Background: Deep vein thrombosis occurs in 10%-20% of patients after orthopedic trauma, whereas the risk of pulmonary embolism (PE), which can have far more catastrophic consequences, is similar to 1%. There is also a difference in the physiologic response to trauma in younger patients compared with those who are more frail. The primary hypothesis was that increasing age is associated with increased PE risk. Methods: We conducted a retrospective cohort study using a national administrative claims database including adult patients with closed lower extremity fractures between 2011 and 2021, including pelvic, acetabular, femur, tibia, fibula, ankle, and calcaneus fractures. Patients with cancer or pre-injury anticoagulation were excluded. The primary outcome was PE incidence within 6 weeks after injury. Multivariable logistic regression models were used to evaluate the association between age and PE incidence adjusted for patient demographics, comorbidities, and post-injury anticoagulation. Results: In 6,514,870 patients (12% treated surgically), PE incidence was 0.3% in the nonoperative cohort and 0.6% in the surgically-treated cohort. In both cohorts, there was a progressive, age-dependent increase in PE incidence within 6 weeks after injury despite anticoagulation use. In the multivariable model, compared with patients younger than 50 years, patients older than or equal to 70 years had the highest adjusted odds for PE (nonoperative: OR=1.72, P<0.001). Conclusions: Older patients with closed lower extremity fractures have an increased PE risk even after accounting for anticoagulation and comorbidities, suggesting a need to revisit prophylaxis strategies and for increased vigilance in these at-risk patients.
Background: Perioperative malnutrition is associated with adverse outcomes, yet nutrition optimization remains underutilized in orthopedic enhanced recovery protocols. This study evaluated whether providing perioperative nutrition education improves patient satisfaction and perceived recovery following outpatient orthopedic surgery. Methods: We conducted a single-center, randomized quality improvement study including adults scheduled for elective outpatient orthopedic procedures. Participants were randomized 1:1 to receive either a standardized preoperative nutrition information packet or an identical blank packet. At 6-week follow-up, all patients completed a survey adapted from the Outpatient and Ambulatory Surgery Consumer Assessment of Healthcare Providers and Systems (OAS CAHPS) instrument assessing satisfaction and perceived recovery. Between-group comparisons used Fisher's exact and t tests, and P values at alpha<0.05 were considered statistically significant. Results: Twenty-six patients were analyzed (12 intervention, 14 control). Baseline demographic and clinical characteristics were similar between groups. Overall satisfaction was uniformly high, with mean facility ratings exceeding 9 of 10 in both arms. No statistically significant differences were observed in satisfaction scores, perceptions of recovery, or reported nutrition-related behaviors. Although most patients indicated that preprocedure instructions improved recovery, adherence rates and dietary changes did not differ by group. Conclusions: A single written perioperative nutrition handout did not improve patient satisfaction, perceived recovery, or nutritional behaviors in the outpatient orthopedic setting. High baseline satisfaction suggests limited measurable benefit from stand-alone print education. Effective perioperative nutrition strategies may require repeated, interactive, and longitudinal counseling integrated into broader enhanced recovery protocols.
Bioactive glass (BAG) and β-tricalcium phosphate (β-TCP) have emerged as promising biomaterials for bone substitution, particularly in the management of osteomyelitis, spondylodiscitis, pseudarthrosis, and prosthetic joint infections. Their osteoconductive, osteostimulatory, and antimicrobial properties have led to their increasing use as bone graft substitutes or adjuncts in the management of bone defects associated with fracture repair, pseudarthrosis, and infectious conditions such as acute and chronic osteomyelitis, typically in combination with standard surgical and antibiotic treatment strategies. This study presents a review with an updated evidence synthesis to evaluate the efficacy, clinical applications, and future perspectives of these materials. A narrative review was conducted, synthesizing evidence from in vitro, in vivo, and clinical studies that examined the use of BAG and β-TCP in bone regeneration and infection control. The review included studies assessing antimicrobial efficacy, bone remodeling potential, and clinical outcomes. Evidence indicates that BAG-45S5 and other types exhibit intrinsic antimicrobial properties, effectively reducing biofilm formation and multidrug-resistant bacterial growth. BAG-45S5 has the most extensive body of evidence, supporting the efficacy of its mechanism of action and its benefits for bone tissue. BAG combined with β-TCP enhances bone regeneration while promoting osteointegration. Clinical studies demonstrated high success rates in chronic and acute osteomyelitis and fracture healing, with reduced need for antibiotics. In conclusion, BAG and β-TCP represent a viable alternative to autografts, offering infection control and bone healing without donor site morbidity. Their integration into synthetic bone grafts and bioactive scaffolds suggests a transformative role in bone regeneration and orthopedic surgery.
