Hip Arthroscopy Technique for Acetabular Osteochondral Loose Bodies After Combined Lower Extremity Trauma
We describe a case of an acetabular fracture and ipsilateral open tibia/fibula fracture with osteochondral loose bodies in the hip joint inhibiting physical therapy potential, treated successfully with arthroscopic removal using an adjusted skeletal traction method. (Source: Techniques in Orthopaedics)
Source: Techniques in Orthopaedics - May 22, 2020 Category: Orthopaedics Tags: Special Technical Articles Source Type: research

Surgical Technique for Closed Reduction and Percutaneous Pinning of Pediatric Lateral Humeral Condyle Fractures
Lateral condyle fractures are intra-articular injuries of the distal humerus and are the second most common elbow fracture in pediatric patients. When these fractures involve significant displacement, anatomic reduction of the lateral condyle fragment is commonly achieved using open reduction techniques. Although a technique for closed reduction of lateral condyle fractures has been proposed in the literature, an instructional, step-by-step description of such a technique has yet to be published. We have built upon the previously published closed reduction technique by focusing on the pathomechanism of injury, with the goa...
Source: Techniques in Orthopaedics - May 22, 2020 Category: Orthopaedics Tags: Special Technical Articles Source Type: research

Manual of Wiring Techniques for Orthopedic Surgery
Cerclage and tension band wiring techniques can be inexpensively and effectively utilized in orthopedic surgical procedures, many of which are enumerated in this article. The following cerclage wiring configurations are described and demonstrated in accompanying videos: wrapped around once and wrapped around twice patterns locked with a symmetric twist, knot twist, eyelet bend-back, or crimped double barrel sleeve; doubled symmetric twist; hairpin loop; and Mittelmeier’s double loop bend-back with twist. Tension band wiring variations are also described and illustrated. Modes of wire failure are discussed and display...
Source: Techniques in Orthopaedics - May 22, 2020 Category: Orthopaedics Tags: Special Technical Articles Source Type: research

Does Patella Resurfacing Affect Postoperative Blood Loss in Patients Undergoing Total Knee Replacement?
Patella resurfacing in total knee arthroplasty remains a surgeon-specific decision. Possible benefits of resurfacing include decreased knee pain and rate of reoperation, while complications can occur. No study has assessed postoperative blood loss and transfusion rate as a function of patella resurfacing. Certain patient groups such as elderly patients, Jehovah’s Witnesses, and coagulopathy patients may especially benefit from decreased blood loss during orthopedic surgeries. A retrospective chart review of patients with total knee arthroplasty performed by a single surgeon was conducted. In total, 124 patients were ...
Source: Techniques in Orthopaedics - May 22, 2020 Category: Orthopaedics Tags: Special Technical Articles Source Type: research

Treatment of Periprosthetic Patella Fractures Using a Lag Screw and Neutralization Plate Construct: A Novel Surgical Technique
In this report, we present a novel fixation method for transverse peri-prosthetic patella fractures that was utilized in 3 knees with resurfaced patellas in 2 patients and has yielded good clinical results. (Source: Techniques in Orthopaedics)
Source: Techniques in Orthopaedics - May 22, 2020 Category: Orthopaedics Tags: Tips and Pearls Source Type: research

The Cost of Postoperative Infection Following Orthopaedic Fracture Surgery
The objective of this paper is to describe the costs associated with postoperative infection following orthopedic fracture surgery. The data provided is based on a narrative review and an analysis of national claims and discharge databases in the United States. The narrative research specifically evaluated the costs associated with postoperative infections following the treatment of proximal femur, tibia, humerus, and ankle fractures. Two US databases were used to estimate the annual incidence of a deep surgical site infection following fracture treatment and the costs associated with that treatment. Previous studies sugge...
Source: Techniques in Orthopaedics - May 22, 2020 Category: Orthopaedics Tags: Symposium Source Type: research

