All Articles

Sean T. Gerlach^*, Dillon J. MacIntyre, Tim P. Gregg

Wellington Regional Hospital, Wellington, New Zealand

Purpose: The aim of this study was to look into the New Zealand Joint Registry (NZJR) data on total hip arthroplasty (THA) in paediatric and adolescent patients aged 20 and under. Specifically, indications for THA, trends in implants and outcome data.

Methods: An analysis of all patients aged 20 and under, recorded in the NZJR from December 1999 until January 2021. Review of similar international reports and NZ adult data undertaken.

Results: We identified 115 THA performed in patients aged 20 and under in the NZJR. Mean age at primary surgery is 17.9 years. Indications included avascular necrosis (24%), fracture (6%), tumour (3.5%), inflammatory conditions (16.4%), post-infective (6.1%), SUFE (8.7%) and various other disorders. A total of 9/115 THA were reported as being revised in the study period with a revision rate per 100 component years of 0.69. Bearing surface has trended towards ceramic heads. Cementless implants have been the most commonly utilized. The approach is almost exclusively posterior (79%). Head size has increased from formerly being 28 or less to now 32 and above.

Conclusions: Rates of THA in this population remain very low, in keeping with international data. Indications are similar to those seen in other registry studies. Trends mimic those seen internationally and in adult cohorts with cementless implants and larger ceramic heads being favored. Revisions were recorded in 9/115 patients with polywear being the most common indication. Outcome measures were excellent with a mean Oxford hip score of 37.4 at 6 months post operatively.

Savannah Gelhard¹, Sydney Vincenti¹, Sara J. Pereira^2*, Nicolas Contreras^2,3

¹University of Utah School of Medicine, Salt Lake City, Utah, USA

²Division of Cardiothoracic Surgery, Department of Surgery, University of Utah, Salt Lake City, Utah, USA

³Huntsman Cancer Institute, Salt Lake City, Utah, USA

Christine Dailey Walck

Department of Mechanical Engineering, Embry-Riddle Aeronautical University, Daytona Beach, Florida, USA

Phillip J Stokey¹, Anderson Lee^1*, Isabell Igo¹, Kyle Behrens¹, Hamzeh Jajeh², Nabil Ebraheim¹

¹Department of Orthopaedic Surgery, University of Toledo College of Medicine and Life Sciences, Toledo, OH, USA

²Department of Specialty Medicine, Ohio University Heritage College of Osteopathic Medicine, Dublin, OH, USA

Introduction: Ganglion cysts of the anterior cruciate ligament (ACL) and meniscus may have generalized clinical symptoms that can make them difficult to diagnose, especially considering their rarity. The aim of this study is to provide a comprehensive review of cysts arising in and around the knee with a focus on differential diagnosis to emphasize the importance of proper evaluation.

Methods: A literature search using the database PubMed, Cochrane, and Google Scholar was performed to find the information that comprehensively covered information relevant to this review.

Conclusion: Intra-articular ganglion cysts of the knee are a rare occurrence that typically cause generalized symptoms. Each type of cyst is different with regards to its origin and location, but their similar clinical presentation makes differentiation based on a history and physical exam difficult. MR imaging is of utmost importance for the evaluation of pathologies in and around the knee joint. Once a proper diagnosis is achieved, direct arthroscopic excision of the cyst or treatment of the underlying cause in the case of a meniscus cyst can definitely treat symptoms with minimal concern for recurrence.

Michelle Jeffery¹, Judy-Mae Lima², Aditi Khokhar³, O. Folorunsho Edobor-Osula^2*

¹Rutgers Robert Wood Johnson Medical School, Piscataway, NJ, USA

²Department of Orthopaedic Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA

³Pediatric Endocrinology, Goryeb Children’s Hospital, Morristown, NJ, USA

This case series details seven pediatric cases of nutritional rickets in an inner-city population of New Jersey. Eighty six percent of these patients were exclusively breast fed, and all self-identified as black or African American. Patients ranged in age from 8 months to 3 years at the time of initial diagnosis. All seven patients were male. Five patients were presented in an office setting, while two were found to have nutritional rickets in an emergency setting. Patients demonstrated classic pathognomonic findings of rickets, including three patients with rachitic rosary. The aim of this case series is to emphasize the importance of surveillance and high clinical suspicion for nutritional rickets, particularly in children with darker skin complexions and who were exclusively breast-fed during infancy. Rapid diagnosis and intervention may delay or negate the need for orthopedic surgical intervention.

