- Table of Contents [PDF]
International Patella Resurfacing Trends in Primary TKA: Where Are We Now? - Landon Larabee, MD, MBA; Bradley J. Lauck, BA; Joshua L. Morningstar, BS; and James F. Fraser, MD, MPH
| This study aims to identify global patella resurfacing trends and serves as an update to a prior analysis of international patella resurfacing rates from 2004 – 2014. Data were abstracted from the annual reports of seven national joint registries from 2014 – 2022 and a literature search was conducted to report clinical outcomes from meta-analyses published in the last 10 years. Average resurfacing rates ranged from 3% (Sweden) to 93% (United States), with decreases in the US (96% to 89%) and Canada (60% to 50%) and the largest increase in Australia (59% to 78%). Canada, UK, and Australia reported decreased revision rates with resurfacing, while the US, Sweden, and Norway reported equivocal revision rates. Meta-analyses consistently reported decreased revision rates for resurfaced patellae. Patella resurfacing rates in TKA continue to be dynamic on an international stage. The continuous evolution of patella resurfacing rates and associated outcomes underscores the value of tracking arthroplasty registry data. (Journal of Surgical Orthopaedic Advances 35(3):117–121, 2026)
Key words: patella resurfacing, primary total knee arthroplasty, registry data, revision rates
Efficacy of Peripheral Nerve Blocks in Posterior Approach Total Hip Arthroplasty: A Systematic Review - Kathleen D. Kinder, BBA; Jeffrey B. Stambough, MD; C. Lowry Barnes, MD; Eric R. Siegel, MS; Simon C. Mears, MD, PhD; and Benjamin M. Stronach, MD
This systematic review investigates whether one nerve block is more effective than the others for posterior approach total hip arthroplasty (THA) patients. PubMed, Embase, and Web of Science were searched for studies published prior to June 6, 2022, investigating the fascia iliaca (FIB), lumbar plexus (LPB), or pericapsular nerve group (PENG) blocks in THA and the effects on postoperative pain scores, opioid usage, and/or length of stay (LOS). The initial 226 articles were narrowed to 10 studies encompassing 595 patients. The FIB group had lower pain scores than the no-block group at 12 hours. The LPB group had lower pain scores than the no-block group at 12 hours, lower opioid consumption at 24 hours and shorter LOS. The PENG group had lower opioid consumption at 48 hours than the no-block group and shorter LOS than the LPB group. Each block type was found to have benefits for improving pain scores, opioid use, or LOS. (Journal of Surgical Orthopaedic Advances 35(3):122–128, 2026)
Key words: total hip arthroplasty, posterior approach, fascia iliaca block, lumbar plexus block, pericapsular nerve
group block
The Use of the Fracture Table Post for Guidewire Placement in Hip Fracture Surgery - Jared L. Sain, MD; Jeremy Silver, MD; Daniel C. Mascarenhas, MD; Steven Mennona, MD; and Carlos A. Sagebien, MD
Hip fractures, common among elderly patients, may result in significant disability and mortality. Fixation techniques often involve cannulated screws, sliding hip screws, or intramedullary nails. Optimal implant placement requires precise guidewire insertion from the lateral cortex into the femoral head. Variable femoral anatomy, particularly femoral version, can complicate guidewire placement despite fluoroscopy use, often requiring multiple screw passage attempts. The authors present a novel visual reference using a fracture table inguinal post to estimate femoral version and improve guidewire insertion accuracy. This technique can enhance placement accuracy and reduce the number of guidewire passages in hip fracture fixation. (Journal of Surgical Orthopaedic Advances 35(3):172–173, 2026)
Key words: femoral neck fracture, guidewire placement, hip fracture
The Effect of Psychiatric Disorders on Ankle Fracture Outcomes - Peyton Keller, BS; Anthony Milto, MD; Steven Scaife, MS; and Youssef El Bitar, MD
