Background: TikTok has become an increasingly popular source of health information. This study aimed to assess the quality and content of TikTok videos discussing glenohumeral dislocation. The hypothesis being that videos produced by healthcare professionals (HCPs) would be superior. Methods: This cross-sectional study used the keyword “shoulder dislocation” to retrieve videos, and the first 173 videos found were reviewed. Inclusion criteria was (1) English language, and exclusion criteria were (1) video following a trend, (2) no association with shoulder dislocation, and (3) being no longer available at the time of the analysis. Videos were classified into two groups: those by general users and those by HCPs. Basic information was extracted, and the content classified by two independent raters into six types: definition, signs/symptoms, risk factors/prevention, evaluation, management, and outcome. The same raters assessed the quality of the information presented with the validated DISCERN instrument. Any disagreements were resolved by a third rater. Pearson correlation and nonparametric Wilcoxon-Mann-Whitney tests were used for statistical analysis. Results: One hundred two of the 173 videos reviewed met the inclusion criteria; 70 from general users and 32 from HCPs. The most discussed topic was management (73), while definition (15) was the least discussed. A significant difference was observed in DISCERN score between videos by HCPs (28.78 ± 7.16) and general users (19.00 ± 5.99; P < 0.01). Conclusion: Videos by HCPs were of higher quality than those by general users, although overall content quality was poor.
INTRODUCTION:Patients with musculoskeletal complaints often search online to identify an appropriate healthcare provider. With the increasing availability of large language models (LLMs), these artificial intelligence (AI) tools can direct patients to providers. This study evaluated the ability of LLMs to recommend appropriate providers based on representative patient musculoskeletal queries. METHODS:Three LLMs (ChatGPT, DeepSeek, and Gemini) were prompted with standardized musculoskeletal queries for two US cities (Lynchburg, VA, and Trumbull, CT). Provider recommendations were considered appropriate if the physician was currently practicing in the requested location and specialized in the relevant area. Listed phone numbers were checked for accuracy. Descriptive statistics and Fisher exact tests were used to summarize findings. RESULTS:The appropriateness of recommended providers differed across models with ChatGPT being most often appropriate (17/17, 100%) compared with Gemini (9/21, 43%) and DeepSeek (4/10, 40%), (P < 0.001). Of the 18 inappropriate recommendations, 13 (72%) were real providers in unrelated specialties and 5 (28%) were hallucinations, all from DeepSeek. Phone number accuracy differed significantly across models with Gemini being most accurate (5/6, 83%), outperforming both ChatGPT (6/9, 67%; P = 0.60) and DeepSeek (2/10, 20%; P = 0.04). DISCUSSION:LLMs showed potential to direct patients to local, specialized musculoskeletal providers based on their report, although the specific contact information was at times inaccurate. As these tools evolve, providers should be aware of AI's ability to make provider recommendations and work to ensure the presentation of their contact information is accessible by these models as best possible.
BACKGROUND:Advances in elective primary total hip arthroplasty (THA) have led to the use of robotic assistance and computer navigation during surgery; recent reports have demonstrated substantial benefits of this technology. However, few studies have made a head-to-head comparison of technology with a specific focus on patient-reported outcomes (PROs) when preoperative patient profiles are well controlled. Therefore, the purpose of this study was to compare outcomes among patients who underwent conventional, robotic-assisted, and computer-navigated procedures. METHODS:This retrospective study included patients aged 25 to 89 years who underwent THAs between January 2020 and May 2025. Patients were matched on age, body mass index (BMI), Charlson Comorbidity Index (CCI), and preoperative Hip Disability and Osteoarthritis Outcome Score for Joint Replacement and were assigned to study groups based on the technology used: (1) conventional, (2) robotic-assisted, and (3) computer-navigated. Postoperative recovery metrics between groups were compared up to 1 year from the surgery. RESULTS:A total of 3799 patients were included: 2582 (68%) in the conventional group, 389 (10%) in the robotic-assisted group, and 828 (22%) in the computer-navigated group. PROs improved with no differences between groups by 12 months but showed slightly slower recovery in computer-navigated cases. Complication rates (return to operating room and hospital readmittance) were similar in all groups. Both robotic-assisted surgery and computer-navigated procedures cost around $1000 more than the conventional procedure, with robotic-assisted procedures taking 3 minutes longer than conventional procedures (P < 0.05). CONCLUSION:Despite added cost, the technology-assisted procedures did not offer substantial improvements to surgical outcomes when used in primary THAs in a high-volume orthopaedic hospital. When controlled by matching demographics, comorbidities, and PROs, the technology-supported THA patients had no clinically relevant differences in postoperative outcomes and had higher hospital utilization compared with the conventional group.