Alexandra C. Echevarria^1*, Robert E. Carrier¹, Anas M. Abbas¹, Bongseok Jung¹, Tim Reed², Rohit B. Verma²

¹Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Northwell Health, Hempstead, NY, USA

²Department of Orthopaedic Surgery, Northwell Health - North Shore University Hospital, Manhasset, NY, USA

Degenerative disc disease describes a ubiquitous condition involving the natural deterioration of an intervertebral disc. Conservative methods such as physical therapy and anti-inflammatories are recommended as first-line therapies for noninvasive management. However, when these interventions fail to reduce pain, surgical intervention is indicated. While laminectomies, discectomies, and spinal fusion procedures have been considered the standard treatment throughout the 20th century, the development of artificial discs has introduced an alternative surgical intervention in the form of total disc replacement. Initially, the novel devices garnered significant attention, thus leading to a rise in the rates of disc replacement procedures performed. However, several years after FDA approval of the first device, the prevalence of procedures steadily decreased. Several factors may have contributed to the downward trend, including the growing financial burden of hospitalization, stringent inclusion criteria indicating the procedure, and lack of provider familiarity and comfort with the procedure. Although the expected prevalence of disc arthroplasty remains unrealized, there is significant potential for an expanded role in the contemporary treatment of degenerative disc disease. This review illustrates the timeline and course of lumbar disc arthroplasty by describing its development, followed by its introduction in Europe and eventual arrival in the United States. The initial growth in popularity due to promising results is explained along with the surgery’s swift decline primarily due to lack of sufficient evidence promoting replacement, poor insurance coverage, lack of clear indications and complications. This review encapsulates all components and describes future directions and clinical value of lumbar disc arthroplasty.

Samuel Kwok^1*, Naveen Nara^1,2,3

¹Department of Orthopaedics, Ballarat Health Services, Ballarat, Victoria, Australia

²Department of Orthopaedics, St John of God Hospital, Ballarat, Victoria, Australia

³Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia

Background: Hip fractures are a significant cause of morbidity and mortality in the elderly population. Surgical fixation using intramedullary nailing is common, with positioning options including lateral and supine on traction table. This meta-analysis aims to compare surgical and clinical outcomes between both techniques.

Method: A systematic search was performed on the Medline database for articles comparing lateral and supine traction nailing intertrochanteric femoral fractures, reporting at least one of the following: surgical set up time, total surgical time, blood loss, fluoroscopy use, tip apex distance, reduction quality, Harris hip scores or complications. Statistical analysis was performed using SAS v9.4. In addition to meta-analysis of differences in means, differences in standardised means were also analysed to account for heterogeneity between hospital protocols and surgical teams.

Results: Initial search returned 773 articles, of which four studies including 384 patients were included for final analysis. Set up time was increased in the supine traction group (random effects mean difference = 15.96 minutes, p = 0.026). Meta-analysis of random effects standardised means found increased total surgical time (mean difference = 0.8, p = 0.017), blood loss (mean difference = 1.1, p = 0.03) and fluoroscopy use (mean difference = 1.1, p = 0.0083). There were no statistically significant differences in tip apex distance, quality of reduction or Harris Hip Scores or complication rates between both groups.

Conclusion: Femoral nailing in the lateral position is not inferior to supine traction; and is one of the tools available for a surgeon to achieve successful fixation.

