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Clinical Outcomes of Total Hip Arthroplasty in Patients with Prior Periacetabular Osteotomy
Periacetabular osteotomy (PAO) has been used as a treatment modality for development dysplasia of the hip (DDH). Many patients will progress to total hip arthroplasty (THA) following PAO. There is a discrepancy in the literature regarding outcomes of THA after PAO.
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Anatomic shoulder arthroplasty in Walch type C glenoid deformity: mid- to long-term outcomes
Hypoplastic glenoid morphology in the setting of glenohumeral osteoarthritis is a rare yet complex surgical problem. Treatment of this patient population with anatomic total shoulder arthroplasty (aTSA) remains controversial. Furthermore, there is no gold-standard approach, with limited guidance for surgeons on the need for glenoid version correction in the setting of a dysplastic glenoid. The purpose of this study was to evaluate mid- to long-term outcomes and reoperation rates of aTSA for the treatment of primary glenohumeral osteoarthritis with Walch type C glenoid deformity.
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Outcomes of initial nonoperative treatment of traumatic full-thickness rotator cuff tears
Nonsurgical management of chronic, degenerative rotator cuff tears (RCTs) can be an effective treatment strategy, but there is limited evidence to support conservative treatment of acute, traumatic RCTs. The objective of this study was to assess clinical outcomes and predictors of treatment success in patients with traumatic RCTs who elected for initial nonoperative treatment.
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Stemless Reverse Shoulder Arthroplasty
Since the Food and Drug Administration (FDA) approval nearly two decades ago, the indications for and utilization of reverse shoulder arthroplasty (RSA) have expanded considerably. Stemless RSA designs have been used in Europe since 2005, but have only recently been introduced in domestic Investigational Device Exemption trials. Potential advantages of stemless RSA are similar to those of stemless anatomic total shoulder arthroplasty, which may include fewer shaft-related complications, avoidance of stress shielding, bone preservation, and easier revision surgery.
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Pediatric Forearm Muscle Herniation Treated With an Acellular Dermal Allograft
Muscle herniations occur through acquired fascial defects in the lower extremities; upper-extremity herniations are rare. The affected patients are typically adult men engaging in strenuous exercise or with injury; pediatric cases are infrequent. We a pediatric patient with a symptomatic, forearm herniation treated with fascial defect closure using an acellular dermal allograft. This case report highlights not only the presence of this rare condition in pediatrics but also a safe and viable treatment option for this patient population.
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An Analysis of Component Positioning, Offset, and Limb Length Restoration in Computer-Assisted Hip Resurfacing Arthroplasty
Hip resurfacing arthroplasty (HRA) is a surgical option with positive outcomes at medium-term follow-up for young, active patients with osteoarthritis. However, early failures of HRA often occur due to improper implant placement. The purpose of this study was to assess the utility of computer-assisted navigation in the effort to optimize implant positioning following HRA.
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Subacromial Balloon Spacer Versus Partial Rotator Cuff Repair in the Treatment of Massive Irreparable Rotator Cuff Tears: Facility Personnel Allocation and Procedural Cost Analysis
Background The subacromial balloon is a novel technology that has shown promise in managing a select patient population with massive irreparable rotator cuff tears. The purpose of this study was to quantify the true facility cost difference between subacromial balloon placement (SBP) and partial rotator cuff repair (PCR). Methodology A prospective cohort of patients with massive irreparable rotator cuff tears randomized to SBP versus PCR between 2015 and 2018 was retrospectively reviewed.
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Augmented baseplates yield optimum outcomes when compared with bone graft augmentation for managing glenoid deformity during reverse total shoulder arthroplasty: a retrospective comparative study
The purpose of this study was to compare the outcomes of primary reverse total shoulder arthroplasty (rTSA) using glenoid bone grafting (BG rTSA) with primary rTSA using augmented glenoid baseplates (Aug rTSA) with a minimum 2-year follow-up.
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A Surgeon-Volume Comparison of Opioid Prescribing Patterns to Adolescents Following Outpatient Shoulder, Hip, and Knee Arthroscopy
Given the wide variation that exists in the amount and duration of postoperative opioid medication prescribed by orthopedic surgeons, the purpose of the current study was to analyze the opioid prescribing patterns at our institution for adolescent patients undergoing outpatient sports medicine procedures Methods: A total of 468 adolescent patients (between the ages of 13 and 18 years old) who underwent outpatient shoulder, hip, or knee arthroscopy (including ACL reconstruction) between 2016 and 2018 were retrospectively identified, and demographic data were collected.