BACKGROUND:Nonsteroidal anti-inflammatory drugs (NSAIDs) have become an increasingly important component of orthopaedic pain management protocols in an effort to reduce dependence on opioids. However, concerns remain regarding their potential impact on fracture healing. Ketorolac is a potent NSAID commonly administered postoperatively in orthopaedic surgery, but its effects on nonunion rates remain unclear. This study aims to evaluate whether short-term postoperative intravenous (IV) ketorolac administration is associated with an increased risk of nonunion or nonunion-related revision surgery in patients undergoing surgical fixation of long bone fractures. METHODS:A retrospective cohort analysis was done using the TriNetX database. Adult patients who underwent surgical fixation of femoral, tibial, humeral, radial, or ulnar shaft fractures between 2003 to 2023 were included. Patients with infection, open fractures, or a history of nonunion were excluded. Cohorts were defined based on postoperative IV ketorolac use within 5 days of surgery. After 1:1 propensity score matching for demographics and comorbidities, nonunion and revision surgery rates were compared using odds ratios (ORs) with 95% confidence intervals (CIs). Subgroup analyses were done by fracture type and age group. RESULTS:A total of 14,951 matched patients (7464 ketorolac; 7487 no ketorolac) were analyzed. No notable differences in nonunion rates were observed between the ketorolac and no ketorolac groups overall (2.2% vs 1.9%; OR 1.187 [95% CI, 0.941 to 1.498]) or within the tibial, femoral, or humeral subgroups. Ulnar and radial shaft fractures lacked sufficient sample sizes for subgroup analysis. Revision surgery rates were likewise comparable between the groups (1.2% vs 1.1%; OR 1.094 [95% CI, 0.803 to 1.491]). Age-stratified analyses showed no increased risk across age groups (18 to 29, 30 to 64, ≥65 years). CONCLUSIONS:Postoperative administration of IV ketorolac within 5 days of surgery does not increase the odds of nonunion or nonunion-related revision surgery for femoral, tibial, or humeral shaft fractures in low-risk adults. These findings support the use of short-duration IV ketorolac as part of multimodal analgesia protocols in postoperative fracture care.
Artificial intelligence (AI) has rapidly integrated into multiple facets of society, specifically within the realm of orthopaedics. To understand its effects, we provide an overview of AI models, their presence in health care over time, current integrations, and regulations regarding AI. This overview highlights different perspectives, the variety of influences that AI currently has, and the implications for the future of orthopaedics. AI is agnostic to the outcome and will have both a positive and negative effect on the next generation of trainees, educators, practitioners, consumers, and leaders, necessitating proactive discussions about AI.
