JOEI The Journal

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.

Orthopaedic care is limited in rural U.S. regions and globally. While telemedicine has improved access, barriers remain when clinicians must perform orthopaedic procedures without prior experience or in-person guidance. Off-grid augmented reality (AR) offers real-time visual feedback and support, potentially expanding orthopaedic care in underserved areas.

The use of preoperative three-dimensional (3D) planning software has increased when preparing for reverse total shoulder arthroplasty (RSA). Malpositioning of the glenoid baseplate and, subsequently, the glenosphere has been linked to poor patient outcomes and increased rates of revisions. The purpose of this study was to evaluate the accuracy of the radiographic measurements, version, inclination, and RSA angle, in preoperative imaging, the preoperative plan, and postoperative imaging.

Variable operating room (OR) staffing reduces efficiency in total joint arthroplasty (TJA). Prior studies show consistent OR teams improve efficiency; however, the impact of a single dedicated team member (DTM) in variable staffing settings is unknown and may be more achievable for a given surgeon. This study evaluated the impact of adding a DTM on OR efficiency and cost.

The purpose of this study was to provide a detailed summary of current publicly available primary and secondary literature, databases, and websites reporting sports-related injuries among male and female collegiate and professional athletes in the United States of America (U.S.A.) to determine whether gender disparities exist in injury reporting.

Orthopaedic surgeons who perform primary total knee arthroplasty (TKA) may often refer more complex patients to specialty-trained arthroplasty surgeons for definitive treatment. While this practice is often appropriate for optimal patient care, these internal referrals may represent a population that is associated with higher baseline risk and worse outcomes. This study aims to identify the risk factors and outcomes associated with primary TKA patients who are referred to subspecialists.

The recording of the JOEI Zoom "Open Mic" featuring Nirav Amin, MD (moderator), Brian Gilmer, MD, & Oscar Vasquez, MD.

Orthopedic oncology depends on strong patient-provider relationships and advanced expertise. Patients in this specialized and nuanced field rely on online platforms, such as U.S. News & World Report (USNWR), to guide their decision-making. While these platforms provide insights into patient satisfaction, they may fail to capture critical nuances such as academic background, research focus, and training recency. This study aims to evaluate the influence of U.S. News physician ratings on patient perceptions of orthopedic oncologists and their correlation with professional credentials.

Resident physician unionization has accelerated across the United States in recent years, reflecting broader changes in healthcare systems, physician expectations, and the economics of medical training. At Thomas Jefferson University Hospitals, residents recently voted to unionize and are currently in the midst of contract negotiations, placing these national conversations directly into the daily lives of trainees across all specialties here. Within orthopedic surgery, these issues carry unique complexity. Orthopedic residency has historically embraced an apprenticeship model deeply rooted in long hours, graduated autonomy, mentorship, and personal sacrifice. Residents are not merely employees performing labor, but trainees undergoing professional and personal development. The emergence of organized labor within residency programs therefore raises challenging questions. Are orthopedic residents primarily learners or workers? Can surgical training maintain its apprenticeship ethos within increasingly contractual labor structures? Which aspects of residency hardship are educationally meaningful versus unnecessarily burdensome? This editorial explores the evolving intersection of unionization and orthopedic residency culture through the lens of modern orthopedic resident trainees at Rothman Orthopedics at Thomas Jefferson University Hospital.

A few months ago, Dr. Buch called me and asked “Hey Chris, you know cones are expensive. Should we really be using them?” And I thought “that’s a pretty easy question.” We’re using cones all the time! We want to optimize fixation, but did it get me thinking, when should we be using cones in metaphyseal fixation? And what is the evidence? What are the finances behind it? You know really break it down.

The wide reach and unique short audiovisual nature of TikTok make it a potential modality for disseminating information about orthopaedic surgery to both patients and medical professionals. However, only a few recent studies have assessed the purpose and creators of orthopaedic surgery content on TikTok.

