Journal of Surgical Orthopaedic Advances

The morbidity associated with the use of static non-articulating knee spacers for the treatment of periprosthetic joint infection (PJI) in challenging clinical scenarios has not been well described. From 2011-2019, 63 molded block static spacers were utilized at two academic institutions for the treatment of PJI with associated severe soft tissue compromise (59%), collateral ligament deficiency (49%), extensor mechanism compromise (48%), or type 3 bone defects (44%). Complications and outcomes were assessed...

In order to evaluate postoperative function and failure rates among younger patients undergoing hemiarthroplasty for humeral head avascular necrosis (AVN), data from patients < 40 years treated between December 2008 - January 2018 was retrospectively analyzed. Pain was assessed preoperatively and at final follow up using a visual analogue scale (VAS). The American Shoulder and Elbow Surgeons (ASES) standardized assessment, single assessment numeric evaluation (SANE) score, and patient satisfaction were assessed at final follow up, as well as surgical revision rates...

Obesity and malnutrition are modifiable risk factors associated with increased postoperative complications following total knee arthroplasty (TKA). Obesity is paradoxically associated with malnutrition. Previous studies have only evaluated the impact of body mass index (BMI) and hypoalbuminemia separately in relation to postoperative TKA outcomes and have attempted to compare the impact of these modifiable risk factors. Our study seeks to establish if increased BMI and decreased albumin levels have a compounding effect on postoperative outcomes...

Our study examined whether risk of revision for aseptic loosening following cemented total knee arthroplasty (TKA) is (1) increased with tourniquetless surgery and (2) affected by patient characteristics or surgical factors. Primary cemented TKAs from 2005-2012 with 2-year follow up were analyzed (n = 5,508 with tourniquet; n=101 without). Revision for aseptic loosening was compared between TKA performed with and without a tourniquet. Patient characteristics were recorded. At mean 4.8-year follow up, risk of aseptic loosening was similar between TKA performed with or without a tourniquet (p = 0...

This study sought to quantify the rate of culture-positive drape contamination with varying degrees of drape manipulation for intra-operative fluoroscopic imaging. In this prospective cohort study, 30 patients with operatively closed lower extremity fractures were evaluated. The clip-drape technique was employed to cover the emitter. Swab samples were collected for bacterial growth. A t-test was applied for statistical comparison. Three of 30 cases (10% of operations) showed evidence of contamination. There was no statistically significant difference between duration of drape use or the amount of drape manipulations...

This study aimed to describe hospital resource utilization of an orthopaedic trauma service and the injury epidemiology during the 2019-2020 coronavirus pandemic to help plan future non-trauma crises. A retrospective chart review was performed on adult patients > 18 years of age who presented to our Level I Trauma Center for musculoskeletal trauma from March 30, 2020 to May 8, 2020 (stay-at-home order) and from March 30, 2019 to May 8, 2019 (comparison group). There were 182 patient encounters and 274 fractures in the 2020 stay-at-home period, and there were 210 patient encounters and 337 fractures in the 2019 control group...

We questioned to what extent traditional predictors of care team burden (via increased length of stay [LOS] after total joint arthroplasty [TJA]) were able to be mitigated through alteration of the care pathway. The impact on LOS of traditional patient risk factors, as well as encounter variables, were analyzed for a consecutive set of patients undergoing surgery before and after a physician-initiated arthroplasty care pathway redesign. We analyzed the impact of these variables on LOS, discharge disposition, and 90-day readmission; separate analyses were performed pre- and post-redesign for LOS...

Instability remains a challenge after total hip arthroplasty (THA). We have previously utilized a monofilament polypropylene mesh to reconstruct the posterior capsule for unstable THA. This study identified 24 hips that underwent mesh reconstruction of the posterior capsule for instability. Survivorship was 70.8% at mean 6.5 years (range 6 weeks-20.1 years). Six patients underwent re-operation, and one patient had the mesh removed. Of eight hips, five (62.5%) with a history of prior revision re-dislocated, while only 2/16 hips (12...

All-terrain vehicles (ATVs) have become popular with respect to recreational activities. Multiple orthopaedic and pediatric organizations currently recommend limiting use of ATVs to older age groups of children with supervision. These recommendations have not generally been adhered to, resulting in a disproportionate number of pediatric orthopaedic trauma, specifically of the upper extremities. A retrospective review of patients 18-years-old and younger who presented to a single, Level I Trauma Center with ATV-related upper extremity trauma between 1996 and 2006 was undertaken to determine the impact of ATV use on the upper extremities of children...

The purpose is to examine the availability of consumer pricing information for arthroscopic meniscal surgery in the United States. Secondary objectives were comparing the price of meniscal repair to meniscectomy and regional pricing differences. Orthopaedic sports medicine clinics were sorted by state and randomly selected from American Orthopaedic Society for Sports Medicine's online directory. Following standardized script, each clinic was called a maximum of three times to obtain pricing information for meniscal surgery...

