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Orthopedics

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https://www.readbyqxmd.com/read/28662252/chronic-expanding-hematoma-after-metal-on-metal-total-hip-arthroplasty
#1
Wataru Ando, Kengo Yamamoto, Tsuyoshi Koyama, Yoshichika Hashimoto, Hirohiko Yasui, Takashi Tsujimoto, Masaharu Aihara, Kenji Ohzono
A 76-year-old woman who underwent bilateral metal-on-metal total hip arthroplasty fell 3 years after this procedure and subsequently incurred continuous pain in her buttock. Plain radiographs showed no fracture and no loosening of the hip prosthesis. Magnetic resonance imaging revealed an abnormal, large, thick-walled mass with heterogeneous signal intensity at the right buttock. The prerevision diagnosis was adverse reaction to metal debris. The mass was surgically resected, and the metal femoral head was replaced by a dual-mobility prosthesis...
June 29, 2017: Orthopedics
https://www.readbyqxmd.com/read/28662251/the-intra-articular-wave-sign-as-a-landmark-for-suture-anchor-placement-in-arthroscopic-remplissage
#2
Cynthia A Kahlenberg, Grant H Garcia, Ryan M Degen, Joseph N Liu, Joshua S Dines
In arthroscopic remplissage, surgeons may inadvertently pass sutures through the teres minor rather than the infraspinatus tendon. This misplacement of the sutures may lead to poor outcomes. The authors describe the novel use of the posterior band of the inferior glenohumeral ligament, known as the "wave sign," as a reliable intra-articular landmark for suture anchor placement to improve suture passage accuracy. Twelve cadaveric shoulders underwent arthroscopic remplissage by a fellowship-trained surgeon. During the first phase of the study, remplissage was performed on 6 specimens with standard technique...
June 29, 2017: Orthopedics
https://www.readbyqxmd.com/read/28662250/surgeons-perspectives-on-premium-implants-in-total-joint-arthroplasty
#3
Amy S Wasterlain, Ricardo J Bello, Jonathan Vigdorchik, Ran Schwarzkopf, William J Long
Declining total joint arthroplasty reimbursement and rising implant prices have led many hospitals to restrict access to newer, more expensive total joint arthroplasty implants. The authors sought to understand arthroplasty surgeons' perspectives on implants regarding innovation, product launch, costs, and cost-containment strategies including surgeon gain-sharing and patient cost-sharing. Members of the International Congress for Joint Reconstruction were surveyed regarding attitudes about implant technology and costs...
June 29, 2017: Orthopedics
https://www.readbyqxmd.com/read/28662249/hemophilic-arthropathy
#4
Christopher R Nacca, Andrew P Harris, John R Tuttle
The musculoskeletal manifestations of hemophilia A and B are some of the most common presenting symptoms and continue to be challenging to practitioners. Hemophilic arthropathy, if not initially adequately treated and managed, may lead to debilitating disease and eventually require the consideration of major surgery, including total joint arthroplasty. Thorough comprehension of the pathophysiology, diagnosis, and both medical and surgical interventions is critical in establishing an appropriate treatment regimen for these patients...
June 29, 2017: Orthopedics
https://www.readbyqxmd.com/read/28662248/surgical-efficiency-of-anterior-cruciate-ligament-reconstruction-in-outpatient-surgical-center-versus-hospital-operating-room
#5
Nathan C Patrick, Christopher A Kowalski, William L Hennrikus
Anterior cruciate ligament (ACL) reconstructions are complex orthopedic procedures in which a proficient team is of vital importance. Outpatient surgical centers (OSCs) often provide orthopedic-specific teams; however, hospital operating rooms (ORs) commonly rotate staff. The purpose of this study was to compare the efficiency of pediatric ACL reconstructions between a surgical center and a hospital OR owned and directed by a single institution. Cases examined involved pediatric patients, aged 12 to 18 years (mean age, 15...