Rafael Izquierdo-Avino

Fracture Liaison Service, Department of Trauma and Orthopaedic Surgery, Hospital Nuestra Señora de Gracia, Zaragoza, Spain

Shaimaa Hassoun¹, Jennifer Arthurs¹, Shane Shapiro^2*, Michael Heckman³

¹Center for Regenerative Biotherapeutics, Mayo Clinic, Jacksonville, FL, USA

²Department of Orthopedic Surgery, Mayo Clinic, Jacksonville, FL, USA

³Division of Biomedical Statistics and Informatics, Mayo Clinic, Jacksonville, FL, USA

Background: The utility of cellular based therapeutic agents in management of various ailments and conditions is promising, particularly in the field of orthopedics. However, an evidence-based medicine approach must be implemented to validate these novel cellular based therapies before they can be translated into routine clinical practice. Given pain relief is a primary goal of novel treatments for orthopedic disease, future orthobiologic clinical trials will need to overcome challenges such as the placebo effect or the placebo response and difficult participant recruitment. In this paper, we describe a clinical study that evaluates the safety and efficacy of autologous stromal vascular fraction (SVF) cells that adheres to a patient blinded, randomized and placebo-controlled study design while still offering the patient the opportunity to participate in the therapeutic intervention by using cell preservation techniques.

Methods: This pilot clinical trial studies the safety and feasibility of intra-articular transplantation of SVF cells in patients with knee osteoarthritis with secondary outcomes of improving pain relief. The RCT aims to recruit 30 patients. Liposuction is performed on each patient to isolate SVF cells. 15 subjects are randomized to receive SVF injection in the same surgical procedure and 15 subjects receive placebo injection directly into their affected knee joint. The placebo group’s SVF cells are then frozen and preserved. At the 6-month follow-up visit, those who received the placebo are unblinded and have the option to receive the SVF injection as a condition for participation in the trial. Feasibility of liposuction, SVF manufacturing, cell preservation/thaw techniques and adverse outcomes are all primarily tracked. Secondary outcomes include standardized patient reported outcomes score responses to the treatments.

Discussion: The design of this pilot study offers study subjects the opportunity to receive a novel therapeutic intervention even within a placebo arm and enables the investigators to blind subjects without performing an unnecessary liposuction or discarding the resulting cellular product which could encourage hesitant individuals to participate in the trial. This may aid in overcoming the challenges associated with recruiting participants for cell therapy trials concerned with being randomized to a control arm. The results of this trial will help to assess both the safety and feasibility of SVF injections to treat knee osteoarthritis as well as help plan larger phase controlled trials.

However, precautionary measures are necessary to ensure the safety and well-being of patients receiving cell-based therapy. Proper handling and storage of the cellular product must be considered and are demonstrated here.

Trial Registration

ClinicalTrials.gov Identifier: NCT03940950

Zhian Chen^1,2, Hongbo Tan², Tianhua Zhou², Yongqing Xu², Yi Cui², Yang Li², Rongmao Shi^2*

¹Kunming Medical University, Kunming, Yunnan, China

²Department of Orthopaedic Surgery, People's Liberation Army Joint Logistic Support Force 920th Hospital, Kunming, Yunnan, China

Far-out syndrome is an unusual type of Bertolotti’s syndrome refers to L5 nerve root compressed by osteophyte in the extraforaminal zone, which leads to radical pain of the leg by radiculopathy. Conservative treatment is generally ineffective and requires operative decompression. We present the case of a 19-years-old patient complained of pain in the right lumbosacral and lower leg, failed for 2 months of conservative treatment. The patient was confirmed as far-out syndrome by imaging examinations showed the right L5 nerve root compressed by osteophytes from pseud arthrosis between the L5 transverse process and sacral ala. The Visual analog scale (VAS) pain score was 6 and the Oswestry disability index (ODI) was 53.33%. Then the osteophytes and pseudarthrosis were surgical removed and the L5 nerve root was decompressed through a posterior approach. The patient’s symptoms were significantly relieved after surgery immediately. The VAS score was 1 and ODI was 15.56% at 1-month postoperatively. At 1-year follow up, the VAS pain score was 1 and ODI was 11.11% and complete military trainings was resumed.

