Isabella Strickler

Background/Objectives: Total hip arthroplasty (THA) reliably improves pain and function, but implant longevity in women aged ≤50 years is influenced by longer duration of implant use and distinct failure mechanisms. Developmental dysplasia of the hip (DDH) is a common underlying diagnosis among patients undergoing THA at younger ages and may increase instability risk, while pregnancy after THA remains an important but understudied consideration. Methods: A narrative review of contemporary studies published from January 2000 through January 2026, supplemented by seminal older studies when directly relevant, was conducted. Evidence was synthesized by clinical mechanism and endpoint, with an emphasis on instability, revision, and pregnancy-related outcomes. Results: Outcomes were generally favorable in young women undergoing THA. DDH-related anatomic complexity may increase instability risk, but this risk appears highly modifiable through contemporary reconstructive and implant strategies. Pregnancy after THA was not consistently associated with increased dislocation or revision, though DDH-specific data are sparse. Conclusions: In women aged ≤50 years, THA longevity is shaped by both prevention of early instability-related revision and preservation of durable long-term fixation. DDH should be viewed as a reconstructive phenotype requiring stability-focused surgical planning and counseling. Future research should standardize instability reporting and evaluate the interactions among DDH severity, implant strategy, and long-term revision risk.

Background: Female athletes sustain anterior cruciate ligament (ACL) injuries at higher rates than male athletes, particularly in pivoting sports. Although neuromuscular prevention programs reduce ACL injury risk, implementation of these programs in high school athletics remains inconsistent. Purpose: To determine the prevalence of ACL injury prevention protocols (IPPs) in girls’ high school athletics in Metro Detroit and evaluate whether socioeconomic status (SES), school type, and access to athletic trainers (ATs) are associated with implementation. Study Design: Cross-sectional study. Methods: A cross-sectional survey was conducted from August 2022 to July 2023 among girls’ basketball, soccer, and volleyball coaches at 131 Metro Detroit high schools. Surveys were distributed through athletic directors at all eligible schools. Survey items assessed coaching characteristics, AT access, awareness of ACL injury risk and prevention programs, and use of general and ACL-specific IPPs. School-level SES and school type were obtained from public education reports. Descriptive statistics summarized responses, and Spearman correlations evaluated associations between SES and prevention-related outcomes. Results: A total of 28 of 131 schools (21%) responded, yielding 57 coach responses. Among the 57 responding coaches, 68.4% reported AT access, 77.2% recognized increased ACL injury risk in female athletes, and 73.7% were aware of ACL prevention programs. General injury prevention programs were used by 70.2% of coaches, whereas 47.4% reported an ACL-specific IPP. Lower SES was significantly associated with reduced awareness of ACL prevention programs (ρ = −0.26; P = .0036). Conclusion: Our study showed that, despite widespread awareness of the increased risk of ACL injury in female athletes, fewer than half of responding coaches reported implementing ACL-specific prevention programs. Lower-SES schools demonstrated reduced awareness of prevention strategies, highlighting opportunities for targeted educational outreach and resource support.

Introduction: Musculoskeletal conditions impose a substantial economic burden on the United States (U.S.) healthcare system, but contemporary national estimates of condition-specific spending for common orthopaedic conditions remain limited. This study utilized the 2023 Medical Expenditure Panel Survey (MEPS) to estimate the national prevalence, condition-specific expenditures, and payer distribution for treated knee injuries and shoulder disorders. Methods: Adults with treated knee injuries or shoulder disorders were identified using ICD-10-CM codes from the MEPS Medical Conditions File. Condition-specific expenditures were estimated by linking diagnoses to medical events and payments using the MEPS Condition–Event Link File. Expenditures were aggregated across inpatient, outpatient, office-based, emergency, home health, and prescribed medicine categories. Survey-weighted analyses were used to estimate national prevalence, mean expenditures, service-level spending patterns, and payer distributions. Survey-weighted Gamma generalized linear models with log link were used to examine patient characteristics associated with expenditures among the U.S. civilian noninstitutionalized population with positive condition-specific spending. Results: The analysis identified 2.55 million adults with treated knee injuries and 2.58 million adults with treated shoulder disorders. Mean annual condition-specific expenditures per person were higher for knee injuries ($10,552; 95% CI: $6128–$14,975) than for shoulder disorders ($4310; 95% CI: $3337–$5283). Knee injury expenditures were concentrated in inpatient and home health care, whereas shoulder disorder expenditures were concentrated in outpatient and office-based care. Private insurance, Medicare, out-of-pocket payments, and Worker’s Compensation each contributed to the financial burden, with payer distributions varying by condition. In adjusted models, fair/poor self-rated health and female sex were associated with higher knee injury expenditures, while no covariates were statistically significant for shoulder disorder expenditures. Conclusions: Treated knee injuries and shoulder disorders showed distinct condition-specific expenditure profiles across care settings and payer sources. These findings provide contemporary national benchmarks for orthopaedic spending and may support future research, utilization monitoring, and value-based reimbursement planning.

