JOEI The Journal

Health literacy plays a crucial role in patient decision-making. National guidelines from the NIH and AMA recommend that patient education materials (PEMs) be written at or below a 6th-grade reading level.

Magnetically driven telescopic intramedullary lengthening nails permit internal distraction osteogenesis without external fixation. While removal is typically uncomplicated, component dissociation at the telescoping junction has been reported as an infrequent but challenging complication.

The author describes his early experiences with using anatomic fluted stems for difficult knee revisions.

Review the diagnostic and therapeutic indications, complications, and technical considerations for the use of In-office needle arthroscopy (IONA).

Incisional tension is an important and recognized contributor to complications surrounding wound sites and suboptimal scarring after sports medicine interventions, especially in areas high in motion which could be subjected to early mobilization. Force modulating tissue bridges (FMTBs) are non-invasive devices that can offload mechanical tension at the wound site. We aimed to evaluate the safety, feasibility and preliminary clinical outcomes of FMTBs when used in ambulatory sports medicine setting.

Despite the known opioid crisis and momentum for opioid prescribing protocols in orthopedic surgery, there are no universal guidelines for procedure-specific opioid prescription amount, or duration of use. We report results of a single, brief quality improvement intervention to reduce opioid prescribing in a private practice setting.

To overcome limitations using manual instruments designed for mechanical alignment to set the tibial resection plane in kinematically aligned (KA) total knee arthroplasty (TKA), this paper reports a new dual-styli and angel-wing tibial resection guide. The primary objectives were to describe the design and perform a preliminary evaluation by reporting the frequency of tibial recuts and the proportion of thinner inserts, which indicated a conservative resection thickness. A secondary objective was to determine the incidence of radiographic varus-valgus (V-V) angle and posterior tibial slope (PTS) baseplate outliers, defined as deviations greater than ±3° from preoperative values.

Complex hip and knee arthroplasty can leave attenuated tendon, capsule, retinaculum, periosteum, and fascia that are difficult to close reliably after definitive reconstruction. The purpose of this report was to describe the clinical applications of a biointegrative collagen implant in complex hip and knee arthroplasty and to characterize early clinical and second-look observations following implantation.

The author shares his perspective on consent and robotic orthopaedic procedures.

The recording of the JOEI "Open Mic" Session featuring Derek Amanatullah, MD, Stephen Duncan, MD, & Ken Urish, MD.

Burnout, characterized by emotional exhaustion, depersonalization, and reduced professional fulfillment, has emerged as a critical issue in orthopaedic surgery. Affecting an estimated 30–40% of surgeons, burnout has been associated to increased medical errors, malpractice risk, decreased patient satisfaction, and alarming mental health consequences, including elevated suicide rates. While traditionally viewed as an individual failing, contemporary evidence highlights its systemic roots, driven by structural inefficiencies, cultural dynamics, and personal vulnerabilities. Key contributors include escalating administrative burden, loss of autonomy, high-stakes clinical demands, and discriminatory workplace cultures, particularly affecting women and underrepresented groups. The consequences extend beyond surgeon well-being to institutional performance and patient safety. Current wellness initiatives are often poorly aligned with the realities of surgical practice, underscoring the need for systemic reform. This review synthesizes the current literature on burnout and provides evidence-based systemic solutions to address it. Evidence-based strategies emphasize leadership and mentorship, peer support, workload optimization, cognitive efficiency, diversity initiatives, and integration of digital innovations to reduce documentation burden. Additionally, programs promoting mindfulness, protected time for meaningful work, and inclusive professional cultures show promise in enhancing resilience and career sustainability. Addressing burnout in orthopaedic surgery requires a paradigm shift away from reactive, individual-focused solutions toward structural interventions that restore professional autonomy, support surgeon well-being, and safeguard patient care.

Tibial plafond fractures are severe injuries that often result in a prolonged treatment and recovery process, as well as poor outcomes and high complication rates. Given this, an online support group exists for patients to gain support and advice from a community of patients with the same injury. Similar groups exist for other chronic medical conditions and traumatic injuries; such groups have been studied to determine the impact on the affected patients. There have been no prior studies specifically investigating the effect of these support groups on patients with tibial plafond fractures.