Introduction: Proximal femoral fractures (PFFs) in older adults carry a high risk of morbidity, mortality, and disability. Although vitamin D deficiency has been associated with increased fracture incidence and poor outcomes, its precise role in hospitalization length, mortality, and long-term recovery remains unclear. Understanding how vitamin D levels interact with other factors, such as renal function and albumin status, could improve patient management strategies. Methods: We conducted a prospective cohort study of 760 patients aged 65 years and older admitted with femoral fractures between November 2022 and October 2024. Serum 25(OH)D levels, corrected calcium, and glomerular filtration rate (GFR) were assessed at admission. Vitamin D status was categorized as deficient (<20 ng/mL), insufficient (20 to 30 ng/mL), or normal (>30 ng/mL). Albumin levels and GFR were also evaluated. Results: When analyzed categorically, vitamin D classification did not markedly predict short-term outcomes, including immediate postoperative mortality or length of hospital stay. However, vitamin D as a continuous variable was modestly associated with shorter hospital stays. By contrast, lower GFR was strongly linked to longer hospitalization and increased in-hospital mortality. Albumin levels were not markedly related to survival. Notably, over a 2-year follow-up, vitamin D status emerged as an important predictor of long-term survival. Conclusion: Although vitamin D status alone may not influence immediate recovery, maintaining adequate levels may improve longer term survival after PFF surgery. Addressing renal impairment and other patient-specific factors remains critical for optimizing outcomes.
Introduction: Digital promotion of orthopaedic research is increasingly associated with scholarly visibility yet the influence of specific social media posting characteristics on online attention remains unclear. The Altmetric Attention Score (AAS) is a weighted score that measures the amount of attention a study has received. The score is based on three factors: the volume of mentions, the medium the mention came from, and the author of the mention. In orthopaedic research, a higher AAS is correlated with higher citation rates. The purpose of this study was to examine the relationship between AAS and the presence of various types of multimedia in posts on X by orthopaedic surgery journals and the time posts were made. Methods: Data were collected from the X accounts of the British Journal of Sports Medicine (BJSM), Journal of Bone and Joint Surgery (JBJS), Arthroscopy , Journal of Arthroplasty , American Orthopedic Society for Sports Medicine Journals (AOSSM), and Journal of the American Academy of Orthopaedic Surgeons (JAAOS) over two separate periods, January 1, 2023, to June 31, 2023, and July 1, 2024, to December 31, 2024. Media types were classified into the following categories: no media, text only, simple media, infographics, and videos. To analyze the effect of post time on AAS score, posts were grouped into three different time groups: 10 pm to 5:59 am , 6 am to 1:59 pm , and 2 pm to 9:59 pm . Statistical analysis for data sets with three or more groups was done with an Analysis of Variance (ANOVA) with post hoc t -tests performed when statistical significance was found. For data sets with only two groups, t -tests were done. Results: One-way ANOVA results showed a significant difference in the average AAS between media types for the Journal of Bone and Joint Surgery (JBJS) in the 2024 period ( P < 0.01) and in Arthroscopy for both the 2023 and 2024 periods ( P < 0.0001 and P < 0.05, respectively). Post hoc t-tests showed a significant difference in average AAS between simple media and infographics for JBJS in 2024 with average AAS scores of 2.81 and 11, respectively ( P < 0.001). In 2023, Arthroscopy showed significant differences in the average AAS of simple media vs infographics, simple media vs text only, and infographics vs no media ( P < 0.0001, 0.0001, and 0.05, respectively). In 2024, Arthroscopy showed significant differences in average AAS for simple media vs infographics, videos vs infographics, and videos vs text only with P < 0.05, 0.005, and 0.05, respectively. For the American Orthopaedic Society for Sports Medicine (AOSSM) journals, t-tests showed a statistically significant difference in average AAS between posts made from 6 am to 1:59 pm and posts made from 2 pm to 9:59 pm with a P < 0.05 and average AAS of 12.9 and 74.5, respectively. Conclusion: Although results were not consistent across all journals, one trend was the increased AAS of infographics. This repeated success suggests a promising avenue for orthopaedic journals to improve the reach of their studies by increasing the utilization of infographics. Time posted did not seem to have a notable effect on AAS, but for the AOSSM Sports Medicine journals, the time frame of 2 pm to 9:59 pm may be an optimal time to maximize reach. Future studies with larger data sets and the development of an objective media classification system may provide an avenue toward strengthening the findings of this study and developing more precise strategies for orthopaedic journals to optimize their social media presence.
