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Sean Ryan, Cary Politzer, Amanda Fletcher, Michael Bolognesi, Thorsten Seyler
Hip fractures are common in elderly patients, and which surgical modality to pursue is often debated. Malnutrition, which cannot be corrected preoperatively in this population, is often not considered. Therefore, the authors sought to investigate the association between hypoalbuminemia and postoperative outcomes based on surgical intervention. Patients undergoing arthroplasty (hemiarthroplasty or total hip arthroplasty), open reduction and internal fixation, and intramedullary nailing placement for treatment of hip fractures were identified in the American College of Surgeons National Surgical Quality Improvement Program database...
September 17, 2018: Orthopedics
Stuart Schexnayder, Ethan Arnaud, Lyndsey Schexnayder, Vikas Patel, Claudia Leonardi, Vinod Dasa
Although it is common practice to assess alignment prior to total knee arthroplasty, preoperative knee alignment and its effect on patient-reported outcomes (PROs) postoperatively has not been well studied. The purpose of this retrospective study was to determine if there are differences in PROs between patients with valgus deformities and patients with varus deformities. Further, this study assessed the baseline differences between these 2 groups preoperatively. Patients were placed into either the valgus or the varus group...
September 17, 2018: Orthopedics
Jin Kyu Lee, Won Rak Choi, Jae-Ho Lee, Kyu-Tae Hwang
The clinical and radiological outcomes of proximal tibia fractures involving the meta-diaphyseal junction treated with unilateral 3.5-mm locking precontoured anatomical plates are reported. Thirty-nine patients (41 proximal tibia fractures) who had proximal tibia fractures with complete meta-diaphyseal dissociation were enrolled in the study. For all patients, immediate postoperative and final follow-up simple radiographs were evaluated to determine the quality of the reduction by assessing coronal and sagittal alignment...
September 17, 2018: Orthopedics
Mitchell Ng, David Brigati, Timothy C Wagner, Kevin Bigart, Anton Khlopas, Assem A Sultan, Michael A Mont, Peter Brooks
Heterotopic ossification is a potential complication that may have a particularly higher association with hip resurfacing. The 2 current mainstays for heterotopic ossification treatment and prophylaxis are administration of nonsteroidal anti-inflammatory drugs and radiotherapy. Recent studies have determined that celecoxib is effective in heterotopic ossification prophylaxis after total hip arthroplasty. However, considering the reportedly higher incidence and severity of heterotopic ossification in these patients, relatively few studies have evaluated its role in hip resurfacing...
September 17, 2018: Orthopedics
Nikhil Sahai, Michael J Faloon, Conor J Dunn, Kimona Issa, Kumar Sinha, Ki Soo Hwang, Arash Emami
Clinical care of patients with unstable thoracolumbar vertebral body fractures may be challenging, especially in the setting of polytrauma patients who require other acute intervention. Compared with the traditional open approach, percutaneous short-segment fixation constructs place less surgical burden on patients regarding operative time and blood loss. Between 2008 and 2012, 32 patients with a mean age of 49 years (range, 19-80 years) underwent percutaneous short-segment fixation at the authors' institution and had a minimum of 6 months of complete clinical and radiographic follow-up...
September 17, 2018: Orthopedics
Abhiraj D Bhimani, Victor Macrinici, Seema Ghelani, Estella Y Huang, Narmeen I Khan, Tha A Saw, Alfonso Mejia
Informed consent is gaining an ever-important place in modern medicine. The practice of patient-centered medicine along with evidence-based medicine requires a balance between the patient's wishes and the physician's oath to do no harm. Surrogate consent, emergency consent, and intraoperative consultation are 3 situations prone to legal and ethical dilemmas in the fulfillment of informed consent. By examining the proposed models and legal precedents that address the challenges in informed consent, discussion of these dilemmas in the context of both law and bioethics may provide a better understanding of how to resolve them...
September 17, 2018: Orthopedics
Steven F DeFroda, Kalpit N Shah, Nicholas Lemme, Sarath Koruprolu, Kristopher J Ware, Brett D Owens
Medial instability of the patellofemoral joint is a rare but known phenomenon; it may result from an incompetent lateral patellofemoral ligament (LPFL). However, biomechanical details of the ligament have not been the subject of scrutiny. The purpose of this study was to describe the biomechanical properties of the LPFL. Ten fresh-frozen human cadaveric knees were dissected to identify the LPFL. The ligament was harvested with a bone plug from the patella and the femoral surface and underwent axial loading to failure...