Arnold H. Menezes

Department of Neurosurgery, University of Iowa Hospitals & Clinics, Iowa City, Iowa, USA

The etiology of os odontoideum has been debated ever since its first description by Giacomini in 1886. There are proponents of congenital origin as well as reports of post-traumatic os odontoideum formation after early childhood craniovertebral junction (CVJ) trauma. We document CVJ ligamentous injury on MRI in an 18-month-old child with sequential imaging demonstrating the os odontoid formation. Our database of 260 surgically treated patients with os odontoideum was analyzed regarding etiology and associated abnormalities. The literature (1970-2022) is reviewed.

Peter R. Reuter^*, Mackenzie Brady

Department of Rehabilitation Sciences, Marieb College of Health & Human Services, Florida Gulf Coast University, Fort Myers, Florida, USA

This cross-sectional study aimed to explore the correlation between hypermobility of the spine and chronic neck/back pain in a university-aged population. Chronic musculoskeletal pain, especially joint pain, is said to be the main complaint of individuals with symptomatic joint hypermobility. Generalized joint hypermobility is usually limited to a small number of joints, with increased range of motion of the lumbar spine the most common form of joint hypermobility. The study collected data over a six-year period from undergraduate Anatomy & Physiology students at a university in the United States, using an anonymous survey. Based on the data from 1,211 respondents the study found that: 1) young adult females are more likely to have hypermobility of the spine than young adult males; 2) young females with spine hypermobility are not more likely to report chronic neck/back pain than females without spine hypermobility; 3) young adult males with spine hypermobility are more likely to report chronic neck/back pain than males without spine hypermobility; 4) young females and males with spine hypermobility experience the same average levels of pain intensity for their chronic neck/back pain than their peers without spine hypermobility; 5) young females with and without spine hypermobility report higher levels of chronic pain intensity than males for chronic neck/back pain.

Ryan P. Bialaszewski^1*, Robert H. Ablove²

¹University of Texas Rio Grande Valley, School of Medicine, Edinburg, TX, USA

²UBMD Department of Orthopaedics and Sports Medicine, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, NY, USA

Introduction: Obesity is a global pandemic and public health crisis associated with a wide range of comorbidities, including osteoarthritis, leading to a significantly younger age at the time of primary total hip arthroplasty (THA) and an increased rate of complications compared to nonobese individuals. As our population continues to get older, combined with an increasing rate of obesity, an increased rate of consultations for total hip arthroplasty is expected. This has led to concerns regarding the implications of obesity on the need for THA itself and the associated complications, especially for arthroplasty surgeons. Unfortunately, few articles provide an all-encompassing review of different complications surrounding obesity within orthopedic surgery, and even fewer around total hip arthroplasty. This literature review aims to provide a comprehensive review of the implications obesity has on total hip arthroplasties, its associated complications, and how we can potentially modify these risks.

Methods: Sources and research articles were identified by searching the databases of PubMed, Google Scholar, and the National Center for Biotechnology Information (NCBI) from 2000 to July 2022. Our search used the specific terms located within the abstract/title, including: “total hip arthroplasty” AND “complications,” AND “obesity, OR obese.” Inclusion criteria for research articles were the English language and peer-reviewed articles published from inception to July 2022. Articles not directly examining the effect of obesity on the incidence of complications following primary THA were excluded. Studies with outcomes of interest included the incidence of postoperative complications, primary THA in obese patients, and clinical outcome measures. A total of 265 studies were identified upon initial search. Thirty-one articles were selected for reference in this literature review.

Results: Obese patients undergo primary THA at an earlier age and experience an increased duration of surgery, higher rates of infection, dislocation, periprosthetic fractures, and venous thromboembolism compared to nonobese patients. The role of pre-operative bariatric surgery before total hip arthroplasty has failed to show reductions in complication rates. Harris Hip Scores are lower in obese patients pre-operatively and post-operatively, but the degree of improvement following THA is similar compared to nonobese patients. Long-term survival of total hip prostheses is similar when compared to nonobese patients.

