Bulletin of the Hospital for Joint Diseases

Traumatic extremity amputation can be devastating for patients' functional and psychological health. Challenges of initial management and considerations for limb salvage versus amputation for mangled lower extremities are well documented. However, literature geared toward orthopedic surgeons highlighting management considerations for the residual limb of an amputation is scarce. This article reviews recent literature on management of the residual limb in the perioperative and rehabilitation phases of treatment...

Computer assisted surgical (CAS) navigation and robotic-assisted total hip arthroplasty (THA) have the potential to improve the reproducibility of accurate component positioning and facilitate complex cases, including revision and preoperative deformity. Numerous studies, including multiple comparing technology with conventional THA control groups, suggest that CAS navigation may improve component accuracy in cases of deformity such as hip dysplasia and significant leg length discrepancy. Revision THA data is also encouraging but limited...

PURPOSE: This study sought to assess the long-term structural integrity of primary anterior cruciate ligament (ACL) reconstructions using Achilles tendon allografts by measuring the side-to-side difference in anterior-posterior tibial translation between the operative knee and the contralateral, asymptomatic knee. METHODS: This study was a retrospective case series consisting of patients who underwent primary ACL reconstruction with Achilles tendon allograft. Allografts were chemically processed using the AlloWash or AlloTrue methods and then received either gamma radiation or electron beam radiation (range: 0...

Congenital talonavicular coalition is less frequent than the talocalcaneal or the calcaneonavicular and accounts for around 1% of all tarsal coalitions. Commonly, patients are asymptomatic and rarely need surgical treatment. Herein, we present a case of bilateral symptomatic talonavicular coalition in a seven-year-old boy who underwent surgery with full relief of symptoms. We also review the literature and discuss this pathological condition in detail.

We present the case of a transgender female patient who had been undergoing feminizing hormone therapy for several years and sustained a Tillaux fracture despite being older than the expected age range for females with this injury pattern. Despite work focused on understanding physeal closure, the molecular signals governing this phenomenon remain incompletely described. This case study illustrates that physeal closure may be delayed in patients undergoing sex hormone therapy with associated transitional fractures possibly occurring later than would be expected for the transitional gender...

BACKGROUND: Few studies have investigated the perspective of caregivers as it pertains to their children having xrays performed. This study sought to identify which factors contribute to the varying views that caregivers have toward giving their children x-rays. METHODS: The data was collected through an anonymous survey administered during visits to the pediatric orthopedic surgery clinic. The survey was completed by the patient's parent, guardian, or caregiver, and was administered by a treating physician...

PURPOSE: Radial head subluxation (RHS), also called nursemaid's elbow, is a common injury in young children treated by various health care providers. The diagnosis typically does not require radiographs, but they are often ordered in the emergency room. This study aimed to determine if there was a difference in the efficacy, cost, and amount of radiographs taken in RHS treatment according to the provider, specifically between orthopedic surgeons and pediatricians. METHODS: We reviewed the charts of 207 patients presenting with RHS in the emergency department (mean age of presentation = 2...

Cementation in hip arthroplasty is a common and reliable technique for achieving a stable bone-component interface. However, there are significant costs to the patient, surgeon, and hospital related to the use of cement. It has been previously demonstrated that increasing ambient room temperature and femoral component temperature decreases cement curing time. A protocol utilizing warmed saline irrigation within the surgical field and a warm saline bath for the femoral component was developed. We performed a comparative cohort study to investigate if this protocol reduced time to cement curing in an in vivo setting...

PURPOSE: Bone tunnel widening (TW) is a well-described complication after anterior cruciate ligament reconstruction (ACLR). The purpose of this study was to evaluate radiographic bone TW and clinical outcomes in patients with ACLR performed with suspensory fixation on both the femoral and tibial tunnels using different soft tissue grafts. METHODS: Patients who underwent primary ACLR with a soft tissue graft (hamstring autograft or allograft or quadriceps autograft) using an all-inside technique were included for analysis...

INTRODUCTION: The direct anterior approach (DAA) has become increasingly more popular for total hip arthroplasty (THA). Critics of the DAA maintain that a higher complication rate exists; however, data collection is prone to bias as the outcome is collected by the surgeons performing either an anterior or posterior approach (PA). This study aims to compare the short-term outcomes, including complication rates, in a Medicare population between THAs performed via DAA and PA. MATERIALS AND METHODS: Baseline patient data was obtained from our institution's database for bundled payments, an unbiased collection source...