Total ankle arthroplasty (TAA) has become a reliable option for end-stage ankle arthritis management with good to excellent survivorship with modern 4th generation implant designs. In cases of implant failure, an array of revision implant options is necessary but not readily available to address all the nuanced requirements. We put forth a case series of revision total ankle arthroplasty (rTAA) to report the early experience and feasibility of 3D printed custom stemmed tibial trays (CSTT).

Orthopedic surgical educational strategies have rapidly advanced, driven by increasing technical complexity in the breadth of procedures within the specialty, the introduction of novel educational supplementation including simulation-based training, and the introduction of structured feedback mechanisms to encourage competency-based training. The learning curve for various common orthopedic procedures have been previously evaluated and described; however, these changes to orthopedic education need to be considered with regards to their effect on learning curve. Increased standardization of educational curricula, including case minimums and definitions of the levels of supervision at various training levels, must be additionally considered with respect to the learning curve for procedures for which orthopedic residents must become competent during training. This review underscores the need for tailored training paradigms emphasizing high-volume exposure for complex procedures and structured simulation for skill-based learning. Standardized definitions of supervision should be included in updated assessments of the learning curve to better inform orthopedic educational initiatives.

Cerclage fixation has become an essential adjunct in total hip arthroplasty (THA), offering surgeons a versatile means of achieving mechanical stability in the face of complex challenges such as intraoperative femoral fractures, trochanteric osteotomies, and periprosthetic fracture management. This comprehensive review synthesizes current evidence regarding anatomical considerations, surgical techniques, fixation options, and clinical outcomes related to cerclage use in both primary and revision THA. Emphasis is placed on the importance of precise anatomical knowledge, particularly in navigating neurovascular danger zones along the femur, to mitigate the risk of iatrogenic injury during cerclage application. Various cerclage systems are evaluated, including traditional stainless-steel wires, multifilament metallic cables, cable-plate constructs, nonmetallic polymer loops, and high-strength sutures, highlighting differences in biomechanical performance, cost, and clinical reliability. Clinical indications for cerclage fixation are reviewed in detail, including its role in prophylactic stabilization of high-risk femurs, fixation of trochanteric osteotomies, and management of periprosthetic fractures. As THA continues to evolve, strategic use of cerclage fixation, grounded in anatomical precision and tailored implant selection, remains a critical skillset for optimizing surgical outcomes and minimizing complications in both routine and complex cases.

Recent studies have shown that online video libraries are poor sources of educational content for patients. Despite this, patients seek videos on the internet to learn about their conditions and treatments, which may increase anxiety prior to surgical procedures. This study tested the hypothesis that watching a high-quality, physician-made video prior to elective hand surgery decreases pre-operative anxiety.

Chat Generative Pre-Trained Transformer (ChatGPT) has continued to become widely utilized in orthopaedic surgery due to its efficiency and ability to produce easily digestible information. Researchers have used ChatGPT to produce topic specific outlines and assist in research endeavors. The purpose of this study was to evaluate the validity of ChatGPT as a resource to orthopaedic researchers in conducting literature reviews for presentations or research papers.

Ipsilateral dislocations of the hip and knee are rare injuries that threaten the limb and demand rapid, orderly care. We report a polytrauma patient with a closed posterior hip dislocation, an ipsilateral open knee dislocation with neurovascular compromise, and a left floating hemipelvis defined by fractures of the superior and inferior pubic rami with sacroiliac joint disruption. This constellation creates a floating hip and makes standard hip reduction unsafe because axial traction through the knee can aggravate soft tissue and vascular injury. We used a modified Allis maneuver that redirects traction to the femur while the knee is rigidly immobilized and the pelvis is stabilized. Closed reduction was achieved promptly. Given persistent ischemia and a Mangled Extremity Severity Score (MESS) of 9, urgent guillotine above-knee amputation was performed.This case underscores priorities that should guide similar presentations: immediate hemodynamic stabilization, continuous reassessment of neurovascular status, protection of compromised soft tissues, and early but safe hip reduction that avoids loading an unstable knee.

The recording of the JOEI "Open Mic" Session featuring Stefano Bini, MD, Max Courtney, MD, & George Guild, MD.