June 29, 2017: Orthopedics
https://www.readbyqxmd.com/read/28662247/effectiveness-of-reoperations-for-adjacent-segment-disease-following-lumbar-spinal-fusion
#6
Austin Drysch, Remi M Ajiboye, Akshay Sharma, Jesse Li, Tara Reza, Dushawn Harley, Don Y Park, Sina Pourtaheri
Although several options are available to address adjacent segment disease (ASD), the most effective surgical treatment has not been determined. In addition, it is important to subdivide ASD into stenosis with or without instability to determine if a decompression alone vs an extension of fusion is necessary. A systematic search of multiple medical reference databases was conducted for studies on surgical treatment of ASD. The primary outcome measures used were radiographic and clinical success rates. Meta-analysis was completed to determine effect summary values, 95% confidence intervals, and Q statistic and I(2) values, using the random effects model for heterogeneity...
June 29, 2017: Orthopedics
https://www.readbyqxmd.com/read/28662246/factors-influencing-orthopedic-surgery-residents-choice-of-subspecialty-fellowship
#7
Joseph J Kavolus, Andrew P Matson, William A Byrd, Brian E Brigman
In the setting of increasing student debt, a rapidly changing health care system, and growing transparency in the age of outcome reporting, residents have many factors to consider when determining which fellowship to pursue. An institutional review board-approved link to an online survey was emailed to orthopedic surgery trainees across the United States. Demographics were collected, and 14 fellowship influences were assessed using a Likert scale. A total of 360 responses were received. Of the respondents, 85...
June 29, 2017: Orthopedics
https://www.readbyqxmd.com/read/28617519/pain-and-opioid-use-after-total-shoulder-arthroplasty-with-injectable-liposomal-bupivacaine-versus-interscalene-block
#8
Marc R Angerame, John A Ruder, Susan M Odum, Nady Hamid
Postoperative pain control is a significant concern after total shoulder arthroplasty. Injectable periarticular liposomal bupivacaine, which has been found to decrease opioid use after orthopedic procedures, has been proposed as a viable alternative to regional anesthesia. This study compared the efficacy of liposomal bupivacaine vs interscalene block among patients undergoing total shoulder arthroplasty. A retrospective review was conducted of 79 patients who underwent anatomic total shoulder arthroplasty performed by a single surgeon between January 2013 and April 2015...
June 15, 2017: Orthopedics
https://www.readbyqxmd.com/read/28617518/tibiofemoral-instability-after-primary-total-knee-arthroplasty-posterior-stabilized-implants-for-obese-patients
#9
Ata Can, Fahri Erdogan, Ayse Ovul Erdogan
Tibiofemoral instability is a common complication after total knee arthroplasty (TKA), accounting for up to 22% of all revision procedures. Instability is the second most common cause of revision in the first 5 years after primary TKA. In this study, 13 knees with tibiofemoral instability after TKA were identified among 693 consecutive primary TKA procedures. Patient demographics, body mass index, clinical symptoms, previous deformity, previous knee surgery, complications, interval between index TKA and first tibiofemoral instability, causes of instability, and interval between index TKA and revision TKA were retrospectively reviewed...
June 15, 2017: Orthopedics
https://www.readbyqxmd.com/read/28617517/selective-fasciotomy-for-chronic-exertional-compartment-syndrome-detected-with-exercise-magnetic-resonance-imaging
#10
Sehan Park, Ho Seong Lee, Sang Gyo Seo
Chronic exertional compartment syndrome that is refractory to conservative management should be treated with surgical fasciotomy. However, owing to the limitations of intracompartmental needle manometry in reaching a definite diagnosis, the appropriate timing for fasciotomy and on which compartment remain unclear. The authors report the case of a 22-year-old male military cadet who reported pain in his left calf when running or walking for long distances. The pain was located at the lateral aspect of the calf, from the mid-calf level to the ankle...