Background: Degenerative meniscus tears are common in middle-aged and older adults, and current guidelines favor nonoperative care. As patients increasingly turn to portal systems to view imaging results and communicate with their physicians, patient-facing wording may shape downstream treatment preferences and expectations. Objective: This study aimed to determine whether subtle differences in physician message framing about an identical degenerative meniscus tear influence preferred management, expectations for improvement with conservative therapy, and satisfaction when a physician recommends a different plan. Methods: A cross-sectional 37-question survey was developed de novo and distributed in January 2026 to lay adults in the United States (≥18 years) recruited via Amazon Mechanical Turk. Respondents were presented with a standardized vignette of an adult aged 60 years with knee pain due to a degenerative meniscus tear. Participants were randomized in a 1:1:1 fashion into 3 physician portal message framing groups: neutral, degenerative, and damage. Outcomes were the preferred next step in treatment, expected improvement with physical therapy, and retained satisfaction under physician-respondent disagreement. Chi-square and Fisher exact tests were used to compare categorical variables. Multivariable logistic regression analyses were used to assess associations between framing groups. Results: Of the 266 completed responses, 195 (73.3%) were included for analysis (neutral: n=67, 34.4%; degenerative: n=63, 32.3%; damage: n=65, 33.3%). Treatment preferences differed significantly across groups (χ22=6.1; P=.047), and the damage group was significantly more likely to prefer aggressive interventions (odds ratio 2.43, 95% CI 1.17-5.06; P=.02). Expectations for physical therapy success differed significantly (χ24=12.3; P=.02), with the damage group being most pessimistic about conservative care. Retained satisfaction under physician-respondent disagreement did not differ by framing group (χ26=6.7; P=.35) but did differ significantly by initial treatment preference (P=.03) and was the lowest among respondents preferring steroid injection. Conclusions: In this exploratory investigation, subtle differences in physician portal message framing regarding a magnetic resonance imaging impression of a degenerative meniscus tear were associated with shifts in treatment preferences and confidence in conservative care. These findings suggest that brief physician portal communications may be associated with shifts in hypothetical patient expectations and treatment preferences before clinical counseling occurs.

Introduction: Total hip arthroplasty (THA) and total knee arthroplasty (TKA) volumes continue to rise, yet postoperative functional recovery and physical therapy (PT) utilization remain highly variable. Frailty and sarcopenia capture biological vulnerability beyond chronological age and may better explain heterogeneity in rehabilitation needs and recovery trajectories. Methods: We conducted a qualitative narrative review guided by SANRA recommendations. PubMed, Scopus, Web of Science, CINAHL, and Google Scholar were searched for English-language studies (January 2000–December 2025) involving adults undergoing THA/TKA that assessed preoperative frailty and/or sarcopenia and reported postoperative functional or rehabilitation-related outcomes. Data were extracted and synthesized thematically without quantitative pooling. Results: Thirty-four studies met inclusion criteria. Despite heterogeneous definitions and measures, both frailty and sarcopenia were consistently associated with slower early mobility, poorer functional recovery, longer hospital stays, and higher rates of non-home discharge. Frailty showed stronger links to post-acute care use and healthcare costs, whereas sarcopenia was more closely tied to impaired early function, delayed ambulation, and greater reliance on assistive devices. Frailty may improve after arthroplasty in some patients, while sarcopenia often represents a more persistent, muscle-specific limitation. Direct reporting of PT dose was uncommon, with only a minority of included studies explicitly reporting physical therapy frequency, duration, or intensity, limiting the ability to assess dose–response relationships. Conclusions: Preoperative frailty and sarcopenia are clinically meaningful predictors of functional recovery and rehabilitation utilization after THA/TKA and support vulnerability-informed discharge planning and stratified rehabilitation pathways. Future prospective studies should standardize vulnerability assessment and directly quantify PT dose, setting, and patient-centered outcomes to inform and test vulnerability-guided rehabilitation strategies, including prehabilitation.

