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Journal of the American Academy of Orthopaedic Surgeons

Neeraj M Patel, Christopher J DeFrancesco, Nakul S Talathi, Joshua T Bram, Theodore J Ganley
INTRODUCTION: Complication rates after physeal-sparing anterior cruciate ligament reconstruction (ACLR) are known to be high in the paediatric population compared with the adult population. However, the outcomes of these skeletally immature patients after all-epiphyseal reconstruction have not been compared with those after transphyseal reconstructions in a more similar age group. This study compares clinical outcomes and complications between all-epiphyseal and pediatric transphyseal ACLR...
December 10, 2018: Journal of the American Academy of Orthopaedic Surgeons
John A Scanelli, Geoffrey R Reiser, John F Sloboda, Joseph T Moskal
Elderly patients undergoing both elective and nonelective hip arthroplasty contribute markedly to health care spending, and the current aging population is likely to require even more resources. Several national joint replacement registries show a lower risk of revision surgery in patients older than 75 years who received cemented femoral components compared with cementless implants for primary total hip arthroplasty. Despite a higher incidence of early periprosthetic femoral fracture, noncemented femoral components are being used with increasing frequency in elderly patients worldwide...
December 7, 2018: Journal of the American Academy of Orthopaedic Surgeons
Cody L Martin, James A Browne
Intra-articular corticosteroid injections have been used for decades in the management of symptomatic osteoarthritis of the knee and remain a common practice. The pain relief from a steroid injection is thought to work by reducing inflammation within the arthritic knee. Substantial variability remains among providers with regard to the technique used to perform the procedure, including the site of the injection, the medications injected, and the level of sterility. The success of steroid injections in relieving arthritic knee pain most often occurs in the short term...
December 5, 2018: Journal of the American Academy of Orthopaedic Surgeons
Joseph Letzelter, J Bradford Hill, Jacques Hacquebord
Surgical site infections (SSIs) in orthopaedics are a common complication, with more than half a million SSIs occurring in the United States each year. SSIs can carry a notable burden for patients and physicians alike. Skin antiseptic solution plays an important role in preventing SSI. Many studies have looked at different skin antiseptic solution in preventing SSIs. Different surgical preps can decrease bacterial loads at surgical sites in varying degrees. Yet, the amount of bacterial load does not always correlate with a lower risk of infection...
December 5, 2018: Journal of the American Academy of Orthopaedic Surgeons
Mai P Nguyen, Nicholas Prayson, Heather A Vallier
INTRODUCTION: Extremity involvement is common among nonfatal gunshot injuries. Most of these injuries are low energy in nature and may be associated with fractures. Although displaced fractures of lower extremity long bones are often treated surgically, the purpose of this study was to review our experience in managing incomplete femur fractures caused by gunshot penetration and to develop treatment recommendations. METHODS: We retrospectively reviewed clinical and radiographic data for 46 consecutive patients with incomplete femur fractures secondary to low-energy gunshot wounds...
December 5, 2018: Journal of the American Academy of Orthopaedic Surgeons
James Nace, Ahmed Siddiqi, Carl T Talmo, Antonia F Chen
Fungal periprosthetic joint infection (PJI) is a devastating complication because it can be difficult to diagnose, manage, and eradicate. Fungal PJI treatment requires a systematic approach. Increased awareness is essential when patients with painful arthroplasties present with immunosuppression, significant comorbidities, multiple surgeries, and history of drug use. Every suspected fungal PJI should be promptly diagnosed using readily available serum and synovial fluid markers. Surgical management involves d├ębridement, antibiotics, and implant retention, one-stage exchange arthroplasty, prosthetic articulating spacers, and two-stage exchange arthroplasty...
December 4, 2018: Journal of the American Academy of Orthopaedic Surgeons
Jourdan M Cancienne, Stephen F Brockmeier, Matthew J Deasey, Brian C Werner
BACKGROUND: A few investigations exist which evaluate the influence of obstructive sleep apnea (OSA) on complications after arthroscopic rotator cuff repair. METHODS: A database was queried for patients undergoing rotator cuff repair with and without OSA and further subdivided into those with and without a billing code for a continuous positive airway pressure (CPAP) device. Thirty-day and 6-month adverse events were assessed. RESULTS: After regression analysis, patients with OSA had markedly increased emergency department visits and hospital admission (P < 0...