Current Treatments of Tibial Surgical Site Infection and Osteomyelitis After Fracture Surgery
Infections after tibia fracture are one of the most challenging areas of orthopedic care. Specialized techniques are required to achieve resolution of the infection and bony union. We detail here our strategies for infection debridement, temporary skeletal stabilization, antibiotic administration, and definitive reconstruction. Special emphasis is on the treatment of osteomyelitis of the tibial shaft; however, these same techniques can be applied to other areas of the skeleton as well. (Source: Techniques in Orthopaedics)
Source: Techniques in Orthopaedics - May 22, 2020 Category: Orthopaedics Tags: Symposium Source Type: research

Best Practices and Evolving Techniques for Preventing Infection After Fracture Surgery
Orthopedic trauma-related infections remain one of the major complications in modern trauma and orthopedic surgery. Despite current preventive practices, infection rates range from ~1% after operative fixation of closed low-energy fractures to>30% in complex open tibia fractures. Fracture-related infections negatively impact clinical outcome with lifelong functional impairment and significantly increase health care expenditure. In addition, the escalating issue of antimicrobial resistance continues to pose a challenge to clinicians. Unfortunately, in orthopedic trauma, only a few preventive measures are strongly support...
Source: Techniques in Orthopaedics - May 22, 2020 Category: Orthopaedics Tags: Symposium Source Type: research

Will My Fracture Surgery Get Infected? Evidence-based Risk Factors
We present a narrative review of the literature to facilitate evidence-based risk stratification for patients undergoing fracture fixation. Risk factors, including diabetes, hyperglycemia, end-stage renal disease requiring hemodialysis, human immunodeficiency virus, acquired immunodeficiency syndrome, hepatitis C, and alcohol abuse, have consistently been shown to increase infection risk in orthopedic surgery. Other risk factors, including smoking, obesity, and the use of immunomodulatory medications, have been shown to have varying direct impact on postoperative SSI depending on the study and the specific fractures examin...
Source: Techniques in Orthopaedics - May 22, 2020 Category: Orthopaedics Tags: Symposium Source Type: research

Non–culture-based Methods to Aide in the Diagnosis of Implant-associated Infection After Fracture Surgery
Implant-associated infection after fracture surgery is an unfortunate reality for patients and physicians that has long-term, far-reaching implications for treatment, functional recovery, and health care costs. Classically, culture-based methods are used for diagnosis, though “culture-negative” infection is not an uncommon clinical scenario. On the other side, false-positive results can lead to unnecessary antibiotic treatment or surgical intervention. For all parties involved, timely, accurate, and noninvasive diagnostic methods are desirable. It is recognized that bacterial biofilms complicate culture-based d...
Source: Techniques in Orthopaedics - May 22, 2020 Category: Orthopaedics Tags: Symposium Source Type: research

How to Diagnose Surgical Site Infection After Fracture Surgery: We Have a Problem!
Infections after fracture are often devastating complications and despite widespread efforts to these infections, there are still 100,000 cases of reported fracture-related infection yearly in the United States. Although infection after fracture surgery is common, there is important uncertainty regarding various aspects of diagnosing these infections including a lack of standardization of what the definition of an infection should be in this setting. Most infections after fracture surgery present with obvious clinical signs of infection, but sometimes the signs are more subtle. Furthermore, it is not possible to obtain dia...
Source: Techniques in Orthopaedics - May 22, 2020 Category: Orthopaedics Tags: Symposium Source Type: research

In Memory of Mark Shirtliff, PhD: Modern Concepts in Diagnosis, Treatment, Prevention, and Cost of Infection After Fracture Surgery
No abstract available (Source: Techniques in Orthopaedics)
Source: Techniques in Orthopaedics - May 22, 2020 Category: Orthopaedics Tags: Preface Source Type: research

