Orthopaedic Reviews

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As the number of primary total hip arthroplasty (THA) procedures performed continues to rise, the burden of revision THA procedures is also expected to increase. Proper evaluation and management of acetabular bone loss at the time of revision surgery will be an increasing challenge facing orthopaedic surgeons. Proper preoperative patient assessment and detailed preoperative planning are essential in obtaining a good clinical result. Appropriate radiographs are critical in assessing acetabular bone loss, and specific classification schemes can identify bone loss patterns and guide available treatment options...

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Management of Anterior Cruciate Ligament Injuries: Evidence-Based Guideline is based on a systematic review of the current scientific and clinical research. This guideline has been endorsed by the National Academy of Sports Medicine, the American Orthopaedic Society for Sports Medicine, the National Athletic Trainers' Association, and the American Academy of Physical Medicine and Rehabilitation. The guideline contains 20 recommendations, including both diagnosis and treatment. In addition, the work group highlighted the need for better research in the treatment of anterior cruciate ligament injuries...

Periprosthetic joint infection remains a clinical challenge with no benchmark for diagnosis. The diagnosis is based on many different clinical variables that may be difficult to interpret, especially in the setting of chronic systemic disease. Synovial fluid aspiration, diagnostic imaging, traditional culture, peripheral serum inflammatory markers, and intraoperative frozen sections each have their limitations but continue to be the mainstay for diagnosis of periprosthetic joint infection. As molecular- and biomarker-based technologies improve, the way we interpret and diagnose periprosthetic joint infection will ultimately change and may even improve diagnostic accuracy and turnaround time...

Osteoporosis is a burgeoning clinical problem that is characterized by decreased bone strength and density. It predisposes patients to fragility fractures and debilitating spine deformities. Several complications are associated with spine surgery in patients with osteoporosis, and there is currently no treatment algorithm to guide the spine surgeon. A multidisciplinary approach to treatment of patients with osteoporosis and spine deformity or fracture is encouraged, and preoperative planning is crucial for successful surgical outcomes...

Total ankle arthroplasty (TAA) is an increasingly popular treatment option for patients with end-stage ankle arthritis. Although improved short- and long-term clinical and radiographic outcomes have been achieved with TAA, revision surgery may be necessary in the setting of aseptic loosening, subsidence, impingement, arthrofibrosis, or infection. Factors such as patient selection, implant design, and surgical technique can all contribute to TAA failure. Treatment of patients with a painful TAA is complex and requires careful consideration of symptom history, workup, and nonsurgical and surgical treatment options...

In athletes, significant advances in anterior cruciate ligament reconstruction techniques and rehabilitation have led to improved surgical outcomes and increased expectations for return to play. Although an expeditious return to sport has become an achievable and often realistic goal, the factors that most influence safe, timely, and successful return to play remain unknown. The literature offers mainly anecdotal evidence to guide the team physician in the decision-making process, with a paucity of criteria and consensus guidelines available to help determine return to sport...

Complex elbow dislocations (ie, fracture-dislocations) are challenging injuries to treat and may result in significant patient morbidity. Chronic instability, posttraumatic arthrosis, and poor functional outcomes are frequent. Orthopaedic surgeons should strive to optimize elbow function through restoration of articular congruity and stability coupled with early rehabilitation. Although most of these injuries require surgical management, not all complex elbow dislocations are equivalent. Understanding elbow biomechanics and the injury mechanism provides valuable insight into the variations of pathology that may be observed...

Paralytic ileus is marked by the cessation of bowel motility. This condition is a major clinical concern that may lead to severe patient morbidity in orthopaedic surgery and trauma patients. Ileus most commonly occurs following spinal surgery, traumatic injury, or lower extremity joint reconstruction, but it may also occur following minor orthopaedic procedures. Possible consequences of ileus include abdominal pain, malnutrition, prolonged hospital stay, hospital readmission, bowel perforation, and death. Therapies used in the treatment of ileus include minimization of opioids, early patient mobilization, pharmacologic intervention, and multidisciplinary care...

Gender differences exist in the presentation of musculoskeletal disease, and recognition of the differences between men and women's burden of disease and response to treatment is key in optimizing care of orthopaedic patients. The role of structural anatomy differences, hormones, and genetics are factors to consider in the analysis of differential injury and arthritic patterns between genders.

Medial epicondylitis, often referred to as "golfer's elbow," is a common pathology. Flexor-pronator tendon degeneration occurs with repetitive forced wrist extension and forearm supination during activities involving wrist flexion and forearm pronation. A staged process of pathologic change in the tendon can result in structural breakdown and irreparable fibrosis or calcification. Patients typically report persistent medial-sided elbow pain that is exacerbated by daily activities. Athletes may be particularly symptomatic during the late cocking or early acceleration phases of the throwing motion...

Periprosthetic joint infections are devastating complications that are difficult and expensive to treat and have a substantial mortality rate. A major goal of modern joint arthroplasty is to minimize these infections. Preoperative factors associated with increased risk of infection include malnutrition, diabetes mellitus, obesity (body mass index >40 kg/m(2)), and rheumatoid arthritis. Administration of appropriate antibiotics before the surgical incision is made is essential to minimize infection. The use of laminar flow rooms, proper skin preparation, limiting operating room traffic, and the use of various wound closure techniques can help to decrease infection rates...

Replantation is the process of reattaching amputated parts. Relative indications for replantation in the upper extremity include amputation of the thumb or multiple digits as well as amputations proximal to zone II and pediatric finger amputations at any level. Preoperatively, the part should be sealed in a bag and placed on ice; maximum ischemia times are approximately 12 hours of warm and 24 hours of cold time for digits, with shorter times tolerated for amputations at more proximal levels. With multiple digit involvement, an assembly line approach is used in the operating room...

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No abstract text is available yet for this article.

No abstract text is available yet for this article.

No abstract text is available yet for this article.

No abstract text is available yet for this article.

No abstract text is available yet for this article.