December 4, 2018: Journal of the American Academy of Orthopaedic Surgeons
Robert F Murphy, Leah Plumblee, William B Barfield, Joshua S Murphy, Nicholas Fuerstenau, David D Spence, Derek M Kelly, Matthew A Dow, James F Mooney
INTRODUCTION: Septic arthritis of the hip (SAH) is a common condition encountered by pediatric orthopaedic surgeons and is treated with arthrotomy and irrigation. Depending on the response to initial treatment, some patients require surgical treatment beyond the index procedure. The purpose of this study was to investigate risk factors for repeat surgical intervention after initial arthrotomy for presumed SAH. METHODS: A multicenter retrospective review of all children who underwent surgical arthrotomy for presumed SAH over a ten-year period was conducted...
December 4, 2018: Journal of the American Academy of Orthopaedic Surgeons
Jad G Khalil, Sapan D Gandhi, Daniel K Park, Jeffrey S Fischgrund
Cutibacterium acnes, long thought to be skin flora of pathological insignificance, has seen a surge in interest for its role in spine pathology. C acnes has been identified as a pathogen in native spine infection and osteomyelitis, which has implications in the management compared with more commonly recognized pathogens. In addition, It has also been recognized as a pathogen in postoperative and implant-associated infections. Some evidence exists pointing to C acnes as an unrecognized source of otherwise aseptic pseudarthrosis...
December 4, 2018: Journal of the American Academy of Orthopaedic Surgeons
Jose C Alcerro, Carlos J Lavernia
INTRODUCTION: The use of stem cell therapy (SCT) and platelet-rich plasma (PRP) injection for knee osteoarthritis (OA) is extremely controversial and at best experimental stage. These treatments are being offered across the nation for "cash-only payments." Our objectives were to determine (1) what proportion of board-certified orthopedic surgeons in Miami-Dade County offer SCT or PRP and (2) how much do practices charge for these services. METHODS: All board-certified orthopedic surgeons' offices in Miami-Dade County were identified by their American Academy of Orthopaedic Surgeons active membership...
November 28, 2018: Journal of the American Academy of Orthopaedic Surgeons
Jacob E Berman, Ana Mata-Fink, Hafiz F Kassam, Theodore A Blaine, David Kovacevic
INTRODUCTION: Identifying patient factors that affect length of stay (LOS) and discharge disposition after shoulder arthroplasty is key in managing patient expectations. In this systematic review, we identify patient-specific covariates that correlate with increased LOS and need for discharge to a facility. METHODS: We searched biomedical databases to identify associations between patient-specific factors and LOS and discharge disposition after shoulder arthroplasty...
November 28, 2018: Journal of the American Academy of Orthopaedic Surgeons
Mary K Mulcahey, Chelsea Nemeth, Jeffrey D Trojan, Mary I O╩╝Connor
INTRODUCTION: Orthopaedic surgery has the lowest percentage of female residents of all surgical specialties. Female medical students may believe that the demands of the specialty, both during training and in clinical practice, may be less conducive to becoming a parent. The purpose of this study was to determine the perceptions of and experiences with pregnancy and parenthood among female orthopaedic surgery trainees. METHODS: An anonymous 24-question online survey was distributed to all current female orthopaedic surgery trainees in the United States via the American Academy of Orthopaedic Surgeons Diversity Advisory Board...
November 28, 2018: Journal of the American Academy of Orthopaedic Surgeons
David P Zamorano, Philip K Lim, Brandon A Haghverdian, Ranjan Gupta
Alcohol is one of most commonly abused substances in the United States, and it has contributed to a growing epidemic of medical ailments, including cirrhosis, neurologic and psychosocial disorders, impairment to fertility, and cancer. Moreover, acute and chronic alcohol use represent a significant risk factor for orthopaedic injury and postoperative complications. Yet, relatively little is known about the clinical implications of alcohol abuse in common orthopaedic procedures. Acute withdrawal from alcohol is potentially fatal, particularly in the orthopaedic inpatient whose abstinence is mandated by the hospital setting...
