High-dose romosozumab promoted bone regeneration of critical-size ulnar defect filled with demineralized bone matrix in nonhuman primates.

Background: Large bone defects are challenging to manage clinically and usually require treatment with bone graft or bone graft substitute. This study evaluated the effect of romosozumab, a sclerostin antibody, in combination with demineralized bone matrix (DBM) on bone regeneration in a critical-size ulnar defect model in nonhuman primates.

Methods: In cynomolgus monkeys (N = 22, male, 10-12 years old), a full-cortex bone defect (0.

Spin and reporting bias in the use of platelet-rich plasma for the treatment of knee osteoarthritis.

Introduction: Systematic reviews and meta-analyses evaluating platelet-rich plasma (PRP) injections are vulnerable to spin (i.e., misrepresentation of study findings).

Novel Technologies in Periprosthetic Joint Infection: Emerging Diagnostics.

Periprosthetic joint infection (PJI) is one of the most challenging complications following total joint arthroplasty (TJA), contributing to high morbidity, increased healthcare costs, and frequent implant failures. The current diagnostic methods, including synovial fluid analysis and microbiological cultures, are limited by their sensitivity and specificity, particularly in culture-negative infections. As a result, there is a growing need for novel diagnostic technologies that can provide rapid and reliable detection of PJI.

Infant anaphylaxis and epinephrine use: Can we improve acute management?

Background: Anaphylaxis is a serious systemic hypersensitivity reaction that is rapid in onset and may cause death.

Methods: The true prevalence of infant anaphylaxis is unknown, but such cases may be increasing in presentation of these patients to emergency departments, with studies that evaluate health-care utilization after implementation of early introduction guidelines that report an increase in the use of emergency department for food-related visits as well as an increase in epinephrine prescriptions for infants.

Results: Reasons for these increases may include early food introduction as well as therapeutic interventions such as early life or preschool oral immunotherapy.

Erratum to 'The Limited Utility of Hemoglobin A1c as a Predictor for Periprosthetic Joint Infection Following Total Joint Arthroplasty: A Continuous Variable Analysis' [The Journal of Arthroplasty 40 (2025) 1836-1844].

Background: Patients who have poorly controlled diabetes mellitus are at increased risk of periprosthetic joint infection (PJI). Nevertheless, an optimal preoperative hemoglobin A1c (HbA1c) threshold has not been established. This study sought to identify preoperative HbA1c thresholds that were predictive of adverse outcomes for total hip arthroplasty (THA) and total knee arthroplasty (TKA) patients.

Total Hip Arthroplasty Among Superobese Patients: Proceed With Caution.

Background: Morbid obesity, defined as body mass index (BMI) ≥40 kg/m, increases perioperative risk following total hip arthroplasty (THA). However, limited contemporary data exists on outcomes of superobese patients (BMI ≥50 kg/m) following primary THA. Using a large modern cohort, this study seeks to quantify the risk of infection and surgical, medical, and thromboembolic complications among superobese THA patients.

Advances in the treatment of anaphylaxis: intranasal and sublingual versus intramuscular epinephrine.

Purpose Of Review: Epinephrine is universally considered the standard of care for the treatment of severe allergic reactions, including anaphylaxis, and, until recently, was preferentially recommended to be given intramuscularly in the thigh. However, newer routes of administration have been studied, with the intranasal route recently approved by regulatory agencies.

Recent Findings: Pharmacokinetic and pharmacodynamic studies suggest that noninjectable epinephrine routes (e.

Epinephrine Nasal Spray Improves Allergic Symptoms in Patients Undergoing Oral Food Challenge, Phase 3 Trial.

Background: Rapid administration of epinephrine is the only approved first-line treatment for severe allergic reactions or anaphylaxis. Despite its well-established history of safety and efficacy, patients and caregivers have reported significant reluctance to administer epinephrine, largely owing to concerns about the injection. An epinephrine nasal spray (neffy) was recently approved as the first needle-free epinephrine option for the treatment of severe allergic reactions.

