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Journal of the American Academy of Orthopaedic Surgeons

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https://www.readbyqxmd.com/read/28045713/differentiating-hip-pathology-from-lumbar-spine-pathology-key-points-of-evaluation-and-management
#1
Aaron J Buckland, Ryan Miyamoto, Rakesh D Patel, James Slover, Afshin E Razi
The diagnosis and treatment of patients who have both hip and lumbar spine pathologies may be a challenge because overlapping symptoms may delay a correct diagnosis and appropriate treatment. Common complaints of patients who have both hip and lumbar spine pathologies include low back pain with associated buttock, groin, thigh, and, possibly, knee pain. A thorough patient history should be obtained and a complete physical examination should be performed in these patients to identify the primary source of pain...
December 29, 2016: Journal of the American Academy of Orthopaedic Surgeons
https://www.readbyqxmd.com/read/28033151/spinal-realignment-for-adult-deformity-three-column-osteotomies-alter-total-hip-acetabular-component-positioning
#2
Jeffrey J Barry, Altug Yucekul, Alexander A Theologis, Erik N Hansen, Christopher Ames, Vedat Deviren
INTRODUCTION: A goal of adult spinal deformity surgery is correction of sagittal imbalance by increasing lumbar lordosis (LL), allowing a previously retroverted pelvis to normalize as evidenced by decreases in pelvic tilt (PT). Realignment of pelvic orientation may alter the position of preexisting total hip arthroplasties (THAs). METHODS: Twenty-seven patients with unilateral THA who underwent thoracolumbar fusions for adult spinal deformity from the pelvis to L1 or above were retrospectively reviewed (levels fused, 10...
December 28, 2016: Journal of the American Academy of Orthopaedic Surgeons
https://www.readbyqxmd.com/read/28033150/complex-distal-radius-fractures-an-anatomic-algorithm-for-surgical-management
#3
Peter Charles Rhee, Robert J Medoff, Alexander Y Shin
Most distal radius fractures result from low-energy mechanisms and can be successfully treated nonsurgically or with a variety of surgical techniques if indicated. High-energy distal radius fractures can involve extensive comminution or bone loss with concomitant ligament, soft-tissue, and neurovascular injuries. In patients with complex distal radius fractures, reconstruction of the distal radius, ulna, and triangular fibrocartilage complex can be challenging. Effective restoration of the bony architecture requires intimate knowledge of the anatomy of the distal radius, a thorough understanding of the goals of treatment, versatility in surgical approaches, and familiarity with multiple fixation options...
December 28, 2016: Journal of the American Academy of Orthopaedic Surgeons
https://www.readbyqxmd.com/read/28030511/ankle-distraction-arthroplasty-indications-technique-and-outcomes
#4
Mitchell Bernstein, Jay Reidler, Austin Fragomen, S Robert Rozbruch
Ankle distraction is an alternative to ankle arthrodesis or total ankle arthroplasty in younger patients with arthritis. Ankle distraction involves the use of external fixation to mechanically unload the ankle joint, which allows for stable, congruent range of motion in the setting of decreased mechanical loading, potentially promoting cartilage repair. Adjunct surgical procedures are frequently done to address lower-extremity malalignment, ankle equinus contractures, and impinging tibiotalar osteophytes. Patients can bear full weight during the treatment course...
December 26, 2016: Journal of the American Academy of Orthopaedic Surgeons
https://www.readbyqxmd.com/read/28027065/joint-contractures-resulting-from-prolonged-immobilization-etiology-prevention-and-management
#5
Christopher T Born, Joseph A Gil, Avi D Goodman
Patients who are immobilized for a prolonged period are at risk for developing joint contractures, which often affect functional outcomes. Nonsurgical interventions are useful for preventing joint contractures. However, once contractures develop, these interventions frequently fail to restore function over the long term. To increase the rehabilitation potential of an extremity with refractory function-limiting contractures, surgery is often required.