Gluteal tendinopathy is a common source of impairment in adults due to degenerative changes in the gluteus medius tendon. We identified patients with gluteal tendinopathy who underwent surgery with a minimum six-month follow up. Radiographs, magnetic resonance images, demographic data, Hip Outcome Score (HOS), Veterans Rand 12-item health survey (VR-12), and a patient survey were reviewed. The cohort consisted of seventeen complete tears and thirty-one partial tears of the gluteal medius tendon (n = 48). Of patients, 72...

There is an ongoing interest in alternatives to total knee arthroplasty, as a means to delay inevitable replacement. A possible, minimally invasive, alternative is a sub-chondroplasty, involving interosseous injection of bone substitute materials such as calcium phosphate (CaPo4), platelet-rich plasma (PRP), bone marrow aspirate concentrate (BMAC) or Injectable demineralized bone matrix (iDBM) into the subchondral bone. Eleven clinical trials were found, investigating the effectiveness of sub-chondroplasties performed using CaPo4, PRP, BMAC, and iDBM...

We present two cases of immunocompetent individuals diagnosed with nontuberculous infections of the hand caused by organisms rarely seen in the clinical setting: Mycobacterium heckeshornense and Mycobacterium chelonae. In the first case, a 50-year-old male presented with tenosynovitis of left long finger. He was subsequently found to have a Mycobacterium heckeshornense infection that was resolved with multiple surgeries and a long-term regimen of several antibiotics. The second case was a 29-year-old female with a history of a trivial hand injury infected with Mycobacterium chelonae...

The objective of this study was to delineate a model for management of developmental dysplasia of the hip (DDH) treatment that incorporates hip ultrasound with objective/predicative parameters at key decision-making times. Hip sonograms of 74 infants (59 females, 15 males; 141 hips) with DDH were retrospectively reviewed. Hip sonographic score (HSS; ranges 0-10) was developed to reflect hip status based on sonographic position, stability, and morphology. Analysis on different management groups (i.e., no treatment, successful treatment, and failed treatment) showed that the trend of HSS is helpful in predicting course of the disease and determining effectiveness of treatment...

The characteristics that contribute to opioid demand in pelvic and acetabular fracture surgery are not well understood. We hypothesize that fracture pattern and psychiatric comorbidities will be associated with increased opioid demand. This study evaluated perioperative opioid prescription filling in 743 patients undergoing operative fixation of pelvic and acetabular injuries. Multivariable linear and logistic regression models were used to evaluate associations between baseline factors and opioid outcomes...

Intertrochanteric femur fractures are associated with high morbidity/mortality, necessitating strategies to limit time under anesthesia, blood loss, and additional trauma while achieving maximal fixation in osteopenic bone. The Orthopedic Designs North America, Inc. Talon DistalFix Femoral Nail System uses deployable barbs to maximize axial and rotational control without distal interlock screws. The purpose of this study was to evaluate perioperative features and postoperative outcomes in patients treated with the DistalFix Femoral Nailing System for isolated intertrochanteric femur fractures...

Redisplacement and subsequent intervention are common for pediatric forearm fractures. We investigated associations between the success of closed reduction and the treating provider's experience. We identified patients aged 4-16 years with forearm fractures treated by closed reduction and cast immobilization. Clinical data and radiographs of 130 patients treated by 30 residents were reviewed to determine the treating resident's pediatric forearm fracture reduction experience and the incidence of initial treatment failure (ITF)...

Limb length discrepancy (LLD) is a frequent complication following total hip arthroplasty (THA) often associated with patient dissatisfaction. Radiographic landmarks are commonly used to determine limb length, but their reliability and accuracy remain to be validated. One-hundred and sixty-two preoperative standing pelvic radiographs from patients undergoing THA were measured using four common landmarks (teardrop, ischial tuberosity, obturator foramen, and iliac crest.) LLD and angular differences between measurements were obtained...

Unsustainable spending and unsatisfactory outcomes have prompted a reanalysis of healthcare policy towards value. Several strategies have been proposed as part of this effort including cost sharing plans to shift costs to patients and gain-sharing models to shift risk to health systems. The patient perspective is rarely elicited in policy formation despite efforts to increase patient-centered care. We conducted a prospective study of 118 patients presenting to hand clinic to assess patient perspective of who should constrain treatment options (patient, physician, insurance company, hospital) and be responsible for costs in scenarios of clinical equipoise...

The purpose of the study was to (1) assess the prevalence of comorbidities and (2) compare demographics of surgically and non-surgically treated distal humerus fracture patients. Retrospective review of data from a national database was performed. The primary outcome was comorbidities; the secondary outcome was demographic trends between treatment groups. Distal humerus fractures are associated with cerebrovascular disease, dementia, diabetes mellitus, heart disease, hyperlipidemia, hypertension, hypothyroidism, kidney disease, liver disease, and lung disease...