BACKGROUND The largest value-based payment system in the United States is the Merit-based Incentive Payment System (MIPS), implemented by the Centers for Medicare & Medicaid Services (CMS). MIPS was designed to adjust physician reimbursement based on performance across several categories. However, concerns arose that MIPS may inadvertently penalize physicians caring for patients of high social risk

BACKGROUND Patients with developmental dysplasia of the hip (DDH) can also present with deformities of the patellofemoral joint, such as femoral trochlear dysplasia. Although previous studies have reported that trochlear dysplasia is clinically important in some patients with DDH, the association between DDH and trochlear dysplasia is still unclear. QUESTIONS/PURPOSES (1) Is trochlear dysplasia more

BACKGROUND Diagnosing iliopsoas tendinopathy is challenging because of nonspecific pain patterns and clinical signs overlapping with those of other hip conditions. Although peritendinous anesthetic injections provide the best diagnostic accuracy, they are invasive and resource intensive. Conventional clinical tests largely focus on hip flexion, potentially overlooking the diagnostic contribution of

BACKGROUND Although the modified Musculoskeletal Infection Society (MSIS) criteria are commonly used, the accurate and timely diagnosis of periprosthetic joint infection (PJI) remains challenging. Serum amyloid A, like C-reactive protein (CRP), is an acute-phase reactant and widely serves as a diagnostic tool for infectious diseases in adults and children. However, the role of serum amyloid A in diagnosing

BACKGROUND Routine collection of patient-reported outcome measures (PROMs) is increasing within orthopaedic settings. Although PROMs have the potential to aid orthopaedic surgeons in clinical decision-making, surgeon engagement with and use of these data is limited. Identifying and addressing the facilitators and barriers to the use of PROMs data by orthopaedic surgeons may increase their usage in

BACKGROUND Patellar fractures represent approximately 0.5% to 1.5% of all trauma-related fractures, and patella baja, or an abnormally low-lying patella, may be a result of treatment. This complication is underappreciated, and although patella baja may result in patient discomfort, stiffness, and later degenerative changes, the association between fracture type, operative treatment, and this complication

BACKGROUND Although TKA is one of the most commonly performed and successful orthopaedic interventions, its efficacy may be reduced in individuals living with dementia. Prior studies have not effectively accounted for confounding by indication or the use of intensive interventions, or considered the fact that cognitive impairment exists on a continuum and that patients with mild dementia may have different

BACKGROUND Proximal tibial resection and reconstruction with a hinged knee megaprostheses may result in severe limb length discrepancy (LLD) in very young children because of the removal of the distal femoral and proximal physis. An alternative reconstruction using a proximal tibial hemiarthroplasty reconstruction has been proposed and reduces the degree of LLD because the distal femoral physis is

BACKGROUND The anatomic location of the anterolateral ligament (ALL) of the knee is critical to ALL reconstruction, but there is not a clear consensus about the location of its footprint. Knowledge of the anatomic footprint is necessary to assess intraoperative positioning and postoperative functional outcomes of ALL reconstruction. Furthermore, while racial and sex-related variations in the ACL have

BACKGROUND The prevalence of hyperlaxity in patients with shoulder instability is high, and its management is challenging. Shoulder hyperlaxity denotes a redundant anterior capsule with an elongated or weak glenohumeral ligament that may be associated with worse functional outcomes after procedures for instability. The functional outcomes and postoperative recurrence after a Latarjet procedure for

BACKGROUND The patient education process is an important part of healthcare, and tools including handouts, videos, and webpage suggestions have been used to aid this process. Although educational slide presentations are commonly used for teaching in academic settings and have been used in certain specialty clinics, their use for educating families and improving the shared decision-making process has

BACKGROUND Functional orthoses offer comparable outcomes to traditional casting in function and symptom relief after ankle fracture surgery, with the potential benefit of improved patient comfort and mobility. Even though early functional treatment after ankle fracture surgery shows promise, uncertainties about functional outcomes, symptom relief, and wound complications remain. QUESTIONS/PURPOSES

BACKGROUND Two-stage revisions for chronic periprosthetic joint infections (PJIs) often include antibiotic-loaded cement spacers to control for infection and preserve function. While studies have reported on complications (dislocations, readmissions, and reoperations) after static versus articulating spacer types, there is a paucity of evidence about whether the degree of spacer constraint in articulating

