Managing Geriatric Patients with Falls and Fractures
Orthopedic fractures in adults 65 and older are common and can lead to functional decline and increased morbidity and mortality. Falls are often the precipitating event for fractures in this population, linked to common aging physiology with increasing comorbid conditions and advancing frailty. Managing falls and orthopedic fractures in the geriatric population is complex, requiring a systematic and collaborative approach spearheaded by a multidisciplinary team focused on improving patient outcomes. (Source: Orthopedic Clinics of North America)
Source: Orthopedic Clinics of North America - May 31, 2023 Category: Orthopaedics Authors: Carla T. Williams, Jeremy Whyman, Julia Loewenthal, Karen Chahal Source Type: research

Socioeconomic Challenges in the Rural Patient Population in Need of Total Joint Arthroplasty
Many challenges exist for the rural patient in need of joint arthroplasty. Optimization for surgery is more difficult due to factors such as deprivation, education, employment, household income, and access to proper surgical institutions. Rural individuals have less access to primary care and even less access to surgical specialists, creating a distinct subset of patients who endure higher costs, poorer outcomes, and lack of care. Reducing socioeconomic disparities in rural communities will require policy initiatives addressing the components of socioeconomic status (income, education, and occupation). Hopefully remote pat...
Source: Orthopedic Clinics of North America - April 14, 2023 Category: Orthopaedics Authors: Aaron Sesler, Jeffrey B. Stambough, Simon C. Mears, Charles Lowry Barnes, Benjamin M. Stronach Source Type: research

Type 1 Diabetes Overview and Perioperative Management
Type 1 diabetes (T1D) is an increasingly common condition. Although often more effective, treatment regimens for patients with T1D have become more variable and complex with newer insulin analogues and increasing use of diabetes technology. Both surgery and anesthesia are known to trigger a stress response that causes dramatic metabolic changes in the patient that tend to increase glucose variability. Close monitoring of glucose levels and clear algorithms for insulin administration can ameliorate these characteristic responses. As T1D treatment technology becomes more effective at maintaining glucose in target range, ther...
Source: Orthopedic Clinics of North America - April 7, 2023 Category: Orthopaedics Authors: Grace B. Nelson, Kathryn M. Sumpter Source Type: research

Perioperative Management of Comorbidities in Spine Surgery
The number of spinal operations performed in the United States has significantly increased in recent years. Along with these rising numbers, there has been a corresponding increase in the number of patient comorbidities. The focus of this article is to review comorbidities in Spine surgery patients and outline strategies to optimize patients and avoid complications. (Source: Orthopedic Clinics of North America)
Source: Orthopedic Clinics of North America - April 7, 2023 Category: Orthopaedics Authors: Zachary R. Diltz, Eric J. West, Matthew R. Colatruglio, Mateo J. Kirwan, Elliot N. Konrade, Kirk M. Thompson Source Type: research

Preventing the Impact of Hyperglycemia and Diabetes on Patients Undergoing Total Joint Arthroplasty
This article will serve as an overview of currently available evidence on how to prevent the impact of hyperglycemia and diabetes mellitus on patients undergoing TJA. (Source: Orthopedic Clinics of North America)
Source: Orthopedic Clinics of North America - April 7, 2023 Category: Orthopaedics Authors: Saad Tarabichi, Javad Parvizi Source Type: research

An Update on the Management and Optimization of the Patient with Morbid Obesity Undergoing Hip or Knee Arthroplasty
The prevalence of obesity in the United States is at a record high of 42%. In 1999, the Centers for Disease Control and Prevention recognized the obesity epidemic as a national problem, spurring the first generation of interventions for obesity prevention and control. Despite billions of dollars in funding, legislative changes, and public health initiatives, the trajectory of American obesity has not waivered. Obesity is also strongly associated with the development of osteoarthritis. The growing population of young, obese, and sick patients presents a unique dilemma for orthopedic surgeons performing joint replacement, as...
Source: Orthopedic Clinics of North America - April 7, 2023 Category: Orthopaedics Authors: Josef E. Jolissaint, Maria S. Kammire, Benjamin J. Averkamp, Bryan D. Springer Source Type: research

Modifiable and Nonmodifiable Risk Factors Associated with the Development of Recurrent Rotator Cuff Tears
Nonoperative and operative strategies exist to manage rotator cuff pathology. Although surgical repair is successful for most patients, others may experience retear or nonhealing of the rotator cuff. Several modifiable and nonmodifiable risk factors are associated with an increased retear rate. The literature shows consistency and agreement regarding many of these risk factors, most notably, patient age, tear size, and rotator cuff muscular atrophy, whereas others remain controversial. It is important that shoulder surgeons are familiar with modifiable and nonmodifiable risk factors associated with retear, to better advise...
Source: Orthopedic Clinics of North America - April 4, 2023 Category: Orthopaedics Authors: Brendan M. Patterson, Maria F. Bozoghlian Source Type: research

Managing the Patient with Peripheral Vascular Disease before Total Knee Arthroplasty Surgery
Peripheral vascular disease (PVD), defined as decreased arterial perfusion to the lower extremities due to atherosclerotic obstruction, is known to occur in patients undergoing total knee arthroplasty with described rates of between 2% and 4.5% PVD is of significance for patients undergoing TKA as it can increase wound healing and infection complications after TKA and is an independent risk factor for arterial complications following TKA. Our goal is to provide a comprehensive review of the pathophysiology of PVD as it relates to TKA, associated outcomes of patients undergoing TKA in the setting of PVD, diagnostic pearls, ...
Source: Orthopedic Clinics of North America - April 4, 2023 Category: Orthopaedics Authors: Andrew Fraval, William J. Hozack Source Type: research