December 23, 2016: Journal of the American Academy of Orthopaedic Surgeons
https://www.readbyqxmd.com/read/28009709/the-effect-of-cervical-interbody-cage-morphology-material-composition-and-substrate-density-on-cage-subsidence
#6
Paul B Suh, Christian Puttlitz, Chad Lewis, B Sonny Bal, Kirk McGilvray
BACKGROUND: Interbody cages used in spinal fusion surgery can subside into the adjacent vertebral bodies after implantation, leading to loss of spinal height, malalignment, and possible radicular symptoms. Several factors may contribute to cage subsidence. METHODS: This in vitro investigation examined the possible contribution of substrate density, cage contact area (ie, cage footprint), cage filling, cage end plate surface texture, and cage material composition on the magnitude of subsidence...
December 22, 2016: Journal of the American Academy of Orthopaedic Surgeons
https://www.readbyqxmd.com/read/28009708/trunnion-corrosion-in-metal-on-polyethylene-total-hip-arthroplasty-a-case-series
#7
Sivashanmugam Raju, Karthikeyan Chinnakkannu, Mohan K Puttaswamy, Matthew J Phillips
INTRODUCTION: Modular total hip arthroplasty implants can help the operating surgeon reproduce the optimum limb length and offset; however, the modularity can lead to fretting and corrosion with associated metal-related problems. Although metal-on-metal bearings are often reported to have problems, recent case reports suggest that the problems can occur with any articulation, usually as a result of problems at the head/neck junction. METHODS: We retrospectively reviewed three cases of a specific implant combination with nontraumatic trunnion failure, with two cases presenting as acute complete dissociation of the femoral head from the neck...
December 22, 2016: Journal of the American Academy of Orthopaedic Surgeons
https://www.readbyqxmd.com/read/28009707/the-spine-in-patients-with-osteogenesis-imperfecta
#8
Maegen J Wallace, Richard W Kruse, Suken A Shah
Osteogenesis imperfecta is a genetic disorder of type I collagen. Although multiple genotypes and phenotypes are associated with osteogenesis imperfecta, approximately 90% of the mutations are in the COL1A1 and COL1A2 genes. Osteogenesis imperfecta is characterized by bone fragility. Patients typically have multiple fractures or limb deformity; however, the spine can also be affected. Spinal manifestations include scoliosis, kyphosis, craniocervical junction abnormalities, and lumbosacral pathology. The incidence of lumbosacral spondylolysis and spondylolisthesis is higher in patients with osteogenesis imperfecta than in the general population...
December 22, 2016: Journal of the American Academy of Orthopaedic Surgeons
https://www.readbyqxmd.com/read/27997413/joint-stability-in-total-knee-arthroplasty-what-is-the-target-for-a-stable-knee
#9
Timothy M Wright
Instability remains a common cause of failure in total knee arthroplasty. Although approaches for surgical treatment of instability exist, the target for initial stability remains elusive, increasing the likelihood that failures will persist because adequate stability is not restored when performing the primary arthroplasty. Although the mechanisms that stabilize the knee joint-contact between the articular surfaces, ligamentous constraints, and muscle forces-are well-defined, their relative importance and the interplay among them throughout functions of daily living are poorly understood...
December 16, 2016: Journal of the American Academy of Orthopaedic Surgeons
https://www.readbyqxmd.com/read/27997412/how-can-we-use-computational-modeling-to-improve-total-knee-arthroplasty-modeling-stability-and-mobility-in-the-implanted-knee
#10
Paul J Rullkoetter, Clare K Fitzpatrick, Chadd W Clary
Validated computational models promise a virtual platform to create optimal articular surfaces that best achieve desired implant characteristics. Today, designers can parametrically define the primary geometric features of an implant, and automatically modify design variables until stability/mobility performance objectives are best achieved. This preclinical, virtual design iteration minimizes the development cycle compared with testing physical prototypes and, by evaluating a broader scope of design concepts, likely improves the clinical performance of the final product...