Background: Orthobiologics are increasingly used as minimally invasive adjuncts in the management of musculoskeletal disorders. In India, their clinical application has expanded in response to the growing burden of osteoarthritis, sports injuries, and degenerative conditions. Objective: To review current evidence on commonly used orthobiologic therapies and assess their clinical relevance, guideline support, and regulatory considerations in the Indian context. Materials and Methods: A focused narrative review was performed on platelet-rich plasma (PRP), bone marrow aspirate concentrate (BMAC), stromal vascular fraction (SVF), mesenchymal stem cells (MSCs), scaffolds, and exosomes. International recommendations were evaluated alongside Indian clinical studies and the evolving national regulatory framework. Results: PRP has demonstrated modest clinical benefit in selected indications and is cautiously supported by international guidelines, whereas cell-based therapies remain investigational. In India, widespread use is marked by variability in preparation, administration, and outcome reporting. Limited high-quality trials, cost-related barriers, and regulatory ambiguity continue to restrict evidence-based adoption. Conclusion: Orthobiologics offer potential clinical value in Indian musculoskeletal practice; however, their routine use should be guided by standardized protocols, India-specific guidelines, robust multicentre trials, and strict regulatory compliance to ensure patient safety and reproducible outcomes.
This narrative review aims to synthesize current research on anterior cruciate ligament (ACL) postoperative rehabilitation, highlighting the evolution from traditional immobilization and early active motion protocols to individualized, multidisciplinary approaches. The review explores models that integrate biological, psychological, and technological factors to optimize knee function restoration, graft healing, and patient quality of life. A comprehensive literature search was conducted using the MEDLINE/PubMed and Scopus databases. Key areas of focus included graft healing, the application of mechanical loads, psychosocial influences, and the integration of advanced technologies such as biomechanical analysis and artificial intelligence. Rehabilitation models examined included standardized criteria-based protocols, functional recovery frameworks, International Classification of Functioning, Disability, and Health (ICF)-based models, and biopsychosocial approaches. The findings highlight the transition from traditional, generalized rehabilitation protocols to personalized, multidisciplinary strategies. Emerging models emphasize the need to balance standardized guidelines with individualized care, address psychosocial factors, and leverage technological innovations to refine treatment plans. These approaches show promise in addressing both physical and psychological dimensions of recovery, enhancing rehabilitation outcomes, and preventing re-injury. This review identifies three critical pillars for optimizing ACL rehabilitation: (1) calibrating rehabilitation to biological graft healing phases to balance tissue protection and mechanical stimulation; (2) integrating psychological readiness assessment using validated instruments to address kinesiophobia and self-efficacy; and (3) leveraging technological innovations such as motion capture and artificial intelligence for objective monitoring and individualized planning. Significant knowledge gaps remain regarding optimal loading parameters across graft types, standardized psychological intervention protocols, and long-term outcomes beyond 2 years. Future research should prioritize multidisciplinary integration, cost-effectiveness of emerging technologies, and sustained functional recovery to advance personalized, evidence-based rehabilitation strategies.
Background: Total hip arthroplasty (THA) in the elderly is burdened with several implications. Although the clinical improvements are relevant, psychological aspects are not yet considered. The purpose is to evaluate the clinical and psychological impact on octogenarians and nonagenarians addressing elective THA. Materials and Methods: We conducted a retrospective evaluation of 79 consecutive THAs in 77 patients aged 85 years or older, with a minimum follow-up of 6 months. Clinical aspects were evaluated using the Hip disability and Osteoarthritis Outcome Score (HOOS), while psychological issues were assessed using the Short Form 12 (SF-12), the EQ-5D-5L score, and the EQ VAS. Results: From the starter cohort, 57 patients were fully evaluated, 13 patients died from causes unrelated to surgery, 8 were lost to follow-up, and 3 patients were revised. Mean HOOS statistically raised from 15.42±12.86 (IC 95%: 12.06–18.79) to 92.19±7.41 (IC 95%: 90.25–94.13) ( P <0.00001). Regarding the SF-12 score, the PCS statistically rose from 26.80±5.89 (IC 95%: 25.25–28.34) to 52.15±5.00 (IC 95%: 50.84–53.46) ( P <0.00001), and the MCS from 30.74±9.41 (IC 95%: 28.27–33.20) to 54.57±6.27 (IC 95%: 52.93–56.21) ( P =0.24627). The EQ-5D-5L score statistically improved in each subscale and EQ VAS ( P <0.00001). The cumulative survival rate was 69.62% at 3.5 years of mean follow-up. Conclusion: THA in octogenarian and nonagenarian patients is a safe procedure with excellent clinical results and improvements in psychological aspects.