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Complications of Single-Incision Versus Dual-Incision Distal Biceps Repair A Systematic Review and Meta-Analysis of Comparative Studies
The purpose of this study was to systematically review and analyze the current evidence in the literature to determine the relative complication rates of the singleincision versus dual-incision approach to distal biceps tendon repair.
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Intraoperative Technology Use Improves Accuracy of Functional Safe Zone Targeting in Total Hip Arthroplasty
Targets of acetabular inclination and anteversion have been suggested based on a patient's spinopelvic mobility. Current methods in total hip arthroplasty (THA) include manual instrumentation, computer-assisted navigation, and robotic-assisted surgery. This study aims to compare the accuracy of these 3 methods in targeting the functional safe zone.
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Reverse Total Shoulder Arthroplasty Biomechanical Considerations and the Concept of Lateralization
The biomechanical concepts underlying total shoulder arthroplasty including differences between the anatomic total and reverse total shoulder arthroplasty (RTSA) are reviewed. The concept of lateralization and its implications on outcomes after RTSA is explained through a historical perspective. Finally, how lateralization can be achieved via different components of an RTSA construct, as well as the potential disadvantages or trade-offs that must be considered when lateralizing in reverse shoulder arthroplasty, are discussed.
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Acute Distal Triceps Tendon Rupture Repair: Case Presentation and Surgical Technique
This case presentation and surgical technique demonstrates a complete distal triceps tendon rupture repair with single-row suture anchor fixation through a posterior midline approach to the elbow in a 17-year-old male rugby player. Key procedure points include complete triceps mobilization for adequate excursion to facilitate repair, identification of the ulnar nerve, isolation and sharp debridement of torn tissue to healthy tendon, thorough debridement of the olecranon reattachment site, suture construct, and order of fixation to optimize tendon-bone apposition.
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Distance of the Posterior Interosseous Nerve From the Bicipital (Radial) Tuberosity at Varying Positions of Forearm Rotation: A Magnetic Resonance Imaging Study With Clinical Implications
The proximity of the posterior interosseous nerve (PIN) to the bicipital tuberosity is clinically important in the increasingly popular anterior single-incision technique for distal biceps tendon repair. Maximal forearm supination is recommended during tendon reinsertion from the anterior approach to ensure the maximum protective distance of the PIN from the bicipital tuberosity.
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The Effect of Platelet-Rich Plasma Leukocyte Concentration on Arthroscopic Rotator Cuff Repair: A Network Meta-analysis of Randomized Controlled Trials
It is unclear whether leukocyte-poor (LP) or leukocyte-rich (LR) varieties of platelet-rich plasma (PRP) as an adjuvant to arthroscopic rotator cuff repair (ARCR) result in improved tendon healing rates.
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Does reverse total shoulder arthroplasty for proximal humeral fracture portend poorer outcomes than for elective indications?
The number of reverse total shoulder arthroplasties (RTSAs) performed annually has increased, and the indications for RTSA have expanded beyond rotator cuff arthropathy to include treatment of complex proximal humeral fractures. No studies exist comparing clinical, functional, and radiographic outcomes in patients receiving RTSA for the treatment of acute fracture vs. those undergoing the procedure for degenerative conditions. This study was designed to fill the void in this knowledge gap. We hypothesized that patients undergoing RTSA for fracture treatment would experience worse clinical outcomes than those undergoing elective RTSA.
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Preoperative Opioid Education has No Effect on Opioid Use in Patients Undergoing Arthroscopic Rotator Cuff Repair: A Prospective, Randomized Clinical Trial
The purpose of this study was to determine whether a preoperative video-based opioid education reduced narcotics consumption after arthroscopic rotator cuff repair in opioid-naive patients.
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Correlation of Patient Reported Outcome Measurement Information System (PROMIS) with American Shoulder and Elbow Surgeon (ASES), and Constant (CS) scores in idiopathic adhesive capsulitis
To correlate the Patient Reported Outcomes Measurement Information System Upper Extremity (PROMIS UE) score with pre-existing validated outcome scores, American Shoulder and Elbow Surgeons score (ASES), and Constant score (CS) in patients with idiopathic adhesive capsulitis (AC).
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Reproducing the Proximal Femur Anatomy: 3D Preoperative Planning and Custom Cutting Guides
Successful outcomes of total hip arthroplasty (THA) depend upon patient-specific factors, surgical technique, and appropriate implant selection. Proper surgical technique requires meticulous preoperative templating, followed by accurate and precise component positioning, a modifiable risk factor which may prevent poor clinical function following THA. Restoration of native hip biomechanics serves to optimize implant wear and THA stability.