November 28, 2018: Journal of the American Academy of Orthopaedic Surgeons
Dawn M LaPorte, Paul Tornetta, J Lawrence Marsh
Orthopaedic resident educators confront many important issues. This may be the most challenging time yet for orthopaedic education. A survey of program directors and chairs aimed to identify the major challenges in orthopaedic education. Many issues were identified, and the following four major themes emerged: (1) loss of professionalism, (2) too much emphasis on procedures, (3) lack of clinical experience, and (4) challenges with external oversight. Professionalism in taking care of patients may be compromised by work-hour limitations and affected by generational differences...
November 21, 2018: Journal of the American Academy of Orthopaedic Surgeons
Catherine M Rapp, Edward J Shields, Brett P Wiater, J Michael Wiater
Venous thromboembolism (VTE) in the orthopaedic literature largely focuses on lower extremity trauma and arthroplasty, with relatively few investigations of VTE after shoulder surgery. Because the rate of shoulder surgery, especially arthroplasty, continues to expand, it is important for practicing surgeons to understand the magnitude of risk, potential consequences, and prevention methods with regard to VTE. VTE after shoulder surgery has been a topic of increasing interest over the past decade, and the purpose of this review is to examine the recent literature on pathophysiology, risk factors, incidence, diagnosis, sequelae, prevention, treatment, and current recommendations regarding VTE after shoulder surgery...
November 21, 2018: Journal of the American Academy of Orthopaedic Surgeons
Lakshmanan Sivasundaram, Joseph Tanenbaum, Nikunj Trivedi, Chang-Yeon Kim, Blaine T Bafus, Harry A Hoyen, Robert J Gillespie, Glenn D Wera
INTRODUCTION: Postdischarge management for shoulder replacement continues to be performed on a case-by-case basis, with no uniform guidelines dictating management. The goal of this study was to develop a nomogram to preoperatively predict a patient's discharge disposition after elective shoulder arthroplasty. METHODS: Patients who underwent elective shoulder arthroplasty between 2012 and 2015 were identified in the National Surgical Quality Improvement Program database...
November 21, 2018: Journal of the American Academy of Orthopaedic Surgeons
Jason B Anari, Alexandre Arkader, David A Spiegel, Keith D Baldwin
Pediatric distal humerus fractures are common, and numerous variations can occur depending on patient's age, position of the extremity at the time of injury, and energy of impact. Classic injury patterns include the flexion/extension supracondylar humerus, medial epicondyle, lateral condyle, and the transphyseal distal humerus. We describe our treatment philosophy for pediatric elbow fractures and how these principles were applied to some unusual fractures that presented to our institution.
November 21, 2018: Journal of the American Academy of Orthopaedic Surgeons
Louis W Catalano, O Alton Barron, Steven Z Glickel, Shobhit V Minhas
The stiff digit may be a consequence of trauma or surgery to the hand and fingers and can markedly affect a patient's level of function and quality of life. Stiffness and contractures may be caused by one or a combination of factors including joint, intrinsic, extensor, and flexor tendon pathology, and the patient's individual biology. A thorough understanding of the anatomy, function, and relationship of these structures on finger joint range of motion is crucial for interpreting physical examination findings and preoperative planning...
November 20, 2018: Journal of the American Academy of Orthopaedic Surgeons
Simon Lee, Johnny Lin, Kamran S Hamid, Daniel D Bohl
The last stage of a supination-external rotation ankle fracture involves either transverse fracture of the medial malleolus or rupture of the deltoid ligament. When the deltoid ligament ruptures, a "bimalleolar equivalent" ankle fracture occurs, and the surgeon is presented with several diagnostic and therapeutic challenges. In the native ankle, the deltoid ligament provides restraint to eversion and external rotation of the talus on the tibia. In bimalleolar equivalent ankle fractures, there is often gross medial instability even after fibular reduction...
November 20, 2018: Journal of the American Academy of Orthopaedic Surgeons
Derek D Berglund, Samuel Rosas, Jennifer Kurowicki, Brandon Horn, Dragomir Mijic, Jonathan C Levy
INTRODUCTION: This study determines the incidence of opioid use before shoulder arthroplasty and analyzes its influence on postoperative use. METHODS: A retrospective analysis of patients undergoing shoulder arthroplasty with at least 2-year follow-up was performed. Then, at pre- and postoperative appointments, the patients were asked "Do you take narcotic pain medication (codeine or stronger)?" RESULTS: Among 490 patients included in the study, 35...
November 20, 2018: Journal of the American Academy of Orthopaedic Surgeons
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