Friends Not Foes
This article discusses the considerations an orthopedist should make when deciding on the timing and the appropriateness of consultation —both preoperatively and perioperatively. Consultation before surgical intervention will especially be useful if the subspecialist will be collaborating in the management of the condition postoperatively (whether inpatient or outpatient). Clear and early consultation in both written and verbal for mat will facilitate quality and expedite the patient’s care. (Source: Orthopedic Clinics of North America)
Source: Orthopedic Clinics of North America - March 26, 2023 Category: Orthopaedics Authors: Nathaniel G. Rogers, Maria Carrillo-Marquez, Annette Carlisle, Catherine D. Sanders, Lauren Burge Source Type: research

Management of Gout in the Hand and Wrist
This article focuses on the medical and surgical treatment of the common manifestations of gout in the upper extremity including tophi, tenosynovitis, joint contractures, neural compression, and arthropathy. (Source: Orthopedic Clinics of North America)
Source: Orthopedic Clinics of North America - March 23, 2023 Category: Orthopaedics Authors: Hayden S. Holbrook, James H. Calandruccio Source Type: research

Understanding Medical Optimization for Patients Undergoing Shoulder Arthroplasty
Many surgeons seek to optimize their patients ’ comorbid conditions preoperatively to reduce postoperative complications. To effectively optimize patients before total shoulder arthroplasty, the surgeon should be familiar with recognizing and treating common medical comorbidities found in an orthopedic patient including anemia, diabetes, maln utrition, cardiovascular conditions, and history of deep venous thrombosis. Screening for depression or other mental illness should also be conducted preoperatively and managed accordingly before surgery. Preoperative opioid use and smoking have significant effects on postoperative ...
Source: Orthopedic Clinics of North America - March 23, 2023 Category: Orthopaedics Authors: Jessica L. Churchill, Conner J. Paez, Vahid Entezari, Eric T. Ricchetti, Jason C. Ho Source Type: research

Update on Medical Management of Diabetes
Diabetes mellitus affects more than 30 million US adults and 537 million people worldwide and accounts for major complications, including more than 100,000 lower extremity amputations annually in the United States. Peripheral neuropathy, peripheral vascular disease, and foot ulcers are frequent findings in diabetes patients at risk for amputation. Suboptimal care of early foot lesions increases the risk of amputation. Studies have shown that these complications can be prevented in people with type 1 and type 2 diabetes by optimizing glycemic control and comorbid risk factors. This review focuses on evaluating and managing ...
Source: Orthopedic Clinics of North America - March 23, 2023 Category: Orthopaedics Authors: Dilasha Katwal, Deirdre James, Sam Dagogo-Jack Source Type: research

Preoperative and Perioperative Management of Diabetics Undergoing Elective Foot and Ankle Surgery
Diabetics are a highly comorbid population with an elevated risk profile when undergoing surgery. Proper preparation and management of modifiable risk factors can optimize outcomes in diabetics. A multidisciplinary approach to preoperative optimization, including surgeons, primary care providers, and anesthesiologists, ensures diabetic patients receive comprehensive evaluation before elective surgery. Orthopedic surgeons must understand preoperative optimization goals as they pertain to nutrition, glycemic control, and cardiovascular disease in diabetic patients. (Source: Orthopedic Clinics of North America)
Source: Orthopedic Clinics of North America - March 23, 2023 Category: Orthopaedics Authors: Patrick Cole McGregor, Ryan LeDuc Source Type: research

Robotic-Assisted Total Knee Arthroplasty is Safe in the Ambulatory Surgery Center Setting
Background: Robotic-assisted total knee arthroplasty (RA-TKA) has become more popular in the United States. With the significant trend towards performing TKA in outpatient and ambulatory surgery center (ASC) settings, this study was implemented to determine the safety and efficacy of RA-TKA in an ASC. Method: A retrospective review identified 172 outpatient TKAs (86 RA-TKAs and 86 TKAs) performed between January 2020 and January 2021. All surgeries were performed by the same surgeon at the same free-standing ASC. Patients were followed for at least 90 days after surgery; complications, reoperations, readmissions, operative...
Source: Orthopedic Clinics of North America - March 8, 2023 Category: Orthopaedics Authors: Travis Eason, William Mihalko, Patrick C. Toy Source Type: research

Technological Advances in Spine Surgery
Accurate screw placement is critical to avoid vascular or neurologic complications during spine surgery and to maximize fixation for fusion and deformity correction. Computer-assisted navigation, robotic-guided spine surgery, and augmented reality surgical navigation are currently available technologies that have been developed to improve screw placement accuracy. The advent of multiple generations of new technologies within the past 3  decades has presented surgeons with a diverse array of choices when it comes to pedicle screw placement. Considerations for patient safety and optimal outcomes must be paramount when selec...
Source: Orthopedic Clinics of North America - March 8, 2023 Category: Orthopaedics Authors: Tarek Yamout, Lindsay D. Orosz, Christopher R. Good, Ehsan Jazini, Brandon Allen, Jeffrey L. Gum Source Type: research