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American Journal of Orthopedics

John J Christoforetti, Jeff Delong, Bryan T Hanypsiak, Misty Suri, Benjamin G Domb, Jason C Snibbe, Michael B Gerhardt
We conducted a study to assess 30 expert hip arthroscopists' ability to identify common surface landmarks used during hip arthroscopy. Thirty hip arthroscopists independently performed a blinded examination of an awake supine human volunteer for identification of 5 surface landmarks: anterior superior iliac spine (ASIS), tip of greater trochanter (GT), rectus origin (RO), superficial inguinal ring (SIR), and psoas tendon (PT). The examiners applied the labels ASIS, GT, RO, SIR, and PT to the landmarks. An ultrasonographer performed a musculoskeletal ultrasound examination and applied labels as well, and a photographer documented the examiner labels after obtaining overhead and lateral digital images with use of fixed camera mounts...
January 2017: American Journal of Orthopedics
Matthew W Bullock, Jason E Lang
Goals of total hip arthroplasty (THA) include pain alleviation, motion restoration, and normalization of leg-length inequality. Asymmetric leg lengths are associated with nerve traction injuries, lower extremity joint pain, sacroiliac discomfort, low back pain, and patient dissatisfaction. The authors present an innovative use of a modified ball-tip guide rod to help accurately restore leg length and femoral offset during direct anterior THA.
January 2017: American Journal of Orthopedics
Joshua W Hustedt, Sarim Ahmed
Periprosthetic infections are a leading cause of morbidity after total joint arthroplasty. Common pathogens include Staphylococcus aureus, streptococcus, enterococcus, Escherichia coli, and Pseudomonas aeruginosa. However, there are many cases in which rare bacteria are isolated. This case report describes a periprosthetic knee infection caused by Plesiomonas shigelloides. In the United States, P shigelloides and 2 other Vibrionaceae family members, Vibrio vulnificus and Vibrio parahaemolyticus, are most often contracted from eating raw oysters and shellfish...
January 2017: American Journal of Orthopedics
Justin W Griffin, Timothy S Leroux, Anthony A Romeo
Overhead throwing is a common causative factor in disorders of the proximal biceps in athletes. In recent years, arthroscopic repair of unstable superior labral tears or biceps tendonitis involving the long head of the biceps tendon anchor has become the standard of care. However, in some cases, superior labrum anterior-posterior (SLAP) repair requires additional evaluation and even revision surgery, which contributes to patient dissatisfaction. Differentiating overall biceps tendonitis from superior labral tears alone can be a challenge...
January 2017: American Journal of Orthopedics
Eric Swart, Peter Tang
Various authors have documented wrist ligament injuries in patients with distal radius fractures (DRFs). We conducted a study to determine whether scapholunate interosseous ligament (SLIL), triangular fibrocartilage complex (TFCC), or chondral injuries directly assessed with arthroscopy predict DRF outcomes. Forty-two patients who underwent open reduction and internal fixation of DRFs were enrolled in the study. At time of fracture surgery, patients were arthroscopically evaluated for SLIL and TFCC injuries and chondral surface damage...
January 2017: American Journal of Orthopedics
Eric Swart, Jacob Tulipan, Melvin P Rosenwasser
Distal radius fractures (DRFs) are common, but the best way to measure the total cost of treating these injuries is not known. We conducted a study to measure the total treatment cost of DRFs to identify which items should be measured, and for how long, to capture all major cost-drivers. Eighty-two patients with DRFs were included in this prospective, observational study. All costs, both direct and indirect, were measured. Direct costs were measured for each patient from internal billing records. Indirect costs were obtained with a customized questionnaire...
January 2017: American Journal of Orthopedics
Joseph T O'Neil, Mark L Wang, Nayoung Kim, Mitchell Maltenfort, Asif M Ilyas
Pain management and opioid consumption after distal radius fracture (DRF) open reduction and internal fixation (ORIF) are highly variable and poorly understood. To optimize postoperative opioid dosage and better understand opioid consumption patterns after DRF-ORIF, we conducted a prospective study with the hypothesis that opioid consumption would increase with worsening fracture classification and various patient demographics. All patients who underwent DRF-ORIF were consecutively enrolled over a 6-month period...
