger heads indicated that dislocations were concentrated in shorter periods after THA. Therefore, dislocations may occur differently over time depending on head sizes, which has not been clearly demonstrated. The purpose was to examine this hypothesis.

METHODS: With first-time dislocation as the endpoint, the Cox proportional-hazards regression model and the Kaplan-Meier analyses were applied to 6,339 THAs performed for nontraumatic osteonecrosis of the femoral head, considering all possible influencing variables. Follow-up was 6.5 years on average (range, 0 to 27).

RESULTS: First-time dislocations occurred in 289 THAs (4.6%) at a mean of 2.9 years (range, 0 to 19) following THA, with head sizes of 22, 26, 28, 32, and ≧ 36 mm in 33, 76, 86, 58, and 36 THAs, respectively (dislocation rate: 13.5, 8.2, 5.7, 2.5, and 2.7%, respectively; p < 0.001 in χ2 test). CPD increased linearly after THA in the 22-mm group, while larger-head groups showed a steep early rise followed by a decline.

CONCLUSION: First-time dislocations occurred differently over time with different head sizes.

PMID:41483131 | DOI:10.1007/s00264-025-06724-9

Int Orthop. 2026 Jan 2. doi: 10.1007/s00264-025-06729-4. Online ahead of print.

ABSTRACT

PURPOSE: Hip arthroscopy is widely used for treating femoroacetabular impingement (FAI), yet long-term data evaluating PASS, MCID thresholds, functional recovery, and revision rates remain limited. This study aimed to assess minimum five year outcomes following hip arthroscopy for FAI and to identify predictors of postoperative success.

METHODS: In this retrospective cohort study, 133 patients with a minimum of five years of follow-up were evaluated. Preoperative and postoperative outcomes included mHHS and VAS scores. Postoperative PROMs included iHOT-12, HOS-ADL, and HOS-Sport. PASS, MCID achievement, return to sport (RTS), return to work (RTW), revision arthroscopy, and conversion to total hip arthroplasty (THA) were recorded. MCID for ΔmHHS was determined using ROC analysis with PASS as the external anchor. Logistic regression identified predictors of PASS.

RESULTS: The mean mHHS improved from 62.0 ± 12.9 preoperatively to 83.6 ± 12.8 at final follow-up (p < 0.001). VAS scores improved from 7.7 ± 1.9 to 3.1 ± 2.3 (p < 0.001). PASS was achieved by 72.2% of patients, and 83.1% met the MCID threshold of a 10-point increase in mHHS. Return-to-sport and return-to-work rates were 96.2% and 96.9%, respectively.

CONCLUSION: Hip arthroscopy for FAI provides durable clinical improvement at long-term follow-up, with high PASS and MCID achievement rates. RTS and RTW rates were excellent, and revision and THA conversion rates were comparable with contemporary long-term reports. Preoperative pain severity was the only independent predictor of PASS.

PMID:41483130 | DOI:10.1007/s00264-025-06729-4

Injury. 2025 Dec 24;57(2):113009. doi: 10.1016/j.injury.2025.113009. Online ahead of print.

ABSTRACT

BACKGROUND: Independent ambulation at hospital discharge is a critical determinant of discharge destination and caregiving burden in older adults with proximal femoral fractures. Preoperative prediction of walking independence may support discharge planning and early intervention.

METHODS: This retrospective observational study included 350 patients who underwent surgery for proximal femoral fractures between April 2018-April 2023. Independent ambulation was defined as Functional Ambulation Category (FAC) = 5. Preoperative variables included age, Body Mass Index (BMI), cognitive function (HDS-R), psoas muscle index (PMI), nutritional and inflammatory markers (GNRI, albumin, total protein, CRP), and pre-fracture walking ability. Patients were divided chronologically into a training set (n = 250) and a temporal external validation set (n = 100). An XGBoost model was developed and evaluated using area under the receiver operating characteristic curve (AUC). SHAP analysis was applied to identify major contributing factors.

RESULTS: Of the 350 patients, 186 (53.1 %) achieved independent ambulation at discharge. The optimized XGBoost model yielded a mean cross-validation AUC of 0.856 and an external validation AUC of 0.829, with accuracy = 0.771, precision = 0.872, recall = 0.774, and F1-score = 0.820. SHAP analysis identified HDS-R as the strongest contributor, followed by height, pre-fracture walking ability, GNRI, and CRP.

CONCLUSIONS: Preoperative prediction of discharge-time walking independence using XGBoost demonstrated high discriminatory performance. Cognitive function, nutritional status, and inflammatory markers were key predictors. SHAP analysis enhanced interpretability, supporting clinical applicability. This model may facilitate individualized discharge planning and early intervention strategies in patients with proximal femoral fractures.

PMID:41478088 | DOI:10.1016/j.injury.2025.113009

J Bone Joint Surg Am. 2025 Dec 31. doi: 10.2106/JBJS.25.01583. Online ahead of print.

NO ABSTRACT

PMID:41474832 | DOI:10.2106/JBJS.25.01583

Injury. 2025 Dec 24;57(2):113011. doi: 10.1016/j.injury.2025.113011. Online ahead of print.

ABSTRACT

INTRODUCTION: In recent decades, there has been a shift in TBI epidemiology, with a rising incidence in older adults. Medication use is an often-overlooked modifiable TBI risk factor. There is a paucity of research specifically examining the relationship between individual medications, polypharmacy, and the risk of TBI. With the goal of informing TBI prevention strategies as well as future research, we conducted a systematic review to assess the association between specific medication use, polypharmacy, and the risk of TBI.

MATERIALS AND METHODS: This systematic review follows the PRISMA guidelines and was prospectively registered in PROSPERO. We conducted a literature search of the following databases: MEDLINE, EMBASE, PsycINFO, Global Health, CINAHL, and Web of Science. We included all randomized controlled, quasi-experimental or observational studies reporting on polypharmacy or single medications and the risk of TBI. We excluded pediatric studies, trauma studies that did not report specifically on TBI, animal studies, case series, and case reports. Reviewers independently evaluated studies according to inclusion and exclusion criteria and risk of bias.

RESULTS: After duplicate removal, our research strategy identified 18,528 studies, of which 197 abstracts were selected for full-text review. Sixteen studies met our inclusion criteria. In total, 7 medication classes and 27 single medications were studied. A single study reported on polypharmacy. Four studies on antithrombotics reported an association with an increased risk of TBI. In 2 studies, antidepressants were associated with an increased risk of TBI. Two studies on antipsychotics showed an association with an increased risk of TBI. One study found a significant increase in the risk of TBI with the use of benzodiazepines. Results on z-drugs were inconsistent, with one study reporting a significant increase in TBI risk with zolpidem but not eszopiclone. The single study evaluating opioids reported an increased risk of TBI. Finally, antiarrhythmics were associated with an increased risk of TBI.

CONCLUSION: In robust studies, antipsychotics, antidepressants, hypnotics, and opioids have all been associated with an increased risk of TBI, while studies on antithrombotics are inconsistent. Further studies are needed to evaluate the risk of these drugs in the general population, especially in the elderly.

PMID:41468799 | DOI:10.1016/j.injury.2025.113011

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

J Bone Joint Surg Am. 2025 Dec 29. doi: 10.2106/JBJS.25.01303. Online ahead of print.

NO ABSTRACT

PMID:41460953 | DOI:10.2106/JBJS.25.01303