Novel Technologies in Periprosthetic Joint Infections: Emerging Therapeutics.

Periprosthetic joint infection (PJI) remains one of the most challenging complications following total joint arthroplasty, contributing to major morbidities, increased health care costs, and high failure rates of conventional treatments. The gold standard for chronic PJI treatment, the two-stage revision, is associated with prolonged hospitalizations, high attrition rates, and variable success rates, necessitating novel approaches to improve patient outcomes. Despite advancements in surgical techniques, infection control methods, and antibiotic therapies, the incidence and success rates of PJI management have remained largely unchanged over the past decades.

Defining Benchmarks for Case Minimums During Accreditation Council for Graduate Medical Education-Accredited Total Joint Arthroplasty Fellowship Training.

Background: Professional societies and accrediting bodies for arthroplasty training increasingly recognize the need for minimum case numbers to enhance surgical training in the United States. This study elucidated benchmarks for case minimum requirements during Accreditation Council for Graduate Medical Education (ACGME)-accredited arthroplasty fellowship training.

Methods: This was a retrospective cohort study of ACGME-accredited arthroplasty fellows who graduated between 2018 and 2023.

Whole-Exome Sequencing of Total Joint Arthroplasty Patients Who Have Known Pulmonary Embolism: A Pilot Study.

Background: The purpose of this study was to identify genetic mutations in exome sequences of patients who had a history of pulmonary embolism (PE) after total joint arthroplasty (TJA).

Methods: From June 2017 to August 2021, 21 patients who had a history of TJA and subsequent postoperative PE were enrolled in three academic institutions for whole-exome sequencing. Their average age was 64 years (range, 46 to 81), and 15 (71.

Towards a common approach for managing food allergy and serious allergic reactions (anaphylaxis) at school. GALEN and EFA consensus statement.

GALEN and EFA propose minimum specifications for all industrialised countries/regions to work towards to support students with food allergies in educational settings. We reviewed research and legislation and gained feedback from over 100 patient and professional groups. We built shared expectations around: 1.

Medicare Reimbursement for Primary Hip and Knee Arthroplasty Is Disproportionately Decreasing Relative to Other High-Volume Inpatient Procedures: Leader of the Pack.

Background: Decreasing Medicare surgeon reimbursement for total hip arthroplasty (THA) and total knee arthroplasty (TKA) may limit access to care. The purpose of this study was to examine trends in Medicare reimbursement fees for primary THA and TKA and compare reimbursement to other high-volume nonarthroplasty procedures.

Methods: A nationally representative database was retrospectively queried to identify the most frequently performed inpatient procedures in the United States from 2016 to 2020.

Low-Level Evidence Used to Substantiate Insurance Coverage Policies for Knee and Hip Arthroplasty.

Background: Access to total knee arthroplasty (TKA) or total hip arthroplasty (THA) has become increasingly regulated by health care insurance providers that require specific criteria be met prior to authorizing surgery as medically necessary. The purpose of this study was to examine references from coverage policies and assess whether they justify the presurgery criteria mandated by insurance providers for approval of total joint arthroplasty in patients who have symptomatic knee and hip degenerative disease.

Methods: The largest private commercial insurance providers in the United States were identified, of which nine had publicly accessible coverage policies for TKA and THA.

Increased Incidence of Spin and Reporting Bias on the Use of Hyaluronic Acid for the Treatment of Knee Osteoarthritis: An Evaluation of Systematic Reviews and Meta-Analyses.

Background: The use of hyaluronic acid (HA) for the treatment of knee osteoarthritis holds clinical and financial implications for manufacturers, incentivizing spin, or the misrepresentation of study findings. We sought to identify the incidence of spin in abstracts of systematic reviews and meta-analyses evaluating the efficacy of HA injections used for the treatment of knee osteoarthritis.