Background: Disorders of the long head of the biceps tendon often require surgical intervention. This study evaluates a biological, implant-free technique for subpectoral biceps tenodesis using press-fit bony plugs harvested from the humeral head. The approach aims to provide a cost-effective, hardware-free alternative while maintaining biomechanical stability and promoting natural tendon healing. Purpose: This study evaluates clinical outcomes of a novel biological fixation technique for subpectoral biceps tenodesis utilizing autologous press-fit bony plugs, assessing its safety and functional efficacy. Methods: A prospective case series was conducted on 30 consecutive patients (17 female, 13 male) undergoing the procedure with a minimum 24-month follow-up. Surgical technique involved harvesting a cortico-cancellous bone plug from the humeral head’s bicipital groove region for subsequent subpectoral tendon fixation. Outcome measures included comparative analysis of preoperative and postoperative VAS pain scores, ASES, and Constant shoulder scores. Results: Patients demonstrated statistically significant improvements across all metrics: ASES scores increased from 52.2 to 95.53 (p=0.001), Constant scores improved from 32.33 to 95.9, and VAS decreased from 6.9 to 0.53. No instances of fixation failure, neurovascular compromise, or cosmetic deformity were observed during the study period. Conclusion: The mini-open subpectoral biceps tenodesis technique using press-fit autologous bone plugs proves to be an effective, biologically advantageous procedure with excellent functional outcomes while eliminating implant-related complications and reducing surgical costs.
The second-generation patellofemoral component used in total knee arthroplasty (TKA) uses porous tantalum, which has lower tensile and yield strengths compared to titanium used in the first-generation implant. However, there is a paucity of studies investigating the complications in either generation. This case involves a female patient with a history of right TKA with a second-generation metal backed patellofemoral component who presented with right knee pain. Exam findings demonstrated positive patellofemoral grind test, medial joint line tenderness, and end-range flexion and extension pain. Radiographs showed a fracture of the metal backing of the proximal lateral patellofemoral component. A revision TKA was performed. Intraoperatively, there was a bony defect in the superior lateral patella underneath the area of the fractured metal patellar component. We hypothesize that the bony defect of the patella resulted in a stress point in the metal backing of the patellofemoral component, eventually causing a fatigue fracture after sustaining repetitive bending forces. The patellar component was revised with a cemented component, which also addressed the bony defect. Surgeons using a cementless metal backed patellofemoral component should take measures to ameliorate any stress points by ensuring circumferential support of the component.
Cervical and lumbar total disc replacement (TDR) has emerged as a motion-preserving alternative to spinal fusion, offering favorable outcomes and reduced adjacent segment disease. However, the use of metal-on-metal implants introduces the rare but clinically significant risk of metal hypersensitivity. This review examines the pathophysiology, diagnostic approach, and treatment considerations surrounding metal allergy in spinal arthroplasty. Metal ions released through implant wear may act as haptens, triggering immune responses, most commonly type IV delayed hypersensitivity, leading to chronic inflammation, soft tissue masses, and implant failure. While metal allergy is well documented in hip and knee arthroplasty, its role in spinal TDR remains underrecognized, with current literature limited to isolated case reports. These reports consistently describe symptom recurrence, sterile inflammatory masses, and histologic findings rich in lymphocytes and eosinophils, often requiring revision surgery and hardware removal. Patch testing is the preferred diagnostic method in patients with a suspected reaction, though its routine use preoperatively is not recommended unless a known history of metal allergy exists. All documented cases in cervical and lumbar TDR were ultimately managed with explanation and fusion, resulting in symptom resolution. Given the increasing prevalence of disc arthroplasty and the estimated 10–15% of the population with metal sensitivity, awareness of this complication is essential. Emerging evidence supports the potential of alternative implant materials such as ceramics and PEEK to mitigate this risk. Further research is warranted to establish incidence rates, optimize screening strategies, and develop hypersensitivity-resistant biomaterials for spinal arthroplasty.