September 17, 2018: Orthopedics
Toufic R Jildeh, Vincent A Lizzio, Fabien Meta, Mohsin S Fidai, Aaron J Kaat, Eric C Makhni
The purpose of this study was to investigate the correlation of Patient-Reported Outcomes Measurement Information System (PROMIS) Pain Interference (PI) score with traditionally collected visual analog scale (VAS) scores and to determine the influence of patient demographics on PROMIS PI and VAS scores. Patient demographics were collected, and PROMIS PI, PROMIS Physical Function (PF), and VAS questionnaires were distributed to 215 patients in orthopedic ambulatory clinics. The primary outcome was correlation between PROMIS PI and VAS questionnaires...
September 17, 2018: Orthopedics
Grant H Garcia, Joseph N Liu, Alexandra C Wong, Anirudh K Gowd, Anthony A Romeo, Joshua S Dines, Lawrence V Gulotta
Long-term clinical evaluation is becoming more important, yet difficulties exist because there are substantial patient costs for extended follow-up. The goal of this study was to validate whether a new shoulder motion evaluation is reproducible and reliable with physician examination. Consecutive patients were administered a shoulder motion assessment during their clinic visit. Patients completed the same evaluation 2 weeks after their visit to determine test-retest reliability. Exact and approximate (within 20° or 4 spinal levels) agreements between patient and physician measurements were calculated...
September 17, 2018: Orthopedics
Young-Hoo Kim, Ketan Pandey, Jang-Won Park, Jun-Shik Kim
The objective of this study was to ascertain whether combined intravenous (IV) and intra-articular (IA) administration of tranexamic acid (TXA) is beneficial for reducing blood loss and the prevalence of deep venous thrombosis (DVT) in primary simultaneous bilateral total knee arthroplasty compared with IV only administration of TXA. One hundred fifty-four patients received a combined IV and IA injection of TXA in 1 knee and an IV only injection of TXA in the other. Transfusion rates and volumes and the amount of blood loss were recorded at 8 hours, 24 hours, and 48 hours...
September 17, 2018: Orthopedics
Russell G Cohen, Nathan C Sherman, Sheridan L James
Cementless fixation design failures led to low use of this alternative technology. A cementless total knee arthroplasty addressed these design flaws. The single radius knee design incorporated additive manufacturing to produce the tibial and patellar implants. Both implants have enhanced porous substrates, optimizing initial bony ingrowth. A nonrandomized prospective review was conducted of 72 cementless knees followed for a minimum of 2 years (mean, 37 months). Surgical time, estimated blood loss, and range of motion at 6 weeks were compared with those of a matched cohort of 70 cemented knees performed by the same surgeon...
August 31, 2018: Orthopedics
Takashi Imagama, Atsunori Tokushige, Kazushige Seki, Toshihiro Seki, Hiroyoshi Ogasa, Toshihiko Taguchi
Clinical outcomes of total hip arthroplasty for rheumatoid arthritis are reportedly worse than those of total hip arthroplasty for osteoarthritis of the hip. The authors examined pre- and postoperative factors associated with the modified Harris hip score (mHHS). Fifty-one joints of 48 rheumatoid arthritis patients who underwent total hip arthroplasty were studied retrospectively. The authors examined the correlation between preoperative rheumatoid arthritis disease activity (Disease Activity Score in 28 joints-C-reactive protein and C-reactive protein) and mHHS at 1 year after total hip arthroplasty...
August 31, 2018: Orthopedics
Nathan A Marsh, Ivan J Antosh, Daniel K O'Conor, Raymond J Ortega, Nicholas S Paneral, Kenneth L Cameron, Matthew Posner
The biomechanical strength of a bone-patellar tendon-bone graft in the tibia may vary depending on whether the interference screw abuts the cancellous vs the cortical surface of the bone plug. In a porcine model, 10×20-mm bone-patellar tendon-bone grafts were prepared and fixed in a 10-mm diameter tibial tunnel using a 9×25-mm titanium interference screw. The screw was positioned on the cancellous surface of the graft in group A (n=13) vs the cortical side of the graft in group B (n=14). Specimens underwent precycling, cyclic loading, and load-to-failure testing...