This study examines the association between psychiatric disorders and in-hospital outcomes following ankle fractures. The authors hypothesized that the presence of psychiatric disorders would be associated with inferior in-hospital outcomes compared to those found in patients without psychiatric disorders. Presence and type of psychiatric disorder, demographics, comorbidities, time to surgery, length of stay (LOS), and total charge were compared for patients hospitalized with ankle fractures. Multivariate regression analysis of National Inpatient Sample (NIS) database showed that the presence of a psychiatric disorder negatively impacted outcomes in inpatient ankle fractures and was associated with increased LOS, increased time to surgery, and increased total charges. The presence of a psychiatric disorder in patients hospitalized with ankle fractures was associated with poorer inpatient outcomes. By recognizing the impact that psychiatric disorders can have on orthopaedic patients, this study suggests that addressing patients’ psychosocial factors may lead to improved outcomes. (Journal of Surgical Orthopaedic Advances 35(3):129–133, 2026)
Key words: ankle fracture, psychiatric disorder, length of stay, patient demographics, comorbidities, total charge
Orthopaedic Surgical Skills Simulation: Comparing Training Utility of Cadaveric Models to Sawbones in Resident Education - Cord Peters, MD, MC, USN; Joshua Kotler, MD, MC, USN; Julia Zuppke, PhD; Jennifer Sanville, MS; Colin Crickard, MD, MC, USN (ret.); Shannon Lorimer, DO, MC, USN; and Christopher Smith, MD, MC, USN
This study aimed to compare the effect of surgical simulation between high-fidelity cadaveric (HF) and low-fidelity Sawbones (LF) models on teaching fracture care assessed with surgical performance using HF cadaveric models. Fourteen orthopaedic surgery residents (PGY-1-PGY-5) were divided into HF and LF groups, matched by training level. Each group practiced fracture fixation on their respective fiidelity-level models with OTA Type 33-C1 distal femur fractures: the HF group on Rimasys pre-fractured cadaveric models (Rimasys GmbH, Cologne, Germany) and the LF group on Sawbones (Pacific Research Laboratories, Inc., Vashon, WA). Both cohorts were evaluated on fracture fixation using high-fidelity Rimasys models with the Objective Structured Assessment of Technical Skill (OSATS) tool. There was no statistically significant difference in performance between groups (mean OSATS score: HF 21.7, LF 17.8, p = 0.19). Despite this, residents unanimously preferred high-fidelity cadaveric simulation, highlighting its potential as a valuable training tool in orthopaedic surgery education. (Journal of Surgical Orthopaedic Advances 35(3):134–137, 2026)
Key words: resident education, surgical simulation, surgical skills, sawbones, cadaveric model, distal femur
Is Metabolic Syndrome an Independent Risk Factor for Complications Following Patellofemoral Arthroplasty? A NSQIP Review of 1,618 Patients - Anna M. Ifarraguerri, MD; Theodore Quan, MD; Alisa Malyavko, MD; Alex Gu, MD; Michael S. Collins, MD; Patrick Siparsky, MD; Jesse E. Otero, MD; and Bryan M. Saltzman, MD
Metabolic syndrome (MetS) is a cluster of metabolic abnormalities including hypertension, insulin resistance, and central obesity that collectively increase patient risk of morbidity and mortality. This study evaluated the clinical impact of metabolic syndrome on 30-day outcomes following patellofemoral arthroplasty (PFA). From 2007 – 2019, patients undergoing PFA with and without metabolic syndrome in the National Surgical Quality Improvement Program (NSQIP) database were identified and the 30-day complications were assessed. Of 1,618 patients undergoing PFA, 1,443 patients (89.2%) did not have metabolic syndrome, whereas 175 patients (10.8%) did. Following adjustment on multivariate analysis, patients with metabolic syndrome had an increased risk of urinary tract infection (odds ratio [OR] 4.54; p = 0.028), postoperative transfusion (OR 2.05; p = 0.008), and an increased length of stay (OR 1.75; p = 0.007). Patients with metabolic syndrome are at an increased risk of 30-day postoperative complications following PFA. Future risk-adjusted reimbursement models should consider the impact that comorbid conditions such as MetS have on patient outcomes. Level of Evidence: III (Journal of Surgical Orthopaedic
Advances 35(3):138–141, 2026)
Advances 35(3):138–141, 2026)
Key words: patellofemoral arthroplasty, metabolic syndrome, complications