Hybrid surgery is a relatively new surgical technique that combines anterior cervical discectomy and fusion (ACDF) and anterior cervical disc replacement (CDR) to treat multilevel cervical disc disease (MCDD). ACDF has long been the standard operative treatment for cervical disc degeneration. CDR is an alternative treatment that is intended to preserve motion at the index levels but has narrower indications. Complications of ACDF are well described and include pseudarthrosis and adjacent segment degeneration. The rates and severity of complications increase with the number of consecutive levels treated with ACDF. Likewise, risk of instability at the index level, an established complication after CDR, increases with the number of levels treated with CDR. Surgical treatment for MCDD often requires a multilevel construct, and the traditional approach is an all-ACDF or all-CDR construct. However, hybrid surgery utilizes both procedures within one construct, reducing the number of levels being treated in a row with the same operation to theoretically mitigate complications. This review describes the indications, risks, and benefits of each treatment, analyzes the biomechanics, and summarizes the clinical results of various ACDF/ CDR hybrid surgery constructs, and compares them to ACDF-only and CDR-only constructs.
Study Design:This is a systematic review and meta-analysis of comparative studies that investigates the efficacy of ultrasonic bone scalpel (UBS) as a tool for decompressive spine surgery.Purpose:The study aims to compare the outcomes of UBS with conventional methods of decompression, such as high-speed drill (HSD) and osteotome.Overview of Literature:We discuss the traditional methods of removing bone during decompressive spine surgery using instruments such as osteotome, rongeurs, and drills. We highlight the advantages of UBS, which selectively cuts bony tissues and spares the adjacent soft tissues, thereby avoiding their inadvertent injury.Methods:A systematic literature search was conducted in electronic databases, including PubMed, Embase, Scopus, and Google Scholar, to identify potentially eligible comparative studies. Data from eligible studies were extracted into spreadsheets, and a meta-analysis was performed using appropriate computer software.Results:The final analysis included seven studies, involving a total of 1024 patients. The results indicate that the UBS group had significantly shorter mean operating time and significantly reduced incidence of complications when compared to osteotome. However, there was no significant difference in the safety profile of UBS and HSD.Conclusions:UBS is a novel technology that shows promising results in terms of efficiency and complication rates in decompressive spine surgery. It has a comparable, if not better, safety profile than conventional methods such as osteotome and HSD and leads to quicker surgeries.
Background:Increased reliance on computers has been linked to a rise in musculoskeletal disorders, particularly Carpal Tunnel Syndrome (CTS), caused by median nerve compression, leading to pain, numbness, and weakness in the hands. This study investigates the prevalence of CTS symptoms among computer users at Isfahan University of Medical Sciences.Methods:A cross-sectional descriptive study was conducted involving computer users at the university. Data were collected using a structured questionnaire that included the Levine Symptom Severity Scale and visual assessment tools. Clinical examinations suggested CTS through Phalen's and Tinel's tests by identifying positive signs related to the condition. A total of 117 participants were analyzed after excluding individuals with underlying conditions.Results:Of the participants assessed, 60.7% exhibited symptoms of CTS, with pain in the dominant hand being the most common. Significant correlations were identified between symptom prevalence and factors such as body mass index (BMI), gender, and daily working hours.Discussion:The findings indicate a high prevalence of CTS symptoms among computer users, underscoring the importance of ergonomic interventions and increased awareness of CTS in the workplace to improve health outcomes and productivity.
Objective: Subspecialty training is an important component of orthopaedic training, and mentorship is known to hold a significant role in subspecialty selection. The objective is to investigate mentorship via the relationship between the presence of female faculty in a subspecialty and the subspecialty fellowship pursuits of female residents within that program. Methods: Graduates and faculty from ACGME-accredited orthopaedic surgery residency programs were identified. Gender and subspecialty/fellowship were collected for all individuals. Residency program locations were stratified into four regions based on state: Northeast, South, Midwest, and West. To compare these categorical variables, chi-square analysis was used. Results: Of 2,151 orthopaedic faculty, 279 (13%) were female. Of 1,423 orthopaedic residency alumni, 209 (15%) were female. Pediatrics had the highest proportion of female faculty (35%) and female alumni (67%), while spine had the least female faculty (5%) and female alumni (5%). Of all female residency graduates, the most highly selected subspecialty was hand (29%). There was a significant relationship between overall female alumni subspecialty choice and the pursuit of subspecialties in which there was at least 1 female faculty at their home institution (P<0.001). Conclusions: This study suggests that gender-based mentorship impacts subspecialty selection as a significant relationship exists between female subspecialty selection and the proportion of female faculty in that subspecialty. Overall, this study highlights the impact of gender diversity within the field orthopaedic surgery and its effects on future orthopaedic surgeons.