August 17, 2018: Orthopedics
Shoichi Hasegawa, Masafumi Horie, Hiroki Katagiri, Kunikazu Tsuji, Takeshi Muneta, Hideyuki Koga
Hypoplastic meniscus is an extremely rare abnormality. The authors present the first case of meniscal hypoplasia with a partial fusion of meniscus and tibial cartilage. A 22-year-old man underwent surgery for a chronic patellar dislocation. Preoperative magnetic resonance imaging and arthroscopy incidentally revealed hypoplasia of both medial and lateral menisci. Moreover, the posterior horn of the medial meniscus and middle body of the lateral meniscus were fused with the cartilage surface of the tibia. Magnetic resonance imaging of the contralateral knee showed similar meniscal anomalies...
August 17, 2018: Orthopedics
Wataru Ando, Futoshi Yukioka, Kengo Yamamoto, Tsuyoshi Koyama, Yoshichika Hashimoto, Yukihiko Yasui, Takeshi Ogawa, Takayuki Tsuda, Kenji Ohzono
The authors report a case of immunoglobulin G4-related disease (IgG4-RD) of the hip. A 60-year-old man diagnosed with osteoarthritis of the right hip was referred to the authors' outpatient clinic for surgical intervention. Laboratory test results revealed elevated C-reactive protein and serum IgG levels. A subsequent laboratory test revealed an IgG4 level of 318 mg/dL. Magnetic resonance imaging revealed an abnormal mass in the right hip joint. The authors suspected IgG4-RD of the hip. The mass was resected during total hip arthroplasty...
August 17, 2018: Orthopedics
Byung-Ho Yoon, In Keun Park
A newer alumina matrix composite ceramic (BIOLOX delta; CeramTec, Plochingen, Germany) was developed to improve resistance to wear while reducing the risk for fractures with alumina-on-alumina design. This article describes a case of fracture of the BIOLOX delta ceramic liner without history of trauma in well-fixed total hip implants. A 61-year-old woman underwent total hip replacement via the posterior approach 20 months earlier because of osteonecrosis of the femoral head. A cementless cup and a stem with a 52/36-mm BIOLOX delta couple bearing were used...
August 17, 2018: Orthopedics
Wen Yang, Meng Si, Yong Hou, Lin Nie
The purpose of this study was to evaluate the superiority of total disk replacement (TDR) using a cervical disk prosthesis vs anterior cervical diskectomy and fusion (ACDF). Ninety-six patients with a diagnosis of degenerative disk disease with radiculopathy or myeloradiculopathy at 2 contiguous levels from C-3 to C-7 were randomly allocated to the TDR group (n=48) or the ACDF group (n=48). Outcome measures were recorded preoperatively and 1 week and 3, 6, 12, 24, and 81 months postoperatively. A total of 80 patients completed the follow-up, including 38 in the TDR group and 42 in the ACDF group...
August 17, 2018: Orthopedics
Jack M Bert, Nathan K Endres, Christopher J Tucker, Annabelle P Davey
Osteoarthritis has one of the highest associations for all-cause mortality in the United States. Comorbidities are common in patients with end-stage disease. In most cases, it is critical to exhaust conservative modalities of care before resorting to surgical intervention. This article discusses common conservative approaches focusing on injectable treatments that can be employed prior to total knee replacement. [Orthopedics. 2018; 41(5):256-260.].
September 1, 2018: Orthopedics
Michael J Heffernan
No abstract text is available yet for this article.
September 1, 2018: Orthopedics
Muyibat A Adelani, Ryan M Nunley, John C Clohisy, Robert L Barrack
Value-based payment programs have incentivized the reduction of many post-acute care services, including home health care. Patient perceptions of home health care services are currently unknown. The objectives of this study were to determine the value that patients place on home health care after joint replacement surgery and to assess their impression of Medicare reimbursement for these services. Patients with traditional Medicare insurance who underwent primary total hip or knee arthroplasty between January 2016 and July 2017 were given a questionnaire in which they were asked to quantify their satisfaction with home health care, estimate Medicare reimbursement for these services, and give their impression of actual reimbursement...
September 1, 2018: Orthopedics
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