January 2017: American Journal of Orthopedics
Tsun Yee Law, Sam Rosas, Florence George, Jennifer Kurowicki, Nate Formaini, Jonathan Levy
Indications for reverse total shoulder arthroplasty (RTSA) have been expanding, and there has been a recent trend in using RTSA to manage proximal humerus fractures. In this study, we used a large private-payer database to analyze this trend over the period 2010 to 2014 and project RTSA use through 2020. Results showed modest quarterly growth in use of RTSA (4.9% compound quarterly growth rate). The number of RTSAs was projected to more than triple by 2020. RTSA is becoming an increasingly popular treatment option for proximal humerus fractures...
January 2017: American Journal of Orthopedics
Brandon J Erickson, Annie Tilton, Rachel M Frank, William Park, Brian J Cole
We conducted a study to determine the rates of symptomatic deep vein thrombosis (DVT) and pulmonary embolism (PE) after high tibial osteotomy (HTO), distal femoral osteotomy (DFO), or tibial tubercle osteotomy (TTO) in patients who did not receive postoperative chemical prophylaxis. All patients who had HTO, DFO, or TTO performed by a single surgeon between 2009 and 2014 were identified. Charts were reviewed to determine presence or absence of DVT or PE. Patient age, smoking status, oral contraceptive (OC) use, and body mass index (BMI) were recorded...
January 2017: American Journal of Orthopedics
Patrick J Denard, Christopher R Adams
We conducted a study to compare a standard anterosuperolateral (ASL) portal with a percutaneous Port of Wilmington (PW) portal for repair of superior labrum anterior and posterior (SLAP) tears. We hypothesized that anchors placed through the PW portal would be less likely to penetrate the glenoid or injure the suprascapular nerve (SSN). This study used 6 matched-pair cadaveric shoulders. Two anchors were arthroscopically placed posterior to the biceps, at 11 o'clock and 10 o'clock, to simulate a SLAP repair...
January 2017: American Journal of Orthopedics
John F Mondanaro, Peter Homel, Baron Lonner, Jennifer Shepp, Marcela Lichtensztein, Joanne V Loewy
The treatment of pain continues to gain in saliency as a component of defining best practice in medical care. Music therapy is an integrative treatment modality that impacts patient outcomes in the treatment of spinal pain. At Mount Sinai Beth Israel, we conducted a mixed-methods study addressing the effects of music therapy interventions on the recovery of patients after spine surgery. The study combined standard medical approaches and integrative music therapy. Sixty patients (35 female, 25 male) ranging in age from 40 to 55 years underwent anterior, posterior, or anterior-posterior spinal fusion and were randomly assigned to either music therapy plus standard care (medical and nursing care with scheduled pharmacologic pain intervention) or standard care only...
January 2017: American Journal of Orthopedics
Chris A Anthony, Andrew J Pugely, Yubo Gao, Robert R Westermann, Christopher T Martin, Brian R Wolf, Annunziato Amendola
We conducted a study of elective hip arthroscopy patients to determine type and incidence of complications and rates of and risk factors for minor and major morbidity. Retrospectively searching the National Surgical Quality Improvement Program database, we identified 1325 patients who underwent elective hip arthroscopy between 2006 and 2013. Univariate and subsequent multivariate analyses were used to identify risk factors for complications. Of the 1325 patients identified, 16 (1.21%) had at least 1 complication, and 6 (0...
January 2017: American Journal of Orthopedics
Dean K Matsuda, Nikhil Gupta, Monti Khatod, Nicole A Matsuda, Faith Anthony, Joshua Sampson, Raoul Burchette
PURPOSE: To compare outcomes of mild dysplasia with cam femoroacetabular impingement (FAI) vs mixed FAI with hip arthroscopy without capsular repair. METHODS: A retrospective review of a 2009 to 2010 multicenter prospective outcome study was performed comparing a cohort with mild dysplasia and cam femoroacetabular impingement (cohort D) to a cohort with mixed FAI (cohort M). Outcome measures included Nonarthritic Hip Score (NAHS) and satisfaction with minimum 2-year follow-up...