Conclusion: Current literature strongly suggests increased complication rates in obese patients who undergo THA. This phenomenon is not solely due to biomechanical forces and is multifactorial, including inflammatory and genetic predispositions, which need further study. The decision to perform THA on obese patients should not solely be based on BMI. Other factors, such as management of comorbidities, surgical exposure, and nursing care, should be considered when deciding on surgical candidacy.

Rita Th. Harmsen^1*, Marjolein E.M. den Ouden², Pieter F. Schillemans³, Henk W. Elzevier¹, Rob G. Nelissen¹, Brenda L. Den Oudsten⁴

¹Departments of Orthopaedics, Biomedical Data Sciences and Department of Urology and Medical Decision Making (H.W.E.), Leiden University Medical Center, The Netherlands

²Research Group Technology, Health & Care, Academy of Social Work, University of Applied Science Saxion, Enschede, The Netherlands

³Private Center of Ultra Sonography Care, NV Hoorn, The Netherlands

⁴Center of Research on Psychological and Somatic Disorders (CoRPS), Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands

Background: In-depth insight into couples’ experiences of sexual activity before and after total hip arthroplasty (THA) and total knee arthroplasty (TKA) is lacking. The aim of this study was to explore patients’ and partners’ experiences, complemented by surgeons’ opinions on safe resumption of sexual activity after surgery.

Methods: Mixed method study: 1) Semi-structured interviews among sexually active couples, 1.5 years postoperatively and 2) A survey among surgeons about recommendations of sexual activity after THA/TKA.

Results: Of the 150 invited couples, 90 (60%) responded (THA: n=39; TKA: n=42). Five couples participated (THA: n=3; TKA: n=2), while 85 (94%) couples refused participation. Two themes emerged: “Couples physically and mentally adjusted to the new situation” and “Couples undoubtedly trusted the surgeon as the provider of information.” In total, 27% (47/175) of THA surgeons participated. Fifty percent agreed with the recommended sexual positions researched by Charbonnier et al. Opinions differed widely regarding when to safely resume sexual activity. Of the TKA surgeons, 36% (76/211) responded. Almost all surgeons (95%) agreed that there were no restrictions. However, some discomfort was expected when patients bend the knee or kneel during sex. Half of the surgeons indicated that providing information about sex was necessary.

Conclusions: All couples physically and mentally adapted to the new situation without considering safety measures. Patients trusted surgeons in providing safety information. Surgeons should inform patients succinct and explicitly, especially since surgeons’ recommendations showed great variability. More motion research on hip and knee may add to uniform guidelines.

Akshay V. Daji¹, Devin Q. John¹, Raj D. Rao^2*

¹HCA JFK Hospital/University of Miami Miller School of Medicine Orthopaedic Surgery Residency Program, FL, USA

²West Palm Beach VA Healthcare System, West Palm Beach, FL, USA

Dariush Dowlat Alizadeh^2*, Seyyed Mohammad Jalil Abrisham¹, Mohammad Reza Sobhan¹

¹Department of Orthopedics, Shahid Sadoughi University of Medical Sciences, Yazd, Iran

²Orthopedic Surgery, Trauma Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran

Background and Aim: Sagittal imbalance is often presented as one of the major problems in individuals suffering from orthopedic pain, particularly those affected by destructive hip joint osteoarthritis. In this regard, total hip arthroplasty (THA) as a therapeutic procedure for such patients has resulted in the restoration of sagittal balance. Therefore, the present study aimed to evaluate the changes in sagittal balance using EOS imaging before and after THA and also reflect on its effect on hip joint function, knee pain, and disability percentage due to low back pain (LBP).