Radiographic Evaluation of the Distal Radioulnar Joint: Technique to Detect Sigmoid Notch Intra-Articular Screw Breach in Distal Radius Fractures
Conclusions: The “extended tangential view” and the “sunrise view” improved one's ability to identify DRUJ screw breach and for directing screw repositioning over standard views. We recommend the “sunrise” and “extended tangential” view be obtained intraoperatively to help guide clinical decision-making. Although the “extended tangential view” is more easily obtained with a mini c-arm than the “sunrise view,” both views should be considered to fully evaluate the DRUJ joint. Clinical Relevance: Both the “extended tangential” and “...
Source: Techniques in Orthopaedics - February 21, 2020 Category: Orthopaedics Tags: Special Technical Articles Source Type: research

Total Hip Arthroplasty in Untreated Ankylosing Spondylitis: Tips and Tricks to Avoid Complications
Ankylosing spondylitis (AS) is a seronegative inflammatory disease that progressively affects the spine and sacroiliac joints and is more common in men with the B 27 human leucocyte antigen. This leads to inflammation, synovitis and, eventually, secondary arthritis in the hips of those affected. Hips of those affected are often completely ankylosed at time of presentation to the orthopedic surgeon. Total hip arthroplasty offers a stable mobile hip for patients who are functionally disabled due to their debilitating disease. As disease progresses, the native hip anatomy, which is familiar to orthopedic surgeon in routine to...
Source: Techniques in Orthopaedics - February 21, 2020 Category: Orthopaedics Tags: Special Technical Articles Source Type: research

A Comparison of Adjuvant Techniques on Setting Time of Octyl-2-Cyanoacrylate (DERMABOND Advanced)
Octyl-2-cyanoacrylate is a topical skin adhesive (TSA) that has gained popularity over the last decade for wound and incisional wound closure. TSAs have been used with or without suture when closing lacerations or operative incisions. One brand of octyl-2-cyanoacrylate, DERMABOND, was shown to have high wound bursting strength and tensile force, large number of normal tensile loading cycles to failure, long time to failure, and short setting time. Many intraoperative methods have been used by surgical staff in an effort to reduce curing time (ie, time for the tissue adhesive to set), including waving a hand or towels over ...
Source: Techniques in Orthopaedics - February 21, 2020 Category: Orthopaedics Tags: Special Technical Articles Source Type: research

Trochanteric-sparing Proximal Femoral Resection for Arthritic Spastic Hips
Progressive hip subluxation or dislocation leading to degenerative disease, in neuromuscular disease, is a significant cause of morbidity to the patient and burden to the caretaker. Surgical salvage procedures have unpredictable success. We hypothesized that modifying the Castle-type proximal femoral resection by securing a retained greater trochanter with its musculature to the capsular arthroplasty and femoral shaft would compartmentalize the femur to decrease proximal femoral migration and heterotopic ossification (HO), thereby precluding the need for traction and HO prophylaxis while improving pain and caretaker satisf...
Source: Techniques in Orthopaedics - February 21, 2020 Category: Orthopaedics Tags: Special Technical Articles Source Type: research

Simple Suction Tube Tensioning Technique for Anterior Cruciate Ligament (ACL) Grafts
No abstract available (Source: Techniques in Orthopaedics)
Source: Techniques in Orthopaedics - February 21, 2020 Category: Orthopaedics Tags: Tips and Pearls Source Type: research

The Transtrochanteric Approach to the Total Femur Replacement: A Novel Technique
Nononcologic total femur replacement (TFR) secondary to periprosthetic fracture, aseptic loosening or infection has had many surgical approach options provided in the literature. No single approach has been proven to be superior in preventing postoperative complications due to its rare and complex nature, however. Therefore, we believe that a successful outcome following a previously undescribed approach for a TFR is valuable contribution to the current literature. Technique, in the following report, we present is a transtrochanteric approach to a TFR. This approach involved a vertical transtrochanteric osteotomy which all...
Source: Techniques in Orthopaedics - February 21, 2020 Category: Orthopaedics Tags: Tips and Pearls Source Type: research

An Easy Positioning Technique for Complex Proximal Tibia Fractures
No abstract available (Source: Techniques in Orthopaedics)
Source: Techniques in Orthopaedics - February 21, 2020 Category: Orthopaedics Tags: Tips and Pearls Source Type: research

