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American Journal of Orthopedics

Brian E Ward, Joshua S Dines
Optimal outcomes following total shoulder arthroplasty TSA and reverse shoulder arthroplasty RSA are dependent on proper implant position. Multiple cadaver studies have demonstrated improved accuracy of implant positioning with use of patient-specific guides/instrumentation compared to traditional methods. At this time, there are 3 commercially available single use patient-specific instrumentation systems and 1 commercially available reusable patient-specific instrumentation system. Currently though, there are no studies comparing the clinical outcomes of patient-specific guides to those of traditional methods of glenoid placement, and limited research has been done comparing the accuracy of each system's 3-dimensional planning software...
February 2018: American Journal of Orthopedics
Philippe Valenti, Denis Katz, Jean Kany, Jean-David Werthel
Removal of a cemented glenoid component often leads to massive glenoid bone loss, which makes it difficult to implant a new glenoid baseplate. The purpose of this study was to demonstrate the feasibility of revisions with a completely convertible system and to report clinical and radiographic results of a retrospective review of 13 cases. Between 2003 and 2011, 104 primary total shoulder arthroplasties (TSAs) were performed with an uncemented glenoid component in our group. Of these patients, 13 (average age, 64 years) were revised to reverse shoulder arthroplasty (RSA) using a modular convertible platform system and were included in this study...
February 2018: American Journal of Orthopedics
Ian Power, Thomas W Throckmorton
Reconstructing proximal humeral bone loss in the setting of shoulder arthroplasty can be a daunting task. Proposed techniques include long-stemmed humeral components, allograft-prosthesis composites (APCs), and modular endoprosthetic reconstruction. While unsupported long-stemmed components are at high risk for component loosening, APC reconstruction techniques have been reported with success. However, graft resorption and eventual failure are significant concerns. Modular endoprosthetic systems allow bone deficiencies to be reconstructed with metal, which may allow for a more durable reconstruction...
February 2018: American Journal of Orthopedics
Brandon L Roller, Keiichi Kuroki, Chantelle C Bozynski, Ferris M Pfeiffer, James L Cook
The aim of this study was to assess the efficacy and safety of a novel magnesium-based resorbable bone cement (OsteoCrete, Bone Solutions Incorporated) for anchor and tendon fixation. Cadaveric humeral testing involved straight pull-to-failure of rotator cuff suture anchors; OsteoCrete was injected through one anchor, and a second anchor served as the uninjected control. Testing was conducted 15 minutes post-injection. A canine preclinical model was used to evaluate the safety of the following parameters: Rotator cuff repair: A double-row technique was used to repair transected infraspinatus tendons; OsteoCrete was injected through both anchors in one limb, and the contralateral limb served as the uninjected control...
February 2018: American Journal of Orthopedics
Ivan De Martino, David M Dines, Russell F Warren, Edward V Craig, Lawrence V Gulotta
Complex glenoid bone deformities present the treating surgeon with a complex reconstructive challenge. Although glenoid bone loss can be encountered in the primary setting (degenerative, congenital, post-traumatic), severe glenoid bone loss is encountered in most revision total shoulder arthroplasties. Severe glenoid bone loss is treated with various techniques including hemiarthroplasty, eccentric reaming, and glenoid reconstruction with bone autografts and allografts. Despite encouraging short- to mid-term results reported with these reconstruction techniques, the clinical and radiographic outcomes remain inconsistent and the high number of complications is a concern...
February 2018: American Journal of Orthopedics
Steven S Goldberg, Eric S Baranek
Proper reconstruction of proximal humeral anatomy is of primary importance to maximize patient outcomes after total shoulder arthroplasty. This article describes a new arthroplasty technique, where a fixed multiplanar bone resection is made and a novel implant, which is designed to precisely match the bone resection, is inserted.