Distal radius fractures is an orthopedic injury commonly operatively treated with volar-based plating. Regional nerve blocks are efficacious in improving post-operative pain control, yet “rebound pain” when the nerve block wears off remains of great concern. This study aims to evaluate the efficacy of liposomal bupivacaine (LB) in providing meaningful, additional pain control on top of a supraclavicular nerve block for patients undergoing distal radius volar plating.

The recording of the JOEI Zoom "Open Mic" Session featuring Richard Buch, MD, Jon Minter, DO, & Herrick Siegel, MD

The increasing ubiquity of personal electronic devices (PEDs) has introduced new cognitive challenges in high-stakes environments such as orthopedic surgery. While PEDs offer communication and informational utility, their misuse during clinical care has raised concerns about situational awareness, workflow disruption, and patient safety.

By Ben Schwartz, MDThe author’s perspective on the relationship between orthopaedic specialists and CMS.

Medicare reimbursement cuts and increasing administrative burdens have contributed to a growing number of physicians opting out of the program, with orthopedic surgeons disproportionately affected due to their patient population, procedural volume, and operational costs. Therefore, this study aimed to analyze (1) trends in the incidence of orthopedic surgeons opting out of Medicare, (2) the demographic and professional characteristics of those opting out, (3) the geographic distribution of opt-outs, and (4) provider characteristics associated with the timing of opt-outs among orthopedic surgeons.

Orthopaedic surgical residency training is a demanding time. It requires discipline, long working hours, and interdependence on your co-residents. Studying, splinting, operating. There’s not much in the way of personal hobbies, free time, or sleep for that matter. The years of training don’t just qualify us for a job, they mold us into surgeons - but is there room to be anything else? Is there room to be both a parent, and an orthopaedic surgical resident?

The author presents his overview on total joint infections.

Antibiotic-loaded cement hip spacers are a cornerstone in the management of prosthetic and native hip infections before second-stage arthroplasty. However, complications such as spacer dislocation or acetabular erosion often stem from a size mismatch between the spacer and the patient’s unique anatomy. In this technical note, we describe a patient-adapted, hand-crafted technique for fabricating a well-fitting antibiotic cement hemi-articulating spacer for infection management. This approach aims at matching the individual’s acetabular anatomy, potentially reducing complications and improving outcomes.

Studies that examine the image-based Rosa robotic knee arthroplasty system in restoring the desired mechanical axis (MA) are rare. The purpose of this study was to measure the accuracy of an image-based robotic knee system in restoring the desired MA.

The recording of the JOEI "Open Mic" featuring Kris Alden, MD, Colin McNamara, MD, & Anton Kurdin, MD.

This article discusses the author’s experience with the diagnosis and treatment of frozen shoulders.

Most glass-related injuries in children are accidental. Therefore, this study aims to identify risk factors associated with more severe glass injuries and recommend ways to prevent them.

Medial-stabilised total knee arthroplasty (MS-TKA) usage has increased significantly over the past decade with encouraging results. MS-TKA mimics the natural knee kinematics, providing superior antero-posterior stability as compared to cruciate-retaining or posterior-stabilised designs. Its proponents suggest that MS-TKA may provide the solution to the residual dissatisfaction seen in many patients following knee replacement surgery.

Prevention strategies can help orthopedic surgeons optimize circumstances to reduce the incidence of SSI and PJI.

In the setting of revision total knee arthroplasty (RTKA), a tibial tubercle osteotomy (TTO) may be required to gain better exposure to the implant. However, complications still limit its use. The purpose of this study was to inform the design of a novel plate for TTO fixation in the setting of RTKA that reduces the occurrence of osteotomy displacement, nonunion, and malunion.

MOTIV™ – Musculoskeletal Outcomes and Tracking Intelligence Vault – is an initiative is designed to help orthopaedic physicians participate more directly in real-world evidence generation across all practice settings. The surgeon contributors define the clinically relevant questions and supply the ground-truth observations from their own care. MOTIV™ connects the initiative to the broader mission of advancing orthopaedic research.This article was developed through a collaborative initiative between the Orthopaedic Research and Education Foundation (OREF) and RegenMed to advance physician-led, real-world evidence generation in musculoskeletal care.