Use of a 3D-Printed Custom Reverse Shoulder Arthroplasty
Reverse shoulder arthroplasty is an established treatment for rotator cuff tear arthropathy of the shoulder. In cases of deformity of the glenoid with limited bone stock, implantation of a noncustomized glenoid implant could be challenging. In this technique article, we report 2 cases with severe glenoid deformity. The first case is a 74-year-old woman presenting with rotator cuff tear arthropathy of the shoulder with a severly deformed glenoid. The second case is a 63-year-old woman with deformity of the glenoid after hemiarthroplasty of the shoulder. Both patients were succesfully treated with a 3D-printed customized gle...
Source: Techniques in Orthopaedics - February 21, 2020 Category: Orthopaedics Tags: Tips and Pearls Source Type: research

Innovative Intraoperative Splints for Tendon Transfer Procedures
Tendon transfers are well accepted treatment modality for managing difficult neurological and musculo tendinous deficits of upper and lower extremities. The most important technical consideration in the final outcome of these procedures are the tension and position with which the donor tendon is attached to the recipient tendon. This technical aspect of the procedure has not been given due importance in the literature. We the authors share our experience of fabricating intra operative splints for various tendon transfer procedures using easily available components of external fixator. (Source: Techniques in Orthopaedics)
Source: Techniques in Orthopaedics - February 21, 2020 Category: Orthopaedics Tags: Tips and Pearls Source Type: research

Preoperative Risk Management in Perioperative Medicine and Value-based Care: What the United States Needs to Understand, What the United Kingdom Knows
In the United States, the economics of health has caused us to recognize that a national strategy is needed to quickly and effectively bend the cost curve of a system that is globally noncompetitive with respect to value and is unsustainable in its current form as a health care delivery model. Heretofore, US national policy and health care reform efforts have principally focused on addressing gaps in coverage. Going forward in the United States the drivers of value for health care will most likely come from re-engineering the delivery system itself. In the setting of perioperative medicine, these value gaps maybe unrecogni...
Source: Techniques in Orthopaedics - February 21, 2020 Category: Orthopaedics Tags: Symposium Source Type: research

A Systematic Approach to Perioperative Smoking Cessation
In this report, we outline evidence-based principles for perioperative smoking cessation and describe initial results from a perioperative smoking cessation program. Results: In the first 100 days of the Duke Perioperative Smoking Cessation Program, we received 420 referrals. Participants had a mean pack-year history of 50.3 (packs/day×years smoking; SD 32.5), a mean Fagerström Test for Nicotine Dependence score of 4.5 (SD 2.5), and a mean expired breath carbon monoxide of 11.8 (SD 7.5) parts per million. Mean days from initial perioperative smoking cessation visit to surgery was 21.4 (SD 22.3). Discussion: ...
Source: Techniques in Orthopaedics - February 21, 2020 Category: Orthopaedics Tags: Symposium Source Type: research

Preoperative Optimization of Chronic Pain Patients Undergoing Surgery
Surgery presents unique challenges in pain management for patients with chronic pain. A perioperative optimization program, starting at decision to surgery, is likely to yield the best results for this population. Perioperative optimization focuses on psychological, medical, and physical optimization. Psychological optimization includes cognitive behavior therapy, relaxation, and music therapy. Medical optimization focuses on the multimodal approaches of pharmacological adjustment and physical optimization focuses on prehabilitation and nutrition optimization. The ideal care model incorporates these optimization strategies...
Source: Techniques in Orthopaedics - February 21, 2020 Category: Orthopaedics Tags: Symposium Source Type: research