The Prevalence and Associated Pathologies of Os Acromiale in a Subspecialty Shoulder Clinic - Michael J. Steflik, BS; B. Gage Griswold, MD; Anna E. Bozzone, BA; Jonathon Whitehead, MD; A. Luke Shiver, MD; Daniel W. Paré, MD; James Frix, MD; Rahil Patel, MD; Thomas Dickerson, BS; and Stephen A. Parada, MD
The purpose of this study was to identify the prevalence of os acromiale and determine associations with diagnosis and patient demographics. Patients who presented to a subspecialty shoulder clinic from July 2, 2018 to May 5, 2021 had their charts retrospectively reviewed for demographic information, diagnosis classification, and imaging. Os acromiale had a radiographic prevalence of 5.5%. African Americans were identified to have os acromiale at a significantly higher frequency than other races (p < 0.001). Rotator cuff tear arthropathy was significantly associated with os acromiale compared to the control cohort (27% vs. 9%, p < 0.001). (Journal of Surgical Orthopaedic Advances 35(3):142–144, 2026)
Key words: os acromiale, radiographic study, epidemiology, rotator cuff pathology, shoulder pathology, prevalence, rotator cuff arthropathy
Cost-Effectiveness of One-Year Preoperative Bisphosphonate Therapy in Preventing Periprosthetic Fracture After Total Hip Arthroplasty: Break-Even Analysis - Sanjay Kubsad, MD; Andrew P. Collins, MD; Dhruv S. Shankar, MD; Suhas P. Dasari, MD; Howard A. Chansky, MD; and Nicholas M. Hernandez, MD
The cost-effectiveness of treating osteoporosis, a risk factor for periprosthetic fracture, in patients undergoing total hip arthroplasty (THA) remains unclear. Economic viability of one-year preoperative administration of U.S. Food and Drug Administration approved bisphosphonate medications for the prevention of periprosthetic fractures was assessed using price data from the National Average Drug Acquisition Cost database. With an incidence of periprosthetic hip fracture of 0.75% and the cost of treating periprosthetic hip fracture at $65,525, zoledronate, alendronate, ibandronate and risedronate are deemed cost-effective for a one-year treatment regimen if they prevented one event of periprosthetic hip fracture out of 6,270 (absolute risk reduction [ARR] = 0.016%), 4,345 (ARR = 0.023%), 1,270 (ARR = 0.079%) and 708 (ARR = 0.141%) cases of THA, respectively. If bisphosphonates are clinically efficacious in reducing periprosthetic hip fracture risk, preoperative therapy is an economically viable intervention across a range of medications and baseline fracture rates. (Journal of Surgical Orthopaedic Advances 35(3):145–148, 2026)
Key words: total hip arthroplasty, osteoporosis, periprosthetic fracture, bisphosphonate, economic cost
Prophylactic Antibiotic Use in the Setting of Non-Operative, Low-Velocity Gunshot Wounds - Kristen C. Harmody, MD; Kelsey M. Healy, MD; Kaitlin A. Henry, MD; Emily Barr, MD; J. Hunter Matthews, MD; Garrett Bullock, PhD, DPT; and Jason J. Halvorson, MD
The management of low-velocity gunshot-induced fractures (LGF), particularly regarding prophylactic antibiotic use, is widely debated. Recent studies have suggested no significant difference in infection rates between patients receiving prophylactic antibiotics for LGF and those who do not. This retrospective study compared infection rates between patients receiving prophylactic antibiotics and those who did not for non-operative, LGF between 2015 and 2020. Data were analyzed for variables including demographics, injury characteristics, and infection within 30 days. Of the 74 patients included, 6 (8.1%) developed infections. With the numbers available, no significant difference in infection rates could be detected (adjusted relative risk: 0.40, 95% confidence interval: 0.01 – 32.2, p = 0.684). An increased risk in males, current smokers and those without insurance was found. The similar infection rates observed between groups indicate that antibiotic use may be more selectively applied, potentially focusing on patients with specific risk factors. Further large-scale, prospective studies are needed to establish evidence-based guidelines. (Journal of Surgical Orthopaedic Advances 35(3):149–153, 2026)
Key words: gunshot, fractures, infection, antibiotic prophylaxis
Pediatric Upper Extremity Compartment Syndrome: An Analysis of Inpatient Outcomes - Victor Koltenyuk, BA; Matthew Merckling, BS; Oserekpamen Omobhude, BS; Ethan Parisier, BS; Jared Sasaki, BS; Kyra Leonard, BS; Ian Jarin, MD; and Harshadkumar Patel, MD