February 2018: American Journal of Orthopedics
Paul B McLendon, Jacob L Cox, Mark A Frankle
Revision shoulder arthroplasty is becoming more prevalent as the rate of primary shoulder arthroplasty in the US continues to increase. The management of proximal humeral bone loss in the revision setting presents a difficult problem without a clear solution. Different preoperative diagnoses often lead to distinctly different patterns of bone loss. Successful management of these cases requires a clear understanding of the normal anatomy of the proximal humerus, as well as structural limitations imposed by significant bone loss and the effect this loss has on component fixation...
February 2018: American Journal of Orthopedics
Carl A Deirmengian, Joshua S Dines, Joseph V Vernace, Michael S Schwartz, R Alexander Creighton, James N Gladstone
The use of arthroscopy for purely diagnostic purposes has been largely supplanted by noninvasive technologies, such as magnetic resonance imaging (MRI). The mi-eye+TM (Trice Medical) technology is a small-bore needle unit for in-office arthroscopy. We conducted a pilot study comparing the mi-eye⁺™ unit with MRI, using surgical arthroscopy as a gold-standard reference. We hypothesized that the mi-eye⁺™ needle arthroscope, which can be used in an office setting, would be equivalent to MRI for the diagnosis of intra-articular pathology of the knee...
February 2018: American Journal of Orthopedics
James M Paci, Amanda Pawlak
Quadriceps tendon ruptures disrupt the extensor mechanism of the knee and require urgent surgical management. Traditional repair techniques have had mixed biomechanical and clinical results risking weakness and extensor lag. We describe a novel technique using tape suture and knotless anchors, which has performed superiorly during biomechanical testing and yielded terrific early clinical results.
January 2018: American Journal of Orthopedics
Charles D Rosen, P Douglas Kiester, Thay Q Lee
We conducted a study to determine the common characteristics of patients who developed radiculopathy symptoms and corresponding heterotopic ossification (HO) from transforaminal lumbar interbody fusions (TLIF) using recombinant human bone morphogenetic protein 2 (rhBMP-2). HO can arise from a disk space with rhBMP-2 use in TLIF. Formation of bone around nerve roots or the thecal sac can cause a radiculopathy with a consistent pattern of symptoms. We identified 38 patients (26 males, 12 females) with a mean (SD) age of 50...
January 2018: American Journal of Orthopedics
David M Dines, Joshua S Dines
No abstract text is available yet for this article.
January 2018: American Journal of Orthopedics
Christopher L McCrum, Justin W Arner, Bryson Lesniak, James P Bradley
Anterior ankle impingement is a frequent cause of pain and disability in athletes with impingement of soft-tissue or osseous structures along the anterior margin of the tibiotalar joint during dorsiflexion. In this study, we hypothesized that arthroscopic decompression of anterior ankle impingement would result in significant, reliable, and durable improvement in pain and range of motion (ROM), and would allow National Football League (NFL) players to return to their preoperative level of play. We reviewed 29 arthroscopic ankle débridements performed by a single surgeon...
January 2018: American Journal of Orthopedics
Justin W Arner, Michael P McClincy, James P Bradley
In a previous study, compared with throwing athletes with superior labral anterior posterior (SLAP) tears, those with concomitant SLAP tears and rotator cuff tears (RCTs) had significantly poorer outcome scores and return to play. Posterior shoulder instability also occurs in throwing athletes, but no studies currently exist regarding outcomes of these patients with concomitant RCTs. The authors hypothesized that throwing athletes treated with arthroscopic capsulolabral repair for posterior shoulder instability with coexistent rotator cuff pathology would have poorer outcome scores and return to play...
January 2018: American Journal of Orthopedics
Colin Y L Woon, Vincent M Moretti, Brian E Schwartz, Benjamin A Goldberg
There is controversy regarding whether total hip arthroplasty (THA) or hemiarthroplasty (HA) is the treatment preferred for displaced intracapsular femoral neck fractures (FNFs). Using the US National Hospital Discharge Survey, we found that, of 12,757 patients admitted for FNF between 2001 and 2010, 4.6% underwent THA and 52.5% underwent HA. More of both procedures were performed over time. Mean age was higher for HA patients. Hospitalization duration and blood transfusion rates were higher for THA. There were region-based differences in frequency of THA and significant hospital-size-based differences in frequency of HA, possibly because of differences in regional training and subspecialist availability...