Perioperative Nutrition Care of Orthopedic Surgery Patient
Despite evidence that malnutrition is associated with significant complications in orthopedic surgery, unrecognized malnutrition continues to be a “silent epidemic,” affecting up to 50% of hospitalized patients. Specifically, presurgical malnutrition is associated with increased risk for surgical site infections, increased length of hospital stay, and increased health care costs in patients following total joint arthroplasty. Serologic markers (ie, serum albumin and total lymphocyte count), anthropometric measurements (ie, calf muscle circumference and triceps skinfold), and assessment and screening tools (ie, ...
Source: Techniques in Orthopaedics - February 21, 2020 Category: Orthopaedics Tags: Symposium Source Type: research

Preoperative Anemia Management: Value-based Care for Orthopedic Surgery
Preoperative anemia is common in elective orthopedic surgical patients and is an independent risk factor for perioperative morbidity and mortality. The detrimental effects of anemia on surgical outcomes impact the costs associated with perioperative care as well. In addition to the direct expenditures related to the complications of anemia, perioperative anemia is the leading predictor of perioperative transfusion and it is estimated that up to 6 million dollars are spent on transfusion-related costs per hospital per year. Anemia is a preventable and manageable condition that can often be treated effectively without relyin...
Source: Techniques in Orthopaedics - February 21, 2020 Category: Orthopaedics Tags: Symposium Source Type: research

Overview: Value-based Care for Orthopedic Surgery
An overview of health care value definitions, the current health care paradigm and brief history of the origins of value-based care in orthopedics are presented. The 4 pillar strategic approach for achieving high-value musculoskeletal services includes (1) increasing revenue, (2) decreasing costs, (3) improving the patient experience, and (4) improving quality. The tactics for success in value-based orthopedic care are reviewed and discussed. (Source: Techniques in Orthopaedics)
Source: Techniques in Orthopaedics - February 21, 2020 Category: Orthopaedics Tags: Symposium Source Type: research

Moving Toward Preoperative Optimization and Value-based Perioperative Care
No abstract available (Source: Techniques in Orthopaedics)
Source: Techniques in Orthopaedics - February 21, 2020 Category: Orthopaedics Tags: Preface Source Type: research

The Next Step to Improve the Quality of Techniques in Orthopaedics
No abstract available (Source: Techniques in Orthopaedics)
Source: Techniques in Orthopaedics - February 21, 2020 Category: Orthopaedics Tags: Editorial Source Type: research

A Simple Technical Tip for Removal of Intramedullary Broken Drill Bit
A 35-year-old man presented to us with nonunion of both bones of the right forearm. He was planned for open reduction and internal fixation. Intraoperatively while trying to open the medullary canal of the ulna with a 2.5-mm noncannulated drill bit, the distal end of the drill bit broke and was stuck within the medullary cavity. Under image intensifier, the broken piece was retrieved with the help of a long depth gauge from the 4.5-mm system. This technique is simple, cost-effective, and less time-consuming. (Source: Techniques in Orthopaedics)
Source: Techniques in Orthopaedics - November 15, 2019 Category: Orthopaedics Tags: Tips and Pearls Source Type: research

A Novel Technique to Remove Posterior Intra-Articular Bodies Within the Hip Through an Anterior Approach
We describe 2 cases of hip intra-articular foreign body removal through an anterior approach utilizing a Satinsky vascular clamp under fluoroscopic guidance. (Source: Techniques in Orthopaedics)
Source: Techniques in Orthopaedics - November 15, 2019 Category: Orthopaedics Tags: Tips and Pearls Source Type: research

External Distraction for Treatment of Rigid Sharp-angled Myelomeningocele-related Kyphosis With Skin Ulceration: Case Report
Objectives of our research: tо follow long-term results of staged surgical treatment of a patient with sharp-angled myelomeningocele-related rigid kyphosis, back skin scarring, and skin ulceration on top of gibbous; to assess efficiency and safety of using external distraction method as a preparatory stage for kyphectomy in such patients. Usage of external distraction with subsequent kyphectomy in patient with sharp-angled myelomeningocele-related kyphosis and skin ulceration led to satisfactory long-term results. (Source: Techniques in Orthopaedics)
Source: Techniques in Orthopaedics - November 15, 2019 Category: Orthopaedics Tags: Special Technical Article Source Type: research