June 15, 2017: Orthopedics
https://www.readbyqxmd.com/read/28598494/decreased-radiation-exposure-among-orthopedic-residents-is-maintained-when-using-the-mini-c-arm-after-undergoing-radiation-safety-training
#11
David Gendelberg, William L Hennrikus, Carissa Sawyer, Douglas Armstrong, Steven King
The resident curriculum of the American Board of Orthopaedic Surgery emphasizes radiation safety. Gendelberg showed that, immediately after a program on fluoroscopic safety, residents used less radiation when using the mini C-arm to reduce pediatric fractures. The current study evaluated whether this effect lasted. Residents underwent a new annual 3-hour session on mini C-arm use and radiation. Group A included 53 reductions performed before training. Group B included 45 reductions performed immediately after training...
June 9, 2017: Orthopedics
https://www.readbyqxmd.com/read/28598493/adult-degenerative-lumbar-scoliosis
#12
Eugene Wong, Farhaan Altaf, Lawrence J Oh, Randolph J Gray
Adult degenerative lumbar scoliosis is a 3-dimensional deformity defined as a coronal deviation of greater than 10°. It causes significant pain and disability in the elderly. With the aging of the population, the incidence of adult degenerative lumbar scoliosis will continue to increase. During the past decade, advancements in surgical techniques and instrumentation have changed the management of adult spinal deformity and led to improved long-term outcomes. In this article, the authors provide a comprehensive review of the pathophysiology, diagnosis, and management of adult degenerative lumbar scoliosis...
June 9, 2017: Orthopedics
https://www.readbyqxmd.com/read/28598492/use-of-2-octyl-cyanoacrylate-adhesive-and-polyester-mesh-for-wound-closure-in-primary-knee-arthroplasty
#13
Andrew J Holte, Josef N Tofte, Greta J Dahlberg, Nicolas Noiseux
Wound closure in primary knee arthroplasty is important both for surgical success, by minimizing the risk of wound complications and infection, and for patient satisfaction with wound care and cosmesis. This article reports the use of a topical self-adhering, pressure-sensitive polyester mesh combined with 2-octyl cyanoacrylate adhesive for final skin closure of primary knee arthroplasty without external staples or sutures. During a 2.5-year period, 360 consecutive primary knee arthroplasty procedures (321 total knee arthroplasty procedures and 39 partial knee arthroplasty procedures) performed by 1 surgeon at 1 institution were reviewed...
June 9, 2017: Orthopedics
https://www.readbyqxmd.com/read/28598491/modularity-in-total-hip-arthroplasty-benefits-risks-mechanisms-diagnosis-and-management
#14
Ben M Vierra, Sarah R Blumenthal, Derek F Amanatullah
Modular implants are currently widely used in total hip arthroplasty because they give surgeons versatility during the operation, allow for easier revision surgery, and can be adjusted to better fit the anatomy of the specific patient. However, modular implants, specifically those that have metal-on-metal junctions, are susceptible to crevice and fretting corrosion. This can ultimately cause implant failure, inflammation, and adverse local tissue reaction, among other possible side effects. Surgeons should be aware of the possibility of implant corrosion and should follow a set of recommended guidelines to systematically diagnose and treat patients with corroded implants...
June 9, 2017: Orthopedics
https://www.readbyqxmd.com/read/28585999/treatment-of-a-pediatric-t-type-intercondylar-humerus-fracture-with-hybrid-percutaneous-pinning-and-external-fixation
#15
D Alex Stroh, Brian T Sullivan, Brett A Shannon, Paul D Sponseller
T-type intercondylar fractures of the distal humerus are rare injuries in skeletally immature patients. Few studies are available to guide the treatment of these injuries. Small case series and expert recommendations suggest superiority of the open approach for direct reduction of the articular surface. This approach poses risks of vascular compromise and elbow stiffness. However, success with percutaneous intercondylar screw fixation has been described for simple split patterns. The authors present a case that illustrates a novel percutaneous technique to treat this fracture type...