Methods: Utilizing a prospective cohort study, a total number of 24 patients suffering from extreme unilateral hip osteoarthritis and in need of unilateral THA were selected based on the inclusion and exclusion criteria, and then, sagittal balance parameters, including pelvic incidence (PI), pelvic tilt (PT), sacral slope (SS), sacrofemoral angle (SFA), sacrofemoral distance (SFD), lumbar lordosis (LL), and stem angle (SA) were investigated after performing standing radiographs by means of the EOS device. One year after THA, all the above-mentioned parameters were also measured by EOS imaging before and after the surgery and the patients completed some questionnaires, which is the Oswestry Low Back Pain Disability Index (OLBPDI) to evaluate disability percentage resulting in LBP, the Knee Injury and Osteoarthritis Outcome Score (KOOS) instrument to assess knee pain, and the Harris Hip Score (HHS) measure to rate hip joint function, and then the results were analyzed using the SPSS Statistics software (ver. 17).

Results: The patients consisted of 13 males (54.2%) and 11 females (45.8%) with the mean age of 52.87±13.05. The mean score of the preoperative PI was also equal to 54.74±10.66 and it was 58.19±11.58 after the surgery (p=0.025). However, the mean values of other parameters at the preoperative stage did not show any significant changes. As well, hip joint function and knee pain resulting from LBP improved in the patients after the surgery (p<0.001).

Conclusion: The study findings demonstrated that THA probably influenced sagittal balance through PI. Moreover, the postoperative hip joint function, knee pain, and disability percentage caused by LBP significantly enhanced compared with those before the surgery. Thus, it was concluded that the evaluation of sagittal balance parameters could help patients with orthopedic pain.

Michael Tang¹, William Fowler¹, Oday Al-Dadah^1,2*

¹Department of Trauma and Orthopaedic Surgery, South Tyneside District Hospital, Harton Lane, South Tyneside, United Kingdom

²Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Framlington Place, Newcastle-upon-Tyne, United Kingdom

Objectives: The Nottingham hip fracture score (NHFS) and the Surgical outcome risk tool (SORT) are both validated scoring systems used to predict mortality rates in patient with Fractured neck of femur (FnF). The primary aim of this study was to compare the accuracy of the predicted 30-day mortality rates between NHFS and SORT in patients with FnF. The secondary aim was to investigate the influence of patient and surgical factors on 30-day mortality.

Methods: The NHFS and SORT score was collected from 212 patients admitted with FnF. Variables including hip fracture type, surgical procedure and peri-operative haemoglobin, gender and ASA grade were also collected and further analysed to assess their influence on 30-day mortality rates.

Results: Overall actual 30-day mortality rate for the study population was 11.3% (n=24). There was a significant difference between the mean predicted 30-day mortality for the NHFS (8.0%) and the SORT score (7.0%, p=0.006). The was no difference in mortality rates between the different fracture types (p=0.889). There was a significant difference in mortality rates when comparing surgical procedures (p=0.031). Patients who had a notable fall in haemoglobin peri-operatively had significantly higher mortality rates (p<0.001). Males had significantly higher mortality rates compared to females (20.0% vs 8.6% respectively, p=0.027). Higher ASA grades also had significantly higher mortality rates (p=0.003).

Conclusion: NHFS was found to be significantly more accurate at calculating 30-day mortality rates compared to the SORT score in patients with FnF. Surgical procedure and patient factors including gender, ASA grade and peri-operative haemoglobin also significantly influenced mortality rates but fracture type did not.

Thomas J. Kean

Biionix Cluster, Internal Medicine, College of Medicine, University of Central Florida, Orlando, FL, USA

Amina Ait Belmahjoub Aamre MD¹, Sergio Barroso Rosa FEBOT PhD^1,2*

¹Department of Medical and Surgical Sciences, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain

²Department of Orthopaedics, Complejo Hospitalario Universitario Insular Materno Infantil de Gran Canaria, Las Palmas de Gran Canaria, Spain

Introduction: Currently there are limited options for shoulder adhesive capsulitis treatment, some of which do not have sufficient backing scientific evidence. This entails a relevant setback for patients, especially in severe or refractory cases. In recent years, remote arterial embolization therapies have demonstrated usefulness in the management of diverse musculoskeletal conditions. This systematic review examines the therapeutic role of arterial embolization in patients with shoulder adhesive capsulitis.