Introduction: Orthopaedic skills modules have been validated in the short term, but their effect on longitudinal development is unknown. The objective of this study was to assess whether orthopaedic surgery interns with access to a home module set had improved Objective Structured Assessment of Technical Skill (OSATS) scores at the end of the academic year compared with the start of the year and with a control class who did not have access to the modules. Methods: In this prospective cohort study, eight incoming postgraduate year one residents (“PGY1”) and eight outgoing PGY1 residents (“control”) were tested on five skills modules. The PGY1 cohort had home access to modules over the year and was retested at the end of the academic year. Grading was conducted by two faculty using the OSATS Global Rating Score (GRS). Objective measures of efficiency (time) and accuracy were recorded. The performances of PGY1 at the beginning of the year versus the end of the year and PGY1 at the end of the year versus control group were compared. Results: A significant improvement was observed in GRS across all modules for PGY1, and the end-of-year PGY1 performed better than the control cohort across all modules (all P < 0.05). For the PGY1 cohort, beginning-of-year versus end-of-year accuracy improved in drill plunge from 13.7 ± 8.6 to 5.7 ± 2.1 millimeters ( P = 0.034) and efficiency improved in angled drilling from 37.6 ± 22.5 to 12.0 ± 3.6 seconds ( P = 0.017). The end-of-year PGY1 demonstrated greater efficiency in drill plunge, depth gauge, and angled drilling compared with the control cohort (all P < 0.05), with no significant differences in task accuracy. Conclusion: The 1-year implementation of low-cost orthopaedic skills modules was associated with improved skill performance among the PGY1 residents relative to their performance at the beginning of the year and relative to a class of control residents who did not have access to the modules.
Introduction: Salter-Harris (SH) III and IV medial malleolar fractures in young children pose a risk of physeal bar formation and subsequent growth disturbance. The aim of this study was to compare surgical versus nonsurgical treatment and to identify factors predictive of physeal injury. Methods: A retrospective cohort analysis examined patients aged ≤10 years treated for SH III/IV medial malleolar fractures between 2012 and 2024 at a single institution. Patients received either surgical (open reduction and internal fixation (ORIF) or percutaneous reduction and screw fixation (PRSF)) or nonsurgical (casting/boot) management and had ≥6 months of radiographic follow-up. Demographic, clinical, and radiographic variables including articular displacement, lateral distal tibial angle (LDTA), and physeal bar formation were compared between treatment groups and subgroups with or without bar formation. Results: Thirty-two patients (16 surgical, 16 nonsurgical) met inclusion criteria. The overall incidence of physeal bar formation did not differ between treatment groups (surgical: 25% vs. nonsurgical: 19%; P = 1.000). Physeal bar formation was significantly associated with greater pre-reduction articular displacement (median: 9.1 mm vs. 2.4 mm; P = 0.045), changes in LDTA (6.2° vs. 1.0°; P = 0.006), and delayed union (57% vs. 4%; P = 0.004). Clinically significant physeal bars occurred exclusively in patients with comminuted fractures ( P = 0.007). Final articular displacement was significantly lower after ORIF (0.0 mm vs. 1.0 mm; P = 0.012), although revision surgery for implant removal was more common ( P < 0.001). Conclusion: The risk of physeal bar formation after SH III and IV medial malleolar fractures was not influenced by surgical versus nonsurgical treatment. Instead, greater initial fracture displacement and comminuted fracture morphology predicted physeal injury.