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The Evolution of Cement Fixation in Total Knee Arthroplasty
Aseptic loosening and infection are two of the leading causes of revision in total knee arthroplasty. While several patient-related factors can play a role in the development of these complications, there are certain modifiable surgeon factors that can help mitigate the risk. Intraoperatively, this can begin with the curing process of bone cement which is broken down into four different stages: mixing, waiting, working, and setting.
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Gastrointestinal Complications Warranting Invasive Interventions Following Total Joint Arthroplasty
Gastrointestinal (GI) complications following total joint arthroplasty (TJA) are uncommon but can be associated with substantial morbidity and mortality. The current literature on GI complications that warrant invasive procedures after TJA is lacking. This study reviews the incidence and outcomes of GI complications after TJA that went on to require invasive procedures.
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A Preoperative Workup of a "Hip-Spine" Total Hip Arthroplasty Patient: A Simplified Approach to a Complex Problem
A large body of evidence has confirmed that patients with spinal deformity, lumbar fusion, and abnormal spinopelvic mobility are at significantly increased risk for instability, dislocation, and revision after total hip arthroplasty (THA).
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What are the prevalence and risk factors for repeat ipsilateral knee arthroscopy?
The number of arthroscopic knee surgeries performed annually has increased over the last decade. It remains unclear what proportion of individuals undergoing knee arthroscopy is at risk for subsequent ipsilateral procedures. Better knowledge of risk factors and the incidence of reoperative ipsilateral arthroscopy are important in setting expectations and counselling patients on treatment options. The aim of this study is to determine the incidence of repeat ipsilateral knee arthroscopy, and the risk factors associated with subsequent surgery over long-term follow-up.
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Salvage of failed internal fixation of intertrochanteric hip fractures: clinical and functional outcomes of total hip arthroplasty versus hemiarthroplasty
Failed internal fixation of intertrochanteric (IT) hip fractures presents a significant challenge in the elderly, osteoporotic population. Conversion total hip arthroplasty (cTHA) and hemiarthroplasty (cHA) are both accepted salvage operations for failed IT fracture fixation, though limited clinical data exist regarding the optimal treatment between these procedures.
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Biomechanical Performance of Medial Row Suture Placement Relative to the Musculotendinous Junction in Transosseous Equivalent Suture Bridge Double-Row Rotator Cuff Repair
To compare the biomechanical performance of medial row suture placement relative to the musculotendinous junction (MTJ) in a cadaveric transosseous equivalent suture bridge (TOE-SB) double-row (DR) rotator cuff repair (RCR) model.
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Periprosthetic Joint Infection After Hip and Knee Arthroplasty: A Review for Emergency Care Providers
Periprosthetic joint infection is among the most common modes of failure of a total hip or knee arthroplasty and can be a common concern when patients present to the emergency department for care. The initial evaluation for periprosthetic joint infection includes a history and physical examination, followed by radiographs (to rule out other causes of pain or failure) and then serum erythrocyte sedimentation rate and C-reactive protein testing.
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The learning curve associated with anteromedial portal drilling in ACL reconstruction
The objective of the current study was to evaluate the accuracy and precision of femoral and tibial tunnel placement during anterior cruciate ligament reconstruction (ACLR) using independent anteromedial portal (AMP) drilling over a three-year observation period.
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Does physical therapy prevent post-operative delay in return of function following tension-band plating?
The clinical outcomes and complications of tension-band plating have been well documented, and commonly include a post-operative delay in return of function. We performed a retrospective comparison study to evaluate the capacity of immediate post-operative physical therapy to prevent this post-operative delay in return of function.
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Current status of pelvic lymph node dissection in prostate cancer
Pelvic lymph node dissection (PLND) is presently considered the gold standard for the detection of lymph node invasion in prostate cancer (PCa) patients. Controversy exists over the adequate extent of PLND for patients at different stages of PCa and over the therapeutic value of the procedure. The most recent consensus advocates extended PLND (ePLND) in a patient with Gleason score ≥7 and serum prostate-specific antigen >10 ng/ml who is undergoing radical prostatectomy. Critics claim more aggressive dissection is associated with an increase in complications, hospitalization time, and cost.
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Developing a successful robotics program
Advancements in the robotic surgical technology have revolutionized the standard of care for many surgical procedures. The purpose of this review is to evaluate the important considerations in developing a new robotics program at a given healthcare institution.
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Traumatic anterior shoulder dislocation with concomitant pectoralis rupture and Bankart lesion