December 16, 2016: Journal of the American Academy of Orthopaedic Surgeons
https://www.readbyqxmd.com/read/27997411/research-priorities-for-optimal-use-of-patient-reported-outcomes-in-quality-and-outcome-improvement-for-total-knee-arthroplasty
#11
Patricia D Franklin
The national Functional and Outcomes Research for Comparative Effectiveness in Total Joint Replacement program routinely collects pre- and postoperative patient-reported outcomes for clinicians to use when making individual patient treatment decisions and monitoring aggregate quality of care and outcomes. When the pre-post gains in pain or function at one site vary from the national norms, the next question is, "how do we improve?" This paper will use the traditional quality management's framework of inputs (patients), processes (clinical care), and outcomes to outline priority research questions to learn how clinicians, hospital managers, and patients can interpret patient-reported outcomes to improve total knee arthroplasty care and outcomes...
December 16, 2016: Journal of the American Academy of Orthopaedic Surgeons
https://www.readbyqxmd.com/read/27984343/value-based-purchasing-for-osteoarthritis-and-total-knee-arthroplasty-what-role-for-patient-reported-outcomes
#12
Catherine MacLean
Prompted by the aims to improve the patient experience of care (including quality and satisfaction), improve the health of populations, and reduce the per capita cost of health care, the US healthcare system is embarking upon a new era in care delivery that seeks to optimize healthcare value. Value, the consideration of quality relative to cost, can be increased by improving quality, reducing cost, or doing both. Given that patient-reported outcomes related to pain, function, and quality of life underlay both the reason patients seek care for and the benchmarks by which treatment success is measured for osteoarthritis, measures of these patient-reported outcomes figure prominently in understanding the quality and hence value...
December 13, 2016: Journal of the American Academy of Orthopaedic Surgeons
https://www.readbyqxmd.com/read/27984342/strategies-to-prevent-periprosthetic-joint-infection-after-total-knee-arthroplasty-and-lessen-the-risk-of-readmission-for-the-patient
#13
Richard Iorio, Feroz Osmani
There is yet to be a standardized total knee arthroplasty (TKA) surgical protocol that has been studied to a sufficient degree to offer evidence-based practices regarding infection and readmission prevention. Although high-level evidence is often sought to provide guidance concerning protocol- and process-level decisions, the literature is often confusing and nondefinitive in its conclusions and recommendations regarding periprosthetic joint infection and readmission prevention. Areas of study that require further investigation include the following: the role of patient optimization and preoperative mitigation of risk; perioperative antibiotics; operating room environment; blood management; operative techniques, implants, and infection prevention measures; wound care management; and post acute care...
December 13, 2016: Journal of the American Academy of Orthopaedic Surgeons
https://www.readbyqxmd.com/read/27984341/orthopaedic-infection-prevention-and-diagnosis
#14
Kevin I Perry, Arlen D Hanssen
Host optimization, reduction of bacteria, and establishing proper wound environment in the preoperative, intraoperative, and postoperative periods are the traditional cornerstones of infection prevention. Most institutions have standardized a systems approach to reduce the incidence of surgical site infections. Typically, these systems-based approaches promote protocols for hand and environmental hygiene, patients risk assessment and screening, surgical delays for identifiable and modifiable risk factors, infection surveillance, antibiotic stewardship programs, communication/coordination of care, physician 360° reporting, and unit-based safety programs...
December 13, 2016: Journal of the American Academy of Orthopaedic Surgeons
https://www.readbyqxmd.com/read/27941416/strategies-to-improve-total-knee-arthroplasty-a-multidisciplinary-research-conference
#15
Kevin L Garvin, Timothy M Wright
No abstract text is available yet for this article.