Pediatric acute compartment syndrome (PACS) results from increased pressure within a fibro-osseous space, reducing local limb perfusion. It can be traumatic or non-traumatic, often due to fractures, burns, or iatrogenic compression. PACS is challenging to diagnose in children due to insidious onset. While lower extremity PACS is well studied, upper extremity PACS remains underexplored. This study analyzes characteristics and inpatient outcomes of pediatric upper extremity PACS. The National Inpatient Sample (2015 – 2019) was queried for patients under 18 diagnosed with ACS. ICD-10 codes identified fractures, and logistic regression assessed associated factors. Among 1,040 patients, radius (33.2%) and ulna (28.8%) fractures were most common. Transfers (odds ratio [OR] = 3.862), delayed fasciotomy (OR = 5.998), and high injury severity score (OR = 1.132) increased complication risk. Black and Hispanic patients had longer hospital stays. Radius and ulna fractures were most associated with upper extremity PACS. Transfer from another hospital and delayed fasciotomy were independently associated with increased inpatient complications. (Journal of Surgical Orthopaedic Advances 35(3):154–157, 2026)
Key words: compartment syndrome, upper extremity fracture, fasciotomy
What Postoperative Kinematic Movement Patterns Correlate with Improved Patient-Reported Outcomes After Total Knee Arthroplasty? - Monish S. Lavu, MHM; Christian J. Hecht II, MD; Argen Omurzakov, BS; Scott Fong, BS; and Atul F. Kamath, MD, MBA
This systematic review aimed to evaluate how postoperative kinematic patterns (i.e., range of motion, function during movement, and gait) measured through fluoroscopy, 3D motion analysis, and wearable/implanted devices were associated with patient-reported outcome measures (PROMs). Fourteen studies evaluating 771 knees were included. Two studies exploring post-surgery exercise kinematics with fluoroscopy showed that increased femoral rotation and adduction during deep kneeling, and greater internal rotation during step-up exercises were linked to better PROMs. Studies examining the association between postoperative gait and PROMs with 3D motion analysis found that walking speed, maximal knee flexion during gait, cadence, and vertical stride regularity were positively associated with improved PROMs. Studies utilizing wearable/implanted devices showed functional improvement following increases in PROMs. These findings may be used to guide future research on implant selection and implantation strategies as well as demonstrate the links between PROMs and more objective metrics. Level of Evidence: III. (Journal of Surgical Orthopaedic Advances 35(3):158–165, 2026)
Key words: total knee arthroplasty, kinematics, patient reported outcomes, gait, exercise
Using the Lymphocyte Transformation Test to Diagnose Early Knee Arthroplasty Failures from Metal Hypersensitivity and Multidirectional Instability - Ibrahim Khalilullah, BS; Suhas Nalla; Ritvik Kakumani; Sashita Subburaj; Vineeth Adari; and Gerhard E. Maale, MD
This study aims to determine the etiology of knee arthroplasty failures from multidirectional instability (MDI) and chronic synovial inflammation. The cohort consisted of 304 patients with MDI, which was diagnosed using routine preoperative testing and physical examination. Metal-LTT was performed to diagnose metal hypersensitivity (MH). Five hypoallergenic prostheses were utilized during revision treatment (Groups 1 – 5). The prevalence of MH was 85.52% (260/304). The prosthesis most successful at resolving symptoms of failure was the Titanium and Niobium Nitride-coated constrained hinge with polyethylene augments (94.6% successful resolution of symptoms). Complication rates were excessive across all groups (44.9%), primarily due to loosening (37.7%) and infections (25%). TKA failures from MDI and chronic inflammation may need to be worked up for MH and treated with revision to a coated hypoallergenic prosthesis. MH patients demonstrated unusually high complication rates. (Journal of Surgical Orthopaedic Advances 35(3):166–171, 2026)
Key words: hypersensitivity, arthroplasty, instability, complications, lymphocyte, hypoallergenic