Methods: Systematic reviews and meta-analyses reporting on HA for knee osteoarthritis were extracted through a Preferred Reporting Items for Systematic Reviews and Meta-Analyses search of Embase, PubMed, and Cochrane databases.

Rivaroxaban Utilization Without Perioperative Tranexamic Acid Is Associated With an Increased Risk of Bleeding Complications Following Total Joint Arthroplasty.

Background: Rivaroxaban provides effective venous thromboembolic prophylaxis, but there are concerns about associated bleeding in total joint arthroplasty (TJA) patients. This study aimed to investigate whether the perioperative administration of tranexamic acid (TXA) in TJA patients receiving rivaroxaban for thromboprophylaxis is associated with a reduced risk of postoperative bleeding complications.

Methods: A healthcare database was utilized to identify all primary total knee arthroplasty (TKA) and total hip arthroplasty (THA) patients between 2015 and 2021.

Emerging Concepts in Periprosthetic Joint Infection Research: Intracellular Organisms.

Despite advances in the treatment of periprosthetic joint infection (PJI), recurrence is a concern for both patients and orthopaedic surgeons. Staphylococcal species are commonly implicated in PJI and are associated with more instances of treatment failure and recalcitrance relative to other organisms. A possible explanation for this is the ability of staphylococci to undergo phenotypic transformation into a quasidormant small colony variant (SCV) phenotype.

Effect of BMI on the risk of postoperative complications following total hip arthroplasty.

Aims: While obesity is associated with an increased risk of complications after total hip arthroplasty (THA), the relationship between BMI and the risk of early postoperative complications has not been fully characterized. This study sought to describe the relationship between BMI and the risk of early postoperative complications, including periprosthetic joint infection (PJI), and composite surgical and composite medical complications.

Methods: Primary, elective THAs performed from 1 October 2015 to 31 December 2021 were identified using the Premier Healthcare Database.

Barriers and Solutions to Optimal Food Allergy Prevention, Diagnostic, and Management Strategies.

Food allergy (FA) remains a significant public health issue, posing challenges for patients, families, clinicians, researchers, and policymakers. Despite advancements in FA diagnosis and treatment, substantial unmet needs remain. Clinicians, researchers, and representatives from governmental organizations (National Institutes of Health and Food and Drug Administration) and industry convened at the 2023 Clinical Development Day hosted by Food Allergy Research & Education to discuss current challenges and propose collaborative solutions for comprehensive FA management.

Medicare Reimbursement for Primary and Revision Total Hip and Knee Arthroplasty: An Updated Analysis From 2000 to 2024.

Background: With physician reimbursements for primary and revision total hip (THA) and knee arthroplasty (TKA) remaining central to health care policy and payment reforms, an updated analysis of inflation-adjusted Medicare surgeon fees for these procedures is essential. Examining recent payment trends offers valuable insights for surgeons, payers, and health care policymakers to understand the evolving reimbursement landscape. This study aimed to analyze physician reimbursement trends for THA and TKA from 2000 to 2024.

Development of a validated, updated North American pediatric food allergy anaphylaxis management plan.

Background: Current North American anaphylaxis action plans (AAPs) lack updated anaphylaxis guidelines that conditionally recommend "immediate activation of emergency medical services" after epinephrine use for patients experiencing a "prompt, complete, and durable response" to treatment. This offers a contextualized "watchful waiting" approach. AAPs may not include newly approved nasal epinephrine or differentiate anaphylaxis presentations by age.

Dexamethasone Is Associated With Lower Rates of Pulmonary Complications Following Cemented Femoral Fixation During Primary Total Hip Arthroplasty.

Background: The utilization of cemented femoral fixation during total hip arthroplasty (THA) has increased in recent years. Perioperative corticosteroids have been shown to attenuate the inflammatory cascade associated with cement-induced cardiopulmonary complications. Therefore, the purpose of this study was to determine if dexamethasone (DEX) utilization was associated with decreased perioperative pulmonary complications associated with cemented THA.