December 9, 2016: Journal of the American Academy of Orthopaedic Surgeons
https://www.readbyqxmd.com/read/27941415/implementation-of-patient-reported-outcome-measures-in-total-knee-arthroplasty
#16
David C Ayers
Patient-reported outcome measures (PROMs) has emerged as a strategy to improve the outcome of total knee arthroplasty. The use of PROMs in routine clinical practice has accelerated because health care in the United States is shifting from a volume-based to a value-based reimbursement system in which quality is increasingly being measured using PROMs. Electronic, internet-based platforms, such as Functional and Outcomes Research for Comparative Effectiveness in Total Joint Replacement, currently exist which offer turn-key solutions for PROM collection, trending, analysis, and benchmarking for busy clinicians...
December 9, 2016: Journal of the American Academy of Orthopaedic Surgeons
https://www.readbyqxmd.com/read/27941414/intraoperative-measurements-and-tools-to-assess-stability
#17
Darryl D DʼLima, Clifford W Colwell
Knee stability is the ability for the joint to maintain an appropriate functional position throughout its range of motion. Knee instability can be defined as excessive laxity during activities of daily living. Intraoperative knee laxity can be affected by implant design, alignment of components, and soft-tissue balancing. Soft-tissue balance is a major contributor to knee instability. Mechanical balancing instruments can be classified as spacer blocks or joint-distraction devices. Conventional wisdom favors rectangular and equal flexion-extension gaps...
December 9, 2016: Journal of the American Academy of Orthopaedic Surgeons
https://www.readbyqxmd.com/read/27941556/preclinical-evaluation-of-photoacoustic-imaging-as-a-novel-noninvasive-approach-to-detect-an-orthopaedic-implant-infection
#18
Yu Wang, John M Thompson, Alyssa G Ashbaugh, Pavlo Khodakivskyi, Ghyslain Budin, Riccardo Sinisi, Andrew Heinmiller, Marleen van Oosten, Jan M van Dijl, Gooitzen M van Dam, Kevin P Francis, Nicholas M Bernthal, Elena A Dubikovskaya, Lloyd S Miller
INTRODUCTION: Diagnosing prosthetic joint infection (PJI) poses significant challenges, and current modalities are fraught with low sensitivity and/or potential morbidity. Photoacoustic imaging (PAI) is a novel ultrasound-based modality with potential for diagnosing PJI safely and noninvasively. MATERIALS: In an established preclinical mouse model of bioluminescent Staphylococcus aureus PJI, fluorescent indocyanine green (ICG) was conjugated to β-cyclodextrin (CDX-ICG) or teicoplanin (Teic-ICG) and injected intravenously for 1 week postoperatively...
December 8, 2016: Journal of the American Academy of Orthopaedic Surgeons
https://www.readbyqxmd.com/read/27941555/what-postoperative-outcome-measures-link-joint-stability-to-patient-satisfaction
#19
Scott A Banks
Total knee arthroplasty is a common, effective treatment for disabling arthritis of the knee. However, not all patients receiving total knee arthroplasty achieve what is considered an optimal outcome, and not all patients report high satisfaction with their results. Because the focus of attention increasingly turns to optimizing outcomes and utilization of healthcare resources, it is worthwhile to review the array of available tools and techniques for quantifying postoperative outcomes after knee arthroplasty and identify how these might be used to guide refinement of the treatment to achieve even better and more predictable outcomes...
December 8, 2016: Journal of the American Academy of Orthopaedic Surgeons
https://www.readbyqxmd.com/read/27922947/microbiology-and-antimicrobial-challenges-of-prosthetic-joint-infection
#20
Douglas R Osmon
Research that leads to better strategies to diagnose and treat prosthetic joint infection (PJI) is critical because PJI is a devastating complication of total knee arthroplasty. A key to the diagnosis and management of PJI is defining the microbiology of PJI and improving the medical management of PJI utilizing both systemic and local antimicrobial therapy. In this review, the author will present his opinions on future research needs as they relate to the microbiology of PJI, including antimicrobial resistance and the antimicrobial treatment of PJI...
December 5, 2016: Journal of the American Academy of Orthopaedic Surgeons
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