A Comparative Study Between 2 Intracarpal Partial Shortening Osteotomy Techniques for Type II Lunate Kienbock Disease
Partial capitate shortening is a decompression procedure for the treatment of positive or neutral ulnar variance Kienbock disease. In 45% to 73% of population, the lunate has a separate hamate facet which is also known as a type II lunate. We hypothesized that capitate shortening alone may not ensure adequate decompression of type II lunate, therefore, an added hamate shortening was performed aiming at a better distal unloading in these situations. Thirty Kienbock patients, stage II, type II lunate, and ulna positive or neutral variance, were recruited in this study, Half of which underwent an isolated partial capitate ost...
Source: Techniques in Orthopaedics - November 15, 2019 Category: Orthopaedics Tags: Novel Research Methods and Models Source Type: research

Cancer Stem Cells and Osteosarcoma: Opportunities and Limitations
Osteosarcoma (OS) is the most common primary bone malignancy and is a leading cause of cancer-related death in children and young adults. Combination chemotherapy developed 3 decades ago significantly improved long-term survival compared to surgery alone. However, despite notable tumor cytoreduction and remission, the 5-year survival rate has remained static at ∼70% since, and the surviving patients have high chemoresistance with sustained risk of recurrent OS that has propensity to metastasize. After metastasis, the 5-year survival rate is abysmally low (∼10% to 20%). Emerging new evidence has revealed that within...
Source: Techniques in Orthopaedics - November 15, 2019 Category: Orthopaedics Tags: Symposium Source Type: research

Stem Cells for the Treatment of Intervertebral Disk Degeneration
Low back pain and neck pain are the first and fourth leading causes, respectively, of years lived with disability. The treatment of intervertebral disk degeneration remains a significant challenge. While there are still many obstacles to overcome, the use of stem cells for the treatment of disk degeneration has emerged as one of the most promising and exciting techniques to restore the structure and function of the degenerated disk. The use of stem cells in treating intervertebral disk disease as well as the obstacles that remain are reviewed here in an evidence-based manner. (Source: Techniques in Orthopaedics)
Source: Techniques in Orthopaedics - November 15, 2019 Category: Orthopaedics Tags: Symposium Source Type: research

Use of Mesenchymal Stem/Stromal Cells for Pediatric Orthopedic Applications
Cell-based therapies using mesenchymal stem/stromal cells (MSCs) have been extensively investigated both in preclinical and clinical settings. Because of their multipotency, MSCs have initially been expected to regenerate tissues by differentiating into native tissue cells. However, accumulating evidence suggests that the observed clinical benefits are largely from the trophic effects of MSCs. In pilot studies, systemic infusion of MSCs has been shown to clinically improve patients with osteogenesis imperfecta and hypophosphatasia even though donor cell engraftment was minimal, suggesting that the trophic effects of MSCs l...
Source: Techniques in Orthopaedics - November 15, 2019 Category: Orthopaedics Tags: Symposium Source Type: research

Allogeneic Versus Autologous Injectable Mesenchymal Stem Cells for Knee Osteoarthritis: Review and Current Status
Conclusions: MSC therapies in the treatment of knee OA are safe and have shown promising results but the available studies are limited. At this time, no definitive recommendations can be made regarding which MSC source to use. Allogeneic MSCs offer theoretical advantages over autologous MSCs, especially in ease of use and consistency of product, but there are concerns regarding cell viability and vitality, as well as the body’s response to nonautologous products. Future clinical trials should focus on randomized head-to-head comparisons of MSC sources as well as the use of multiple injections for patients with knee...
Source: Techniques in Orthopaedics - November 15, 2019 Category: Orthopaedics Tags: Symposium Source Type: research