Pacific Island countries face persistent and profound gaps in access to essential orthopaedic care driven by geographic dispersion, fragile infrastructure, and workforce shortages. Reliance on overseas medical referral schemes, often politically influenced and consuming substantial portions of limited health budgets, can improve access for individual patients but fails to build local capacity or ensure timely intervention for trauma and infection. Evidence from low- and middle-income settings demonstrates that “train-in-place” education models can expand the workforce, improve care processes, and reduce preventable disability. The Pacific Islands Orthopaedic Association exemplifies a regionally tailored approach through a tuition-free curriculum that retains trainees within their home health systems, reintegrates graduates as educators, and progressively reduces dependence on expatriate teams. To translate this model into durable system-level gains, parallel investments in procurement, supply chains, biomedical maintenance, and enabling policy are essential. Standardized capacity assessments encompassing workforce, case mix, infrastructure, readiness, and overseas medical referral utilization, coupled with regional train-in-place orthopaedic education, offer a scalable pathway to timely, high-quality care across the Pacific. The purpose of this article was to evaluate the current literature on strategies to increase access to musculoskeletal care in the Pacific, with a focus on home-training programs in the Pacific and their cost effectiveness.
Soft-tissue sarcomas (STSs) are a complex and remarkable heterogeneous group of uncommon malignancies originating from fat, muscle, and other connective tissues. They constitute approximately 1% of all cancers with 50 to 70 distinct histologic subtypes or tumor entities. This type of tumor, also known as “the loneliest cancer” because of its rarity, can manifest at any age, but they are most commonly diagnosed in individuals older than 40 years. They can rise from any anatomic location (somatic, visceral, or bone), but the extremity is the most common primary site. STS presents a notable clinical challenge due to its gradual onset and variable symptoms. Consequently, soft-tissue masses should be thoroughly evaluated to rule out malignancy. Some STSs can be aggressive and tend to have high recurrence and metastasis rates (40-50%), particularly in the lungs (80% of the cases) and less often in the liver, brain, bones, and peritoneum, where their occurrence might indicate a poor prognosis. The fact that they are rare and their histologic morphology varies and sometimes can overlap with different genetic, molecular, and clinical profiles contributes to their delayed and complex diagnoses. A high index of suspicion, coupled with appropriate clinical and radiologic assessment and biopsy, can help identify STS. A systematic, multidisciplinary team (e.g., orthopaedic surgeons, oncologists, radiologists, and pathologists) approach is essential for accurately diagnosing and treating soft-tissue sarcomas. Correlating clinical and radiologic information and involving a multidisciplinary team aid in accurate diagnosis. Biopsy, a crucial step, requires rigorous rules and appropriate technique selection. Histologic diagnosis can be challenging because of limited material and divergent interpretations. Advanced tools such as immunophenotypic panels and genetics can enhance accuracy. The fifth edition of the WHO manual can classify soft tissue, while the AJCC-TNM system can stage tumors. Surgical resection, often supplemented with radiation and chemotherapy, is the primary treatment for STS. However, some subtypes (e.g., liposarcoma, synovial sarcoma, and undifferentiated pleomorphic sarcoma) have high local recurrence rates or metastasis, leading to inconsistent treatment outcomes. Innovative immune and radiation therapy treatment regimens and targeted therapy can offer potential effective alternatives for these challenging cases.
A 14 +6 year-old (bone age 13 +0 years) genetically 46, XX, phenotypic female patient underwent distal femur and proximal tibia screw epiphysiodesis for a leg length discrepancy related to overgrowth following juvenile ACL reconstruction. The patient was considering, but had not committed to, gender affirmation treatment (internally the patient felt male). The patient later started testosterone, which altered predictions of height and leg length discrepancy at maturity. Screws were removed to minimize overshortening of the previously long leg. Upon screw removal, modest growth of the operative limb resumed. Following removal of transphyseal screws in skeletally immature patients, growth may resume.
By the time the orthopaedic surgeon sees a patient with symptomatic knee osteoarthritis, the disease has already progressed to an advanced stage. As a result, studying the full natural history of the knee is especially difficult. A few large longitudinal cohorts, the Osteoarthritis Initiative and Multicenter Osteoarthritis Study in particular, provide the bulk of the data for most extant studies. In this review, we report on the current state of knowledge regarding the study of the natural history of the knee, including the difficulties of natural history research, the tools used to assess knee osteoarthritis, the major longitudinal studies in knee osteoarthritis, and the ability of early interventions to modify natural history. In addition, we will preview what is possible using artificial intelligence and newer large longitudinal cohorts.