November 2017: American Journal of Orthopedics
Steven Magister, Seth Yarboro
Patella fractures, although uncommon in the context of corresponding long bone fractures, carry a disproportionately high degree of morbidity, and are often challenging to treat. As such, this study sought to evaluate the efficacy of a Krackow suture augment when compared to standard tension band fixation and cerclage suture augment in patella fracture repair. Cadaveric patella extensor mechanisms were used for biomechanical testing. Specimens were divided among 3 groups, each with a different repair technique: modified anterior tension band (MATB), MATB plus cerclage suture, and MATB plus Krackow suture...
November 2017: American Journal of Orthopedics
Kofi Agyeman, Juan Pretell-Mazzini, Ty Subhawong, Darcy A Kerr, Jean Jose
Gorham disease, a rare condition of unknown etiology, presents as skeletal lucency on radiographs, prompting the classic eponym of vanishing bone disease. Initial clinical presentation varies considerably but typically involves prolonged soreness in the affected region and, rarely, acute pathologic fracture. The nonspecific nature of complaints, lack of markers of systemic illness, and rarity of the disease contribute to delayed diagnosis. Several imaging studies (eg, plain radiographs, computed tomography, magnetic resonance imaging, nuclear studies) provide nonspecific findings, but frank cortical destruction and true "disappearance" of bone with extensive soft-tissue edema are evident...
November 2017: American Journal of Orthopedics
Carmen E Quatman, John H Alexander, Paul E Wakely, Joel L Mayerson
In this article, we report a case of transformation of a benign giant cell tumor (GCT) of the calcaneus into an epithelioid angiosarcoma. The patient presented to our service in 2003 and was followed until 2014. Transformation occurred 11 years after curettage, cryotherapy, cementation, and a well-documented disease-free interval. Longitudinal radiographs, magnetic resonance imaging, and histopathology were evaluated by the same medical team. There are only a few case reports and case series of malignancy associated with GCT of bone...
November 2017: American Journal of Orthopedics
David M Levy, Brandon J Erickson, Joshua D Harris, Bernard R Bach, Nikhil N Verma, Anthony A Romeo
As isolated fractures of the greater tuberosity present a therapeutic challenge, we systematically reviewed all studies of greater tuberosity fracture management. Inclusion criteria were level I to IV evidence and 2-year follow-up. Thirteen studies and 429 shoulders were included in our analyses, which compared 3 paired groups: treatment type (nonoperative vs operative), fracture displacement amount (<5 mm vs >5 mm), and surgery type (open vs arthroscopic). Concomitant anterior glenohumeral instability was documented in 28...
November 2017: American Journal of Orthopedics
Charles F Land, William J Rosenblum, Justin Kennon
The mainstay of complex open lower extremity fractures and dislocations is the temporizing external fixator. We propose the use of external fixator attachments that allow for the reduction of fractures and dislocations intraoperatively. By using external fixator carbon fiber rods, the surgeon is able to create a capital "T" (sweet T) shaped attachment and connect this to a Schanz pin. Simultaneously, the external fixator carbon fiber rods can be configured into the shape of a capital Greek letter pi (Cherry II) and applied to an external fixator pin...
November 2017: American Journal of Orthopedics
Neil S Kumar, Andre M Jakoi, Amrit S Khalsa, Andrew M Star
We conducted a study to determine if knowledge of implant cost affects fixation method choice in the management of stable intertrochanteric hip fractures. We retrospectively reviewed the cases of 119 patients treated with a sliding hip screw (SHS; Versafix), a short Gamma nail (SGN), or a long Gamma nail (LGN). Of the 119 fractures, 71 were treated before implant costs were revealed, and 48 afterward. The 2 groups were similar in age, sex, fracture types, American Society of Anesthesiologists physical status classification, and preinjury ambulatory status...
November 2017: American Journal of Orthopedics
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