Regenerative Medicine and Cell Therapy in Orthopedics—Health Policy, Regulatory and Clinical Development, and Market Access
Orthopedic indications collectively represent a large clinical and economic burden, especially given the aging world population. To meet this area of unmet need, a wave of regenerative medicine therapies, including stem cells and other cell-based therapies, is currently in clinical development and anticipated to inundate the global market over the next few years. Although intended to be transformative, orthopedic cell therapies face several practical opportunities and challenges. Such therapies could reduce the health care burden, in part by replacing traditional drug therapies and highly-invasive surgical interventions wi...
Source: Techniques in Orthopaedics - November 15, 2019 Category: Orthopaedics Tags: Symposium Source Type: research

The Promises and Challenges of Stem Cells Use for Orthopedic Applications: A New and Exciting Era in Biological Treatments
No abstract available (Source: Techniques in Orthopaedics)
Source: Techniques in Orthopaedics - November 15, 2019 Category: Orthopaedics Tags: Preface Source Type: research

Revision Total Knee Arthroplasty With Ipsilateral Below Knee Amputation Positioned Over a Radiolucent Triangle
Positioning for primary and revision total knee arthroplasty in patients with ipsilateral below knee amputation requires special consideration. Prior case reports have described various strategies, each having their own limitations. Here we describe a novel technique flexing the amputated extremity over a radiolucent triangle. All equipment for this technique is readily available in most operating rooms and does not require the need for a second assistant to help stabilize the extremity during the procedure. (Source: Techniques in Orthopaedics)
Source: Techniques in Orthopaedics - August 27, 2019 Category: Orthopaedics Tags: Special Technical Article Source Type: research

Comparing Conventional and Navigation-assisted Techniques for Lateral Opening-wedge Femoral Varus Osteotomy
Conclusions: Duration of surgery and tourniquet time were longer in the NAV osteotomy group. The use of NAV for femoral varus osteotomy did not result in any significant difference in final alignment. (Source: Techniques in Orthopaedics)
Source: Techniques in Orthopaedics - August 27, 2019 Category: Orthopaedics Tags: Novel Research Methods and Models Source Type: research

Consensus on Reducing Risk in Total Joint Arthroplasty: Revision Surgery
Rates of revision hip and knee arthroplasty continue to increase. Patients undergoing revision hip and knee arthroplasty face a different set of challenges than those undergoing primary arthroplasties, with increased rates of medical and surgical complications. Specifically, patients undergoing revision arthroplasty have higher rates transfusion, more unplanned readmissions, greater cardiac and renal complications, and more frequent surgical complications including surgical site infections and need for reoperation and revision surgery. Multiple strategies may be used in an effort to lower these risks, including shifting th...
Source: Techniques in Orthopaedics - August 27, 2019 Category: Orthopaedics Tags: Symposium Source Type: research

Soft Tissue Issues and Considerations in Total Knee Arthroplasty
Total knee arthroplasty is projected to increase beyond substantial numbers due to an aging population. An important factor to avoid common complications is meticulous attention to soft tissue and skin healing. Comprehensive knowledge of wound healing and vascular anatomy provides a stable foundation for the physician and surgeon. This is complimented by updated information on common complications and preoperative optimization of undesirable factors that could hinder the success of a total knee arthroplasty. The need for prophylactic intervention may be determined during the preoperative evaluation and is recommended in pa...
Source: Techniques in Orthopaedics - August 27, 2019 Category: Orthopaedics Tags: Symposium Source Type: research

Reducing Risk in Bilateral Total Knee Arthroplasty
As the utilization of total knee arthroplasty increases and the population ages, the number of patients who require surgical treatment of both knees is rising. These procedures may be conducted simultaneously or sequentially; the simultaneous bilateral approach is increasingly considered the preferred option because it permits a symmetric recovery while avoiding risks associated with an additional operation, anesthetic, hospitalization, and recovery period while reducing the costs associated with sequential procedures. Despite these advantages, concerns have been raised regarding increased risks for deep vein thrombosis, p...
Source: Techniques in Orthopaedics - August 27, 2019 Category: Orthopaedics Tags: Symposium Source Type: research

