Orthopedic Clinics of North America

No abstract text is available yet for this article.

Accurate screw placement is critical to avoid vascular or neurologic complications during spine surgery and to maximize fixation for fusion and deformity correction. Computer-assisted navigation, robotic-guided spine surgery, and augmented reality surgical navigation are currently available technologies that have been developed to improve screw placement accuracy. The advent of multiple generations of new technologies within the past 3 decades has presented surgeons with a diverse array of choices when it comes to pedicle screw placement...

Osteochondral lesions of the ankle joint are typically associated with a traumatic etiology and present with ankle pain and swelling. Conservative management yields unsatisfactory results because of the poor healing capacity of the articular cartilage. Smaller lesions (<100 mm2 or <10 mm) can be treated with less invasive procedures such as arthroscopic debridement, anterograde drilling, scaffold-based therapies, and augmentation with biological adjuvants. For patients with large lesions (>100 mm2 or >10 mm), cystic lesions, uncontained lesions, or patients who have failed prior bone marrow stimulation, management with autologous osteochondral transplantation is indicated...

Shoulder arthroplasty is a rapidly improving and utilized management for end-stage arthritis that is associated with improved functional outcomes, pain relief, and long-term implant survival. Accurate placement of the glenoid and humeral components is critical for improved outcomes. Traditionally, preoperative planning was limited to radiographs and 2-dimensional computed tomography (CT); however, 3-dimensional CT is becoming more commonly utilized and necessary to understand complex glenoid and humeral deformities...

Current technologies for image guidance navigation and robotic assistance with spinal surgery are improving rapidly with several systems commercially available. Newer machine vision technology has several potential advantages. Limited studies have shown similar outcomes to traditional navigation platforms with decreased intraoperative radiation and time required for registration. However, there are no active robotic arms that can be coupled with machine vision navigation. Further research is necessary to justify the cost, potential increased operative time, and workflow issues but the use of navigation and robotics will only continue to expand given the growing body of evidence supporting their use...

The purpose of this study was to determine early survivorship and complication rates associated with the implantation of a new patient-specific unicompartmental knee implant cast from a three-dimensional (3D) printed mold, introduced in 2012. We retrospectively reviewed 92 consecutive patients who underwent unicompartmental knee arthroplasty (UKA) with a patient-specific implant cast from a 3D printed mold between September 2012 and October 2015. The early results of a patient-specific UKA implant were favorable in our cohort, with survivorship free from reoperation of 97% at an average 4...

Artificial intelligence (AI) is used in the clinic to improve patient care. While the successes illustrate AI's impact, few studies have led to improved clinical outcomes. In this review, we focus on how AI models implemented in nonorthopedic fields of corrosion science may apply to the study of orthopedic alloys. We first define and introduce fundamental AI concepts and models, as well as physiologically relevant corrosion damage modes. We then systematically review the corrosion/AI literature. Finally, we identify several AI models that may be implemented to study fretting, crevice, and pitting corrosion of titanium and cobalt chrome alloys...

This review article presents the current state of remote patient monitoring (RPM) in total joint arthroplasty. RPM refers to the use of telecommunication with wearable and implantable technology to assess and treat patients. Several forms of RPM are discussed including telemedicine, patient engagement platforms, wearable devices, and implantable devices. The benefits to patients and physicians are discussed in the context of postoperative monitoring. Insurance coverage and reimbursement of these technologies are reviewed...

BACKGROUND: Robotic-assisted total knee arthroplasty (RA-TKA) has become more popular in the United States. With the significant trend towards performing TKA in outpatient and ambulatory surgery center (ASC) settings, this study was implemented to determine the safety and efficacy of RA-TKA in an ASC. METHOD: A retrospective review identified 172 outpatient TKAs (86 RA-TKAs and 86 TKAs) performed between January 2020 and January 2021. All surgeries were performed by the same surgeon at the same free-standing ASC...

One of the primary aims of total knee arthroplasty (TKA) is restoration of the mechanical axis of the lower limb. Maintenance of the mechanical axis within 3° of neutral has been shown to result in improved clinical results and implant longevity. Handheld image-free robotic-assisted total knee arthroplasty (HI-TKA) is a novel way of performing TKA in the era of modern robotic-assisted TKA. The aim of this study is to assess the accuracy of achieving targeted alignment, component placement, clinical outcomes, as well as patient satisfaction after HI-TKA...