The recording of the JOEI Zoom "Open Mic" Topic Session featuring Korboi Evans, MD, Morteza Meftah, MD, & Jack Sizemore, PA

Pickleball has emerged as one of the fastest-growing sports in the United States, with participation expanding across all age groups. Pickleball is thought of as a low impact sport and a better understanding of injury patterns would help guide prevention strategies particularly in older, at-risk populations.

The landscape of orthopaedic surgery residency training is evolving. As the field grapples with questions of value, access, workforce preparation, and the growing complexity of the healthcare system, residency programs are increasingly challenged to produce not only technically skilled surgeons, but also thoughtful physician leaders capable of navigating a rapidly changing environment. The University of Texas at Austin Dell Medical School Orthopaedic Surgery Residency was built with such a goal in mind. Though a newer program, our leadership have made an effort to structure the program around a set of principles: high-touch mentorship, exposure to diverse practice environments, value-based care, and resident-driven leadership, that together attempt to create a unique training experience.

Monostotic fibrous dysplasia (MFD) involving the upper extremity is typically amenable to conservative treatment. However, surgery may be indicated in the presence of fragility fractures. While curettage with bone grafting is often used, graft resorption and local recurrence are common. This article describes 3 consecutive patients with MFD who underwent curettage with autograft cancellous bone chips, using a trapdoor technique with adjuvant dehydrated alcohol and cryoablation.

Artificial intelligence (AI) is increasingly influencing orthopedic practice by improving diagnostic accuracy, surgical planning, and research efficiency. Despite these advances, the adoption of AI-based tools in routine orthopedic workflows remains limited due to the technical expertise and financial resources traditionally required for software development. 

The economic burden of cancer is substantial, particularly within orthopaedic oncology, where metastatic bone (MBD) imposes significant cost-efficiency challenges on healthcare systems. As a major component of bone disease in cancer, MBD contributes greatly to overall costs and impacts value-based care efforts. MBD is prevalent in 60-84% of patients with metastatic cancer, leading to increased medical expenses and hospitalization costs due to skeletal-related events (SREs). Direct costs associated with orthopedic tumor surgeries are considerable, encompassing inpatient and outpatient care, medication, and long-term follow-up.

The aims of this study were to determine the incidence of block-related complications after adductor canal blocks (ACB) in total knee arthroplasty (TKA), identify associated risk factors, and investigate if there were any differences in clinical outcomes.

Pyrocarbon hemiarthroplasty heads are an alternate bearing surface compared to metal with favorable wear properties. Pyrocarbon has a high wear resistance, low friction and favorable modulus when compared to cortical bone. 

Total Knee Arthroplasty (TKA) is one of the most common orthopedic procedures globally, with wound closure playing a critical role in postoperative recovery and complication prevention. Despite advances, the optimal closure technique remains debated. This narrative review evaluates current wound closure techniques in TKA highlighting their biomechanical and clinical

The posterior cruciate ligament (PCL) is a major stabilizing structure of the flexion space, yet current evidence is inconclusive regarding change in gap laxity associated with its resection. This study aimed to describe the association between PCL resection and knee gap balancing using intra-operative robotic assessment.

The author reflects on what was, is, and will be in orthopaedics based on his fifty years in the field.

Lumbar spine fusion is one of the most common surgical procedures performed in the operative management of adult degenerative spine disorders. The dual incision, mini-open TLIF surgery uses a minimally invasive surgical technique that decompresses neural elements through placement of an anterior interbody disc spacer and posterior stabilization with pedicle screws.

rofit margins for ambulatory surgery centers (ASCs) can vary significantly. Top decile ASCs have EBITDA (earnings before interest, taxes and depreciation allowance) profit margins exceeding 40%, while those in the bottom quartile struggle with EBITDA margins below 15%. Increasing ASC profitability is more important than ever for surgeons as the ASC income can help offset reductions in their earnings due to decreasing or stagnant payment rates combined with rising practice costs.

Pedometer data has been historically used as a metric of early mobilization and functional recovery after spine surgery. Wearable pedometers augment traditional patient-reported outcome measures (PROMs) after spine surgery. 

After sterile processing, orthopedic instrument trays are occasionally found to have retained bone from prior procedures. This study aims to assess the effect on heavily contaminated bioburden, adjacent tray, and instrument contamination risk of a standard medical facility sterile processing cycle for orthopedic instruments.