Methods: A systematic review of articles published to date was performed, according to the methodology in the Cochrane Systematic Reviews Manual (MECIR) and the PRISMA checklists. PubMed, Scopus, Google Scholar, three other databases and three trial registries were examined for relevant studies. The ROBINS-I tool was used for quality assessment of included studies.

Results: Ninety four potential articles were found, seven of which were included. In the selected studies, arterial embolization was carried out in 127 patients, 113 of whom had abnormal vessels. In all studies, a reduction in pain and improvement in mobility was observed in less than six months after the procedure. There were no major adverse effects or recurrent symptoms reported. Due to large data heterogeneity, a meta-analysis was not performed. Three literature reviews were also included as part of the background discussion.

Conclusions: Arterial embolization is an effective and safe treatment option in patients with shoulder adhesive capsulitis, resulting in reduced pain and restored joint function. Controlled randomized trials are required to evaluate the attributable effect of the technique to the reported clinical improvement.

Lauren McMichan¹*, Dawn A. Skelton², Sebastien F.M. Chastin^2,3, Alexandra Mavroeidi¹

¹Department of Physical Activity for Health, School of Psychological Science and Health, University of Strathclyde, Glasgow, UK

²Research Centre for Health (ReaCH), Department of Physiotherapy and Paramedicine, School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK

³Department of Movement and Sports Science, Ghent University, Ghent, Belgium

Introduction: Understanding daily movement patterns (i.e., the relative proportion of time spent on Sedentary behaviour (SB), light physical activity (LPA), moderate-vigorous physical activity (MVPA) and sleep) to establish links with chronic diseases is a contemporary topic. Little research has looked at the effects of 24-hour movement behaviour on bone health (particularly bone mineral density (BMD)) despite investigation on other health parameters.

The aim of this rapid narrative review was to build on previous work published on the association between SB and BMD in older adults by investigating the association of the more holistic 24- hour movement behaviours in relation to BMD.

Methods: A database search of Web of Science and NIH PubMed was conducted using broad MeSH terms (older adults, sedentary, and bone). Searches were limited from the year 2019 onward.

Results/Discussion: Five published articles were reviewed, and there are discrepancies amongst the findings which could be attributed to the different measurement methods (Peripheral Quantitative Computed Tomography (pQCT) versus Dual-energy X-Ray Absorptiometry (DEXA)) and the sites of measured BMD. There are also notable differences between genders, with BMD in men appearing to be most reliant on time spent in MVPA, compared to women who appear to see benefit to BMD with replacement of SB with LPA and not require more time spent in MVPA. This highlights the complexity of movement behaviours and requires further research.

Marcus Wong^*, Jonathan J Lee, Jaime Guerrero, Sean M Barber

Department of Neurosurgery, Houston Methodist Neurological Institute, Houston, TX, USA

Eiko Sakai^1*, Mari Sato², Chikara Sato^2,3,4

¹Division of Dental Pharmacology, Department of Developmental and Reconstructive Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan

²National Institute of Advanced Industrial Science and Technology, Tsukuba, Japan

³School of Integrative and Global Majors (SIGMA), University of Tsukuba, Tsukuba, Japan

⁴Biological Science Course, Graduate School of Science and Engineering, Aoyama Gakuin University, Sagamihara, Japan

Jennifer R. Arthurs¹, Zubin Master²,  Shane A. Shapiro^3*

¹Regenerative Medicine Therapeutics Program, Mayo Clinic, Jacksonville, Florida, USA

²Biomedical Ethics Research Program and the Center for Regenerative Medicine, Mayo Clinic, Rochester, Minnesota, USA

