JOEI The Journal

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 earn...

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...

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 f...

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...

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...

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 do...

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 participa...

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 a...

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 avai...

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 biomechani...

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 peri...

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...

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 ass...

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...