BACKGROUND Tumor resections around the knee leave defects that are often reconstructed with megaprostheses. Because megaprostheses have a large surface area, modular design, and constrained coupling mechanism, they are prone to metal wear, which can result in elevated levels of metal ions, particularly cobalt (Co) and chromium (Cr). Currently, there are limited published data on elevated ion levels

BACKGROUND To encourage high-quality, reduced-cost care for total joint arthroplasty (TJA), the Centers of Medicare & Medicaid Services mandated a pay-for-performance model, the Comprehensive Care for Joint Replacement (CJR), as part of the Patient Protection and Affordable Care Act (PPACA). The CJR incentivizes cost containment, and it was anticipated that its implementation would reduce access to

BACKGROUND Rotationplasty was first introduced as an alternative to above-the-knee amputation after resection of bone sarcomas of the distal femur by Salzer in 1974. Although the procedure involves a substantial body image issue, it has many advantages such as durability of the reconstruction (compared with limb salvage procedures) and avoidance of phantom pain (compared with amputation). Although

BACKGROUND Joint stability is a major factor associated with success after TKA. However, most assistive technologies, such as robotic-assisted TKA, do not incorporate a standardized laxity assessment. To address this gap, we opted to perform a randomized controlled trial comparing the results of a manual versus a robot-assisted TKA system with standardized laxity assessment. QUESTIONS/PURPOSES (1)

BACKGROUND Lower extremity injuries are common in conflict-related trauma, with gunshot wounds (GSWs) causing localized damage and explosive trauma leading to extensive tissue injuries. Existing research lacks direct comparisons of injury severity and treatment outcomes between GSWs and explosive trauma in modern conflicts. This study clarifies these differences to improve triage strategies, surgical

BACKGROUND Ewing sarcoma is a rare and highly aggressive pediatric bone cancer that is histologically composed of small, round blue cells. These histologic findings can make it difficult to assess intraoperative frozen section bone marrow margins because the bone marrow that regenerates after preoperative chemotherapy has a similar appearance, especially on frozen section analysis. Prior studies have

BACKGROUND Frailty has been associated with a greater risk of complications and higher treatment costs for various medical conditions and surgical procedures. The Modified Frailty Index, which analyzes five or six medical comorbidities, helps grade the severity of a patient's frailty. Patients with frailty, as recognized by this index, are more likely to face adverse medical and surgical events after

BACKGROUND Women are underrepresented in the field of orthopaedics, and growth of the proportion of women is lagging behind all other medical specialties. Improvement begins with recruiting more women residents; however, few data exist regarding the factors that may attract women applicants to orthopaedic training programs. QUESTIONS/PURPOSES In the 2020 to 2023 match cycles: (1) Was there a relationship

BACKGROUND Understanding the spinopelvic relationship is essential in THA planning, especially given the elevated hip dislocation risk in patients exhibiting abnormal spinopelvic movements. Rotations of the spinopelvic unit affect the functional orientation of the acetabulum and, in turn, the placement of the acetabular cup. Currently, however, the kinematic behavior of the pelvis is not considered

BACKGROUND Technological advancements in spine surgical care are disproportionately slanted toward fusion-based procedures, which may influence surgeons to prefer these over other less expensive techniques. These issues may be particularly magnified within the context of integrated care delivery systems such as the Military Health System, where patients can be treated at centers with different philosophies

BACKGROUND Fulcrum bending radiographs can be used to assess coronal flexibility in patients with adolescent idiopathic scoliosis (AIS) to estimate postoperative correction. To obtain fulcrum bending radiographs, patients are passively bent over a radiolucent fulcrum at the apex of the curve. Available studies have disagreed about the accuracy in estimating postoperative correction, although these

BACKGROUND Abnormal cervical sagittal alignment (CSA), typically cervical kyphosis, is more common in patients with adolescent idiopathic scoliosis (AIS) than in teenagers without AIS. Changes in CSA after posterior spinal fusion for AIS have been observed and may be associated with patient-reported clinical outcomes and age-related cervical disc degeneration. Previous studies have shown inconsistent

BACKGROUND Chronic patellar tendon rupture is a rare but serious injury that can lead to significant functional impairment if not treated effectively. Traditional repair methods often result in rerupture because of tendon defects, adhesions, and poor tissue quality. Although tendon graft reconstruction is the first-line treatment, the role of combining the remaining scar tissue with tendon grafting