Subchondral bone cysts are intraosseous cystic lesions typically associated with degenerative joint diseases in weight-bearing joints; however, their occurrence in the humeral trochlea is extremely rare. We report a case of a 19-year-old Japanese archer who presented with a 2-year history of right elbow pain. CT revealed an 8- × 4- × 4-mm cystic lesion with partial disruption of the subchondral bone plate on the lateral aspect of the humeral trochlea. As arthroscopic access is technically challenging and intra-articular curettage through the joint surface would damage the cartilage, a navigation-assisted extra-articular approach was selected. A patient-specific three-dimensional surgical plan was designed to achieve cylindrical excision of the lesion and was reconstructed with a β-tricalcium phosphate bone substitute. Postoperative CT scans confirmed complete removal of the cyst. Postoperatively, the patient's elbow pain gradually improved and had completely resolved at 14 months. This case demonstrates that navigation-assisted extra-articular curettage is a feasible technique for treating deep subchondral bone cysts of the humeral trochlea while preserving the articular cartilage.
AIMS:Reverse total shoulder arthroplasty (rTSA) relies on a competent deltoid muscle to provide stability and function. This study aims to determine the importance of ultrasonically measured deltoid muscle volume on patient strength, function, and satisfaction after rTSA. METHODS:We retrospectively reviewed 56 shoulders in 28 patients underwent rTSA with surveys of American Shoulder and Elbow Society questionnaire (ASES), simple shoulder test, and ultrasonography measurement of deltoid volume. Statistical analysis was done to determine the correlation between deltoid muscle volume and abduction strength, ASES score, Constant-Murley Score, Visual Analog Scale, range-of-motion testing, between surgical shoulder and nonsurgical repair groups, respectively. RESULTS:A strong positive correlation was observed with deltoid muscle volume and abduction strength, and a moderate positive correlation between deltoid muscle volume and the Constant-Murley Score. No notable difference was observed between the mean deltoid volume for the surgical and nonsurgical sides. No correlation existed between deltoid volume and ASES. A decrease in deltoid muscle volume was observed with patients' age, but no trend regarding length of time since surgery. These findings indicated that deltoid muscle assessment in candidate selection and postoperative care are associated with improved postoperative outcomes. CONCLUSION:Deltoid volume is a robust predictor of postoperative abduction strength and has a moderate association with shoulder function including muscle strength and range of motion but does not correlate with pain or satisfaction. The results can inform clinicians to prioritize deltoid evaluation during patient selection and follow-up, guiding additional research on optimizing rehabilitation and implant design. LEVEL OF EVIDENCE:IV.
INTRODUCTION:Alcohol use disorder (AUD) is a prevalent, relapsing condition. Despite well-documented links between alcohol misuse and adverse health outcomes, the role of AUD in orthopaedic surgery is underexplored, and systematic screening remains uncommon. The aim of this study was to examine the incidence of alcohol use and potential misuse among orthopaedic patients and assessed whether patients flagged for risk engaged in documented discussions about alcohol use with their care teams. METHODS:We retrospectively reviewed intake data from orthopaedic trauma, spine, bone health, and general registries between May 2020 and April 2025. Alcohol use was initially assessed with a nonstandardized intake questionnaire and later with the validated Alcohol Use Disorder Identification Test-Consumption (AUDIT-C) tool. Patients meeting thresholds for possible misuse were flagged. Clinical notes were reviewed to determine whether flagged patients had alcohol use discussed by their orthopaedic team. RESULTS:Among 99,269 patients screened, 67.9% reported some alcohol use, and 2.5% reported a personal history of AUD. Of 1040 patients completing the AUDIT-C, 29.2% screened positive for potential misuse; 11.1% of bone health patients also met criteria for at-risk drinking. Only 80 of 718 flagged patients (11.1%) had a documented alcohol-related discussion, with higher rates in bone health registries and among older patients. CONCLUSION:Alcohol use and misuse are common among orthopaedic patients, yet systematic screening and discussion are infrequent. Integrating validated screeners such as AUDIT-C into routine intake and supporting clinicians with training and referral pathways represent critical opportunities to improve patient safety and orthopaedic outcomes.