Hip, spine, and pelvis function as a unified kinetic chain. Any spinal pathology, results in compensatory changes in the other components to accommodate for the reduced spinopelvic motion. The complex relationship between spinopelvic mobility and component positioning in total hip arthroplasty presents a challenge in achieving functional implant positioning. Patients with spinal pathology, especially those with stiff spines and little change in sacral slope, are at high instability risk. In this challenging subgroup, robotic-arm assistance enables the execution of a patient specific plan, avoiding impingement and maximizing range of motion; especially utilizing virtual range of motion to dynamically assess impingement...

No abstract text is available yet for this article.

The proximal humerus is a common location for primary tumors, benign lesions, and metastatic disease. Advances in neoadjuvant and adjuvant therapy have allowed for limb-salvage surgery in most of the cases. There are numerous of options for surgical management of proximal humerus lesions and the decision to pursue one over another depends on factors such as age, comorbidities, pathology, location within the proximal humerus, planned resection margins/size of defect, and bone quality. Long-term outcomes for these techniques tend to be retrospective comparative studies, with recent studies highlighting the improved outcomes of reverse total shoulders...

Giant cell tumor of the distal radius presents a significant challenge in management due to high risk of recurrence and potential loss of function. Shared decision-making guides management, particularly for more advanced lesions. Intralesional curettage can optimize wrist function but at the cost of a higher recurrence risk. Wide resection decreases local recurrence but has higher complication rates regardless of reconstruction method. No functional difference exists between motion-preserving procedures and arthrodesis; therefore, patients should be clearly informed of the risks and benefits of each treatment option...

Skin antisepsis, such as ready-to-use, no-rinse, 2% chlorhexidine-impregnated cloths, is one of the fundamental cornerstones for reducing periprosthetic infections after primary lower extremity total joint arthroplasties. This systematic review presents background material concerning the problem and methods to deal with and then describes the use of chlorhexidine cloth prophylaxis related to various surgical applications. The authors found an almost universal benefit of the cloths. In the meta-analysis, the total pooled effect showed a reduction in infection rates...

Benign bone tumors are a wide variety of usually asymptomatic neoplasms, which in most cases are diagnosed due to secondary causes. As such, their real incidence is unknown. In the majority of cases, plain radiographs are enough for diagnosis; more advanced imaging, such as CT scan or MRI is sometimes performed for equivocal lesions. Treatment approach depends on whether the lesion is symptomatic and the risk of further progression, or development of secondary malignancies. When non expectant management is decided, treatment options include minimally invasive methods and surgery...

The management of pathologic fractures differs from nonpathologic fractures with respect to preoperative evaluation, surgical strategies, adjuvant therapies, and complication rates. These issues must be understood to provide appropriate musculoskeletal care for patients with metastatic disease.

Heterotopic ossification (HO) refers to benign ectopic bone formation in soft tissue and is common following trauma surgery. HO bone can restrict movement and progress into ankylosis that may necessitate surgical intervention. This article discusses the current literature on the pathophysiology, prophylaxis, treatment, and epidemiology of postoperative HO following orthopedic trauma.

With improved chemotherapeutic treatment, patients with primary or metastatic bone tumor have improved prognoses and longer life expectancies; therefore, durable limb-salvage constructs are critical. For tumors of the proximal femur, endoprosthetic replacement is an option for treatment in primary and metastatic disease, with the goals being tumor and pain control, earlier mobilization, shorter recovery period, and, in primary tumors, cure. This study provides a summary of current concepts in the treatment of oncologic lesions in the proximal femur with endoprostheses...

Modern improvements in total ankle arthroplasty (TAA) have increased the performance of this procedure for treatment of end-stage ankle arthritis. A common finding after TAA is the formation of periprosthetic bone cysts, which can be clinically silent or result in TAA failure. The exact cause of periprosthetic bones cysts has not been established, but major theories are related to osteolysis secondary to implant wear, micromotion, and stress shielding. Treatment can be nonoperative with clinical observation for small, asymptomatic cysts...