Hill-Sachs lesions are a challenging clinical problem in the context of anterior shoulder instability. Historically, unless very large, these lesions were thought to be less significant than glenoid defects. Recently, more importance has been placed on whether a Hill-Sachs lesion is on-track or offtrack, with off-track lesions predisposing patients to higher risk of postoperative recurrent instability. Given the high risk for recurrent shoulder instability in patients with Hill-Sachs lesions that are off-track, augmentation procedures, such as the remplissage procedure, are often indicated alongside a Bankart repair...

INTRODUCTION: Hip resurfacing arthroplasty (HRA) is a surgical option with positive outcomes at medium-term follow-up for young, active patients with osteoarthritis. However, early failures of HRA often occur due to improper implant placement. The purpose of this study was to assess the utility of computer-assisted navigation in the effort to optimize implant positioning following HRA. MATERIALS AND METHODS: A retrospective analysis of 262 consecutive HRAs at a single institution was performed...

BACKGROUND: Subchondral insufficiency fracture of the femoral head (SIFH) is a relatively newly used diagnosisfollowing an insidious onset of hip pain in individuals without apparent antecedent trauma. The aim of this study was to investigate the outcomes of a consecutive series of patients with SIFH treated at one institution. METHODS: A total of 93 patients aged 23 to 91 years who were treated for SIFH in the outpatient clinics at one academic, urban medical center between August 2012 and August 2019 were identified...

PURPOSE: The purpose of this study was to evaluate the rate of return to work and recreational sport in patients after superior capsule reconstruction (SCR) with dermal allograft. METHODS: A retrospective review of patients who underwent SCR at our institution between 2015 and 2019 was performed. Patients were only included if they had a minimum of 1-year follow-up and were participating in work or recreational sport preoperatively. Return to work, return to recreational sport, and the level of return were assessed...

PURPOSE: Both limited-open and percutaneous techniques have been described for retrograde insertion of intramedullary metacarpal screws. The percutaneous approach does not allow direct visualization of the starting point at the metacarpal head. However, it limits soft tissue dissection and expedites the procedure. The purpose of our study was to determine whether percutaneous, retrograde intramedullary screw fixation causes substantial iatrogenic damage to the extensor tendon. We also investigated whether larger sized screws would cause greater tendon injury compared to smaller screws...

INTRODUCTION: Cement burns following arthroplasty pro-cedures are a rare but serious complication. To the authors' knowledge, this report is the first of its kind in total knee arthroplasty. CASE: A 61-year-old female underwent an otherwise rou-tine left total knee arthroplasty. On postoperative day one, a 3 cm by 3 cm cement burn was noted on the distal aspect of the popliteal fossa of the operative leg. The burn was noted to be a full-thickness (third degree) burn that required plastic surgery burn service management and limited the patient's postoperative recovery and function...

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INTRODUCTION: We analyzed two different government joint registries for survivorship associated with one platform shoulder system and compared reasons for revision and trends in usage of anatomic total shoulder arthroplasty (aTSA) and reverse total shoulder arthroplasty (rTSA) over a period of more than 10 years to elucidate reasons for any changes in market trends. METHODS: A review of the United Kingdom (UK) and Aus- tralian national joint registries was performed for a single platform shoulder prosthesis (Equinoxe; Exactech, Inc, Gainesville, Florida, USA) from 2011 to 2022 to investigate changes in annual usage rates of primary aTSA and primary rTSA relative to differences in survivorship and reasons for revision for each prosthesis type...

BACKGROUND: In situ pinning is one of the primary treat-ments for slipped capital femoral epiphysis (SCFE) in pedi-atric patients, many of whom have multiple comorbidities. Despite the fact that SCFE pinning is a frequently performed procedure in the United States, little is known regarding sub-optimal postoperative outcomes in this patient population. The purpose of this study was thus to identify the incidence, perioperative predictors, and specific causes of prolonged hospital length of stay (LOS) and readmissions following fixation...

BACKGROUND: The SARS-CoV-2 (COVID-19) pandemic resulted in new, non-orthopedic roles for many members of our New York City based orthopedic department, including redeployment to medicine wards, emergency departments, and intensive care units. The purpose of this study was to determine if certain areas of redeployment predisposed individuals to higher likelihood of positive diagnostic or serologic testing for COVID-19. METHODS: In this study, attendings, residents, and phy-sician assistants within our orthopedic department were surveyed to determine their roles during the COVID-19 pandemic and whether they were tested via diagnostic or serologic methods for detecting COVID-19...