Introduction: The rapid expansion of glucagon-like peptide-1 receptor agonist (GLP-1 RA) use for weight management and diabetes has raised perioperative questions, particularly regarding delayed gastric emptying and infection risk. Emerging real-world data suggest a more nuanced perioperative profile. This scoping review synthesizes evidence on preoperative GLP-1 RA exposure and postoperative outcomes across orthopaedic procedures, with emphasis on soft-tissue sports medicine, and is intended to map associative perioperative outcomes rather than establish causality. Methods: Following Arksey-O'Malley and Joanna Briggs Institute methodology and PRISMA-ScR reporting, we searched PubMed, Scopus, Web of Science, CINAHL Ultimate, Academic Search Premier, and Ovid Emcare (2015 to 2025). Eligible studies evaluated adult orthopaedic patients with documented GLP-1 RA use and postoperative outcomes. Three reviewers independently screened and extracted study characteristics, exposure timing, perioperative management, and outcomes. Results: Of 117 records screened, 35 studies met inclusion. Most were large retrospective cohorts spanning arthroplasty, spine fusion, trauma fixation, foot/ankle fusion, shoulder arthroplasty, and rotator cuff repair. Across hip, knee, and shoulder arthroplasty, GLP-1 RA use was generally associated with similar or lower 90-day complications, reduced periprosthetic joint infection, shorter length of stay, and fewer readmissions or revisions. Spine findings were mixed: Several cohorts showed lower infection and readmission, while others noted increased pneumonia, acute kidney injury, or pseudarthrosis in long-term semaglutide users. Trauma and ankle fracture cohorts showed no increase in short-term complications and in some cases lower mortality, with isolated signals for increased late fall-related injuries. Soft-tissue cohorts (rotator cuff repair and distal radius fixation) demonstrated fewer adverse events without increased aspiration or revision surgery risk. Functional outcomes (PROMIS) were rarely reported. Conclusion: Preoperative GLP-1 RA exposure is not broadly associated with increased postoperative risk and often correlates with lower infection, readmission, and mortality rates—particularly in arthroplasty, spine, and ankle fracture fixation cohorts. Findings in spine surgery are more mixed and warrant cautious interpretation, especially with prolonged semaglutide exposure. Outcomes in sports-medicine procedures seem reassuring, although prospective multicenter studies with standardized perioperative protocols and PROMIS-based outcomes are needed.

BACKGROUND Degenerative meniscus tears are common in middle-aged and older adults, and current guidelines favor nonoperative care. As patients increasingly turn to portal systems to view imaging results and communicate with their physicians, patient-facing wording may shape downstream treatment preferences and expectations. OBJECTIVE This study aimed to determine whether subtle differences in physician message framing about an identical degenerative meniscus tear influence preferred management, expectations for improvement with conservative therapy, and satisfaction when a physician recommends a different plan. METHODS A cross-sectional 37-question survey was developed de novo and distributed in January 2026 to lay adults in the United States (≥18 years) recruited via Amazon Mechanical Turk. Respondents were presented with a standardized vignette of an adult aged 60 years with knee pain due to a degenerative meniscus tear. Participants were randomized in a 1:1:1 fashion into 3 physician portal message framing groups: neutral, degenerative, and damage. Outcomes were the preferred next step in treatment, expected improvement with physical therapy, and retained satisfaction under physician-respondent disagreement. Chi-square and Fisher exact tests were used to compare categorical variables. Multivariable logistic regression analyses were used to assess associations between framing groups. RESULTS Of the 266 completed responses, 195 (73.3%) were included for analysis (neutral: n=67, 34.4%; degenerative: n=63, 32.3%; damage: n=65, 33.3%). Treatment preferences differed significantly across groups (χ22=6.1; P=.047), and the damage group was significantly more likely to prefer aggressive interventions (odds ratio 2.43, 95% CI 1.17-5.06; P=.02). Expectations for physical therapy success differed significantly (χ24=12.3; P=.02), with the damage group being most pessimistic about conservative care. Retained satisfaction under physician-respondent disagreement did not differ by framing group (χ26=6.7; P=.35) but did differ significantly by initial treatment preference (P=.03) and was the lowest among respondents preferring steroid injection. CONCLUSIONS In this exploratory investigation, subtle differences in physician portal message framing regarding a magnetic resonance imaging impression of a degenerative meniscus tear were associated with shifts in treatment preferences and confidence in conservative care. These findings suggest that brief physician portal communications may be associated with shifts in hypothetical patient expectations and treatment preferences before clinical counseling occurs. CLINICALTRIAL