BACKGROUND:The joint arthroplasty population has a high number of comorbidities at the time of surgery, which increases the cost of care per episode. The goal of this study was to analyze the distribution of comorbid diseases in patients who have undergone total joint arthroplasty at our institution, which serves the poorest congressional district in the United States. We hypothesized that patients in an urban safety-net hospital would have higher comorbidity rates and higher Charlson Comorbidity Indices and that this would suggest the need for improved risk stratification in payment systems. METHODS:A retrospective analysis was conducted by reviewing consecutive patients who underwent total joint arthroplasty between 2008 and 2023 (N = 3011). Relevant comorbidities were used to calculate the age-adjusted Charlson Comorbidity Index. From this, we determined the score distribution and identified the most frequent conditions. Descriptive statistical analysis was conducted to determine the mean and variance. RESULTS:Within the patient population concerning CCI scores, 10.93% of the patient population scored 0, 22.42% scored 1, 27.33% scored 2, 20.86% scored 3, 10.73% scored 4, and 7.74% scored 5 and above. The mean CCI score was 2.25 ± 1.50. The most frequently occurring comorbid conditions according to hospital criteria in this population were hypertension (N = 2078, 69.01%), obesity (N = 1366, 45.37%), diabetes (N = 906, 30.09%), and anemia (N = 694, 23.05%). A total of 19.10% of patients were current smokers. Of all TJA patients, 96.9% had at least 1 comorbidity. CONCLUSION:The major finding from this retrospective analysis revealed the presence of a high incidence of comorbidities in the our health system's total joint arthroplasty population. We confirmed that this closed urban population is a unique subset of at-risk individuals who are undergoing TJA, which may increase their complication rates. Consideration for proper risk stratification in communities like this need to be considered.
OBJECTIVES:As the population ages, hip fractures are projected to increase. These fractures carry high morbidity and mortality in older adults. Dementia, common among these patients, may further worsen outcomes. This study evaluates the impact of preexisting dementia on mortality after surgical repair of femoral neck and intertrochanteric fractures, with the study hypothesis that the presence of preoperative dementia can result in increased mortality postoperatively. METHODS:Using the TriNetX Research Network, 68,639 patients aged 65 to 90 years who underwent surgical treatment of femoral neck or intertrochanteric fractures from 2015 to 2025 were identified. Patients were grouped based on the presence or absence of a dementia diagnosis before fracture. Surgeries included hemiarthroplasty, internal fixation, or intramedullary nailing. Propensity score matching adjusted for age, sex, and comorbidities. The primary outcome was all-cause mortality at 90 days, 2, and 5 years for patients who had sufficient follow-up data. Secondary outcomes included 90-day readmissions and complications (pneumonia, stroke, urinary tract infection, and heart failure). Risk ratios (RRs) with 95% confidence intervals (CIs) were calculated. RESULTS:Patients with dementia had higher mortality at all time points. In intertrochanteric fractures, dementia patients had increased mortality at 90 days (RR, 0.61; 95% CI, 0.57 to 0.65; P < 0.001), 2 years (RR, 0.68; 95% CI, 0.65 to 0.70; P < 0.001), and 5 years (RR, 0.76; 95% CI, 0.73 to 0.78; P < 0.001). In femoral neck fractures, mortality was also higher at 90 days (RR, 0.56; 95% CI, 0.49 to 0.63; P < 0.001), 2 years (RR, 0.64; 95% CI, 0.59 to 0.70; P < 0.001), and 5 years (RR, 0.71; 95% CI, 0.67 to 0.76; P < 0.001) in patients with dementia. At 90 days for both fracture types, the risk of mortality was nearly double among dementia patients. Similarly, 90-day readmissions and postoperative complications, including pneumonia, stroke, urinary tract infection, heart failure, and revision surgery, were statistically significantly higher among dementia patients. CONCLUSION:Preexisting dementia is associated with higher mortality after hip fracture repair in older adults, approaching nearly double at 90 days. Readmissions and complications are also markedly higher among dementia patients. These findings underscore the importance of tailored perioperative planning, enhanced care pathways for patients with cognitive impairment, and shared decision making between the patient, caregivers, and the care teams.