June 6, 2017: Orthopedics
https://www.readbyqxmd.com/read/28585998/correlation-of-the-features-of-the-lumbar-multifidus-muscle-with-facet-joint-osteoarthritis
#16
Bo Yu, Kaibiao Jiang, Xinfeng Li, Jidong Zhang, Zude Liu
Facet joint osteoarthritis is considered a consequence of the aging process; however, there is evidence that it may be associated with degenerative changes of other structures. The goal of this study was to investigate the correlation between lumbar multifidus muscle features and facet joint osteoarthritis. This retrospective study included 160 patients who had acute or chronic low back pain and were diagnosed with facet joint osteoarthritis on computed tomography scan. Morphometric parameters, including cross-sectional area, muscle-fat index, and percentage of bilateral multifidus asymmetry at L3-L4, L4-L5, and L5-S1, were evaluated with T2-weighted magnetic resonance imaging...
June 6, 2017: Orthopedics
https://www.readbyqxmd.com/read/28585997/diagnosis-and-management-of-traumatic-patellar-instability-in-the-pediatric-patient
#17
Steven F DeFroda, Joseph A Gil, Alex Boulos, Aristides I Cruz
Instability of the patella is a common cause of knee pain and dysfunction in pediatric and adolescent patients and can be due to several factors. Although some patients will recall a specific traumatic event others may not, requiring the diagnosis to be made on the basis of physical examination and imaging. Congenital dislocation and connective tissue disorders should also be considered, even in the setting of trauma. There are radiographic parameters that may identify causes of instability such as trochlear and patellar abnormalities, and magnetic resonance imaging can identify signs of trauma such as bony edema, loose osteochondral fragments, and increased tibial tubercle-trochlear groove distance...
June 6, 2017: Orthopedics
https://www.readbyqxmd.com/read/28585996/posterior-percutaneous-endoscopic-cervical-foraminotomy-and-diskectomy-with-unilateral-biportal-endoscopy
#18
Jae Hyun Park, Su Gi Jun, Je Tae Jung, Sang Jin Lee
This report describes a new, minimally invasive procedure, posterior percutaneous endoscopic cervical diskectomy, performed with a unilateral biportal endoscopic approach. The procedure is used to treat cervical foraminal soft disk protrusion. This report also describes the short-term results with this procedure. In 2015, 14 patients underwent this new, minimally invasive procedure. The technique was applied with a standard arthroscopy device and conventional spine instruments. The Neck Disability Index and visual analog scale scores for the neck and upper arm were evaluated, and 13 consecutive patients were included in the analysis...
June 6, 2017: Orthopedics
https://www.readbyqxmd.com/read/28585995/outcomes-of-primary-total-knee-arthroplasty-in-patients-with-hematopoietic-stem-cell-transplantation
#19
Brian P Chalmers, Cameron K Ledford, Kevin I Perry, Tad M Mabry, Arlen D Hanssen, Matthew P Abdel
Patients who have undergone hematopoietic stem cell transplantation to treat underlying bone marrow pathology represent a unique and potentially high-risk patient population for total knee arthroplasty (TKA). This study retrospectively reviewed 15 TKA procedures performed on 11 patients with a history of hematopoietic stem cell transplantation. The authors analyzed patient survivorship; clinical outcomes, including complications; and implant survivorship. Mean follow-up was 5 years (range, 2-10 years). Patient survivorship free from mortality was 91% (95% confidence interval, 76%-100%) and 55% (95% confidence interval, 25%-85%) at 2 and 5 years, respectively...
June 6, 2017: Orthopedics
https://www.readbyqxmd.com/read/28585994/new-technique-for-removal-of-screws-with-damaged-heads
#20
Takahiro Iwata, Satoshi Nozawa, Masato Maeda, Haruhiko Akiyama
Removal of orthopedic implants may sometimes be difficult because of ongrowth of new bone. Titanium screws can become encased or stripped during the process of initial open reduction and internal fixation or at the time of hardware removal. Difficulty in removing screws from a locking plate is particularly well-known. Two patients with tibial and femoral diaphyseal fractures were treated using a locking plate or an intramedullary nail. However, after fracture healing, it was difficult to remove the locking screw or reconstruction screws because of damage to the heads...
June 6, 2017: Orthopedics
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