Reducing Risk in Total Joint Arthroplasty: Vascular Status
This article will provide a brief update on the literature and consensus recommendations regarding (1) patients with increased bleeding risk and increased venous thromboembolic event risk, (2) patients with a history of peripheral vascular disease, and (3) patients with lymphedema. (Source: Techniques in Orthopaedics)
Source: Techniques in Orthopaedics - August 27, 2019 Category: Orthopaedics Tags: Symposium Source Type: research

Reducing Risk in Total Joint Arthroplasty: Assessing Mental Health, Mood, and Movement Disorders
Preoperative and postoperative mental health status (MHS) of total joint arthroplasty patients can affect immediate and long-term outcomes following surgery. Alterations in MHS can be acute or chronic. The most common etiologies include acute changes due to (1) delirium or stroke, (2) movement disorders (Alzheimer dementia, Parkinson disease, multiple sclerosis, epilepsy), and (3) mood/behavior disorders (major depressive disorder, anxiety, bipolar disorder, schizophrenia). Across etiologies, alterations in MHS are associated with worse clinical/patient-reported outcomes and greater total cost of care. Prevention via pharm...
Source: Techniques in Orthopaedics - August 27, 2019 Category: Orthopaedics Tags: Symposium Source Type: research

Consensus on Reducing Risk in Total Joint Arthroplasty: Narcotic Use
Because of the potential adverse events associated with opioid use, the purpose of this consensus was to provide guidelines to help reduce the risks when performing lower extremity joint arthroplasty. Specifically, the authors addressed: (1) the use of nonopioid pain management; (2) national and state guidelines; (3) the role of pain management specialists; and (4) multimodal pain management options for total hip and knee arthroplasty. A literature search was performed utilizing the PubMed database focused on total hip and knee arthroplasty pain managed with opioids. The authors recommend that patients be started with nono...
Source: Techniques in Orthopaedics - August 27, 2019 Category: Orthopaedics Tags: Symposium Source Type: research

The Effects of Smoking on Postoperative Complications After Total Joint Arthroplasty
The evidence that preoperative smoking cessation provides decreased postoperative morbidity and complications is continuing to develop and offer stronger results. Although the intensity of the intervention required for a long-term positive impact remains unknown, direct communication between the physician and their patient in combination with nicotine replacement therapy seems to offer the greatest reduction in postoperative morbidity. With many institutions now implementing group classes to prepare patients for their upcoming surgery, adding a smoking cessation group therapy component may further offer patients mutual sup...
Source: Techniques in Orthopaedics - August 27, 2019 Category: Orthopaedics Tags: Symposium Source Type: research

Reducing Risk in Total Joint Arthroplasty: Immunocompromised Patients
Immunodeficiency limits the body’s natural ability to fight infection, thus increasing the patient’s risk of postoperative complications. Moreover, rates of immunosuppression in the United States are on a steady climb secondary to the duality of greater life expectancy of the immunosuppressed and expanding indications for immunosuppressant use. Taken together, these 2 factors foreshadow the growing challenge orthopedic surgeons will face, as higher rates of immunocompromised patients will inevitably present for procedures in the decade ahead. These patients present with the 3-fold effect of a weakened ability t...
Source: Techniques in Orthopaedics - August 27, 2019 Category: Orthopaedics Tags: Symposium Source Type: research

Acute and Chronic Renal Insufficiency in the Total Joint Arthroplasty Patient
With the projected increase in joint replacement in the next few decades, along with the increased prevalence of renal insufficiency, arthroplasty surgeons must have a good understanding of the routine management of renal impairment in the perioperative setting. Multiple studies have demonstrated significant effect on arthroplasty outcomes, morbidity, and mortality. We highlight several key strategies in the perioperative management of both acute and chronic renal insufficiency. A multidisciplinary approach should be pursued in the perioperative management of renal disease, with important considerations for cardiovascular,...
Source: Techniques in Orthopaedics - August 27, 2019 Category: Orthopaedics Tags: Symposium Source Type: research