Lower extremity joint replacement is the second largest inpatient expense to U.S. Centers for Medicaid & Medicare Services (CMS), prompting value-based care experimentation most recently seen in the Bundled Payment for Care Improvement Advanced Model (BPCI-A). BPCI-A tested a new target pricing methodology and welcomed acute care hospital, physician group practice (PGP), and convener participants.

The recording of The Journal of Orthopaedic Experience & Innovation Zoom "Open Mic" featuring Scott Mabry, MD, Robert Sershon, MD, Charles Taunt, DO, and Ira Kirschenbaum, MD (Moderator).

Medial patellar instability is a potentially severe ligamentous condition that significantly impairs normal knee function, with most cases due to iatrogenic injury to the lateral soft tissue restraints. Idiopathic causes are exceedingly rare. We present a unique case of a 32-year-old woman with chronic idiopathic medial patellar instability managed with LPFL reconstruction using a semitendinosus allograft. This report contributes to the limited literature on non-iatrogenic medial patellar instability and supports LPFL reconstruction as a viable treatment option.

Peptide therapies have rapidly entered musculoskeletal and orthopaedic care through direct-to-consumer performance clinics and widespread online promotion. Agents such as BPC-157 and thymosin beta-4 derivatives (TB-500) are increasingly used by patients seeking accelerated recovery, despite uncertain efficacy and limited perioperative safety data.This scoping review aimed to characterize the available evidence regarding commonly used peptide therapies relevant to musculoskeletal pathology and to examine safety considerations and perioperative implications for orthopaedic surgical patients, with emphasis on total joint arthroplasty (TJA).

Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) are increasingly prescribed for both glycemic control and weight loss, particularly in patients undergoing total joint arthroplasty. While studies on total hip and knee arthroplasty suggest potential perioperative benefits, the impact of GLP-1 RA use on outcomes following total shoulder arthroplasty (TSA) is unclear. Given the unique biomechanical demands of TSA, rising TSA volumes, and increasing GLP-1 RA use, this systematic review aims to evaluate the current literature on the impact of GLP-1 RA therapy on postoperative outcomes in TSA patients.

Total knee arthroplasty (TKA) is a treatment option for individuals with symptomatic osteoarthritis who have failed conservative therapy. In this manuscript the authors describe the pathophysiology of post-operative edema and explore the patient dependent factors potentially contributing to lymphatic dysfunction and thus directly influencing the TKA postoperative course. A proposed multimodal perioperative protocol is presented that focuses on identifying limb edema/lymphedema preoperatively, intraoperative technique changes that may decrease swelling post-TKA.

Thumb carpometacarpal (tCMC) arthritis is a common and debilitating condition for aging people worldwide. Conservative treatments including activity modification, bracing, anti-inflammatory medications, and steroid injections remain the initial treatment of choice. Given the size of the tCMC joint, intra-articular image-guided injections (IGI) may provide more consistent and superior outcomes with comparison to peri-articular anatomic landmark injections (ALI). This study systematically reviews the accuracy and efficacy of intra-articular IGA versus ALI.

The purpose of this review was to evaluate treatment modalities for adductor tendinopathy and determine the superiority of conservative or surgical approaches with a specific focus on return-to-sport (RTS) rates.

Since the removal of total hip arthroplasty (THA) from the Medicare Inpatient‑Only (IPO) list in 2020, there has been a growing trend towards outpatient procedures. Recent studies have demonstrated equivalent complications and patient-reported outcome measures (PROMs) among inpatient and outpatient THA patients, but existing selection tools primarily emphasize medical comorbidities. This study assessed the value of incorporating preoperative PROMs into clinical-decision making tools to adequately identify patients most suitable for outpatient THA.