³Department of Orthopedic Surgery, Mayo Clinic, Jacksonville, Florida, USA

Stem cell therapies occupy a unique place in the American public’s consciousness which has led to excessive enthusiasm over their potential to cure orthopedic conditions. Much has been written about direct-to-consumer marketing of cell therapies for a myriad of medical conditions. Far less has been studied on the attitudes that drive many patients to seek stem cell and orthobiologic therapies for musculoskeletal conditions. Previously published research on patient motivations for seeking stem cell therapy to treat orthopedic maladies such as osteoarthritis and chronic tendinopathies has shown that some patients were motivated by factors not supported by current medical evidence. These differing responses strongly suggest the need for patient-centered counseling to address misinformation about stem cell therapies for musculoskeletal conditions and increase health literacy about outcomes of orthobiologics.

Aneesh G. Patankar¹*, Suleiman Y. Sudah², Christopher R. Michel², David S. Constantinescu³, Mariano E. Menendez⁴, Jeremy B. Ruskin⁵, Ajul Shah⁶

¹Rutgers, Robert Wood Johnson Medical School, Piscataway, NJ, USA

²Department of Orthopedics, Monmouth Medical Center, Long Branch, NJ, USA

³Department of Orthopedic Surgery, University of Miami, Miami, FL, USA

⁴Midwest Orthopaedics at Rush, Rush University, Chicago, IL, USA

⁵Central Jersey Hand Surgery, Eatontown, NJ, USA

⁶The Center for Hand and Upper Extremity Surgery, Institute for Advanced Reconstruction, Shrewsbury, NJ, USA

Purpose: Sociodemographic factors have been shown to influence musculoskeletal health. However, little is known regarding the frequency of reporting and analysis of certain sociodemographic variables (e.g., age, sex, height, weight, body mass index (BMI), race, and ethnicity) in randomized clinical trials (RCTs) pertaining to hand surgery. The purpose of this study was to assess the rate of reporting and analysis of these variables in RCTs published in the Journal of Hand Surgery (JHS).

Methods: A systematic review was conducted of RCTs published in JHS between 2015 and 2021. For each study, we determined whether the following sociodemographic variables were reported and/or analyzed: age, sex, height, weight, BMI, race, and ethnicity. Frequencies were reported by year and as a cumulative total. Studies were evaluated using the Cochrane risk-of-bias tool.

Results: A total of 45 RCTs met inclusion criteria, with about half (53.3%) originating from the United States. Age (97.8%) and sex (91.1%) were the most frequently reported sociodemographic variables, followed by race (17.8%), BMI (11.1%), and ethnicity (8.9%). Age (17.8%) was the most frequently analyzed variable, followed by sex (13.3%), and race (4.4%); the remaining variables were not analyzed in any study.

Conclusions: While age and sex are reported at a high rate, only about 1 in 4 RCTs published in JHS report either race or ethnicity. All sociodemographic variables were infrequently included as part of statistical analysis. The significance of these findings should be recognized and used to interpret and enhance the methodology of future RCTs.

Kathryn A. Barth, Claire D. Eliasberg, Karen M. Sutton^*

Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY, USA

There has been an increasing focus on sex-specific differences within the context of sports medicine. Differences exist between the sexes leading to disparities in the types of injuries female athletes sustain and the rates at which they experience them. Recognition and awareness of subtle differences between the sexes can lead to a more nuanced diagnosis and treatment of such injuries. The purpose of this study is to review shoulder pathologies that are relevant to the female athlete, specifically adhesive capsulitis, multidirectional instability, and traumatic unidirectional shoulder instability, and highlight the differences in diagnosis, treatment, and outcomes between the sexes. Women suffer from adhesive capsulitis at a greater rate than men and there are risk factors such as breast cancer surgery that are unique to women. Females are much more likely to experience atraumatic shoulder instability than their male counterparts. While females represent a minority of patients who suffer traumatic unidirectional shoulder instability, they should not be overlooked with regards to this condition. There are challenges related to the diagnosis and treatment of these pathologies that are distinctive to female athletes.