INTRODUCTION:In modern healthcare systems, the role of advanced practice providers (APPs), including nurse practitioners (NP) and physician assistants (PA), has increased in many settings, in step with the increased demand for healthcare services. The purpose of the present investigation was to evaluate trends in the prevalence, reimbursement, and characteristics of care provided by APPs in the treatment of spinal disorders in the United States from 2013 to 2022. METHODS:A retrospective cohort study using the publicly available Medicare Provider Utilization and Payment database from the Centers for Medicare and Medicare Services was conducted on diagnostic, procedural, and therapeutic services provided by advanced practice providers from 2013 to 2022. Provider-type and billing codes were used to identify healthcare professionals providing care for spine patients, such as ordering radiographs, assisting in surgical procedures, or performing office visits. Trends were analyzed using linear regression modeling with projections generated through 2030. RESULTS:Over the study period, the number of surgeons involved in spine care decreased from 3953 (71.2%) in 2013 to 3951 (66.7%) in 2022. The number of APPs who billed for the care of spine patients increased 23.3% from 1600 in 2013 to 1974 in 2022. The most common services billed for by APPs included radiographs and office visits. There were increased odds (OR: 1.20, 95% CI, 1.03-1.41, P < 0.001) of a spine provider in rural areas being an APP versus spine surgeon. Forecasting analysis for 2030 demonstrated continuation of these trends regarding the number of providers, services, and geographic distribution. DISCUSSION:Increased utilization of APPs in the care of patients with spinal pathology is likely to continue with the growing prevalence of patients with spinal disorders.
OBJECTIVES:To see whether there are differences between primary and revision surgeries while stratifying results by cervical and lumbar regions. METHODS:Michigan Spine Surgery Improvement Collaborative is a multi-institutional quality-improvement collaborative across Michigan. The analytic sample included patients who underwent spine surgery between February 24, 2014, and January 31, 2025. Descriptive statistics were used to compare demographic characteristics and patient-reported outcomes between primary and revision procedures. RESULTS:A total of 49,577 patients undergoing primary lumbar surgery and 3745 undergoing revision were identified. For cervical procedures, 20,473 primary and 3281 revision cases were included. Patients undergoing revision surgery were slightly older across both spinal regions. In unadjusted analyses, revision lumbar patients consistently demonstrated worse outcomes than those undergoing primary surgery. Return to work at 1 year was lower among revision patients, and they also had markedly higher odds of opioid use and emergency department visits. In the cervical cohort, similar differences were observed. In addition, cervical revision patients demonstrated higher odds of readmission and return to the operating room. After adjusting for patient demographics, comorbidities, and surgical factors, revision surgery remained an independent predictor of worse outcomes in both spinal regions. CONCLUSIONS:Revision spine surgery is associated with worse outcomes compared with primary procedures even after adjusting for baseline risk factors. The results are consistent across cervical and lumbar revisions about pain scores, physical function, opioid use, and patient satisfaction. Opioid usage continued to be higher, while return to work was delayed for lumbar revision patients. STUDY DESIGN:Retrospective database.