Complex acetabular defects with associated infection as well as multiple revision procedures remain a significant reconstructive challenge due to compromised bone stock, altered anatomy, and increased risk of recurrent infection. Custom triflange implants have been used to restore pelvic stability in severe bone loss; however, conventional metallic constructs may present limitations in previously infected environments, including challenges with imaging assessment and biomechanical load transfer. Patient-specific implants manufactured from Poly Ether Ketone Ketone (PEKK), a high-performance polymer with mechanical properties closer to cortical bone, may offer an alternative reconstructive strategy.

Total knee arthroplasty (TKA) and total hip arthroplasty (THA) are some of the most commonly performed surgical procedures. Due to the soft tissue damage sustained intraoperatively, pain is a common occurrence which is frequently treated with opioid analgesics. Conventional wisdom still espouses large numbers of opioids for post-op pain relief. However, opioid related adverse events such as addiction, mental status changes, fall risk, and sedation remain a problem. Suzetrigine is a novel non-addictive FDA approved medication to treat acute pain. Lowering opioid use in the early phases of recovery has been shown to reduce long-term opioid use for patients.

This review describes a systems-based framework for delivering high-volume total hip and knee arthroplasty in a resource-limited environment through long-term international collaboration. 

The purpose of this study was to identify pre- and post-operative radiographic measurements in patients who achieved excellent range of motion to optimize implant positioning in patients undergoing rTSA. We hypothesized that restoring the lateral humeral offset to closely align with the patient’s pre-operative anatomy, along with achieving optimal lateralization and distalization shoulder angles as outlined in the literature, would correlate with excellent clinical outcomes.

The recording of The Journal of Orthopaedic Experience & Innovation Zoom "Open Mic" featuring Nathanael Heckmann, MD (moderator), James Baker, MD, & Chris Hoedt, MD.

Computer navigation (CN), with or without the use of robotics, is increasingly utilized in primary total joint arthroplasty (TJA). Although evidence supporting its clinical benefit remains limited, its role in the revision setting is even less defined. This study evaluates national utilization trends and compares 2-year implant-related complications of CN and conventional revision total hip (rTHA) and knee arthroplasty (rTKA).

This study identifies a 20.1% overall citation error rate in orthopaedic surgery literature, with nearly 10% classified as major errors. A new classification system for citation accuracy is introduced, revealing significant pre-existing inaccuracies. The research also shows that current AI tools, like ChatGPT, cannot reliably verify citations due to limited access and the rubric used.

A retrospective study compared a novel antimicrobial surgical irrigant, XPerience (XP), to standard povidone-iodine rinse in 1,295 hip/knee arthroplasty patients. The XP group had no periprosthetic joint infections (0/471), while the control group had a 0.5% infection rate (4/824). Although differences weren't statistically significant, findings suggest XP may lower infection.

This systematic review analyzed 26 studies on cognitive deficits in athletes after sports-related concussions, involving 4,534 participants. Findings revealed impairments in attention, memory, processing speed, and executive function across acute, intermediate, and long-term periods. While most deficits resolve within weeks, severe cases may persist.

This study analyzes 250 pelvic fracture patients treated with sacroiliac or transiliac-transsacral screw fixation over 12 years. Painful hardware was reported by 18.4% of patients, leading to implant removal at an average of 6.7 months post-surgery. All patients who underwent removal experienced significant pain reduction, with no complications recorded.

The relationship between patient health literacy and surgical outcomes is an increasingly popular topic within healthcare circles. To our knowledge, no specific assessment of shoulder health literacy has been validated in the literature, and the role that health literacy has in the outcomes of shoulder-arthroplasty patients is unclear.

Iliotibial band syndrome (ITBS) is a common overuse injury that is found predominantly in athletes that undergo extensive repetitive lower extremity movement such as runners and cyclists. Despite extensive literature relating to ITBS, the quality of evidence and research trends remain unclear.

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 outcomes. 

The summary of the classic JOEI article that will change the way you look at OR efficiency and time.

Will robotic-assistance improve outcomes in knee replacement over traditional optical navigation?