January 2017: American Journal of Orthopedics
Nicole Friel, Gift Ukwuani, Shane J Nho
Management of the hip capsule has evolved with increased awareness that capsular closure during hip arthroscopy restores the normal anatomy of the ilio-femoral ligament and therefore restores the biomechanical characteristics of the hip joint. Both anatomical and clinical studies have found that capsular closure or plication after hip arthroscopy restores normal motion and allows patients to return to activity more quickly. Capsular closure is technically challenging and increases operative time, but gross instability and microinstability can be avoided with meticulous closure/plication...
January 2017: American Journal of Orthopedics
Robert Kollmorgen, Richard Mather
Arthroscopic labral repair and refixation have garnered much attention over the past several years. Restoration of suction seal and native labral function has been an evolving focus for achieving excellent results in hip preservation surgery. Authors have reported using several labral management techniques: d├ębridement, labralization, looped suture fixation, base stitch fixation, inversion-eversion, and reconstruction. The optimal technique is yet to be determined. Absolute indications for labral repair are symptomatic intra-articular pain, joint space >2 mm, and failed conservative management...
January 2017: American Journal of Orthopedics
Benjamin R Kivlan, Shane J Nho, John J Christoforetti, Thomas J Ellis, Dean K Matsuda, John P Salvo, Andrew B Wolff, Geoffrey S Van Thiel, Allston J Stubbs, Dominic S Carreira
As the field of hip arthroscopy continues to grow rapidly, our understanding of the population of patients undergoing hip arthroscopy has led to improved diagnosis and management of hip joint pathologies. The Multicenter Arthroscopic Study of the Hip (MASH) Study Group conducts multicenter clinical studies in arthroscopic hip preservation surgery. Patients undergoing arthroscopic hip preservation surgery are enrolled in a large prospective longitudinal cohort at 10 separate sites nationwide by 10 fellowship-trained hip arthroscopists...
January 2017: American Journal of Orthopedics
Jeffrey J Nepple, John C Clohisy
Our understanding of femoroacetabular impingement (FAI) as a cause of hip pain and secondary osteoarthritis has rapidly evolved since Ganz's description in 2003, which refined concepts described a half century earlier. The concepts of cam and pincer-type impingement continue to be better defined and have evolved from relatively simple concepts to more complex and variable disease patterns that are patient-specific. Ganz and colleagues described open treatment of FAI through the development of the surgical hip dislocation approach...
January 2017: American Journal of Orthopedics
Marc J Philippon, Ioanna Bolia, Renato Locks, Hajime Utsunomiya
Femoroacetabular impingement (FAI) surgery aims to restore the native anatomical relationships between bones and the soft tissues comprising the hip joint. The goal of this approach is to mimic the natural biomechanical function of the hip joint and translate it into a perfect clinical outcome. In this article, we describe the indications and contraindications for our preferred hip arthroscopic techniques for correcting FAI in both primary and revision cases and discuss the role of postoperative rehabilitation and use of biologics in further improving patient outcomes...
January 2017: American Journal of Orthopedics
Paul B Lewis, Alexander E Weber, Shane J Nho
Diagnostic imaging is an essential aspect of the work-up for nonarthritic hip pain. This review, a comprehensive summary of orthopedic diagnostic imaging for nonarthritic hip pathology, includes the modalities of radiographs, computed tomography, and magnetic resonance imaging. The use of each modality in the work-up for nonarthritic hip pain is discussed.
January 2017: American Journal of Orthopedics
David P Trofa, Sophie E Mayeux, Robert L Parisien, Christopher S Ahmad, T Sean Lynch
In this review, we describe precise methods for evaluating the athlete's hip or groin with an emphasis on recognizing the most common extra-articular and intra-articular pathologies, including adductor strains, athletic pubalgia, osteitis pubis, and femoroacetabular impingement with labral tears.
January 2017: American Journal of Orthopedics
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