Background:Management of minimally displaced greater tuberosity (GT) fractures following shoulder dislocation remains controversial. While surgical fixation is commonly employed in cases with significant displacement, the benefits of surgical versus non-surgical treatment in cases with minimal displacement remain unclear.Methods:In this retrospective non-randomized clinical study, 43 patients with minimally displaced GT fractures following anterior shoulder dislocation were evaluated. Patients were divided into surgical (n=12) and non-surgical (n=31) groups based on the treatment received. Functional outcomes were assessed after a minimum follow-up of two years using the American Shoulder and Elbow Surgeons (ASES) score and the Simple Shoulder Test (SST). Subgroup analysis was performed based on age, sex, work status, fracture type, and other clinical variables.Results:Overall functional outcomes were comparable between the two groups (ASES: 89.8 +/- 14.5 surgical vs. 89.1 +/- 15.2 non-surgical, P=0.88; SST: 11.1 +/- 1.1 vs. 10.4 +/- 1.6, P=0.17). However, complications occurred in 8.3% of surgical patients and 6.5% of non-surgical patients. Subgroup analysis showed significantly worse ASES and SST scores in patients with split fractures and comminution. In the young population subset, both treatment groups had similarly favorable outcomes.Conclusion:In cases of minimally displaced GT fractures following shoulder dislocation, non-surgical management provides comparable functional outcomes to surgical treatment. Surgical intervention may be reserved for specific fracture patterns, such as comminuted or split fractures, where poorer outcomes were observed. Careful patient selection is critical to optimizing results and minimizing complications.
Study Design:Randomized controlled survey study.Purpose:Evaluate the level of similarity between AI-generated and fellowship-trained spine surgeon-written operative reports.Overview of Literature:Large language models (LLMs) are a subset of generative artificial intelligence (AI) designed to produce human-like text. LLMs have demonstrated an ability to generate contextually accurate, detailed, and coherent writing across various domains. Their potential to enhance healthcare efficiency, particularly in streamlining medical documentation such as operative notes, is of growing interest.Methods:Operative reports for two common spine surgeries-anterior cervical discectomy and fusion (ACDF) and lumbar microdiscectomy were generated using ChatGPT-3 (OpenAI). A fellowship-trained spine surgeon wrote corresponding operative reports. These reports were randomized and presented to attending surgeons, fellows, and residents in orthopedic or neurosurgery, who were asked to identify whether each report was written by AI.Results:Fifty-two respondents completed the survey. For ACDF, 69.2% correctly identified AI-generated reports (P=0.050); for lumbar microdiscectomy, 61.5% were correct (P=0.239). In side-by-side comparisons, correct identification improved to 79.2% for ACDF (P=0.004) and 60% for microdiscectomy (P=0.317). Accuracy increased with training level, from 55.6% among residents to 100% among attending spine surgeons. Most participants reported that AI-generated reports had human-like language (86.3%), adequate detail (68.6%), essential procedural steps (78.4%), and accurate descriptions (68.6%). Notably, 87.5% expressed interest in incorporating AI into future operative documentation.Conclusions:Differentiation of AI-generated operative reports improves with training level. These reports share many characteristics with surgeon-written notes and are viewed favorably, suggesting a future role for AI in surgical documentation.Level of Evidence: IIConclusions:Differentiation of AI-generated operative reports improves with training level. These reports share many characteristics with surgeon-written notes and are viewed favorably, suggesting a future role for AI in surgical documentation.Level of Evidence: II
Background: Understanding peri-operative influences of patients' past medical history during spinal surgery is essential for promoting good clinical outcomes. A paucity of literature exists regarding the effect of common degenerative disorders like arthritis on spinal fusion outcomes. Methods: A retrospective review of a prospectively maintained database was utilized to examine patients undergoing spine fusion surgery at any spinal segment. Patients with a past medical history of arthritis were identified and analyzed for the following peri-operative events. Results: 532 patients met inclusion criteria, of which 192 suffered from comorbid osteoarthritis. Patients with arthritis were significantly older (P<00.1), had a higher BMI (P=0.0193), and were more likely to be former smokers (P<0.001). When examining intra-operative features, the arthritic cohort construct length was significantly longer (5.79 vs. 6.55, P=0.0112). There were no significant differences in rates of intra-operative complication. Post-operatively, there were no differences in complications, either in surgical site infection (P=0.89) or in the rate of venous thrombotic events (P=1). On follow-up, there were no significant differences in rate of instrumentation failure (P=0.11) or need for revision surgery (P=0.32). Multivariable analysis demonstrated the same trend for all intra-operative findings and all post-operative observations. Conclusion: Arthritis was not associated with increased incidence of intra-operative complications or increased need for fusion revision for our cohort. The presence of arthritis did yield an increased intra-operative blood loss without clear clinical significance. These results suggest that the presence of additional degenerative inflammatory disease does not intrinsically yield a greater incidence of peri-operative complications or failure rates.
